Picking the Right Device w/ Dr. Joel Cohen

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

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

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educator, and technology innovator.

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The title of today's episode is
"Picking the Right Device." Dr. Bass,

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we've talked about various
devices in these podcast episodes.

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What's the idea behind this one?

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There are multiple devices on the
market designed to treat a given beauty

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condition,

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even multiple devices with
specific FDA clearances for those

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conditions.

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Doctors do a lot of research and
speak with multiple colleagues

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before purchasing a device
to use in their practice.

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And then they spend time learning how
to use those devices to best advantage

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once they get them.

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What can patients do to
find the best devices?

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This is a much harder task
put in practical terms.

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How should you approach
finding your device care?

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What are the hot new devices
that really represent progress?

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But before we dive into that topic, we
have a special guest joining us today.

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I'm happy to introduce my friend
and colleague, Dr. Joel Cohen,

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who's a dermatologist in Denver, Colorado.

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Dr. Cohen is extremely
involved and active in clinical

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research and lecturing and teaching
about the latest advances in

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aesthetic dermatology.

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So Dr. Cohen,

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what are the big groups of devices and
how would you break it down for us?

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So in our practice we have a lot
of devices and as Larry indicated,

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some of these actually can
treat the same conditions.

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But I like to really focus on devices
that allow us to treat lines and

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wrinkles etched in the
skin as well as scars,

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and then devices that allow us
to treat pigmentation and then

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devices and procedures that allow
us to treat areas of redness

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such as rosacea or telangiectasias.

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Do you have preferences within these
different classes or does it depend on

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patient specific details?

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You know,

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I think that there are some really
solid platforms that are out there

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that allow you to treat
many of these conditions.

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And the Sciton platform,
the Joule X is one of those.

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So with 1/2-20 plug,

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you can treat patients with a fractional
blade of erbium called ProFractional.

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You can use full field erbium resurfacing,

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which is what I do a lot
of and published a lot on,

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especially around the
mouth and around the eyes,

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to really give patients huge results
with oftentimes just one treatment.

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And then also it has the
hybrid fractional called Halo,

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which combines non-ablative
fractional on the bladed.

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Fractional has broadband light where
you can treat on a stamping mode

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or you can treat on the new
high intensity rapid output,

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the hero mode, which is in motion.

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And then there's single shot
erbium and micro laser peel.

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So essentially by plugging the
device in once into 1/2-20 plug,

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you can calibrate different hand
pieces that you want to use.

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And it's a very efficient laser and a
very popular laser in our practice such

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that we have two of them.

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That leads me to wonder,

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how do you evaluate patients for
device treatments versus other options?

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So many of my patients come in
asking specifically about an

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area such as lines and wrinkles
around the mouth or the eyes.

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And in many cases those are the
first areas that really date them.

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They're focusing in the mirror.

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So I always express to them that you
really have to pick the right tool to the

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job.

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You can't use a neuromodulator
like Dysport or Botox to treat

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lines that are already etched in the skin,
such as around the mouth, their eyes.

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You really need to do something to help
with effacing those lines and that would

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be laser resurfacing.

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Yeah, I think that's a critically
important point. You know,

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a lot of people have heard of some
aesthetic treatment or another,

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or maybe their friend
had it and they don't

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really understand exactly what the
treatment is designed to accomplish.

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They kind of think it fixes everything.

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So it's really important to get the right
tool for the right job, as you said.

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I think that's beautifully put.

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and I agree with you a hundred
percent that one of the

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main features that it's essential
for whatever aesthetic provider

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you work with to be able to address,

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is lines and wrinkles,

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because that's definitively
an aging change.

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Leaving that behind, even
if you fix something else,

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really doesn't leave
you looking your best.

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And the ability to address that is
just critically important for anybody

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who's trying to work in the
area of facial rejuvenation.

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So the area around the mouth,

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I really divide things
into three subtypes and I

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actually published a scale on
this in dermatologic surgery.

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But for people who have prominent
muscle around the mouth from the

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orbicularis oris muscle,

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but it has not imprinted
those smokers lines yet,

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I think it's perfectly helpful to
use a neuromodulator like Dysport

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or Botox to try to minimize
that muscle from imprinting

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the lines.

