So Many New Fillers, So Little Time w/ Dr. Michael Gold

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your cohost Doreen Wu.

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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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Our guest expert today is
dermatologist Dr. Michael.

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Gold hailing from Nashville, Tennessee.

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The title of today's episode is
so many fillers. So little time

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gone are the days when injectables like
Botox and fillers were considered a

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shocking topic for living room discussion,

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whether it's adding filler
to the undereyes to fill
in the tear drop hollows,

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or restoring volume to the areas of the
midface that have lost the collagen or

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reserves of their youth,

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injectable fillers have become
increasingly commonplace
and to take society.

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Dr. Bass, can you give us the
history of fillers in the US?

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How did we get to where we are today with
the vast number and variety of fillers

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on the market?

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Fillers in the modern era
really started with the FDA

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approval for Restylane and
Juvederm back around 2004.

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And that was the beginning of a
new set of indications and a new

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focus compared to what had happened
previously with collagen injection,

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which was a more
superficial injection and,

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and really corrected
features in a softer fashion.

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So we were able to do different things
with these new fillers Restylane

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in Juvederm that led us fill it,

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the nasolabial folds the marionette
lines and increasingly work on other

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areas of the face.

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Now we're continuing to evolve into

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a couple of later generations of fillers,

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and I'm going to ask our guest
today, Dr. Gold, to discuss that.

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Why do we have a dermatologist
on the, the park avenue,

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plastic surgery class? Well, first of all,

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what dermatologists do and what plastic
surgeons do in the aesthetic arena

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is becoming increasingly aligned.

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We're doing more and more of the
same things for the same reasons.

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Dr. Gold is a particularly
good guest because he is really

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an expert in almost all aesthetic things.

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He has an encyclopedic knowledge of

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aesthetic fillers, energy based devices,

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the whole range of aesthetic treatments.

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And he has shared that
knowledge in multiple medical

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education courses and training
courses that are presented worldwide.

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So I'm very proud and happy
to welcome him as a guest

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and, uh, Dr. Gold,

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if you would share with us where fillers
have gone from that first generation of

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Restylane and Juvederm.

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Sure. So first of all,
thank you for having me. Um,

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I think one of the things that
you said Dr. Bass or Larry,

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I'm going to call you is, you know,

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we dermatologists and
plastic surgeons today. Um,

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we work together, um, and, and,

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and that's been one of the
biggest changes in medicine over

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the last 25 years, um,
that I've noticed. Um, and,

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and in a very good way,
um, we all sort of,

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at least I know my boundaries
and I know what I don't

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want to ever do. And that's why
we have people like Dr. Bass. And,

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and there are certain procedures that I
may do that the plastics don't do. And,

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you know, they do that. And obviously
we do the medical dermatology too,

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which he doesn't want to do .
And, um, and so I think we've, you know,

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we we've shared our knowledge
and our best practices.

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We have learned tons from the plastics
over the, over the years. And so again,

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thank you for having me.

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The fillers are a fascinating
group of compounds and, and, um,

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you know, yeah, I think
you you're right. What we,

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we started with collagens
and, um, and they worked, um,

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for what they were meant to do,
which was to fill with, you know,

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these more superficial places.

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And then we got a deeper collagen
that really didn't do much, but, um,

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but it was our entry into
putting things into the skin to

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try to make lines and
wrinkles better and so forth.

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And then as Larry said, uh, um,

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Restylane was one of the first what
we call hyaluronic acid fillers,

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which are, um, products
that are, they absorb water.

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And then over time they actually
turn into collagen. So, um, so we,

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we've learned a lot
from the early days of,

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of what Restylane,

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which is a particle filler
to more to gel fillers,

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all in this hyaluronic acid category.

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And there's been an explosion.
Um, there are lots of these,

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whether it's the Restylane family, the
Juvederm family, the Prollenium family,

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um, the Belotero family,
um, those are the main.

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Now we have the RHA family.

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Those are the US fillers
that we have hyaluronic acid.

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And they're all sort of tricks and tweaks
on what we, what has come before it.

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So some are more malleable
in certain areas.

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Some are better for deeper
volume deficits. Um,

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some are better.

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We're going to see a whole explosion of
some products for some very superficial

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lines coming up. Um,

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and it has to do with the
cross-linking of the hyaluronic acid

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and the amount of particles per
milliliter of that hyaluronic

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acid itself. So there's a lot of
factors that go into making these, um,

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and each company has their own
proprietary way to do this.

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So I think the hyaluronic acid fillers
and the nice other thing about hyaluronic

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acid, they're reversible, um,
which is also really important,

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um, if something, you know,
goes wrong for the most part,

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unless you're in a blood
vessel, um, we can reverse that.

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And even if we're in a blood
vessel outside of the eye,
we can reverse that. Um,

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so I think, you know, this,

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the fillers are best used by
those that understand anatomy.

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Um, they understand where to put the
filler and where not to put the filler.

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They understand if something goes
wrong, how to take care of it.

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Those are the things that I, you know,

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always preach to people
about how we do things.

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And I think you gotta know how to do it,

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but you gotta know how to take
care of somebody if it goes wrong.

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So the HAs or the hyaluronic acids are a
great group of fillers. Um, but we ask,

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we also have other fillers out there
that we call biostimulatory fillers,

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and I don't know how much you want to
get into them, but they're, those are,

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we call them sculpture radius,

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and Bellafill and they're little takes
on this. They're longer lasting. They,

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again, produce more
collagen over time. Um,

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and they are very useful for their,

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the proper indications that we
have for them. Um, and again,

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I think it's up to the healthcare
provider to learn how to properly

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pick which one to use where, um,
because again, I don't think, you know,

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the average person is going to be an
expert on everything, right. But also,

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we have a whole host of fillers coming.

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So part of my world and Larry's world
is we get to play with some of the new

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products, um, you know, over time
and, and so forth. But there's a,

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there's a whole slew of products that
are coming from Europe and from Korea

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and other places that we're going to
have to figure out where they play a role

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here in the us.

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I want to go back to, uh,

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the fillers of the past and kind of talk
about some of the indications that they

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were used for.

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Sure. So the, the first products were
col were called collagen. I mean,

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it was called the collagen
corporation and they had two,

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they had two fillers at the
beginning, Zyderm 1 and Zyderm 2.

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Um, and they came from
a, a cows hide collagen.

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So not like the cows you see in the field,

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this was a very select herd that was, um,

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kept in very strict conditions.

