Stackable Beauty Treatments w/ Dr. Julius Few

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Welcome to Park Avenue
Plastic Surgery Class,

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

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I'm your co-host, Doreen Wu,

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

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

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educator and technology innovator.

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The title of today's episode is
"Stackable Treatments." Okay,

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Dr. Bass, you've done it again.

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This is another of those episode
titles that spark my interest.

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Where are we going in this episode
and where does the title come from?

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Well,

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there's always been this concept in
plastic surgery of the reconstructive

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ladder.

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So if someone has a trauma defect or a

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congenital malformation,

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there's this approach that starts with
the simplest ways to reconstruct it.

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And depending on the complexity
of the problem and the

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likelihood of success
with the simple approach

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goes progressively up the
reconstructive ladder to more complex,

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more involved,

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more extensive kinds of
reconstructive surgeries.

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And in aesthetic plastic surgery,

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it's really the same idea.

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We always try to start with
the small or simple option

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and go up the chain as need requires.

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Separate from that, plastic
surgery has become multimodality.

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We don't pick one thing
to address a problem,

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but often we're picking a few things.

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And so we have a guest
joining us today on this

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episode, Dr. Julius Few,

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who has lectured and
written extensively on

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these sorts of concepts.

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And Dr. Few is a plastic surgeon who is a

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clinical professor of plastic
surgery at the University of Chicago.

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He is also a clinical provider
at Northwestern University,

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and he runs a very busy and very
popular practice based in both

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Chicago and Beverly Hills.
In addition to that,

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he is an associate editor of
the Aesthetic Surgery Journal,

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which is the number one journal
on aesthetic surgery in the world

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where he edits the aesthetic
medicine section of the journal.

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And he's written a textbook for plastic
surgeons that discusses a lot of the

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issues that we're going to
discuss in this episode today.

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So Dr. Few, thank you for
joining us again on the podcast.

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Thank you for having
me. It's a lot of fun.

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Only correction I'm going to make is that
you actually contributed and helped me

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write that book. So much appreciated.

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Well, I should really say you edited the
book in addition to writing many of the

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chapters, but yes,

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along with a variety of
the usual suspects who you

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and I have lectured with year after year,

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I did contribute

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in a small way to that wonderful book.

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Welcome, Dr. Few. So let's get started.

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Can you explain what stackable treatments
are and how you first came up with the

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idea?

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Well, it's the concept. This
is really full circle because

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as a number of people may not know

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before going out to Beverly Hills,

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I actually was fortunate
enough to work out of

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Larry's office on Park
Avenue and back during that

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time, because originally it was
more so focused on taking care of

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predominantly broadway entertainers
that I had known over the years,

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as well as national news agency providers,

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the journalists, et cetera,
that basically said, look,

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if you come to New York periodically,

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we'll bring our friends and we'll make
it worth your while and you can do your

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nonsurgical thing.

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And so back then you have to realize
that the prevailing thought in

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dermatology,

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and obviously dermatology was ahead of
plastic surgery on the nonsurgical space,

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but nonetheless, in dermatology,
if you go back 12 or more years,

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the idea of doing multiple
non-invasive things at

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once was largely considered heresy.
It was too risky.

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The idea of, for example,

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putting a filler in with a micro-focused
ultrasound treatment like Ultherapy,

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if you're doing them together, that
was a bad thing. You can't do that.

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The person will blow up or something.

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And so ultimately what happened out of

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necessity when I was coming to New York
and I was seeing patients who ultimately

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had skin issues combined with volume
issues and who really combined

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with drooping or sagging of
their tissue was the idea

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that it was really a
multiplane or multi-level

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rejuvenation. We want it to
rejuvenate the skin with the laser.

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We want it to rejuvenate volume
by replacing it with either a

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natural or a paddle aesthetic option,

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and then ultimately to do something
like an Ultherapy or a thread lifting

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procedure that I helped to develop.

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But we wanted to do it all at the same
time for efficiency think because I was

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going to primarily be there
for a set period of time,

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and the people I was taking care
of were on a very tight timeline as

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well. And what we found ultimately,

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which was applied again to clinical study,

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was that not only could it be done safely
and that you could sequence things in

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a safe and effective way, but actually
there was the true definition of synergy.

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You actually got a result that was
better than what you would've got

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doing one of them by
themselves. And actually,

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my patients were the ones who
pointed it out. I literally,

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I had one patient in particular,

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woman, at the time on a major

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network as a daytime news person,

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and she was the one who pointed out
she would come to Chicago and get a

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filler here or a laser treatment,

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but she never did it all at once.
And in New York,

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I did her treatment all at once, and
she's the one that pointed out, she said,

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"I can't believe this.