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And I say minimize and not completely
prevent because I think it's important to

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be realistic with people that we're
not using high doses in the lower face.

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We're using very low
precise dosing to really try

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to decrease some of the muscle bulk
but not make the muscle not function,

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which can feel funny.

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If people have some lines that are etched
in the skin but they're not deep and

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they're not numerous,

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then I think you can get into those
lines in many cases with a filler.

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And we all have our favorite fillers in
terms of fine line fillers to get into

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those.

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But when people have really significant
number of lines and they're deep and

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they're etched, then resurfacing
really makes the most sense.

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And for those patients, I like to
use full field erbium resurfacing.

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It's something where you can recognize
your endpoint of pinpoint blading.

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I don't use epinephrine in
my block around the mouth,

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so I can recognize that
endpoint more clearly.

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And I really see a tremendous amount
of improvement usually with just one

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treatment.

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Whereas fractional bladed of resurfacing
may take multiple treatments and not

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still get to the point where you
can get with full field erbium.

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And I think full field erbium is,

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is very different than CO2 in the fact
that we can recognize our endpoint and it

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has more water binding coefficient.

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It doesn't go as deep and it hasn't been
associated with that delayed pigment

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loss that we saw many years ago.

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I saw in my fellowship 20-something
years ago from full field CO2.

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Yeah, I mean, I've always been
on the erbium side of things,

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not the CO2 side of things.
And that perioral area,

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the lipstick bleed lines,
full field is the way to go.

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It does involve short
interval of recovery time,

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typically a raw period of
about five to seven days

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depending on how
aggressively you need to go.

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But compared to the cumulative recovery
time of doing multiple fractional

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treatments and given the,

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the amount of improvement
that's typically obtained,

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I think it's preferred
to figure out how you can

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squeeze that into your schedule. Now
I'm curious to hear, because there,

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you know, there's sort of been
the introduction of some more

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superficial filler materials in
the United States and likely a

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couple more coming.

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Does that tilt the scale a little
bit in favor of the fillers

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or it does hasn't improved things

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enough to really change your initial
stratification that you published in Derm

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Surge?

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I don't think it really changes
the way that I presented that.

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I think where people have numerous lines,

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it's just not realistic that we can get
into all those lines, especially if,

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you know,

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they are more deep and of different

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calibers in terms of the
morphology of all those lines.

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But I do think that some of
the fillers really have been a

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very significant advance
in what we had before.

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So the most common filler that I use for
the perioral lines is Restylane Kysse.

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I find it to have less swelling than
many of the other products and I think it

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integrates into the skin really
nicely and it's very common for me to

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use it not only into the lip substance,

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the mucosa and the red part of the lip,

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but also to some of the
fine lines around the mouth.

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I think that the RHA Redensity
product is also really nice product

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for etched lines around the mouth.

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But when patients again
have numerous lines and it's

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just not realistic to
fill all those areas,

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and in many cases there's textural
change to the skin that we call actinic

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elastosis or sun damage type changes
where you can't treat that with

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filler. And really that's where
resurfacing comes into play.

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And you get a durability of result.

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That filler is just
never going to give you.

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Agree.

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And I do like to use
neuromodulators to prevent

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patients from contracting the muscle
in those exact spots which could

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recapitulate the lines
and etch them over time.

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They're not going to go back
to where they were at baseline,

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but I think it makes sense to see
patients every four months or so

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for tiny little aliquots of
Botox or Dysport or Jeaveau or

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Xeomin into the orbicularis oris
muscle on the upper lip as well

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as on the lower lip. And to talk
about the lower lip for a moment,

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you know,

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I always was much more aggressive on the
upper lip than on the lower part of the

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lip. And at one point I asked a
colleague and friend, Jason Pozner,

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to do OCT

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analysis of the characteristics
and compare between the
upper and the lower lip

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because he had that device and I
have the pictures in my lecture.

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And since then he really showed
me that the lower lip and the

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mucosa changing over the vermilion
border to the area be before

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you get to that little crease in the
chin is very similar to the upper lip.

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So I now treat that very
similarly between upper and lower

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lip.

