The Point Is: Everything in Beauty Treatments Using Needles and Needling

1
00:00:00,510 --> 00:00:04,380
Welcome to another episode of
Park Avenue Plastic Surgery Class,

2
00:00:04,440 --> 00:00:07,980
the podcast where we explore controversies
and breaking issues in plastic

3
00:00:07,981 --> 00:00:10,460
surgery. I'm your co-host Doreen Wu,

4
00:00:10,480 --> 00:00:14,820
and I'm excited to be here with Dr.
Lawrence Bass Park Avenue plastic surgeon,

5
00:00:15,420 --> 00:00:16,820
educator, and technology innovator.

6
00:00:17,480 --> 00:00:21,420
The title of today's
episode is The Point Is:

7
00:00:21,420 --> 00:00:23,900
Everything in Beauty Treatments
Using Needles and Needling.

8
00:00:24,870 --> 00:00:29,060
Dr. Bass, most of us think of plastic
surgery as involving the operating room,

9
00:00:29,140 --> 00:00:31,220
incisions, stitches, and recovery.

10
00:00:31,450 --> 00:00:34,820
What are surgeons doing with needles
that are enough of a big deal to put it

11
00:00:34,821 --> 00:00:35,780
into the mix with surgery?

12
00:00:37,330 --> 00:00:41,900
Well, let's back up for a second
and talk about definitions.

13
00:00:43,060 --> 00:00:48,020
Just so we lay out the playing
field in which needle treatments and

14
00:00:48,021 --> 00:00:50,220
needling treatments are taking place,

15
00:00:52,240 --> 00:00:54,440
there are treatments that are invasive,

16
00:00:54,470 --> 00:00:57,840
like surgery where there
are open incisions,

17
00:00:58,580 --> 00:01:01,920
and as you said, stitches
and recovery time.

18
00:01:02,960 --> 00:01:06,320
There are minimally invasive procedures.

19
00:01:07,760 --> 00:01:12,240
These typically involve
very small incisions,

20
00:01:13,000 --> 00:01:16,800
maybe like a big needle
puncture or like a small

21
00:01:17,270 --> 00:01:20,720
incision of an inch or
something like that.

22
00:01:21,920 --> 00:01:26,880
Like endoscopic surgery and
arthroscopic surgery and

23
00:01:26,881 --> 00:01:31,880
laparoscopic surgery that allows
surgery to be done inside.

24
00:01:31,881 --> 00:01:35,000
Often very substantial surgery

25
00:01:36,550 --> 00:01:39,000
just through very small incisions.

26
00:01:39,580 --> 00:01:44,080
And then there are other minimally
invasive things like liposuction,

27
00:01:44,081 --> 00:01:49,040
which use very small incisions. A lot
of things are happening on the inside,

28
00:01:49,041 --> 00:01:51,760
but the surgical impact is much less.

29
00:01:52,910 --> 00:01:55,560
Then there are microinvasive treatments,

30
00:01:55,561 --> 00:01:59,480
things essentially that are
done with needle punctures.

31
00:02:00,920 --> 00:02:05,080
And sometimes those needle
punctures are big needles,

32
00:02:05,950 --> 00:02:10,080
like even as big as a millimeter or

33
00:02:10,840 --> 00:02:13,520
slightly bigger two millimeters.

34
00:02:14,580 --> 00:02:19,400
And sometimes those are the
tiniest needles that are out

35
00:02:19,401 --> 00:02:24,040
there and everywhere in between.

36
00:02:25,020 --> 00:02:27,360
And then there are noninvasive treatments,

37
00:02:28,390 --> 00:02:31,880
things that don't break
the skin surface at all,

38
00:02:32,980 --> 00:02:35,760
and they're the least invasive category.

39
00:02:36,790 --> 00:02:38,290
Now let's get to the bottom line.

40
00:02:38,400 --> 00:02:42,810
Will these treatments really give me
major results and allow me to avoid the

41
00:02:43,250 --> 00:02:44,810
recovery and downtime of surgery?

42
00:02:45,830 --> 00:02:47,160
That's a great question,

43
00:02:47,540 --> 00:02:51,560
and I already alluded to
the issue of recovery.