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Am I imagining things or is it the
situation where it's better than

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when I did things separately?" So
then the nidus for us doing clinical

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study work, which indeed has shown this.

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And so then that I ultimately,

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I came up with really the
idea of stackable treatments.

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Really when I was watching my two
boys, they were very young at the time,

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playing with their toys
and stacking things,

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and I was literally in front of my
computer working, trying to watch them.

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And I realized, wait a minute,
this is what I'm doing.

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I'm stacking nonsurgical modalities or

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techniques and a way to
build this as Larry were

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saying almost like a ladder or a pyramid,

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which ultimately was bigger
than the sum of the part. And so

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I wrote about it.

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I published it actually in a dermatologic
journal back then because there's no

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way a plastic surgery journal wanted
to hear about this at the time.

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And as I was formulating these
ideas, I published it 12 years ago.

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I really started thinking about
it more like 15 years ago.

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And this was at the end of the
day, as you bring it together,

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now it's commonplace,

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but nobody at a major meeting
would talk about the idea that

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you couldn't do laser on somebody who
you just put filler in that nobody would

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even say that's even an issue,
let alone doing more than that.

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So I think we've come a long way.

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And I think the other thing to remember
about medicine and science is that

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it is inappropriately.

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So it is incredibly
conservative in its concept,

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but it's conservative because
of the scientists behind it.

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We all are taught to
approach things in a very,

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very almost like religious
way. Oh, you can't do that.

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You can't look at this a certain way.

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But then until you've
actually scientifically
vetted or tested the concept,

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can you then build from there?

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That's one of the things
that I thoroughly enjoy about

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studies I've done with Larry as
well as our clinical work together.

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And this happens a lot in
surgery and probably in medicine

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generally.

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A lot of things that were taboos when they

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get thoroughly investigated,

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completely transformed
the way we deliver care.

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A hundred percent.

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I mean, when I started
training in surgery,

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everyone came in the hospital
the night before an operation,

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stayed the night after
at a minimum and would

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not be permitted to eat or drink until
they could prove their digestive system

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was working,

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which causes your digestive
system to stop working

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because you're not
putting anything into it.

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And by the time I finished
my surgical training,

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a good measure of those
rules were out the window.

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And plastic surgery,

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popular plastic surgery might be a
few hundred thousand operations a

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year in the United States.
Just to give listeners a sense,

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the kinds of treatments that Dr.
Few is talking about stacking or

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combining are done
millions of times a year.

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There'll be a couple of
million injections a year of

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neuromodulator of almost
that many a filler,

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similar number of energy-based
treatments of all stripes.

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So there's a lot of very robust

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experience compared to
the much more limited

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experience with surgery at
ascertaining the right way to do

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it, what the effects are,

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how that happens over time when it gets
repeated over and over because we don't

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do surgery repetitively,

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but we do a lot of these
treatments repetitively. And that

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experience informs the
clinical management approach,

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the care planning or beauty planning
that the experienced plastic

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surgeon will bring for
you on particularly the

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nonsurgical side.

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I completely agree,

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and I think what's interesting
and someone who also practices on

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Park Avenue,

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and I consider a friend as somebody

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who, he was one of your teachers, Larry,

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but he was also somebody who I was able
to spend time with when I was doing

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fellowship work for
oculoplastics in New York.

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And the reality is you see
even him at the later stages of

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his career, and I'm talking
about Sherrell Aston.

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Where Sherrell is now applying
energy based modalities to

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his facelift surgery. And again,

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I think if you look at

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concepts and things of that sort,

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you and I remember specifically, I
can't remember which city we were in,

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but at being at an surgery
meeting and you and I were

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talking about the idea that any day,

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all day if we had a
surgery like a facelift

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and the ability to add a laser
or a skin tightening nonsurgical

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device,

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we could outperform just about any
surgeon who wanted to do just the surgery

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alone.
And so it's very interesting or

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exciting for me to see at this stage of

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our collective careers
where somebody as bright as

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incapable as certainly Sherrell
is to now say, "okay, I get it.

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Now I'm just start bringing this into my

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fold." I think it tells you something. So

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you and I,

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we were on the early side when
people kind of looked at people,

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meaning plastic surgeons looked
at this idea, and I remember some,

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not Sherrell,

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but I remember other plastic surgeons
saying to me at different meetings when

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these concepts are just coming to
bear, "this is a waste of time.

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Why are you doing this?
Surgery is the gold standard.

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You've done all this great training,

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why would you waste your
effort on non-surgery?".

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Well, I'll answer that question for you.

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And the answer to that question is,

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I'm a surgeon. I love doing
big operations. Like you said,

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I spend an awful lot of time and
energy learning how to do that.