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And I'm seeing better results in terms
of the etch lines and wrinkles on the

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lower lip. And in addition,

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I've always treated the red part of
the lower lip in our fair complected

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patients who have these etched lines
on the entire area around the mouth

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because they're fair complected,

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they've had a lot of sun exposure to
lead to some of those imprinting in the

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lines.

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And they do have skin changes we
call actiniculitis and the lower

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lip in many cases, which is
a pre-cancerous condition.

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Yeah,

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that's an important point that
resurfacing reduces the actinic

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burden and therefore your
risk of skin cancer in

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addition to providing
a cosmetic improvement.

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The point about neuromodulators is,

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is also important and
illustrates how particularly as

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changes get more advanced,

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a multi-modality approach is
usually going to get you to the most

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complete correction that's obtainable.

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Agree. And I think, you know,

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when patients quote clinical trials or
we talk to them about a trial that we

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may have done that's using monotherapy,

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we're using one tool to really look at

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the duration and the efficacy and the
degree of improvement that patients get.

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But in real life,

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we're using our entire toolbox to try to
get to patients to that point that they

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look at themselves in the mirror and
they're happy with the improvement.

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And then it comes to a point where we
talk about let's try to maintain that

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improvement. So from a
resurfacing perspective, you know,

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I don't think it's reasonable that every
few years somebody is going to want do

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a heavy full field erbium resurfacing
and take a week or more in terms

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of the actual healing time. So
after they've done that once,

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I like to do lower density
fractional erbium or lower density

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fractional CO2 perhaps every
six or eight months just

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to get them a little bit more improvement.

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And I think that that's where things
like microneedling can come into play

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to allow them that stimulation
and new collagen formation.

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But one of the lasers that I'm really
excited about is a new laser called the

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Acclaro laser. It's called UltraClear.

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And there are multiple
modes on this laser.

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And the lightest mode is
called the 3D miracle.

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And it really truly is
a lunchtime procedure.

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Patients can come in to the office,

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take standardized photos,

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no anesthesia is actually required.

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Patients can have the treatment
in as little as 10 to 15 minutes,

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and the discomfort is one out of 10.

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And I consider myself pretty
wimpy and my wife would agree,

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and truly that is one out of 10
discomfort for me. So it really,

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it's not much more than just feeling the
vibration and a little bit of heat on

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the skin.

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And patients have a little
stinging for a few hours and

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00:14:24,531 --> 00:14:29,450
that's it. So they're pink
and dry for about two days.

235
00:14:29,580 --> 00:14:31,650
So I've done the
treatment on Friday night,

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00:14:31,960 --> 00:14:35,650
I've gone out with people on Saturday
night and they don't really realize unless

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00:14:35,651 --> 00:14:39,850
I take my glasses off that I'm a little
bit pink on the rest of my face and by

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00:14:39,851 --> 00:14:41,690
Monday I look absolutely fine.

239
00:14:41,780 --> 00:14:46,730
So I think that that's important
for people who want to do

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00:14:46,731 --> 00:14:50,090
treatments but don't want a lot of
downtime and understand that there'll be a

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00:14:50,091 --> 00:14:54,880
cumulative effect and be people who've
reached the endpoint that they want

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00:14:54,881 --> 00:14:55,161
to,

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00:14:55,161 --> 00:14:59,560
such as with full field orum resurfacing
around the mountain eyes and they just

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00:14:59,560 --> 00:15:01,720
want to continue that type of improvement.

245
00:15:02,150 --> 00:15:07,040
Yeah, that points up another
important concept with device,

246
00:15:07,880 --> 00:15:11,720
which is if you're doing
an aggressive peel,

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00:15:12,690 --> 00:15:14,920
as you said, you know, once maybe enough,

248
00:15:15,100 --> 00:15:19,360
and then some maintenance treatments
down the line in the years ahead.

249
00:15:20,140 --> 00:15:21,600
But I'm in New York City,

250
00:15:21,601 --> 00:15:26,560
a lot of people have a crazy work schedule
or a crazy social schedule or both,

251
00:15:27,020 --> 00:15:29,840
and they can't take the downtime.

252
00:15:31,350 --> 00:15:36,160
It's okay to proceed with
other treatments and if

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00:15:36,480 --> 00:15:40,120
you don't yet have
pronounced aging changes,

254
00:15:40,260 --> 00:15:44,200
you may not need the bigger
treatment that's recovery based.