44
00:02:51,810 --> 00:02:56,040
So minimally invasive procedures
sometimes still have major

45
00:02:56,560 --> 00:03:01,560
recovery or they might not
have time when you're flat

46
00:03:01,561 --> 00:03:02,960
on your back in bed,

47
00:03:02,980 --> 00:03:06,600
but there's some work and social downtime.

48
00:03:07,290 --> 00:03:10,360
So that's the first thing to talk about.

49
00:03:11,430 --> 00:03:16,280
it's important to understand
very clearly no matter

50
00:03:16,281 --> 00:03:20,040
how minimal the treatment sounds like,

51
00:03:20,590 --> 00:03:23,720
what the recovery is
really going to be like,

52
00:03:24,590 --> 00:03:27,320
even if the treatment
is minimally invasive,

53
00:03:27,850 --> 00:03:31,760
to make sure that fits with your
desires and lifestyle requirements.

54
00:03:33,470 --> 00:03:36,320
Some treatments have
little to no recovery,

55
00:03:36,540 --> 00:03:41,480
but there's always some kind of
risk lurking in the background of

56
00:03:41,481 --> 00:03:42,320
more recovery.

57
00:03:43,010 --> 00:03:47,480
So an example of that
is a Botox injection.

58
00:03:47,570 --> 00:03:50,000
Usually there's no recovery.

59
00:03:50,390 --> 00:03:54,520
It's literally a lunchtime treatment
only takes a few minutes and you can go

60
00:03:54,521 --> 00:03:57,080
right back to work or almost any activity,

61
00:03:58,300 --> 00:04:00,880
but there's always that risk of a bruise.

62
00:04:01,020 --> 00:04:05,440
Any time you break the skin with a
needle, there's some risk of a bruise.

63
00:04:06,980 --> 00:04:09,480
You just have to keep that
in the back of your mind.

64
00:04:09,481 --> 00:04:14,280
If you do the treatment enough
times and things like Botox are

65
00:04:14,281 --> 00:04:15,560
recurrent treatments,

66
00:04:16,310 --> 00:04:20,640
sooner or later you're going to get
unlucky and have a bruise and a little

67
00:04:20,641 --> 00:04:22,480
disruption in your social schedule.

68
00:04:23,760 --> 00:04:28,240
There are ways to minimize that. You
know, if you avoid aspirin, alcohol,

69
00:04:28,420 --> 00:04:33,040
non-steroidal, anti-inflammatory
medicines like ibuprofen, Naprosyn

70
00:04:35,600 --> 00:04:39,720
that minimizes the risk and

71
00:04:41,180 --> 00:04:44,720
how you behave afterwards.
Everyone has different rules,

72
00:04:44,721 --> 00:04:47,680
but I ask people to avoid
sports spending, lifting,

73
00:04:47,880 --> 00:04:52,360
consuming any alcohol for a
few hours afterwards, again,

74
00:04:52,361 --> 00:04:54,640
to help minimize the risk of bruising.

75
00:04:55,210 --> 00:04:58,660
What about the results? Are they
comparable to the surgical results?

76
00:04:59,620 --> 00:05:02,740
In terms of results,

77
00:05:02,740 --> 00:05:07,100
and that's really the bottom line
in in all treatments, you know,

78
00:05:08,830 --> 00:05:12,750
we're undertaking it to look better
in a way that's obvious and visible.

79
00:05:14,430 --> 00:05:19,150
There's an awful lot of variation
in this very large playing field of

80
00:05:19,670 --> 00:05:21,390
treatments, and

81
00:05:22,910 --> 00:05:26,590
particularly on the energy based side
of it. There's not a lot of data.

82
00:05:29,430 --> 00:05:33,910
So most of the treatments with needles
are either recurrent treatments or

83
00:05:34,270 --> 00:05:35,510
treatments that are done in a series,

84
00:05:36,270 --> 00:05:41,030
so three or five treatments or
sometimes more or required to

85
00:05:41,470 --> 00:05:44,830
get a meaningful result. And as I said,

86
00:05:45,110 --> 00:05:47,310
there's not a lot of
outcome data about that.