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But for the benefit of my patients,

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if I can bring a result
that they want or need

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in a simple nonsurgical way,

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it would be completely inappropriate
for me to say it's got to be a big

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surgery or nothing.

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So solving problems for people in the

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simplest way possible,
the lowest risk way,

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the lowest recovery way is the minimum

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obligation we owe our patients.

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And I don't owe any obligation
to the surgical profession

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to uphold the virtue of
surgery over everything else.

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I owe all my allegiance to my
patients, totally different thing.

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But I'll tell you,

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Dr. Aston was really one
of my great mentors in

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aesthetic surgery.

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And one of the things I admire
most about him is that even as a

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very senior surgeon,

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he is still integrating new things

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into his practice, into his clinical care.

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He's not doing the same thing he
did 10 years ago and 20 years ago.

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He continues to update,

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and we all know surgeons who adopt
every new thing or buy every new

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device without any
discrimination of whether it's a

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worthwhile advance or just some new hype.

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He's very discerning in what he
incorporates and very cautious,

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but he hasn't stopped adding
new things and innovating on

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his own. And I have tremendous
amount of respect for that.

241
00:15:46,370 --> 00:15:49,760
As do I, as do I. He's a true gentleman.

242
00:15:49,760 --> 00:15:51,800
And I think at the end of the day,

243
00:15:52,700 --> 00:15:55,580
it shows his intellectual curiosity.

244
00:15:55,940 --> 00:16:00,800
I suspect listen at him
seeing the great work that you

245
00:16:00,810 --> 00:16:04,070
do, certainly influenced
him. What's the saying?

246
00:16:04,430 --> 00:16:09,320
We've all watched our parents
become almost like the ones who

247
00:16:09,320 --> 00:16:14,300
are asking us for counsel.
And I think, listen,

248
00:16:15,170 --> 00:16:18,740
he trained you very well.
Certainly his concepts were very,

249
00:16:18,890 --> 00:16:22,550
very significant in my surgical practice.

250
00:16:23,000 --> 00:16:27,050
But he now can see, look, the
reality is it's multiples.

251
00:16:27,050 --> 00:16:32,030
You have surgery or you can only
do so many in a year with all of

252
00:16:32,030 --> 00:16:33,860
plastic surgery involved,

253
00:16:34,550 --> 00:16:39,380
and literally a fraction
of that pool of providers

254
00:16:39,740 --> 00:16:42,500
is doing 10 x what surgery is.

255
00:16:42,500 --> 00:16:47,480
So I think when you start to see
those realizations and what it can do,

256
00:16:48,830 --> 00:16:52,580
it really does create this continuum
of care where you can go from

257
00:16:52,640 --> 00:16:56,960
nonsurgical to multiple nonsurgical to

258
00:16:56,960 --> 00:17:01,640
pre-surgical to post-surgical.
And so it's not just

259
00:17:01,640 --> 00:17:06,020
a, because again, if I look
at our meetings from 10
years ago, people would say,

260
00:17:06,020 --> 00:17:06,853
"oh,

261
00:17:07,970 --> 00:17:11,540
is it a facelift or is it
an injectable?" Well, no,

262
00:17:11,540 --> 00:17:12,980
they're not mutually exclusive.

263
00:17:13,370 --> 00:17:18,320
You can get a much better result when
you bring all these elements together.

264
00:17:18,380 --> 00:17:20,990
I mean, when you look at skincare,

265
00:17:20,990 --> 00:17:25,640
you look at the application of
nonsurgical medicine and then surgery,

266
00:17:26,840 --> 00:17:30,680
it becomes dramatic. And now things
that we thought, for example,

267
00:17:30,680 --> 00:17:35,000
and I'll segue a little bit. If
you look at even things that,

268
00:17:35,210 --> 00:17:39,440
for example, I've reviewed in
the journal prior to publication,

269
00:17:40,190 --> 00:17:44,180
a number of articles that are very dynamic
that are interesting that are being

270
00:17:44,180 --> 00:17:47,060
submitted about how, for example,

271
00:17:47,070 --> 00:17:49,410
a filler can behave like a neurotoxin,

272
00:17:50,040 --> 00:17:53,190
so behave like a Botox, Dysport,

273
00:17:53,190 --> 00:17:57,870
Xeomin type product because of the way it

274
00:17:57,930 --> 00:18:02,280
modulates the muscle where
it's placed. So for example,

275
00:18:02,280 --> 00:18:04,590
if you put filler and
you can look, and again,

276
00:18:04,650 --> 00:18:06,990
this is a very dynamic subject right now,

277
00:18:07,020 --> 00:18:10,860
there's some really interesting articles
that will be coming out in the next six

278
00:18:10,860 --> 00:18:12,840
months.
But for example,

279
00:18:12,840 --> 00:18:17,490
putting filler around the mouth can
dynamically affect the way the lip

280
00:18:17,520 --> 00:18:18,720
musculature moves.