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And their collagen was taken
away. The, the hide was taken,

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the collagen was extracted,

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gone through all the testing to make
sure he had no out there was no, uh,

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potential allergens,

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but patients actually got skin tested
to make sure they weren't allergic. Um,

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and then we, so obviously Zyderm 1
was the most superficial collagen.

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So if you had a very fine line, whether
it was lips or around your eyes,

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or even your glabella, the, the frown
lines we used to inject Zyplast,

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Zyderm into those, um, Zyderm
2 was for a little bit deeper,

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and then they realized they
needed some volume collagen,

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and that became Zyplast, um, that,

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that transferred into
something called Cosmoplasty,

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Cosmoplast took away the cow part of it.

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So it was natural derived collagen
that we then put into people's skin.

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Yeah, those were great products in the,
you know, this was in the late eighties,

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early 1990s. Um, and that's all we had.

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So if people needed it or wanted
fillers, um, there were no ionic acid.

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And then Restylane came out,
you know, around in Europe,

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in the mid to late nineties.
And, and it came here,

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I think it was 2003 or
four, like you said, Larry.

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And so that was our first foray
into, Hey, we have this wonderful,

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you know,

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clear filler that acts as you know,

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it's hyaluronic acid absorbs
water, and then, you know,

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it takes away lines and
wrinkles. And that was, again,

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something unique to that line of fillers.

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And, and that was kind of
the initial indication.

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Uh the Restylane,

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Juvederm first approvals were
things like moderate to severe

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facial folds increases. So
not so much fine wrinkles,

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but things like nasolabial fold. And,

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and that's what people started realizing
that these needed to be injected

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differently,

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that they produced a little different
effect than the lighter collagen

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fillers, because they were heavier.

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And that water absorbing property you
mentioned was really important because as

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the filler degrades it
embibes or absorbs more and

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maintains closer to

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its initial volume than
something like a collagen fill,

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just degrades linear.

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And,

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and when these products
all came to the US,

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the FDA sort of said, okay,

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you want to introduce a filler
into the United States. Well,

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how do you prove it works?
So again, the rest in trials.

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And so being able to look
at your nasolabial folds,

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you can compare right to left.

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And so the original studies
were Restylane collagen,

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um, because that's what we had to study.

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And obviously Restylane did better
than collagen, but so you had,

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and we had scales that
had to be created and then

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vetted so that through the FDA.

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And so the easiest scales on the
face to do at the beginning were

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the nasolabial folds. It's easy. Um,

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now we have scales for the
nasolabial folds, the cheeks,

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the lips crow's feet the frown
lines. I mean, there's forehead.

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We have scales for everything
now, but back in the early 2000s,

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we only had nasolabial folds.

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So every filler that came to the US,

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even if they were not really
for the nasolabial folds,

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the entryway was the
easiest path to get in,

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was to study the nasolabial folds.

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But it it's really expanded out
from there because doctors were very

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smart about figuring other indications,

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what we call off-label indications
that were not the exact FDA approval.

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And then the manufacturer circled back
and actually did clinical studies on

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those. And this is something
that, that I love to do.

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And I know Dr. Gold loves to do
it's fun to be able to play with

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new materials, but also to actually
look very critically generate data,

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look very critically at the outcomes
for very specific indications

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and understand and really wring
out how these products work and

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perform.

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It's also, it's also nice
when they, after the approval,

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when the patients come in and they go,
well, I heard about this product X,

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have you ever used it?
Well, I had, you know,

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put 50 people on this
clinical trial for the FDA.

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I did 150, 200 injections over the
last two or three years with people,

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um, using this product.

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And we know everything about this product
that we've learned over these two or

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three years, instead of somebody going
well, the rep came in and gave, you know,

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I have a syringe of something
brand new. I've never tried before.

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So by the time these products
come to market, again, it,

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you gotta learn them, but we are fortunate
that by the time they come to market,

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we know all about them.

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So, so Dr. Gold, where,

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where have they gone on formal
indications since those initial nasolabial

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fold studies?

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So, uh, I mean,

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we have fillers now that have
approvals for the nasolabial

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folds for volumizing the cheeks. Um,

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we have fillers that are
approved for the lips. Um,

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that's really the main indications
that people have gotten approvals for

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off label. They're still
being used all over the place.

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00:14:22,970 --> 00:14:26,570
And I think clinical trials are
going on with certain products,

228
00:14:26,850 --> 00:14:31,250
like radius is looking at
jawline definition. Um,

229
00:14:32,050 --> 00:14:36,890
some other fillers are
looking at temple hollows. Um,

230
00:14:37,290 --> 00:14:41,960
so there are places that people are
still looking at it, there's this,

231
00:14:42,800 --> 00:14:46,960
um, concept of hyper,
we call it hyper dilute,

232
00:14:47,160 --> 00:14:51,880
but dilutes a really bad word. So
we like the word blended or blended,

233
00:14:52,640 --> 00:14:56,640
um, radius or sculpture in the
neck, in the decollete. And,

234
00:14:56,880 --> 00:14:57,720
and I think we're,

235
00:14:58,320 --> 00:15:01,160
we're going to get to the point where
they're going to be studying that to

236
00:15:01,520 --> 00:15:05,080
improve the, the way the appearance
of the neck and the decollete area.

237
00:15:05,280 --> 00:15:10,070
I think that's nice, um, for
those patients that want that. Um,

238
00:15:10,490 --> 00:15:13,310
and so you there,

239
00:15:13,890 --> 00:15:17,950
the indications are there
that I, I know that, you know,

240
00:15:18,290 --> 00:15:21,110
Radiesse has an indication
and Sculptra as well,

241
00:15:21,310 --> 00:15:25,510
I think for the hands and for
rejuvenating the hands, um, um,

242
00:15:25,590 --> 00:15:28,940
I know Radiesse does, um, I know
Sculptra's working on it. Um,

243
00:15:29,080 --> 00:15:33,900
I'm not sure they've gotten it yet, but
they're probably there. And so I think,

244
00:15:33,960 --> 00:15:36,420
you know, you have to look
at the class of filler,

245
00:15:36,421 --> 00:15:39,900
what the fillers penetration depth is,

246
00:15:40,360 --> 00:15:43,300
as far as where you're injecting
this and figure out where,

247
00:15:43,301 --> 00:15:44,620
where we're going to use it. Now,

248
00:15:44,621 --> 00:15:49,090
some of the new fillers are going to
come out for very superficial lines and

249
00:15:49,091 --> 00:15:52,250
wrinkles, um, and they're coming. Um,

250
00:15:52,390 --> 00:15:57,330
and then we're going to have a whole
class of fillers eventually that

251
00:15:57,470 --> 00:16:01,370
are, um, going to come
out what, outside the US,

252
00:16:01,371 --> 00:16:06,120
they're known as skin boosters,
where they really are just sugars.