87
00:05:47,790 --> 00:05:52,630
So it's really critical to
understand what the goal of

88
00:05:52,830 --> 00:05:53,663
the treatment is.

89
00:05:54,150 --> 00:05:58,960
And a lot of treatments that work in
a very similar way and look almost

90
00:05:59,960 --> 00:06:04,520
almost identical can be more
focused on either skin laxity

91
00:06:05,440 --> 00:06:09,280
or skin smoothing or skin surface changes.

92
00:06:11,200 --> 00:06:15,380
And so if that matches up
with what your goal is,

93
00:06:15,820 --> 00:06:17,180
that's a good fit for you.

94
00:06:18,020 --> 00:06:22,740
But just because it's a hot device or
it's supposed to make the skin better,

95
00:06:23,100 --> 00:06:24,980
if it's not matched up with your goal,

96
00:06:25,940 --> 00:06:29,260
then it may not be the right
choice for your individual needs.

97
00:06:29,980 --> 00:06:32,940
Now some of the technologies
have parameter flexibility.

98
00:06:33,340 --> 00:06:37,980
They can expose at different
depths in the skin so they can hit

99
00:06:38,500 --> 00:06:43,100
more than one clinical
application area within the skin.

100
00:06:44,580 --> 00:06:47,220
But not all of the devices
have that capability.

101
00:06:47,740 --> 00:06:51,860
So it's important to know the
details or be working with a

102
00:06:52,820 --> 00:06:57,740
plastic surgeon who's very knowledgeable
and experienced with these kinds of

103
00:06:58,340 --> 00:06:59,173
devices.

104
00:06:59,330 --> 00:07:01,660
Okay, so now that we have an overview,

105
00:07:01,900 --> 00:07:04,860
let's talk about the various
needle puncture procedures.

106
00:07:05,010 --> 00:07:07,340
What are the main categories
of needle treatments?

107
00:07:07,960 --> 00:07:11,450
Well, the first thing is
injectable treatments.

108
00:07:12,140 --> 00:07:16,330
So a treatment where you're
trying to inject something

109
00:07:16,650 --> 00:07:21,130
under the skin or into
the skin using a needle

110
00:07:21,470 --> 00:07:25,010
and filler treatments like Restylane,

111
00:07:25,280 --> 00:07:30,010
Juvederm and the others are examples
of this where you are injecting

112
00:07:30,120 --> 00:07:34,570
a essentially mechanical filler or shape

113
00:07:34,571 --> 00:07:36,010
changer

114
00:07:37,790 --> 00:07:42,350
Botox treatments where you're injecting
a medication that has a specific

115
00:07:42,351 --> 00:07:46,950
pharmacologic effect of blocking
the nerve signal and relaxing

116
00:07:47,120 --> 00:07:51,830
muscles that therefore
relaxes wrinkles or creates

117
00:07:51,831 --> 00:07:53,310
another change in the skin.

118
00:07:54,870 --> 00:07:57,270
There are needling treatments.

119
00:07:57,271 --> 00:08:02,270
So these are treatments that
use many tiny sterile needles to

120
00:08:02,271 --> 00:08:07,190
create tiny punctures in the
skin to a predetermined or

121
00:08:07,191 --> 00:08:11,910
to a variable depth depending
on the capabilities of the

122
00:08:11,911 --> 00:08:12,744
technology.

123
00:08:15,110 --> 00:08:19,270
Creating a lot of punctures
in the skin is little

124
00:08:20,170 --> 00:08:25,150
microtrauma that the body recognizes
and responds to biologically.

125
00:08:25,880 --> 00:08:30,510
So it creates biostimulatory
effects such as neogenesis,

126
00:08:30,511 --> 00:08:35,030
the formation of new collagen in
the skin and neovascularization.

127
00:08:36,290 --> 00:08:38,590
And when you create the little punctures,

128
00:08:38,591 --> 00:08:43,270
you also release small amounts
of blood into the skin.

129
00:08:43,890 --> 00:08:48,710
And that may be one of the ways
that the biostimulatory effect

130
00:08:48,711 --> 00:08:48,950
takes place,

131
00:08:48,950 --> 00:08:53,790
because a number of elements in
the blood do have biostimulatory

132
00:08:53,791 --> 00:08:55,680
effects in and of themselves.