281
00:18:19,890 --> 00:18:23,850
And this is something that now
we're just beginning to see.

282
00:18:23,880 --> 00:18:24,960
Or for example,

283
00:18:24,960 --> 00:18:29,670
there's an article that was
just published about how using a

284
00:18:29,670 --> 00:18:31,820
neuromodulator like a Botox, Xeomin,

285
00:18:32,100 --> 00:18:36,960
Dysport can actually lift the
face and very elegant objective

286
00:18:36,960 --> 00:18:40,770
studies that look at how
positioning of musculature,

287
00:18:40,780 --> 00:18:45,630
it's no longer about using these agents
just to get rid of wrinkles or to

288
00:18:45,630 --> 00:18:46,830
fill in laugh lines.

289
00:18:46,830 --> 00:18:51,780
It's actually about actually
modulating and optimizing the

290
00:18:51,780 --> 00:18:55,200
way our facial anatomy ages and behave.

291
00:18:56,040 --> 00:18:58,830
And then in addition to that,

292
00:19:00,120 --> 00:19:04,410
how and where things are
applied and what you're applying

293
00:19:04,800 --> 00:19:08,640
can affect what the response is.

294
00:19:08,970 --> 00:19:13,350
And this relates to our increasing

295
00:19:13,360 --> 00:19:18,360
understanding of regenerative medicine
and our attempts not just with

296
00:19:18,420 --> 00:19:22,860
stem cells and things like that, that
are not really in clinical use yet,

297
00:19:23,250 --> 00:19:26,250
but with many of the modalities we do use,

298
00:19:26,340 --> 00:19:30,630
how we apply them affects
what kind of regenerative

299
00:19:31,380 --> 00:19:33,330
result is produced.

300
00:19:34,110 --> 00:19:38,880
And I'll give you an example from that
course that you came and lectured at a

301
00:19:38,880 --> 00:19:39,570
number of times,

302
00:19:39,570 --> 00:19:44,520
summit in and aesthetic medicine that
I used to run in Southern California.

303
00:19:44,880 --> 00:19:49,290
And we had a Stanford
bioengineer who was trying to

304
00:19:49,290 --> 00:19:52,890
regenerate cartilage and other tissues.

305
00:19:53,430 --> 00:19:56,310
And by using certain matrix materials,

306
00:19:56,310 --> 00:19:58,860
depending what you put
them next to in the body,

307
00:19:58,860 --> 00:20:02,070
the body will produce a very different

308
00:20:02,970 --> 00:20:05,040
rebuilding of that tissue.

309
00:20:06,000 --> 00:20:09,780
And so we're understanding a lot of the

310
00:20:09,780 --> 00:20:14,220
rules that the body follows and how

311
00:20:14,220 --> 00:20:19,080
to lead the body where we want
it to go in ways we didn't even

312
00:20:19,080 --> 00:20:22,680
imagine when we were sitting
there practicing suturing

313
00:20:23,700 --> 00:20:26,790
in the bio skills lab as residents.

314
00:20:27,690 --> 00:20:31,620
This is so true. And I
mean at the end of the day,

315
00:20:32,310 --> 00:20:32,940
I love,

316
00:20:32,940 --> 00:20:37,590
and this to me what you just
touched on is really the

317
00:20:37,590 --> 00:20:40,650
next door in aesthetic medicine.

318
00:20:41,100 --> 00:20:43,590
It's the idea of pro-aging,

319
00:20:44,430 --> 00:20:48,490
restorative modalities that really

320
00:20:49,480 --> 00:20:54,070
in a positive way influence the way
that we externally show signs of

321
00:20:54,070 --> 00:20:54,903
aging.

322
00:20:55,150 --> 00:20:59,290
And I think if you look at most medicine,

323
00:20:59,290 --> 00:21:03,550
it's about prevention. You have
anti-hypertensive to prevent a stroke.

324
00:21:03,560 --> 00:21:08,050
You have cholesterol lowering
medications to present to prevent athe,

325
00:21:08,050 --> 00:21:11,920
sclerotic disease. But in aesthetics,

326
00:21:12,100 --> 00:21:15,430
we have not taken that approach until now.

327
00:21:15,580 --> 00:21:19,840
So I personally have, because I've
always been curious about this,

328
00:21:19,840 --> 00:21:24,820
if you actually modulate certain
features that we know are

329
00:21:24,820 --> 00:21:28,060
age related kind of signs of change,

330
00:21:28,960 --> 00:21:32,830
then does it delay the outward
appearance of that age?