253
00:16:07,480 --> 00:16:10,760
Um, so the, the amount of ionic
acid in there, there's no,

254
00:16:10,761 --> 00:16:15,160
there's very little of any crosslink
and they really just contain a lot of

255
00:16:15,161 --> 00:16:15,994
sugar. So

256
00:16:17,670 --> 00:16:22,320
they improve the quality and
surface structure of the skin.

257
00:16:22,590 --> 00:16:24,390
They don't make wrinkles disappear.

258
00:16:24,530 --> 00:16:27,790
So that's a whole new class
that exists in Europe. Yeah.

259
00:16:28,370 --> 00:16:32,990
That's really interesting. But my question
hearing that is how do the, you know,

260
00:16:32,991 --> 00:16:37,830
the way we keep the hyaluronic
acid from degrading is

261
00:16:37,831 --> 00:16:41,510
with cross-linking mm-hmm
and size of the molecule.

262
00:16:41,660 --> 00:16:45,620
It's a polymer, basically, it's,
it's like a sugar that's polymerized,

263
00:16:45,820 --> 00:16:48,340
a really long chain of sugar.

264
00:16:49,160 --> 00:16:53,300
So how do they get durability
with those, with those, uh,

265
00:16:53,370 --> 00:16:55,380
skin quality injections?

266
00:16:55,760 --> 00:17:00,060
So a lot of, so again, they're very
superficial injections, so they're really,

267
00:17:00,061 --> 00:17:04,410
you know, right in the
superficial part of the dermis,

268
00:17:05,290 --> 00:17:08,810
um, and the clinical work
outta Europe is that, you know,

269
00:17:08,811 --> 00:17:10,850
people get six to nine months duration.

270
00:17:11,430 --> 00:17:12,490
Wow, that's pretty good.

271
00:17:13,070 --> 00:17:15,850
So, so that, you know, we'll
have to see how I always say it.

272
00:17:15,851 --> 00:17:20,360
We have to see how that translates when
the US gets it. Um, then we'll have,

273
00:17:20,380 --> 00:17:23,640
you know, our data and then we'll
be able to decide, um, what,

274
00:17:23,641 --> 00:17:28,480
but if you can inject and there's some
that do it by free hand injections.

275
00:17:28,660 --> 00:17:32,480
And there are some devices out
there that exist, um, that are,

276
00:17:32,481 --> 00:17:36,160
that are skin booster devices. So you
just sort of put it on the machine,

277
00:17:36,190 --> 00:17:38,750
does the work, you, you guide the machine.

278
00:17:39,130 --> 00:17:42,590
So the needle depth is always
the same and so forth and so on.

279
00:17:42,650 --> 00:17:46,990
So there's a lot out there
outside the US. Um, and again,

280
00:17:47,010 --> 00:17:51,920
we have to see how fast and
how much of that will come to

281
00:17:51,921 --> 00:17:53,840
the US, but I know there's several coming.

282
00:17:53,840 --> 00:17:58,410
Okay. That's really interesting. Yeah. We,

283
00:17:58,550 --> 00:18:03,410
we know that development is not going
to stop and a lot of growth is expected

284
00:18:03,411 --> 00:18:05,450
in injectables, um,

285
00:18:05,960 --> 00:18:08,880
with all the different products
that are out there now,

286
00:18:09,820 --> 00:18:13,160
how do you pick what
you stock in the office?

287
00:18:13,220 --> 00:18:15,120
How do you pick what
you give for patients?

288
00:18:15,500 --> 00:18:18,320
What's the decision making
process like for you?

289
00:18:18,321 --> 00:18:22,080
Because that's something I've
always puzzled over. I, you know,

290
00:18:22,160 --> 00:18:26,520
I don't know that I want to stock 40
products like the Europeans typically do

291
00:18:26,770 --> 00:18:27,230
mm-hmm.

292
00:18:27,230 --> 00:18:29,070
well, I
think again, in Europe,

293
00:18:29,140 --> 00:18:33,550
it's a lot easier because the average
cost is much less, you know, here,

294
00:18:33,551 --> 00:18:36,950
here in the us, this is the
holy grail and, and, you know,

295
00:18:36,951 --> 00:18:39,790
all medicines are more so, um,

296
00:18:39,791 --> 00:18:43,270
and that goes to all the
cosmetic medicines versus
what you can get in Europe,

297
00:18:43,410 --> 00:18:45,030
but you can't bring 'em back from Europe.

298
00:18:45,050 --> 00:18:48,780
So don't go over there when you go and
buy products and try to bring back.

299
00:18:48,781 --> 00:18:53,260
That's not allowed. Um, but
I think, you know, it, it,

300
00:18:53,740 --> 00:18:56,380
I think the average that
not the average, I think if

301
00:18:58,100 --> 00:18:59,260
you're a good injector,

302
00:19:00,120 --> 00:19:04,850
you have learned your skill set
on a group of products. Again,

303
00:19:04,990 --> 00:19:09,370
it could be one from column A and
one from column B, but it all,

304
00:19:09,430 --> 00:19:13,810
it doesn't have to necessarily be
in one family. Um, but you know,

305
00:19:14,030 --> 00:19:16,930
if you're, if you're a Restylane person,

306
00:19:17,510 --> 00:19:21,490
you're going to learn the seven or
eight Restylane products that exist,

307
00:19:21,491 --> 00:19:25,800
and you're going to learn every bit
of them and how do it what's makes one

308
00:19:25,801 --> 00:19:29,000
different than the other, and where
do I use one versus the other?

309
00:19:29,260 --> 00:19:32,120
And then you may say, you know, I
don't need all eight. I need three,

310
00:19:32,910 --> 00:19:34,970
and those are going to be
my three go to products.

311
00:19:34,971 --> 00:19:37,730
And I'm going to know
everything that can be known,

312
00:19:37,910 --> 00:19:42,760
be learned about those three products.
Or you may say I I'm a Juvederm person,

313
00:19:42,820 --> 00:19:47,600
and I really want to use the, you know,
the Voluma vol, you know, all the,

314
00:19:47,601 --> 00:19:49,880
the vols out there that exist.

315
00:19:49,900 --> 00:19:52,920
And some of the new things that
are coming in the Juvederm family,

316
00:19:53,660 --> 00:19:56,320
and then you might be a
person that says, you know,

317
00:19:56,530 --> 00:19:58,360
price is really important to me.