255
00:15:44,900 --> 00:15:49,760
But a lot of the lighter treatments
need to be done in a series.

256
00:15:51,780 --> 00:15:56,720
And doing a treatment without
doing the requisite number of

257
00:15:58,400 --> 00:16:03,400
typically required treatments is likely
to get you a disappointing result.

258
00:16:03,401 --> 00:16:07,040
So a lot of the devices,
particularly fractionated treatments,

259
00:16:07,070 --> 00:16:12,000
need to be used in a series
and a maintenance fashion.

260
00:16:13,170 --> 00:16:14,960
If you don't do enough of them,

261
00:16:14,961 --> 00:16:18,680
you're predictably not going
to get a meaningful result.

262
00:16:18,690 --> 00:16:23,520
So that's a really important
part of understanding what
you're getting into when

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00:16:23,521 --> 00:16:28,480
you start with a treatment
and going with some of

264
00:16:28,481 --> 00:16:32,720
that advice from your
dermatologist or plastic surgeon

265
00:16:34,000 --> 00:16:38,920
who's going to advise you in their
experience what's likely to be needed

266
00:16:38,921 --> 00:16:40,720
to get you where you're trying to go.

267
00:16:41,560 --> 00:16:43,670
So practicing in Denver,

268
00:16:43,671 --> 00:16:48,550
and we have patients that
are still attorneys or people
who are very visible and

269
00:16:48,551 --> 00:16:53,470
work for some of the big companies
in the tech world or in some of the

270
00:16:53,471 --> 00:16:55,510
defense department world. So, you know,

271
00:16:55,511 --> 00:16:58,310
not everybody can take
downtime throughout the year,

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00:16:58,311 --> 00:16:59,910
but everybody takes vacation.

273
00:17:00,330 --> 00:17:05,150
And I think that it's realistic to
say that for somebody who wants to see

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00:17:05,151 --> 00:17:09,710
major improvement and may have some very
significant social event on their radar

275
00:17:10,200 --> 00:17:13,870
in four to six months, like their
daughter's wedding or something like that,

276
00:17:14,060 --> 00:17:16,710
they really need to pick
the right tool for the job.

277
00:17:16,770 --> 00:17:20,230
And I really encourage
those patients to come in.

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00:17:20,590 --> 00:17:23,790
We'll do the resurfacing,
they'll take at least a week,

279
00:17:23,791 --> 00:17:25,310
a week and a half off of work.

280
00:17:25,440 --> 00:17:29,910
They're usually re-epithelialized at
that point and their skin is healed over

281
00:17:29,911 --> 00:17:33,790
and they may just have some pink and
that's going to last several weeks.

282
00:17:33,790 --> 00:17:38,190
And we try to give them a tinted
sunscreen that is an effective sunscreen,

283
00:17:38,191 --> 00:17:40,910
but also a camouflage so that
they can go back to work.

284
00:17:41,360 --> 00:17:46,310
So that seems to work for my patients
and I do take care of a lot of

285
00:17:46,311 --> 00:17:48,990
patients who come here
specifically for me to,

286
00:17:49,040 --> 00:17:51,640
to resurface and then they'll
take vacation in the mountains.

287
00:17:51,930 --> 00:17:56,640
So some of these people live
in California in the media

288
00:17:56,641 --> 00:18:00,040
world, and some people live
in New York. And it's just,

289
00:18:00,041 --> 00:18:04,160
we make it work for them, but for the
people that it just never seems to work.

290
00:18:04,161 --> 00:18:08,800
I think having alternatives like
the lower density fractional CO2 or

291
00:18:08,960 --> 00:18:13,480
fractional erbium where you can heal
up in probably about four days or a

292
00:18:14,000 --> 00:18:15,880
extended weekend is important.

293
00:18:15,940 --> 00:18:20,920
And those sequences of doing multiple
treatment sessions is really critical to

294
00:18:20,921 --> 00:18:21,754
success.

295
00:18:22,480 --> 00:18:26,240
We've discussed many types of
devices, their various modalities,

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00:18:26,241 --> 00:18:30,680
their functions in the episode so far.
I'm curious, where's the special sauce?