133
00:08:59,000 --> 00:09:03,690
Needling treatments in which a
material is injected are also used

134
00:09:03,691 --> 00:09:08,370
using multiple small
needles to make many tiny

135
00:09:08,371 --> 00:09:12,770
punctures, but also introduce a little
bit of medicine into the skin. And in,

136
00:09:12,771 --> 00:09:17,610
in the United States print
principally that's platelet

137
00:09:17,611 --> 00:09:20,210
rich plasma or PrP,

138
00:09:20,770 --> 00:09:25,570
which is harvested by drawing
a large tube or sometimes two

139
00:09:25,571 --> 00:09:28,170
tubes of blood from, from the patient.

140
00:09:28,630 --> 00:09:33,570
And then preparing the fraction within
the blood that's platelet rich by

141
00:09:33,571 --> 00:09:38,410
spinning the blood in a centrifuge
the material can then be

142
00:09:38,411 --> 00:09:42,250
re-injected into the skin using
the microneedling devices.

143
00:09:43,900 --> 00:09:47,770
Finally there's energy
based microneedling,

144
00:09:48,970 --> 00:09:53,650
basically using radio frequency
energy to expose the superficial

145
00:09:54,130 --> 00:09:58,490
or the deep layers of the skin
or even just beneath the skin

146
00:09:59,930 --> 00:10:04,930
with little bits of energy to create a
controlled injury that during healing

147
00:10:06,130 --> 00:10:11,090
amplifies the neocollagenesis
and other effects. And as we age,

148
00:10:11,530 --> 00:10:14,010
you know, the amount of
collagen in our skin diminishes,

149
00:10:14,890 --> 00:10:19,690
the organization diminishes our skin
thins and the blood supply to the

150
00:10:20,010 --> 00:10:23,610
skin diminishes. So creating new collagen,

151
00:10:25,250 --> 00:10:30,090
restoring or creating new
micro circulation to the
skin are important to keep

152
00:10:30,330 --> 00:10:33,010
the skin looking and
behaving like younger skin.

153
00:10:34,890 --> 00:10:37,770
And depending on what
application you're looking

154
00:10:41,610 --> 00:10:44,970
at, this energy based microneedling
can have the principal effect,

155
00:10:45,250 --> 00:10:50,050
as I mentioned earlier, of
skin surface correction,

156
00:10:51,250 --> 00:10:55,410
skin quality issues that are seen
on the surface of the skin or

157
00:10:56,450 --> 00:11:00,890
scar and wrinkle reduction
or even laxity reduction.

158
00:11:01,560 --> 00:11:05,560
Which brings me to the age old
question of which device is best.

159
00:11:05,790 --> 00:11:09,160
What are some factors that we should
consider when making this decision?

160
00:11:10,390 --> 00:11:13,870
There are so many devices right now and

161
00:11:15,760 --> 00:11:17,410
many of them are excellent.

162
00:11:17,720 --> 00:11:22,570
It's best to understand
what feature specifically

163
00:11:22,571 --> 00:11:24,050
is going to be addressed,

164
00:11:25,070 --> 00:11:29,930
how many treatments that's going to
require to see a meaningful result and

165
00:11:29,931 --> 00:11:34,690
how much downtime is involved.

166
00:11:34,690 --> 00:11:38,850
I also think it's important to
understand how much discomfort the

167
00:11:39,050 --> 00:11:43,410
treatment itself is likely to have and
in the first few hours of recovery,

168
00:11:43,411 --> 00:11:47,330
because there's a lot of
variation device to device,

169
00:11:47,440 --> 00:11:51,890
some of the devices are minimally

170
00:11:51,910 --> 00:11:53,800
uncomfortable and others,

171
00:11:53,801 --> 00:11:58,320
the area really needs to be
completely injected with local

172
00:11:58,321 --> 00:12:02,920
anesthesia to be numb in order
for the treatment to be tolerable.