318
00:19:59,380 --> 00:20:03,110
And Prollenium makes
really good, um, you know,

319
00:20:03,180 --> 00:20:07,030
fillers in the Versa family for
the, for that work really well.

320
00:20:07,290 --> 00:20:12,110
And I like that. And you may be a Merz
person and say, I want to use Belotero,

321
00:20:12,280 --> 00:20:16,310
which we only have one in the US and
there's five or six outside the US.

322
00:20:17,350 --> 00:20:18,660
Um, but you know,

323
00:20:20,100 --> 00:20:24,800
I don't think you can be
an expert in every filler

324
00:20:25,020 --> 00:20:26,640
out there. Um,

325
00:20:26,960 --> 00:20:31,720
I like to think those of us that do
the clinical trials know more about it.

326
00:20:33,050 --> 00:20:36,170
Um, and you know, if you're
going to play in this sandbox,

327
00:20:36,510 --> 00:20:39,200
you gotta pick which
sandbox you want to go to.

328
00:20:39,900 --> 00:20:44,240
And if you want to play in all the
sandboxes, you know, that's great. Um,

329
00:20:44,520 --> 00:20:47,280
I play in everybody's sandbox, um,

330
00:20:47,281 --> 00:20:51,520
because I work with every one of these
companies and I, and I, you know,

331
00:20:52,400 --> 00:20:57,120
um, but as far as choosing which
ones on a specific patient, I sort

332
00:21:00,540 --> 00:21:05,260
of use my clinical judgment that I think
this one is going to work better for

333
00:21:05,261 --> 00:21:09,810
you. Um, you've had X before,
you're going to stick with X,

334
00:21:09,870 --> 00:21:14,850
if you did well. Um, and I try to,

335
00:21:16,450 --> 00:21:21,330
I try to always match the filler to the
indication, not the group of fillers.

336
00:21:21,430 --> 00:21:26,360
So the name filler, but I know that I
have these three volumizing fillers here.

337
00:21:27,520 --> 00:21:31,880
Um, you know, first thing is, are we
doing a special on one, you know, buy one,

338
00:21:31,940 --> 00:21:34,520
get one at half price, or, you know,

339
00:21:34,521 --> 00:21:38,680
what did the company do for me
this month that we wanna do? Um,

340
00:21:38,940 --> 00:21:42,800
or are we not doing anything? And they're
going to, you know, this is the cost.

341
00:21:43,060 --> 00:21:46,070
And so I cost is very important, um,

342
00:21:47,210 --> 00:21:49,990
as much here as it is everywhere. Um,

343
00:21:50,290 --> 00:21:53,630
and so I take all that into
consideration, but it's not easy.

344
00:21:54,820 --> 00:21:57,720
Now, let me ask about it from
the patient's perspective.

345
00:21:58,330 --> 00:22:01,960
Let's say you have a new patient who
comes into your office for a consultation.

346
00:22:02,800 --> 00:22:04,630
Um, they want to look more rejuvenated,

347
00:22:04,810 --> 00:22:08,190
but they've never had any fillers
done before and are interested. Um,

348
00:22:08,191 --> 00:22:10,470
what are some tips for
how to pick a filler?

349
00:22:11,760 --> 00:22:14,500
So I think, you know, the
first thing that we all do,

350
00:22:15,780 --> 00:22:17,100
I think if you're going to be a good

351
00:22:19,660 --> 00:22:22,570
cosmetic person, first of all,

352
00:22:23,200 --> 00:22:27,730
like Dr. Bass is the most calm person
I've ever met. All right. And so,

353
00:22:27,731 --> 00:22:31,890
you know, even when we're in discussions
in meetings, he never gets upset.

354
00:22:32,470 --> 00:22:34,250
So I think that having the demeanor

355
00:22:35,970 --> 00:22:40,030
of being a good listener
is really important. Um,

356
00:22:40,450 --> 00:22:42,660
and dermatologists are very quick,

357
00:22:42,920 --> 00:22:46,020
so we don't always listen like we should,

358
00:22:46,400 --> 00:22:49,500
but the first question is always
the same to all my people.

359
00:22:50,170 --> 00:22:54,760
What is bothering you? It it's
it, you know, here's the mirror,

360
00:22:55,590 --> 00:22:59,190
show me what is your concern today?

361
00:22:59,191 --> 00:23:03,980
Because they may have a line
on their face or wrinkle that

362
00:23:03,981 --> 00:23:07,620
they means nothing to
them now. And it may,

363
00:23:07,621 --> 00:23:09,700
and it may be the only thing I focus on.

364
00:23:11,190 --> 00:23:13,970
So you've gotta sort of, I,

365
00:23:14,330 --> 00:23:16,970
I let the patients guide me on the,

366
00:23:17,080 --> 00:23:19,450
what bothers them scenario,

367
00:23:20,460 --> 00:23:25,360
but as it always does, or 99%
of the time the patients say,

368
00:23:26,490 --> 00:23:29,940
this is what bothers me, but you
have to tell me what, you know,

369
00:23:29,941 --> 00:23:34,700
what can you do to make me look
better? What, what should I do? Um,

370
00:23:34,880 --> 00:23:39,770
and then you sort of put together a game
plan and the game plan doesn't have to

371
00:23:39,771 --> 00:23:43,570
be everything in one day.
And, and again, when we're,

372
00:23:43,571 --> 00:23:48,280
especially when we're talking about
and toxins and devices and skincare,

373
00:23:49,360 --> 00:23:53,200
um, and that's not even your surgical
world that you, that you still live in,

374
00:23:53,950 --> 00:23:58,080
that is not a one day process.
So you may get a toxin today,

375
00:23:58,140 --> 00:24:02,280
and we've just discussed about the
skincare. I mean, just about the fillers,

376
00:24:02,500 --> 00:24:05,710
or you may get a filler, an toxin,
and then next time you come,

377
00:24:05,880 --> 00:24:10,150
we're going to introduce devices or
some other thing into what we do.

378
00:24:10,530 --> 00:24:15,360
So it's always about listening
and then finding out their

379
00:24:15,361 --> 00:24:19,980
biggest concern. And then once
I learn their biggest concern,

380
00:24:19,981 --> 00:24:24,810
sort of mapping out a
strategy that will get

381
00:24:24,811 --> 00:24:27,570
them from a to B in,

382
00:24:27,571 --> 00:24:32,490
within a price point that I know will,
will be within their budgets too,

383
00:24:32,491 --> 00:24:37,250
because the worst thing that you
can say to somebody is, wow, uh,

384
00:24:37,251 --> 00:24:38,250
you've got, you know,

385
00:24:38,251 --> 00:24:41,490
you've got all this stuff and you're
going to take eight syringes of filler at,

386
00:24:41,600 --> 00:24:44,960
you know, a thousand dollars a piece.
And, and it's going to be $8,000.