297
00:18:30,681 --> 00:18:33,160
Does it lie with the
device or the provider?

298
00:18:34,140 --> 00:18:38,990
I think really seeing an
experienced physician who has done

299
00:18:38,991 --> 00:18:42,790
a lot of resurfacing is
critical to success. So Larry,

300
00:18:42,791 --> 00:18:45,710
as a plastic surgeon who's done
a lot of erbium over the years,

301
00:18:46,120 --> 00:18:49,670
me as a dermatologist who's done
a lot of erbium over the years,

302
00:18:49,720 --> 00:18:52,990
we both lecture on it at national
and international meetings.

303
00:18:53,240 --> 00:18:54,670
We both publish on it.

304
00:18:54,790 --> 00:18:59,750
We're showing patients our
results because showing patients

305
00:19:00,380 --> 00:19:03,990
pictures of what you might be able
to accomplish that aren't yours,

306
00:19:04,310 --> 00:19:09,110
isn't really going to get patients
to that point where they feel that

307
00:19:09,111 --> 00:19:10,550
they're seeing the right person.

308
00:19:10,690 --> 00:19:14,430
And that may not give them the results
that they're looking for unless they are

309
00:19:14,431 --> 00:19:18,910
seeing the right person and really
recognizing the endpoint and using

310
00:19:19,050 --> 00:19:22,830
and knowing how to use this
equipment is really key to success.

311
00:19:23,600 --> 00:19:25,690
Yeah, I agree with that completely.

312
00:19:25,750 --> 00:19:30,270
The devices have precision

313
00:19:30,970 --> 00:19:34,390
and very controlled parameters,

314
00:19:35,450 --> 00:19:40,350
and that's a virtue compared to a hand

315
00:19:40,380 --> 00:19:44,590
rendered process like a chemical
peel where there's a lot of

316
00:19:45,310 --> 00:19:50,190
input and variability that can't
be controlled to anything like the

317
00:19:50,191 --> 00:19:53,710
level of precision that a device has.

318
00:19:53,710 --> 00:19:57,030
The output from a laser
when the settings are a

319
00:19:57,031 --> 00:20:00,790
certain way is going to only
vary the tiniest amount.

320
00:20:01,410 --> 00:20:05,550
But selecting those
parameters, applying them,

321
00:20:05,551 --> 00:20:09,350
applying them to the right person
for the right reasons takes years of

322
00:20:09,351 --> 00:20:10,470
experience to learn.

323
00:20:12,050 --> 00:20:15,310
And that's brought to you by the provider.

324
00:20:16,270 --> 00:20:18,630
so finding someone
who's willing to listen,

325
00:20:18,631 --> 00:20:23,590
who's going to customize
the plan for you and knows

326
00:20:23,591 --> 00:20:28,270
how to apply these devices backwards
and forwards is going to work heavily in

327
00:20:28,271 --> 00:20:29,104
your favor.

328
00:20:30,030 --> 00:20:34,010
And what do you think is the ideal
setting for these treatments?

329
00:20:34,100 --> 00:20:37,930
In a med spa, a clinical office,
or some other type of provider?

330
00:20:38,680 --> 00:20:39,031
No,

331
00:20:39,031 --> 00:20:43,950
I think when you're talking about big
procedures like heavy resurfacing and

332
00:20:43,951 --> 00:20:45,030
ablated resurfacing,

333
00:20:45,490 --> 00:20:49,200
I'm most comfortable recommending
this be done in a medical office.

334
00:20:49,270 --> 00:20:50,920
I think first of all,

335
00:20:51,200 --> 00:20:54,360
we do nerve blocks for
these types of treatments.

336
00:20:54,890 --> 00:20:59,880
We oftentimes will have nitrous
on hand to get people through the

337
00:20:59,881 --> 00:21:01,480
procedure and make them comfortable.

338
00:21:01,990 --> 00:21:06,040
I think it's really important to
understand how to prep the patient and the

339
00:21:06,041 --> 00:21:08,800
different modalities that
we use to prep patients.