331
00:21:33,220 --> 00:21:37,840
And what I found, and I have
a cohort or for your audience,

332
00:21:37,840 --> 00:21:42,820
a group of people I followed for
20 consecutive years who we can

333
00:21:42,820 --> 00:21:47,620
show in a very tangible way how the

334
00:21:47,620 --> 00:21:51,700
outward signs of aging has been
significantly delayed nonsurgically.

335
00:21:53,920 --> 00:21:56,830
And so really, I do believe,

336
00:21:56,830 --> 00:22:01,210
and you can say that we
heard it first on your

337
00:22:01,220 --> 00:22:01,960
podcast,

338
00:22:01,960 --> 00:22:06,880
but I would argue that
towards the end of our kids'

339
00:22:07,090 --> 00:22:10,780
generation, facelift
surgery will not be a thing.

340
00:22:12,250 --> 00:22:17,110
I do not believe it will because
I think within the next 25 years,

341
00:22:18,130 --> 00:22:20,740
technology will definitely catch up,

342
00:22:21,250 --> 00:22:25,270
and our understanding of these
concepts will come to full

343
00:22:25,660 --> 00:22:26,410
fruition,

344
00:22:26,410 --> 00:22:31,390
and we will then be able to do
what was unthinkable right now.

345
00:22:31,450 --> 00:22:34,090
Because as it is, if you
look at 25 years ago,

346
00:22:34,300 --> 00:22:38,620
it was unthinkable that we
could have beauty in a syringe.

347
00:22:39,070 --> 00:22:41,710
I mean, it was unthinkable
that you could do these things.

348
00:22:41,710 --> 00:22:46,540
And so I do believe the
idea of stackable anatomy

349
00:22:46,540 --> 00:22:47,373
based,

350
00:22:47,800 --> 00:22:52,420
kind of targeted therapy
is going to prove to

351
00:22:52,450 --> 00:22:57,220
be the most effective way to
age in the most graceful way.

352
00:22:57,940 --> 00:23:02,860
I'll just provide a very crude
metric that I've experienced.

353
00:23:02,860 --> 00:23:04,930
And when I first went into practice,

354
00:23:04,940 --> 00:23:08,470
which is a little over 25 years ago,

355
00:23:08,770 --> 00:23:12,430
basically average facelift age was 50.

356
00:23:12,820 --> 00:23:16,810
Now if you look at The Aesthetic Society's

357
00:23:16,810 --> 00:23:21,310
statistics, they break it
down into a certain age range,

358
00:23:21,320 --> 00:23:25,720
but it's late fifties to early sixties now

359
00:23:26,710 --> 00:23:31,450
25 years later. Now, why is that?
Well, there's a lot of reasons.

360
00:23:31,450 --> 00:23:35,530
Some of it is lifestyle. We smoke
less, we drink less, we exercise more,

361
00:23:36,100 --> 00:23:37,810
we put sunscreen on.

362
00:23:39,730 --> 00:23:43,750
But a lot of it is the

363
00:23:44,840 --> 00:23:49,550
recurrent support of a youthful

364
00:23:49,550 --> 00:23:53,450
anatomic state with energy treatments,

365
00:23:53,450 --> 00:23:56,180
with neuromodulators, with fillers,

366
00:23:56,900 --> 00:23:59,240
all the things we're
doing with skin products,

367
00:23:59,240 --> 00:24:03,710
all the things we're doing to maintain the

368
00:24:03,800 --> 00:24:08,480
morphologic state of youth and
the biologic state of youth

369
00:24:09,590 --> 00:24:12,590
has shifted that age.

370
00:24:12,860 --> 00:24:17,060
And we still see patients at that
age group, which is the average,

371
00:24:17,090 --> 00:24:19,910
who clearly don't yet
need a surgical lift.

372
00:24:21,560 --> 00:24:24,170
So that's a very crude metric.

373
00:24:24,170 --> 00:24:28,760
It's not absolute scientific
proof, but it's very bottom line.

374
00:24:31,040 --> 00:24:31,650
It is.

375
00:24:31,650 --> 00:24:36,380
And I think that there's plenty
of evidence to support that

376
00:24:36,390 --> 00:24:38,840
being more than just anecdote.

377
00:24:38,840 --> 00:24:43,820
So I think it's interesting.
It makes what we do,

378
00:24:44,000 --> 00:24:47,630
I think interesting because
it never gets boring.

379
00:24:47,630 --> 00:24:51,950
The idea that we can be as creative with

380
00:24:52,920 --> 00:24:57,260
these tools, which by the
way, on an annual basis,

381
00:24:57,260 --> 00:25:01,460
the toolbox keeps growing. We keep
having more tools, more options.