387
00:24:45,180 --> 00:24:48,160
And then we're going to have to
repeat this in about a month and half,

388
00:24:48,161 --> 00:24:52,660
because you're going to need more,
you know, and if that's the case,

389
00:24:52,661 --> 00:24:55,460
they need a facelift
or they need, you know,

390
00:24:55,461 --> 00:24:58,100
they need something beyond what
I'm going to be able to give them.

391
00:24:58,100 --> 00:25:02,730
Yeah. And I think your whole
point about, uh, you know,

392
00:25:02,750 --> 00:25:05,890
you don't have to do it all at
once is really important. I mean,

393
00:25:05,910 --> 00:25:08,130
you didn't age in a month,

394
00:25:08,190 --> 00:25:12,890
you aged in decades and we're
going to rebuild and you

395
00:25:12,891 --> 00:25:15,850
rebuild a little bit here
in a little bit. There,

396
00:25:15,851 --> 00:25:17,810
you want to see a meaningful improvement.

397
00:25:18,090 --> 00:25:22,640
I mean you want to see something is
happening that that's important for

398
00:25:22,641 --> 00:25:26,280
patients, but we don't have to
change everything overnight.

399
00:25:27,520 --> 00:25:30,780
We just need to be getting
younger, looking better,

400
00:25:30,781 --> 00:25:35,540
looking enhanced rather than letting
the aging progress we need to, you know,

401
00:25:35,541 --> 00:25:40,290
prevent, maintain, and restore
which is a big part of.

402
00:25:40,290 --> 00:25:43,930
It. And even, you know, a little
bit sometimes goes a long way.

403
00:25:44,310 --> 00:25:47,130
Oh, absolutely. I, I, I think, you know,

404
00:25:47,820 --> 00:25:52,690
we're Americans and we have this mistaken
notion more is always better and it's

405
00:25:52,691 --> 00:25:54,890
not, it's not always true. You know, we,

406
00:25:54,950 --> 00:25:59,840
we want to accent your appearance
and little changes sometimes

407
00:26:00,140 --> 00:26:02,720
really, really make an impressive change.

408
00:26:02,860 --> 00:26:07,760
Why is Botox one of the most
popular treatments of any

409
00:26:07,761 --> 00:26:10,800
aesthetic treatment in
the history of humankind?

410
00:26:11,300 --> 00:26:16,190
And we're just treating for starters,
those little elevens between the eyebrows.

411
00:26:16,410 --> 00:26:18,030
It seems like such a small thing,

412
00:26:18,050 --> 00:26:22,350
but people feel so happy
when they see how they look

413
00:26:23,160 --> 00:26:26,910
after Botox, that they
never want to stop doing it.

414
00:26:27,570 --> 00:26:28,630
And they want to know how much,

415
00:26:28,820 --> 00:26:33,740
what else Botox or any of the botulinum
toxins will do for them. Right. Right.

416
00:26:33,800 --> 00:26:38,460
You did, you did the little lines here
and they're like, that's unbelievable.

417
00:26:39,220 --> 00:26:42,780
Um, so yeah, I think sometimes it's, it's,

418
00:26:43,030 --> 00:26:45,200
it's under, as I said,

419
00:26:45,201 --> 00:26:50,080
understanding what the patient
wants and that doing it

420
00:26:50,081 --> 00:26:54,800
over, doing it as Dr. Bass said, slowly
and, and, you know, you don't need,

421
00:26:54,801 --> 00:26:59,120
you want the wow, right. We all want
the wow effect for our patients,

422
00:26:59,420 --> 00:27:01,000
but we don't want them to look weird.

423
00:27:02,480 --> 00:27:04,260
Really important, really, really.

424
00:27:04,260 --> 00:27:06,980
Important, you know, and all
you have to do is, you know,

425
00:27:06,981 --> 00:27:10,300
look on the internet and look at
all these chats and all this stuff,

426
00:27:10,301 --> 00:27:11,180
which I never do,

427
00:27:11,600 --> 00:27:15,740
but there are weird people saying
weird things and we've gotta

428
00:27:17,020 --> 00:27:17,853
maintain our

429
00:27:19,740 --> 00:27:24,730
strict code of do no harm, do be,

430
00:27:24,990 --> 00:27:25,850
be, you know,

431
00:27:25,870 --> 00:27:29,730
put yourself in their shoes and make
sure that what you're doing to them,

432
00:27:29,790 --> 00:27:32,610
you would do have somebody
do to you. Because again,

433
00:27:32,611 --> 00:27:35,970
we know what the good and
bad is. And so we only,

434
00:27:35,971 --> 00:27:39,330
we don't want to create the bad. We
really just want to create the good.

435
00:27:39,330 --> 00:27:42,280
And that's an important point. You know,

436
00:27:42,420 --> 00:27:44,480
if I make my living doing this,

437
00:27:44,500 --> 00:27:48,800
and if I'm telling you not to do something
or to meter the amount you're doing,

438
00:27:49,390 --> 00:27:51,280
that, that doesn't work to my advantage.

439
00:27:51,540 --> 00:27:53,800
If I'm telling you that it's
solely for your benefit,

440
00:27:54,470 --> 00:27:58,400
because I want you to look natural
and, and beautiful. Uh, and,

441
00:27:58,510 --> 00:28:01,150
and beauty is a process.
It's not an event.

442
00:28:02,720 --> 00:28:06,860
And that's really what you've spent your
whole career doing. Right. Right. Uh.

443
00:28:07,560 --> 00:28:11,660
And, and you want the patient to look,
you want the patients to look natural,

444
00:28:12,680 --> 00:28:16,780
you know, so even if you're
treating somebody's glabella
for the, you know, the,

445
00:28:17,280 --> 00:28:19,690
the forehead lines or whatever,

446
00:28:20,440 --> 00:28:23,450
it's okay to have a little
bit of movement, you know,

447
00:28:23,451 --> 00:28:27,070
20 years ago we wanted everybody
to be frozen. All right.

448
00:28:27,290 --> 00:28:32,190
And now having a little bit
is okay. And if they don't,

449
00:28:32,191 --> 00:28:35,870
if they don't want that, you can
put a little more in, but you, it,

450
00:28:36,160 --> 00:28:39,580
you gotta sort of understand the,

451
00:28:39,880 --> 00:28:43,220
the aging process, the natural look.