173
00:12:03,730 --> 00:12:08,360
So that's a broad range
and you want to know where

174
00:12:09,000 --> 00:12:12,040
in that range you're
signing up for in a given

175
00:12:12,041 --> 00:12:15,760
treatment. Energy based microneedling,

176
00:12:15,761 --> 00:12:20,640
I think the biggest role is
in skin quality more than

177
00:12:20,750 --> 00:12:24,720
laxity reduction or wrinkle reduction.

178
00:12:25,760 --> 00:12:30,600
But there's a role in all of
those things for these devices

179
00:12:30,601 --> 00:12:35,440
particularly for certain
individuals who have

180
00:12:35,630 --> 00:12:39,440
a degree of a feature
but not a severe degree.

181
00:12:40,560 --> 00:12:43,040
Let's just circle back to
injectables for a moment.

182
00:12:43,370 --> 00:12:46,480
We talked about this extensively
in previous episodes,

183
00:12:46,481 --> 00:12:50,480
but can you remind us what are the
goals of injectables and who is it for?

184
00:12:51,730 --> 00:12:56,720
So injectables play a major
role at most stages of aging

185
00:12:57,100 --> 00:13:02,040
and the principle role in
the first few decades of

186
00:13:02,041 --> 00:13:06,760
facial aging facial volume and

187
00:13:06,761 --> 00:13:11,200
smoothing of dynamic wrinkles mild shape

188
00:13:11,201 --> 00:13:15,760
enhancements to maximize
facial harmony and allure

189
00:13:16,890 --> 00:13:21,880
is really the principle focus
of these sorts of treatments.

190
00:13:23,150 --> 00:13:25,240
Lastly, before we conclude Dr. Bass,

191
00:13:25,460 --> 00:13:28,000
can you share some important
takeaways for our listeners?

192
00:13:29,100 --> 00:13:33,830
It's important to understand the
level of invasiveness where we started

193
00:13:34,030 --> 00:13:36,670
out in this episode, and more important,

194
00:13:36,850 --> 00:13:41,590
the recovery time and social
downtime of any treatment.

195
00:13:42,880 --> 00:13:47,710
So have that clearly in mind to make
sure it's going to fit with your

196
00:13:47,711 --> 00:13:52,710
lifestyle and you don't
get caught out with of some

197
00:13:52,711 --> 00:13:56,710
disruptive downtime that
you weren't expecting.

198
00:13:58,270 --> 00:13:59,630
Many treatments are recurrent,

199
00:14:01,550 --> 00:14:06,190
so important to understand what's
going to be needed to maintain a

200
00:14:06,590 --> 00:14:08,190
result, how often it's typically

201
00:14:10,390 --> 00:14:15,230
performed so you can assess what
you're getting into and how to get

202
00:14:15,430 --> 00:14:18,150
the most out of the treatment.

203
00:14:18,150 --> 00:14:23,070
The nice thing about recurrent treatments
are they're easy to try and see if you

204
00:14:23,270 --> 00:14:23,710
like them.

205
00:14:23,710 --> 00:14:27,070
And if you think they're great and
have a big impact on your appearance,

206
00:14:27,310 --> 00:14:28,143
you keep doing them.

207
00:14:28,790 --> 00:14:31,670
And if you don't think they contribute
a lot at this stage of the game,

208
00:14:31,950 --> 00:14:35,750
you just stop doing
them and leave it aside.

209
00:14:37,670 --> 00:14:39,510
Other treatments are part of a series,

210
00:14:41,110 --> 00:14:46,110
so there you need to understand
the number and frequency of

211
00:14:46,630 --> 00:14:47,463
treatments

212
00:14:48,250 --> 00:14:52,720
that are typically needed
to get worthwhile results
or that your plastic surgeon

213
00:14:53,520 --> 00:14:58,200
tells you are probably going to be
required for you as an individual

214
00:14:58,800 --> 00:15:01,080
given your current stage of aging.

215
00:15:03,680 --> 00:15:04,513
As I said earlier,

216
00:15:05,080 --> 00:15:09,760
make sure the capabilities
of the treatment match your
aesthetic issue and goals

217
00:15:10,680 --> 00:15:15,680
and that the treatment is being used
for what it's intended for. You know,

218
00:15:16,000 --> 00:15:20,600
most treatments can give something
really useful and really satisfying if

219
00:15:20,920 --> 00:15:24,800
they're being used for a problem
that they're designed to solve.