382
00:25:01,550 --> 00:25:03,680
It's one of the reasons why, to be honest,

383
00:25:03,680 --> 00:25:08,150
I've been one of the longer
serving associate editors for the

384
00:25:08,150 --> 00:25:11,870
journal, and I come close
to saying, it's my time.

385
00:25:11,870 --> 00:25:14,780
I'm going to hand it
over to the next person.

386
00:25:16,250 --> 00:25:17,660
But the truth is,

387
00:25:18,020 --> 00:25:21,710
it's honestly one of the
most dynamically interesting,

388
00:25:21,720 --> 00:25:26,330
intellectually challenging
areas is to serve in that

389
00:25:26,810 --> 00:25:30,440
capacity. And also to
frame it historically,

390
00:25:31,010 --> 00:25:35,480
cosmetic medicine or
aesthetic medicine is rapidly

391
00:25:35,930 --> 00:25:40,430
approaching the largest segment
of the journal by submission.

392
00:25:40,790 --> 00:25:42,830
If you look at submissions to the journal,

393
00:25:43,430 --> 00:25:48,230
it's coming really close. We've had
exponential growth so much though that

394
00:25:48,230 --> 00:25:49,250
we brought in,

395
00:25:49,250 --> 00:25:53,240
I brought in with the insight
of Foad Nahai and Jeff Kenkel,

396
00:25:53,270 --> 00:25:56,300
who I couldn't respect two people more,

397
00:25:58,160 --> 00:26:01,040
brought in a co section editor,

398
00:26:01,040 --> 00:26:05,030
associate editor for me because the
volume's so great. And by the way,

399
00:26:05,030 --> 00:26:09,740
the other thing that I would add just
subtly is so much of this data is coming

400
00:26:09,740 --> 00:26:11,210
in from Asia. I mean,

401
00:26:11,210 --> 00:26:16,160
I would say that the exponential
growth of material coming

402
00:26:16,160 --> 00:26:19,400
in, which is very dynamic
from China, Korea,

403
00:26:21,490 --> 00:26:22,520
that again,

404
00:26:22,520 --> 00:26:26,840
it's taking conceptually what
we've looked at and then trying

405
00:26:26,870 --> 00:26:28,820
to expand it. Because again,

406
00:26:29,030 --> 00:26:31,970
you're talking about populations
that are exponentially larger,

407
00:26:32,420 --> 00:26:37,220
that are wanting to look at
modalities and frankly deal with

408
00:26:37,230 --> 00:26:42,200
some of the same challenges
that African or Latin skin

409
00:26:42,210 --> 00:26:46,470
would have to deal with. So
the future is very interesting.

410
00:26:47,430 --> 00:26:52,020
I think that's an important point.
I don't think it's an accident,

411
00:26:52,020 --> 00:26:55,440
and I don't think it's purely the
difference in population size,

412
00:26:55,440 --> 00:26:57,120
why we're seeing things from there.

413
00:26:57,690 --> 00:27:02,010
The American approach is
take it all away in one step

414
00:27:02,070 --> 00:27:04,680
quick, and we're very impatient,

415
00:27:04,710 --> 00:27:09,360
and I think many other cultures
around the world understand the

416
00:27:09,360 --> 00:27:13,980
need for an ongoing process of

417
00:27:14,010 --> 00:27:17,940
maintenance, not only of our
health and other wellness issues,

418
00:27:17,940 --> 00:27:19,860
but of our appearance.

419
00:27:20,190 --> 00:27:24,990
And so they're teed up
culturally to pursue this

420
00:27:24,990 --> 00:27:29,940
approach in ways that the average
New York City person is so busy

421
00:27:29,940 --> 00:27:34,680
running down the street that
if you stop to check your

422
00:27:34,680 --> 00:27:37,950
phone or sightsee, if you're
a tourist in New York,

423
00:27:38,220 --> 00:27:40,020
you just about get bowled over.

424
00:27:40,230 --> 00:27:44,640
And that kind of impatience is
not what this process is about,

425
00:27:44,940 --> 00:27:49,800
but it's probably a much more
rational way to approach your beauty

426
00:27:49,810 --> 00:27:50,643
care.

427
00:27:50,940 --> 00:27:55,920
I completely agree. I mean, I think
that, and listen, at the end of the day,

428
00:27:55,980 --> 00:27:59,730
global perspectives make
the entire specialty better.

429
00:27:59,850 --> 00:28:03,720
It's one of the reasons
why I'm very proud,

430
00:28:03,730 --> 00:28:05,010
and you said it correctly,

431
00:28:05,070 --> 00:28:09,840
the Aesthetic Surgery Journal is the
largest aesthetic dedicated journal in the

432
00:28:09,850 --> 00:28:10,683
world.