452
00:28:43,680 --> 00:28:45,420
And we want everybody to look natural.

453
00:28:46,840 --> 00:28:50,600
I want to go back to the earlier
discussion about fillers abroad and in the

454
00:28:50,601 --> 00:28:52,760
global market. Mm, Dr. Gold,

455
00:28:53,000 --> 00:28:56,390
how does the international filler market
differ from what we have here in the

456
00:28:56,710 --> 00:28:57,543
US?

457
00:28:57,750 --> 00:29:00,750
There are hundreds of them.
We, we, I think I don't even,

458
00:29:00,830 --> 00:29:04,790
I stopped counting what we have here.
We probably have, and Larry correct me.

459
00:29:04,990 --> 00:29:06,030
We have like 20 fillers.

460
00:29:06,830 --> 00:29:07,663
Yeah. That's about right.

461
00:29:08,190 --> 00:29:12,270
Okay. There are hundreds,
hundreds of fillers in Europe.

462
00:29:13,390 --> 00:29:17,180
Now having said that, and
the reason was that be, was,

463
00:29:17,340 --> 00:29:21,770
it was easy to get approval. You,
you basically just had to say, well,

464
00:29:22,090 --> 00:29:25,080
we're just like that. And so they,

465
00:29:25,360 --> 00:29:27,520
they had to prove that they worked,

466
00:29:29,290 --> 00:29:32,050
and that was really it in 2018,

467
00:29:32,530 --> 00:29:36,040
the rules changed in
the European union. Um,

468
00:29:36,800 --> 00:29:41,480
that said that if you're a filler
company and you wanna introduce a filler,

469
00:29:42,200 --> 00:29:46,600
or if you have had fillers,
you have to do two things.

470
00:29:47,720 --> 00:29:51,040
You have to do a study on
those with HIV lipoatrophy.

471
00:29:52,960 --> 00:29:57,820
First second, you had to do
a safety and efficacy study.

472
00:29:58,700 --> 00:30:03,170
So in the US, we don't care if it
works, they they're not coming here.

473
00:30:03,330 --> 00:30:05,980
If they don't work, we're
just going to prove they work.

474
00:30:06,820 --> 00:30:09,380
We wanna prove their safety
or, and their efficacy.

475
00:30:10,300 --> 00:30:14,340
That's the most important thing when we
do clinical studies is looking at the

476
00:30:14,620 --> 00:30:19,250
safety profile. And so that's
why we do what we do in Europe.

477
00:30:19,510 --> 00:30:21,210
Now, since 2018,

478
00:30:21,870 --> 00:30:26,690
any new filler has to do exactly what
we do and that didn't exist before

479
00:30:26,691 --> 00:30:29,490
then. And if you wanted to
maintain yourself on the market,

480
00:30:29,990 --> 00:30:31,730
you had to go back and do those safety.

481
00:30:31,750 --> 00:30:34,770
And these studies on a
significant number of patients.

482
00:30:35,310 --> 00:30:38,080
So you could have come out with
a filler with like, I, you know,

483
00:30:38,081 --> 00:30:41,680
they did a 10 patient
study, but it worked. Um,

484
00:30:41,820 --> 00:30:45,320
and so they got approval EU
approval. Now they can't do that.

485
00:30:45,380 --> 00:30:49,000
So I think the numbers are dropping. Um,

486
00:30:49,180 --> 00:30:52,200
but those that we're seeing in
Europe that haven't gotten here yet,

487
00:30:52,510 --> 00:30:56,510
have all gone through this
safety and efficacy study,

488
00:30:57,550 --> 00:31:01,030
um, that they've had it go through.
And it was amazing a couple years ago,

489
00:31:01,080 --> 00:31:05,470
right before the, in the 2018 19 realm.

490
00:31:05,471 --> 00:31:08,750
Cause I go to a lot of
meetings in Europe. Um,

491
00:31:09,270 --> 00:31:13,110
I had every company wanting
to talk to me about, you know,

492
00:31:14,100 --> 00:31:18,420
what I would, I help, you
know, consult with them on,

493
00:31:18,421 --> 00:31:22,340
on making sure that they were doing
it right and so forth and so on.

494
00:31:22,510 --> 00:31:27,340
Which for me was great because now those
companies are coming to the US and,

495
00:31:27,341 --> 00:31:30,340
and you know, we're helping them. So, um,

496
00:31:30,341 --> 00:31:33,990
but yeah, the, yeah,

497
00:31:34,050 --> 00:31:36,360
you want to make sure that the,

498
00:31:36,890 --> 00:31:40,880
these things are safe and I'll
give you one, for instance, um,

499
00:31:40,890 --> 00:31:45,120
there was a filler, it worked
incredibly well in Europe.

500
00:31:45,420 --> 00:31:47,200
At least it looked like it did.

501
00:31:47,300 --> 00:31:50,360
It looked like it was going to
last about a year to 18 months.

502
00:31:51,300 --> 00:31:54,470
And sort of, as soon as they
got their European approval,

503
00:31:54,580 --> 00:31:57,510
they started their US FDA clinical trials.

504
00:31:57,511 --> 00:32:02,380
And about six months after the

505
00:32:02,381 --> 00:32:06,180
filler injections, people started
getting what are called grans,

506
00:32:07,690 --> 00:32:10,960
um, which really hadn't been seen in the
European stuff because they hadn't been

507
00:32:10,961 --> 00:32:14,770
studied out that long, or they
didn't do a lot of injections.

508
00:32:15,830 --> 00:32:20,130
And, you know, there was a class
action lawsuit against the company.

509
00:32:20,131 --> 00:32:24,330
The doctors were in trouble. I mean,
I had nothing to do with this trial,

510
00:32:24,331 --> 00:32:29,020
but again, it's why we
do clinical trials. Um,

511
00:32:29,130 --> 00:32:32,890
because we want to make sure
before we take it to the masses,

512
00:32:32,940 --> 00:32:37,330
we're studying it again with the right
doctors that know what to do and know how

513
00:32:37,331 --> 00:32:40,080
to handle problems. Um, you know,

514
00:32:40,220 --> 00:32:45,160
and so those scenarios are not going to
happen very often here in the US because

515
00:32:45,220 --> 00:32:50,090
the companies have to go through
so much today to get a filler

516
00:32:50,440 --> 00:32:52,170
into the country, into the US.

517
00:32:52,390 --> 00:32:56,730
So we can be very comfortable that if
they've made it into their quote unquote

518
00:32:56,731 --> 00:32:57,760
pivotal trial,

519
00:32:58,470 --> 00:33:03,200
that we know it's going to work and
we are comfortable that we're going to

520
00:33:03,201 --> 00:33:07,400
study their safety through at
least a year, if not longer.

