Lifting Without Cutting #5: Sofwave w/ Dr. Jason Pozner

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Welcome to Park Avenue
Plastic Surgery Class,

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

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I'm your co-host, Doreen Wu,

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

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

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educator and technology innovator.
This is episode five in our series,

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Lifting Without Cutting, where we explore
non-surgical options for skin laxity.

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In today's episode, we
are discussing Sofwave.

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I didn't realize how many options there
are for this indication. Dr. Bass,

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what are we talking about in this episode?

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Well, you're right,
Doreen. There are many,

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many devices that doctors are
using or trying to use to reduce

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skin laxity without surgery.

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I focus the attention in this series
on the most widely used devices and

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treatments,

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mostly those with specific
FDA clearances for lifting.

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In this episode, I've invited my
friend and colleague, Dr. Jason Pozner,

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to talk about Sofwave,

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a treatment for nonsurgical
lifting of face and neck skin,

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which is one of the most recent
additions to this category.

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Dr. Pozner's a board certified
plastic surgeon in Boca Raton,

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Florida with extensive experience
with a range of lasers and other

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energy-based devices and an
extensive practice in facial

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rejuvenation, both
surgical and non-surgical.

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He's been a guest on the podcast
on multiple occasions. Dr. Pozner,

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thank you for joining us again
and welcome. Thank you, Larry.

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Thank you Doreen for having me.

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Okay, Dr. Bass. So before we
get into the details of Sofwave,

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give me a history lesson.

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Well,

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the first device that really focused in on

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using energy to lift skin
that was marketed that way,

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that had clearances from
FDA for that was Thermage.

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This was a radiofrequency device
that came on the market in

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2004.

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It treated one depth right
at the skin underneath the

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skin interface, and it was
a full field treatment.

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It exposed the entire area being treated.

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The next big device in
this regard was something

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called Ultherapy, which is still
on the market today and still used.

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This is micro-focused ultrasound.

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These are little dots of sound energy

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that go in the skin as a broad
exposure and focus down to a

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tiny.at a predetermined depth underneath.

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So this allowed you to do
fractionated treatments at multiple

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depths just at the base of the skin and

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underneath.

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And it also had visualization like
the ultrasounds we use to look

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at people's babies and joints and
things like that. And that came on the

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market in 2009. And in fact,

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Dr. Pozner and I were both involved in
some of the development efforts for that.

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And more recently we have Sofwave,
which it also uses ultrasound,

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but in parallel beams.

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This exposes a single depth in cylindrical

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patterns coming on the market in

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2019.

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The idea is that each of
these exposures creates heat,

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that the heat,

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that little minimal controlled
injury that that produces,

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stimulates the body to
add collagen and creates

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densification of the tissues
and some tighten up or

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pulling in all directions of the tissues
between the skin and the underneath.

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That gives me a pretty good sense of
what the device does. So Dr. Pozner,

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can you tell me about what the treatment
process is like and how long does it

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take? What type of anesthesia is used?

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Sure.

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So let's talk a little bit more about
the history before I get into that.

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So when the patients ask
us about this technology,

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so I simply asked them some
questions in return. So I go,

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have you heard of Ultherapy?
Absolutely. So they said,

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what's the difference between
Sofwave and Ultherapy?

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And I always have my handy
iPhone ready and I say,

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Ultherapy is iPhone one.
Sofwave is iPhone 14.

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New technology with a lot of advances
over the ensuing many years. And in fact,

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I had the first Ultherapy unit,
clinical unit in the world in 2009,

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and we all did all of the
studies as Dr. Bass said.

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So with this process,

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I think this is on the easier
side of treatment for patients,

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and I've had this done too. I did
one a couple of weeks ago on myself.

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So typically with this treatment,

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I try everything. So typically with
this treatment, the patient comes in,

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clean your face, take your makeup off,

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photograph them like we
do for every procedure,

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and then put a numbing cream on their
face that sits for anywhere from 15 to 45

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minutes depending on the numbing cream.

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Then we wash off the numbing cream and
we put some ultrasound gel on the patient

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and the ultrasound gel helps the
ultrasound energy transmit into the skin.

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And then what we do is this transducer,

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the head of the transducer is one
by four centimeters. So like that,

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and then you just put it along with
your face, neck, brow, under eyes,

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and you leave it on there and
each pulse is five seconds.

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So it'll go 1, 2, 3, 4, 5,

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and then there's cooling at the same
time. So Ultherapy didn't have cooling.

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This chills the skin and then the
pulse is for five seconds and sometimes

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you can feel little the fifth second,
and then there's a one second post,

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cool down, and then you move it
and then you do a second pass.

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So a typical face to neck takes between
30 and 40 minutes to do a full face.

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With this, you can count
the number of pulses.

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Is there any recovery time
after a Sofwave treatment?

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Is it a single treatment or a series?

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So good question. The
answer is, I don't know.

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We sell it both ways as a
series and a single treatment.

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I don't like selling too many things in
series. I like to tell patients, do one,

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see what you like. If
you want to do it again,

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we'll do it again in a month or so.