340
00:21:08,801 --> 00:21:12,920
I've written a lot on that as well out
of my academic department at University

341
00:21:12,921 --> 00:21:15,440
of California Irvine, even
though I'm based in Colorado.

342
00:21:16,480 --> 00:21:21,360
And then finally really
understanding what potentially

343
00:21:21,361 --> 00:21:25,600
can go wrong and having the ability to
write a prescription for prophylactic

344
00:21:26,590 --> 00:21:28,400
antivirals, which is what we do,

345
00:21:28,620 --> 00:21:33,120
but also seeing patients in follow up
and knowing when something may be going

346
00:21:33,121 --> 00:21:33,441
wrong,

347
00:21:33,441 --> 00:21:37,720
when to suspect something like infection
and how to be able to treat that.

348
00:21:38,090 --> 00:21:42,520
So for all those reasons, I'm most
comfortable with the ablative resurfacing,

349
00:21:42,710 --> 00:21:47,320
especially the heavier full field
resurfacing being done in a medical

350
00:21:47,321 --> 00:21:52,080
office, and a physician who has used
and trained on this type of device

351
00:21:52,260 --> 00:21:53,240
for a long time.

352
00:21:54,170 --> 00:21:56,020
I think that all of that is right.

353
00:21:56,021 --> 00:22:00,900
And the other thing which I've
talked about a lot on this podcast

354
00:22:01,310 --> 00:22:04,700
is this notion that this is medical care.

355
00:22:04,701 --> 00:22:08,980
Medical care is very safe,

356
00:22:08,981 --> 00:22:10,180
very predictable,

357
00:22:10,360 --> 00:22:15,060
but in the hands of someone
who is properly trained as

358
00:22:15,061 --> 00:22:17,500
part of their residency training,

359
00:22:17,590 --> 00:22:21,540
as part of their specialty
to perform a given treatment

360
00:22:22,240 --> 00:22:26,940
and who is watching what
is going on the ability

361
00:22:26,990 --> 00:22:30,620
to coordinate a plan of care as well,

362
00:22:30,690 --> 00:22:35,620
rather than just render
a certain product like

363
00:22:35,621 --> 00:22:40,260
a Botox injection or a BBL treatment with

364
00:22:40,780 --> 00:22:45,690
the pulse light is another important

365
00:22:45,691 --> 00:22:48,050
part of having an efficient beauty plan,

366
00:22:48,250 --> 00:22:51,050
a cost effective beauty plan,

367
00:22:51,270 --> 00:22:53,930
and one that gives you the
results you're looking for.

368
00:22:54,800 --> 00:22:58,700
And I think it's very important
for physicians to show patients

369
00:22:59,340 --> 00:23:02,740
their own results, show
them their pictures,

370
00:23:02,741 --> 00:23:06,380
not the company's cherry picked
pictures of the best case scenario,

371
00:23:06,381 --> 00:23:10,630
but show them multiple
examples of your own work.

372
00:23:10,631 --> 00:23:12,710
Show them what the downtime looks like,

373
00:23:13,020 --> 00:23:17,350
what the final result can look
like in a few different examples.

374
00:23:17,370 --> 00:23:21,270
And that's the best way to actually
do things. And for a patient,

375
00:23:21,340 --> 00:23:25,030
I think it's important to ask, "how
long have you been using this laser?

376
00:23:25,650 --> 00:23:29,070
How many treatments have you
done in the past few years?

377
00:23:29,071 --> 00:23:33,030
How many treatments have you done
in the past year, past month,

378
00:23:33,100 --> 00:23:37,590
past week?" to make sure somebody is
truly comfortable using that device.

379
00:23:38,470 --> 00:23:42,990
Those are fantastic points. Lastly,
before we conclude Dr. Bass,

380
00:23:42,991 --> 00:23:45,640
what should our listeners take
away from today's episode?

381
00:23:46,570 --> 00:23:49,040
In modern aesthetic medicine,

382
00:23:49,040 --> 00:23:52,480
there's a whole range of devices to

383
00:23:52,490 --> 00:23:57,320
address all of the common
beauty needs in our face

384
00:23:58,380 --> 00:23:59,213
as we age.