521
00:33:07,400 --> 00:33:12,240
So I think part of this is about
how FDA has dealt with fillers

522
00:33:12,241 --> 00:33:17,060
compared to European regulatory agencies.

523
00:33:17,200 --> 00:33:20,220
And basically, you know,
FDA did the job, right?

524
00:33:20,320 --> 00:33:25,220
We have a relatively small number
of fillers with a great deal of

525
00:33:25,221 --> 00:33:28,740
data, with a great deal of experience, uh,

526
00:33:28,840 --> 00:33:32,740
and study demonstrating
that they're efficacious,

527
00:33:33,330 --> 00:33:38,210
that there are specific indications
where there's really solid proof,

528
00:33:38,211 --> 00:33:42,530
they're efficacious. And as Dr.
Gold said a hundred percent,

529
00:33:42,760 --> 00:33:46,530
most important that they're safe, uh,

530
00:33:46,790 --> 00:33:49,650
and that's critical, uh,

531
00:33:49,670 --> 00:33:54,520
the ability to then vary and
customize the fillers a little bit

532
00:33:54,540 --> 00:33:59,440
or blend as Dr. Gold said
gives you some control

533
00:33:59,820 --> 00:34:02,360
as a, as a provider. Uh,

534
00:34:02,460 --> 00:34:07,280
but basically it's that knowing
you're starting with a safe

535
00:34:07,680 --> 00:34:12,590
material that's biologically
compatible and that has a track record

536
00:34:13,490 --> 00:34:15,510
is, is really the difference.

537
00:34:15,730 --> 00:34:20,400
And then the qualifications
of the provider injecting,

538
00:34:20,401 --> 00:34:23,600
which varies a lot in
the European markets, uh,

539
00:34:23,601 --> 00:34:27,480
from country to country who is
legally qualified to inject.

540
00:34:28,020 --> 00:34:32,150
And here that's much more
uniform and standard,

541
00:34:32,490 --> 00:34:35,350
at least when it comes
to injecting fillers.

542
00:34:36,250 --> 00:34:37,790
Before we end Dr. Gold,

543
00:34:38,090 --> 00:34:41,550
can you share any important points for
our listeners to keep in mind about

544
00:34:41,551 --> 00:34:42,384
fillers?

545
00:34:43,250 --> 00:34:45,330
Um, to me, yeah. I mean, I think

546
00:34:47,180 --> 00:34:51,590
always go to somebody that knows what
they're doing. I think, you know,

547
00:34:52,210 --> 00:34:54,310
you're in New York City, I'm in Nashville.

548
00:34:54,870 --> 00:34:58,830
I think there's somebody that can
inject that wants to inject a filler,

549
00:34:59,190 --> 00:35:04,110
probably, you know, every 15
yards from where you work. Um,

550
00:35:04,490 --> 00:35:07,510
and the reality is they,

551
00:35:07,660 --> 00:35:12,100
they don't have your experience and
they don't have your knowledge. And,

552
00:35:12,980 --> 00:35:17,420
um, again, I don't badmouth anybody.
Um, but I think, you know, we've,

553
00:35:17,421 --> 00:35:18,000
you've gotta,

554
00:35:18,000 --> 00:35:22,740
you've gotta go to somebody to have
these procedures done that really

555
00:35:22,741 --> 00:35:25,820
understand what they do. And
even here in Nashville, um,

556
00:35:26,930 --> 00:35:30,370
I sometimes get amazed at

557
00:35:32,340 --> 00:35:35,740
somebody putting in the filler where we
know they should never put that filler.

558
00:35:36,500 --> 00:35:40,840
Um, so an inappropriate filler
in an inappropriate location. Um,

559
00:35:41,020 --> 00:35:44,000
and so as I do, I know you do,

560
00:35:44,100 --> 00:35:48,800
we spend some time actually trying to
reverse some bad results that people get.

561
00:35:48,940 --> 00:35:51,680
And so I think that if people

562
00:35:53,870 --> 00:35:58,360
do their homework and go
to reputable providers that

563
00:35:59,410 --> 00:36:02,470
are really knowledgeable,

564
00:36:03,290 --> 00:36:07,950
that's the most important thing for
the healthcare worker that does this.

565
00:36:09,100 --> 00:36:13,350
This is in point and shoot
as is not botulinum toxin.

566
00:36:13,660 --> 00:36:16,860
This is a learned skill. Um,

567
00:36:17,320 --> 00:36:21,700
and you've gotta know the anatomy.

568
00:36:22,740 --> 00:36:26,340
Um, you've gotta know where
not to put the needle.

569
00:36:26,760 --> 00:36:30,660
You need to know what to do
if something goes wrong, um,

570
00:36:31,110 --> 00:36:35,370
which is rare and really
rare, but that's the,

571
00:36:35,371 --> 00:36:39,770
you know, that can define
your whole career. So,

572
00:36:40,610 --> 00:36:42,490
um, we want to, so the,

573
00:36:42,650 --> 00:36:47,370
I it's always patient beware out
there for everything they do.

574
00:36:48,410 --> 00:36:52,690
Um, you know, I, and, and it doesn't
have to be in the cosmetic arena.

575
00:36:52,830 --> 00:36:54,320
It's for everything. You know,

576
00:36:54,500 --> 00:36:57,760
why are you going to this person
to get this done? When you know,

577
00:36:57,761 --> 00:37:01,880
there's somebody down the street,
that's a real expert. Well,

578
00:37:01,881 --> 00:37:03,440
they charge more money. Well,

579
00:37:03,550 --> 00:37:08,040
they charge more money because their
educational level and their skill level

580
00:37:08,580 --> 00:37:12,150
and their expertise is worth
it to me to go to them.

581
00:37:13,520 --> 00:37:15,740
You know, I always say
that, why do I, you know,

582
00:37:16,200 --> 00:37:20,860
why do I go to who I consider to be
the best cardiologist in this city

583
00:37:21,330 --> 00:37:23,500
once a year to listen to my heart,

584
00:37:25,250 --> 00:37:28,460
I've done it for 30 years.
He was my chief resident.

585
00:37:28,461 --> 00:37:32,810
When I was an intern at Grady
hospital at Emory in Atlanta.

586
00:37:34,030 --> 00:37:37,730
He is the, to me, the finest
cardiologist I ever met.

587
00:37:38,630 --> 00:37:43,210
And once a year, I want him listening
to my heart. I have no heart problems,

588
00:37:43,211 --> 00:37:47,290
but once a year he tells me
I have no heart problems.