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And many people do return for
a couple of these in a row,

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but I'm not a big series fan.

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And the answer to your previous question
is there is zero recovery from this.

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You actually leave the office feeling
and looking a little tighter so you get

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some instant gratification and
you can go into our bathroom,

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put some makeup on and go out for
that three martini lunch, no problem.

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And I think that's an
important point though,

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that this is something where
you can see improvement in a

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single treatment because there
are radio frequency wanding

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devices that for sure you
would have to do five or

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six times also comfortable.

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Also easy to do also no recovery,

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but you're not going to do a treatment
and see what happens because you're not

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going to see anything happen,

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that you're going to have to do a
minimum of five or six treatments

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to try to get some kind of a
modest tighten up going on the

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face.

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So even though you may choose to do
more than one because you want a little

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more of a good thing,

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the notion is that one treatment
is enough to get you some visible

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change.

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What I like about this is
the patients are happy.

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So we've had probably three
years into this device by now,

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we had among the first commercial
units out there, maybe not the first,

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but I was within the first week
or two of commercial release.

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And when we bought this, we
didn't know what was going on.

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We didn't know whether patients
were happy. And on Ultherapy,

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I was on the Ultherapy advisory board
and all the clinical studies with

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Ultherapy showed 20% of the
patients had no response,

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not a bad response, not a
limited response, no response.

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And Ultherapy hurt. So many
of the patients had this
done, didn't get a result,

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told their friends, it hurt,
it didn't get a result,

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and that's not a good way to sell a
procedure to your patients with Sofwave.

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We've treated a few hundred patients and
I can count on two fingers the patients

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that got limited results, two out
of a few hundred. And interestingly,

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I just re-treated one of those
patients and she got a good result.

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So I think maybe didn't get
enough pulses in that patient,

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but patients are happy.

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Not one patient has asked for their
money back and almost no complaints.

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If anything,

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they sign up for another one because they
had an easy procedure that had a good

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result and they wanted
another one with no downtime.

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Speaking of results, how much
improvement can I expect?

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Exactly what features are being targeted?

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So this device is different
than the Ultherapy device.

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And I think the problem with
Ultherapy is in retrospect,

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we were targeting too deep.
We were targeting through
the skin. Matter of fact,

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some of the patients worldwide that got
the best results out of Ultherapy were

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patients probably with fuller
faces with thicker skin.

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Some of the Asian
patients did really well.

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I think they burned some fat
and just slimmed out their face.

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But the thin skin Caucasian patients,

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I don't think it had
much result on at all.

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Sofwaves focus down to a
much more superficial level
that's right in the middle

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of the dermis. So I don't
care what your ethnicity is,

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you're going to get targeted
in the middle of your skin.

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Doesn't matter if you're a millimeter
or thicker or not by different ethnic

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groups, so you and you're
going to get tightened.

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So I think overall they were getting more
efficacy and what we've learned about

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the Sofwaves is the same lesson
we learned with Ultherapy.

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The more passes you do, the more energy
you put in, the better results you get.

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So we've kind of gone for a little
longer treatment now recently,

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and we seem to be getting
even some better results.

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And I think treating close to the skin is

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important.

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The concept of treating deep and

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taking ligaments that we know
surgically have to be released in

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order to be repositioned is
not likely to be worthwhile.

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I had always focused

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my lines with Ultherapy
on the more superficial

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transducers and really scale
back the number of any deeper

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lines.

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Smart.

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But the ability to treat
with minimal discomfort,

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the ability to treat a
large area quickly has

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kind of led to some
application of this technology

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in body treatments because
body skin tightening

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and smoothing is important
and sort of an unmet need.

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And also more recently has
resulted in a specific FDA

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clearance for cellulite. Isn't that right?

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Absolutely. Absolutely. They
just got clearance for cellulite.

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We're just starting to introduce
that into our practice.

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This is a nice machine
for your office. Again,

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the one thing is it's delegatable. I
do a couple of these here and there,

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but we delegate this and it's so
safe that you really cannot get

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into trouble with this device.

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We had a couple of nerve injuries with
Ultherapy that were luckily temporary,

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but you cannot get any injury with
this. It just doesn't go deep enough.

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And overall, because when I
look at all of these devices,

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I always like to ask this question,

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is this a wrinkle treatment in any way
or it's really a loose skin treatment or

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is it a little bit of both?

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I think this is a lifting treatment,

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and I think when I look
at lifting technology,

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I look at three different technologies
for 2023 that we have available.

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One is Sofwaves, and I
consider that to the left.

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That is the easiest treatment
we do with no downtime and

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good reproducible results.

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I look at Ellacor on the right
as the most aggressive treatment,

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probably the best results, but
really aggressive with some downtime.

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And I put in the middle the microneedling
radio frequency devices because you

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can target multiple levels and you can
make that more aggressive than Sofwave

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and you have a little more
downtime than Sofwave.

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But I'm not convinced that
the microneedling radio
frequency devices are any

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better than Sofwave. Not yet.

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We need to have some head-to-head
studies between them,

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but that's how I kind of explain
it to the patient. So no downtime,

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extreme downtime, a
little bit of downtime.