385
00:24:00,210 --> 00:24:04,970
Selecting which device is
right is a product of a

386
00:24:04,971 --> 00:24:08,770
consultative relationship
with an expert provider,

387
00:24:08,920 --> 00:24:11,050
a dermatologist, a plastic surgeon,

388
00:24:11,051 --> 00:24:14,530
someone who's been trained
to perform these treatments.

389
00:24:15,520 --> 00:24:19,770
It's important to plan
for the recovery you need

390
00:24:20,220 --> 00:24:24,530
or understand what's going to
be involved in the treatments,

391
00:24:25,110 --> 00:24:26,450
the number of treatments,

392
00:24:26,451 --> 00:24:31,330
the time course over which results are
going to be obtained so that you're

393
00:24:31,331 --> 00:24:34,330
sure this is a good
fit for you. And again,

394
00:24:34,860 --> 00:24:39,450
an experienced provider will work
to customize something that's

395
00:24:39,890 --> 00:24:40,930
a good fit for you.

396
00:24:42,430 --> 00:24:45,020
Dr. Cohen, any takeaways
you would like to add?

397
00:24:45,960 --> 00:24:50,650
I think that there's a lot of different
modalities that we can use to help

398
00:24:51,130 --> 00:24:55,450
patients achieve their goals in improving
lines and wrinkles. In many cases,

399
00:24:55,890 --> 00:25:00,050
to see more significant improvement,
it's going to be lasers, but to see less,

400
00:25:00,250 --> 00:25:03,890
it may be things like chemical peels and
it really depends on what the patient

401
00:25:04,250 --> 00:25:06,890
can do, what they can afford,
and what their downtime is.

402
00:25:07,410 --> 00:25:12,330
But seeing an expert physician who
performs these procedures all the time is

403
00:25:12,570 --> 00:25:16,130
really key. And then understanding
that there are different densities.

404
00:25:16,730 --> 00:25:21,210
And sometimes when I see a patient and
I recommend a procedure, they might say,

405
00:25:21,490 --> 00:25:24,410
you know, "I had a friend
who had fractional CO2,

406
00:25:24,690 --> 00:25:27,770
or I had a friend that had the
procedure you're talking about,

407
00:25:28,010 --> 00:25:32,050
and the downtime was too much." They
don't realize that it's apples to oranges

408
00:25:32,730 --> 00:25:36,010
comparisons. We are in control
of the density that we can treat,

409
00:25:36,290 --> 00:25:37,490
which is the percent coverage,

410
00:25:38,130 --> 00:25:43,050
and we could modulate that to be more
specific to usually the downtime that

411
00:25:43,051 --> 00:25:43,884
a patient can do.

412
00:25:44,170 --> 00:25:49,170
So you can modulate it to maybe be
a range of just a few days versus a

413
00:25:49,410 --> 00:25:50,770
heavier range of a week.

414
00:25:51,980 --> 00:25:53,860
Thank you, Dr. Cohen, Dr. Bass,

415
00:25:53,861 --> 00:25:57,340
for sharing your perspectives and
expertise on this often pondered topic.

416
00:25:57,840 --> 00:26:00,100
And I'll add my thank you to Dr. Cohen.

417
00:26:00,330 --> 00:26:05,100
I think this was an outstanding
perspective on what's going on with

418
00:26:05,101 --> 00:26:09,860
devices and how to apply them to best
advantage from someone who's truly an

419
00:26:09,861 --> 00:26:10,900
expert in the area.

420
00:26:11,380 --> 00:26:14,500
Thank you, Larry. I appreciate it.
It's a pleasure to join you all.

421
00:26:15,420 --> 00:26:19,020
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

422
00:26:19,450 --> 00:26:20,900
Follow us on Apple Podcasts,

423
00:26:21,020 --> 00:26:23,180
write a review and share
the show with your friends.

424
00:26:23,630 --> 00:26:26,780
Be sure to join us next time to avoid
missing all the great content that's

425
00:26:26,781 --> 00:26:30,380
coming your way. If you want to
contact us with comments or questions,

426
00:26:30,381 --> 00:26:31,380
we'd love to hear from you,

427
00:26:31,610 --> 00:26:36,020
send us an email at podcast@drbass.net
or DM us on Instagram,

428
00:26:37,100 --> 00:26:37,500
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