433
00:28:10,800 --> 00:28:15,630
And this is in no small
part due to the Herculean

434
00:28:15,630 --> 00:28:17,700
effort of Foad and Jeff,

435
00:28:18,360 --> 00:28:23,070
along with our editorial board,
which I'm honored to be part of,

436
00:28:23,850 --> 00:28:25,020
really saying, look,

437
00:28:25,860 --> 00:28:30,630
we are better if we have input
from the international stage.

438
00:28:31,200 --> 00:28:33,540
And honestly, the concepts,

439
00:28:33,540 --> 00:28:37,260
even though you could argue Asia
was a little later to the party,

440
00:28:37,680 --> 00:28:42,420
they're making up in gangbusters.
And it's just, again,

441
00:28:42,420 --> 00:28:45,420
conceptually it's a little
different. The approach is different.

442
00:28:45,420 --> 00:28:48,360
And I personally have learned from it.

443
00:28:48,360 --> 00:28:52,170
I think the minute that
anybody in this game

444
00:28:52,980 --> 00:28:56,610
takes the view that they figured it
all out and you should just stop,

445
00:28:57,300 --> 00:28:58,133
you should call it

446
00:29:00,060 --> 00:29:04,230
every time I think I've figured
out one part of this specialty,

447
00:29:04,680 --> 00:29:07,590
there's something that comes
along and I look at it and I say,

448
00:29:07,950 --> 00:29:10,830
how in the world did I not think of this?

449
00:29:11,250 --> 00:29:15,150
Literally as I'm reading and reviewing
manuscripts that are submitted,

450
00:29:15,390 --> 00:29:17,130
there's just so many clever things.

451
00:29:18,150 --> 00:29:21,840
And it's also fun to know that like Larry,

452
00:29:21,900 --> 00:29:25,020
your work has been sourced a
lot. My work has been sourced,

453
00:29:25,620 --> 00:29:29,730
but it has created the backbone of work

454
00:29:30,540 --> 00:29:34,890
that is in the current literature cycle.

455
00:29:34,890 --> 00:29:38,220
So I think it all kind of flows

456
00:29:38,230 --> 00:29:40,140
together.

457
00:29:40,990 --> 00:29:40,990
So Dr. Few,

458
00:29:40,990 --> 00:29:44,650
what are some of the new additions to
the stack since you first came up with

459
00:29:44,650 --> 00:29:46,900
this concept? Can you
give us some examples?

460
00:29:47,680 --> 00:29:49,780
Wow, there's so many. To be quite honest.

461
00:29:49,780 --> 00:29:54,190
I think certainly the second generation of

462
00:29:54,190 --> 00:29:55,690
micro-focused ultrasound,

463
00:29:55,690 --> 00:29:59,800
Sofwave is something newer
that has come to the scene

464
00:30:01,180 --> 00:30:04,540
using the laser platforms, which Larry,

465
00:30:04,540 --> 00:30:09,400
I think I've often asked your
opinion on different lasers

466
00:30:09,400 --> 00:30:13,030
before I brought them in. So you were
in this space at the very beginning.

467
00:30:14,650 --> 00:30:15,610
But nonetheless,

468
00:30:15,610 --> 00:30:20,170
I think certainly some of the newer lasers
really have been game changers for us

469
00:30:20,170 --> 00:30:25,120
in stacking because
they deliver a targeted,

470
00:30:25,690 --> 00:30:27,130
very effective,

471
00:30:28,210 --> 00:30:32,830
but also time effective
treatment that then makes it

472
00:30:32,830 --> 00:30:34,570
easier to stack. Because
at the end of the day,

473
00:30:34,570 --> 00:30:37,960
the old version of stacking
took a long time. I mean,

474
00:30:37,960 --> 00:30:42,790
I'd have somebody in my chair
for a couple of hours because the

475
00:30:42,790 --> 00:30:46,390
modalities were slower.
Now they're much faster,

476
00:30:46,870 --> 00:30:50,020
which means you can do more. And
certainly the integration of threads,

477
00:30:50,020 --> 00:30:54,400
which I helped bring on the scene
about six years now, seven years ago,

478
00:30:54,730 --> 00:30:58,420
that's fairly pervasive as well.
So if we move it all together,

479
00:30:58,810 --> 00:31:03,100
it really is the three prong
approach, which if I simplify it,

480
00:31:03,580 --> 00:31:06,790
it's managing the skin,
managing volume loss,

481
00:31:07,150 --> 00:31:11,890
and then managing sagging
and all in kind of total

482
00:31:12,460 --> 00:31:13,930
as a stackable approach.