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And what type of patient would
you recommend Sofwave to?

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Who is the ideal candidate?

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I think this is a younger patient that's
not yet ready for a facelift or someone

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who had a facelift looking for
a little bit of improvement.

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I think if they're heavy jowled and have
a lot of laxity of them face and neck,

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they're looking for an improvement that
this device is not going to give them,

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and I think they're going
to be underwhelmed by the
treatment and unhappy with

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their result.

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But if you take someone with a little bit
of laxity and understands what they're

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getting into, I think
they'll be very satisfied.

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And I think we've been very successful
in choosing the correct patients.

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That's why we don't have
a lot of complaints.

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There's lots of people out there who are
new to this industry who they'll take

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every 85-year-old with wrinkles and you're
going to get her a face lift result.

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And Dr. Bass and I are kind
of old dogs in this. We

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know that money upfront is going to lead
to a dissatisfied patient and grief on

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the long end.

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Yeah, I mean,

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you said something very telling
that we do these treatments and we

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work in aesthetic medicine and surgery
because we'd like to make people

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happy. And so I always want to do
treatments that make people happy,

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that are satisfying and fun for them
because that's why I went into this.

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And if that's not where
I'm going to end up,

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it's not what I want to be doing
because it's just unhappiness for me and

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for the patients. But basically

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I think there are two things
about these technologies that are

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kind of important. One is,

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even though you might respond
if you have a lot of laxity,

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you don't get to the
meaningful results stage.

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If you have a turkey waddle under
your chin and I take 20% of that

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away with a nonsurgical treatment,
80% of it is still there.

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You still have a turkey wattle,

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you still definitively look like
you're in a later stage of aging,

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a certain decade of life.
And if you only have a little bit there,

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that can probably be well
treated with one of these

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technologies. And so the
result is much more meaningful.

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It's taken what's starting to look
like it's aging and put it back

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into a quiet place.

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I think the other thing that's
interesting is that a lot of other

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countries around the world use these
kind of technologies very differently

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than we do.

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They start doing them very early
in the aging process before there's

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much visible aging change. They're
not looking for a visible change,

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they're looking for prevention
and they do the treatments

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once a year, twice a year,

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very lightly not to look different,

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but to stay looking the same.

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And they go forward five years,

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seven years more looking the same
as they did way back when they

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started. But Americans are in
a rush. We want a big change.

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We want it quick in one treatment,

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and companies want to sell a
single very expensive treatment.

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That's a better business model for them.

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And so it's left us with a little bit
of a disconnect that we're starting to

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work around with some
of these newer devices.

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Especially you're correct the Asian
countries are really good with

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prejuvenation. They've
sold a lot of Sofwaves in,

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believe or not in Taiwan lately,

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but Taiwan has taken off like crazy
and I suspect the Asia Pacific,

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other countries are going to hit.
This is going to take off very soon,

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and Korea is a hotbed. Once it hits
in Korea, that's going to be it.

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And then I'm not sure about
its China approval yet.

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China approval will be also good.

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Lastly, Dr. Pozner,

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what takeaways would you leave our
listeners with when it comes to Sofwave?

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This is an exciting technology
that is cutting edge,

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and if you're looking for
some prejuvenation or a
little bit of tightening in

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your face and you meet the right
criteria, which is not needing a facelift,

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this is a great technology for you.

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If you go like this and that's your
result you want, this is not for you.

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

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So this is a transcutaneous
energy treatment. In other words,

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the energy has to go across the skin
to get to the deep surface of the

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skin and just below,
which is the target area.

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So in order to do that safely,

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that means it's on the
lighter side of treatments.

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But the Sofwave technology
treats a much bigger volume of

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tissue than preceding,

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more fractionated
technologies at that single

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depth. That's probably
most important, as I said,

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because it's lighter than
other treatments that are

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in micro invasively or
minimally invasively,

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putting energy into or under the skin.

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It's for earlier stages of aging.

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And the best use may well be that
prevention and maintenance more

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than restoration,

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but that requires us as Americans to
rethink our game plan a little bit.

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And finally, I agree a hundred
percent with Dr. Pozner,

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in the presence of obvious hanging skin,

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it's simply not a good option.

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That's the place where something surgical
is going to be much more effective and

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much more meaningful.

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So I'd like to thank Dr. Pozner for
joining us yet again on the podcast.

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He just has a wealth of expertise
in all things device and

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all kinds of non-surgical options,

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so I greatly appreciate him joining
us and sharing it with us in such a

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forthright fashion. Thank you for
having me. Hopefully I'll be on again.

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Thank you Dr. Pozner,

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for coming on yet again and sharing your
extensive device experience with all of

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us.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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Follow us on Apple Podcasts,

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00:19:12,600 --> 00:19:14,700
write a review and share
the show with your friends.

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00:19:15,090 --> 00:19:18,210
Be sure to join us next time to avoid
missing all the great content that's

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00:19:18,210 --> 00:19:21,750
coming your way. If you want to
contact us with comments or questions,

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we'd love to hear from you.

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Send us an email at podcast@drbass.net
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