589
00:37:48,630 --> 00:37:52,800
That's worth every penny
that I pay to that visit.

590
00:37:53,980 --> 00:37:56,120
And so if somebody wants to come to me,

591
00:37:56,240 --> 00:38:00,720
I want them to have that comfort level
that I know what I'm doing or come to

592
00:38:00,721 --> 00:38:05,440
you. We know, you know what you're
doing and not somebody that is just,

593
00:38:05,500 --> 00:38:09,950
you know, Hey, they just did a weekend
course. And, you know, so and so,

594
00:38:10,050 --> 00:38:14,550
and watch somebody inject somebody
and, you know, so they just,

595
00:38:14,730 --> 00:38:15,790
so it's buyer beware.

596
00:38:16,750 --> 00:38:19,070
I think what Dr. Gold
said is exactly right.

597
00:38:19,700 --> 00:38:23,910
It's really critical to have
expertise, skill, experience,

598
00:38:24,200 --> 00:38:25,350
background knowledge,

599
00:38:25,410 --> 00:38:29,700
to be able to use fillers safety safely,

600
00:38:29,701 --> 00:38:31,940
which again is critically important.

601
00:38:32,760 --> 00:38:34,820
And to get great results,

602
00:38:35,630 --> 00:38:40,320
make great selections of which
filler is appropriate or how the

603
00:38:40,321 --> 00:38:43,600
filler should be blended
or customized, uh,

604
00:38:43,620 --> 00:38:48,560
to address the features that are really
bothering the individual patient in the

605
00:38:48,561 --> 00:38:49,394
United States.

606
00:38:49,500 --> 00:38:54,150
We have the core for the group
of four aesthetic providers

607
00:38:54,730 --> 00:38:59,110
who as part of their residency
training and experience are

608
00:38:59,260 --> 00:39:02,030
trained in providing aesthetic treatments.

609
00:39:02,031 --> 00:39:05,950
They didn't pick it up in a
weekend course or some other way.

610
00:39:05,951 --> 00:39:10,190
But this is part of their medical
knowledge and training part of their board

611
00:39:10,300 --> 00:39:15,220
certification. And those are plastic
surgeons, dermatologists, facial,

612
00:39:15,221 --> 00:39:18,420
plastic surgeons, and
oculoplastic surgeons.

613
00:39:19,200 --> 00:39:21,020
So those individuals,

614
00:39:21,520 --> 00:39:24,580
you have a baseline
assurance that this is a,

615
00:39:26,330 --> 00:39:30,010
a part of their specialty that
they were trained to perform.

616
00:39:30,470 --> 00:39:35,320
And then if they have a great deal of
experience doing injectables on top

617
00:39:35,380 --> 00:39:40,360
of that then they're
particularly qualified to

618
00:39:40,361 --> 00:39:44,320
bring you the best result.
So that, that really is,

619
00:39:45,500 --> 00:39:50,430
is the best way to get what you're
looking for with fillers, be safe,

620
00:39:50,490 --> 00:39:51,323
be natural,

621
00:39:52,090 --> 00:39:56,590
and have someone who will listen and
respond to your aesthetic concerns.

622
00:39:56,591 --> 00:39:58,550
That's right. That's
right. Well, Dr. Gold,

623
00:39:58,750 --> 00:40:03,110
I I'd really like to thank you for joining
us for this episode of park avenue,

624
00:40:03,111 --> 00:40:04,590
plastic surgery class,

625
00:40:05,330 --> 00:40:09,260
and bringing your encyclopedic
knowledge and wealth of experience.

626
00:40:09,950 --> 00:40:12,490
Thank you. All right. Take care.

627
00:40:12,490 --> 00:40:14,930
Everybody. Take care. Thank
you. Thank you for joining us.

628
00:40:15,020 --> 00:40:15,853
Thank you.

629
00:40:16,310 --> 00:40:20,650
My thanks to Dr. Gold for taking time
out of his busy schedule to be here with

630
00:40:20,651 --> 00:40:22,130
us and shares expertise.

631
00:40:22,640 --> 00:40:25,770
It's always exciting to hear from
experts who are at the forefront of their

632
00:40:25,780 --> 00:40:26,510
field.

633
00:40:26,510 --> 00:40:31,240
And this episode has certainly given
me a lot to think about if you have any

634
00:40:31,241 --> 00:40:33,600
remaining questions for
Dr. Bass and Dr. Gold,

635
00:40:33,700 --> 00:40:37,560
or if you think of other exciting trends
or developments in plastic surgery that

636
00:40:37,561 --> 00:40:39,760
you would like us to
discuss in a future episode,

637
00:40:39,900 --> 00:40:43,240
please reach out by email or
Instagram. We'll see you next time.

638
00:40:44,240 --> 00:40:47,600
This is Doreen Wu. Thanking you
for joining Dr. Bass, Dr. Gold,

639
00:40:47,600 --> 00:40:52,240
and me for this discussion of injectable
fillers in the US and abroad and

640
00:40:52,241 --> 00:40:54,080
how the industry has evolved over time.

641
00:40:55,460 --> 00:40:59,280
Be sure to join us next time to hear
about another aspect of this fascinating

642
00:40:59,281 --> 00:41:02,560
field, as always, don't forget
to subscribe to our podcast.

643
00:41:02,820 --> 00:41:06,590
So you don't miss out on any of the
exciting content that is coming soon.

644
00:41:07,920 --> 00:41:11,910
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

645
00:41:12,040 --> 00:41:16,550
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,

646
00:41:17,350 --> 00:41:19,190
educator, and technology innovator.

647
00:41:19,490 --> 00:41:21,950
The commentary in this
podcast represents opinion.

648
00:41:22,140 --> 00:41:24,740
This podcast does not
present medical advice,

649
00:41:25,040 --> 00:41:29,060
but rather general information about
plastic surgery that does not necessarily

650
00:41:29,120 --> 00:41:32,220
relate to the specific conditions
of any individual patient.

651
00:41:32,600 --> 00:41:37,320
No doctor-patient relationship
is established by listening
to or participating

652
00:41:37,460 --> 00:41:38,293
in this podcast,

653
00:41:38,550 --> 00:41:42,600
consult your physician to advise you
about your individual healthcare.

654
00:41:42,860 --> 00:41:44,280
If you enjoyed this episode,

655
00:41:44,460 --> 00:41:48,520
please share it with your friends and
be sure to subscribe to our podcast on

656
00:41:48,521 --> 00:41:52,510
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657
00:41:52,810 --> 00:41:55,110
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