220
00:15:25,560 --> 00:15:29,120
And if you're trying to use them in a
backhanded way to solve another problem,

221
00:15:30,440 --> 00:15:35,360
typically the results are not very
satisfying and potentially the

222
00:15:35,720 --> 00:15:40,550
risks are greater. Finally,

223
00:15:41,030 --> 00:15:45,350
make sure you're at the right stage of
aging to really get benefit from the

224
00:15:45,710 --> 00:15:46,543
treatment selected.

225
00:15:47,310 --> 00:15:51,950
It's very appealing to do a
non-invasive or a minimally invasive or

226
00:15:53,070 --> 00:15:53,903
microinvasive treatment,

227
00:15:53,910 --> 00:15:56,870
which is what most of the needle
treatments are microinvasive.

228
00:15:58,430 --> 00:15:59,630
But at some stages

229
00:16:02,350 --> 00:16:06,950
your skin is not really
likely to respond in a

230
00:16:07,830 --> 00:16:12,430
substantial way or the
degree of correction required
is not likely to be that

231
00:16:12,670 --> 00:16:16,350
which a microinvasive treatment and
needling treatment can give you.

232
00:16:17,350 --> 00:16:20,710
Other times it's just a
question of amount. You know,

233
00:16:20,711 --> 00:16:24,110
if you're 35 years old, you may
need a little bit of filler.

234
00:16:24,120 --> 00:16:25,990
If you're 65 years old,

235
00:16:25,991 --> 00:16:30,150
you're going to need more than
a little bit to look your best.

236
00:16:30,151 --> 00:16:32,150
If you're 85, it's going to be more.

237
00:16:33,440 --> 00:16:37,040
Thank you Dr. Bass for sharing
your insight and expertise with us.

238
00:16:37,041 --> 00:16:40,560
And thank you to all of our listeners
for joining us today to hear about the

239
00:16:40,561 --> 00:16:43,600
ever expanding role of needling
treatments in aesthetic care.

240
00:16:43,870 --> 00:16:47,040
I hope you found this episode as
intriguing and informative as I did.

241
00:16:47,370 --> 00:16:50,800
If you think of other exciting
developments or trends
in plastic surgery that

242
00:16:50,801 --> 00:16:52,880
you would like us to discuss
in an upcoming episode,

243
00:16:52,881 --> 00:16:56,720
please reach out by email or
Instagram. We'll see you next time.

244
00:16:57,840 --> 00:17:01,850
This is Doreen Wu thanking you for joining
Dr. Bass and me for this discussion

245
00:17:01,851 --> 00:17:05,610
of how needles play an important role in
beauty treatments and plastic surgery.

246
00:17:06,140 --> 00:17:09,850
Be sure to tune in next time and don't
forget to subscribe to our podcast to

247
00:17:09,851 --> 00:17:12,570
stay up to date with all of the exciting
content that is coming your way.

248
00:17:13,850 --> 00:17:18,170
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

249
00:17:18,171 --> 00:17:22,810
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,

250
00:17:23,610 --> 00:17:25,530
educator and technology innovator.

251
00:17:25,630 --> 00:17:28,290
The commentary in this
podcast represents opinion.

252
00:17:28,291 --> 00:17:30,810
This podcast does not
present medical advice,

253
00:17:31,030 --> 00:17:35,130
but rather general information about
plastic surgery that does not necessarily

254
00:17:35,131 --> 00:17:38,450
relate to the specific conditions
of any individual patient.

255
00:17:38,740 --> 00:17:43,610
No doctor patient relationship
is established by listening
to or participating

256
00:17:43,620 --> 00:17:44,453
in this podcast.

257
00:17:44,660 --> 00:17:48,770
Consult your physician to advise you
about your individual healthcare.

258
00:17:48,780 --> 00:17:50,560
If you enjoyed this episode,

259
00:17:50,561 --> 00:17:54,880
please share it with your friends and
be sure to subscribe to our podcast on

260
00:17:54,881 --> 00:17:58,760
Apple Podcasts, Google, Spotify, Stitcher,

261
00:17:58,970 --> 00:18:01,320
or wherever you listen to podcasts.