483
00:31:14,800 --> 00:31:17,110
Lastly, before we conclude Dr. Bass,

484
00:31:17,110 --> 00:31:19,450
can you share some takeaways
with our listeners today?

485
00:31:20,290 --> 00:31:24,730
So selection of the
right treatment is really

486
00:31:25,180 --> 00:31:29,500
about the right time based on
the severity of aesthetic needs,

487
00:31:29,500 --> 00:31:31,330
what stage of aging you're at,

488
00:31:31,840 --> 00:31:36,640
and that requires a careful clinical

489
00:31:36,650 --> 00:31:41,320
assessment by an experienced
plastic surgeon or dermatologist to

490
00:31:41,770 --> 00:31:46,750
rightsize things because fortunately,

491
00:31:46,750 --> 00:31:51,610
we have all these options that
Dr. Few has been talking about and

492
00:31:51,730 --> 00:31:55,360
talking about, so we're not
forced to do it one size fits all.

493
00:31:56,620 --> 00:32:00,790
Multimodality is the name of the game,

494
00:32:00,790 --> 00:32:05,710
and I think if Dr. Few expressed that
very eloquently during this episode,

495
00:32:06,460 --> 00:32:11,260
if you use a treatment for
what it's good at doing

496
00:32:11,920 --> 00:32:16,870
in combination with another treatment
at a level that it's good at doing,

497
00:32:16,870 --> 00:32:20,620
you get a synergistic effect. You
get a more complete correction.

498
00:32:20,950 --> 00:32:25,300
It's better than taking one
modality and pushing it too hard,

499
00:32:25,690 --> 00:32:27,910
which doesn't really
give you a better result.

500
00:32:27,910 --> 00:32:30,820
It just gives you more
risk of a complication.

501
00:32:32,350 --> 00:32:36,250
And if you listen to everything
we've been talking about,

502
00:32:36,250 --> 00:32:40,280
it's not just about correcting.
Aging changes already exist,

503
00:32:40,640 --> 00:32:45,470
but it's prevention and maintenance
as well to really slow the aging

504
00:32:45,470 --> 00:32:47,720
process going forward.

505
00:32:48,740 --> 00:32:51,770
And Dr. Few, any takeaways you'd
like to share with our listeners?

506
00:32:52,490 --> 00:32:56,240
I can't beat what Larry just
said. It's perfect. Honestly,

507
00:32:56,250 --> 00:33:00,500
I think you summarized it
elegantly. I thank you Doreen,

508
00:33:00,500 --> 00:33:04,760
so much for being a great
host and Larry as well.

509
00:33:04,770 --> 00:33:06,710
And this is very informative.

510
00:33:07,490 --> 00:33:11,270
Thank you so much for joining us today
and sharing your perspective on how to

511
00:33:11,270 --> 00:33:14,180
plan plastic surgery care at
different stages of aging.

512
00:33:14,540 --> 00:33:18,260
And Dr. Few, it's been an
absolute pleasure having you.

513
00:33:18,800 --> 00:33:23,600
You're a very dear, not
old, but very dear friend,

514
00:33:23,960 --> 00:33:28,850
but listening to the intellectual
thought process and getting to

515
00:33:28,860 --> 00:33:33,740
discuss some of these issues that
I know you've spent thousands of

516
00:33:33,740 --> 00:33:37,910
hours thinking about
over decades as I have,

517
00:33:38,630 --> 00:33:42,830
was really very informative for me,

518
00:33:42,830 --> 00:33:45,560
you refined my perspective despite again,

519
00:33:45,620 --> 00:33:48,980
a field where I feel I
understand it reasonably well.

520
00:33:48,980 --> 00:33:50,990
You still added to that understanding.

521
00:33:51,470 --> 00:33:55,940
Well, I'm honored. I'm honored and
as have you, so it's a lot of fun.

522
00:33:55,940 --> 00:33:56,840
I'm honored to be here.

523
00:33:58,640 --> 00:34:02,330
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.

524
00:34:02,720 --> 00:34:04,940
Follow us on Apple
Podcasts, write a review,

525
00:34:05,000 --> 00:34:06,380
and share the show with your friends.

526
00:34:06,740 --> 00:34:09,860
Be sure to join us next time to avoid
missing all the great content that's

527
00:34:09,860 --> 00:34:13,400
coming your way. If you want to
contact us with comments or questions,

528
00:34:13,400 --> 00:34:14,330
we'd love to hear from you,

529
00:34:14,780 --> 00:34:19,040
send us an email at podcast@drbass.net
or DM us on Instagram

530
00:34:19,910 --> 00:34:20,000
@drbassnyc.