Podcast Host (likely Amitai Eshel or Co-host) (2:41)

We all have.

Joel Marshall (2:42)

Yeah, that's true. That's true.

Podcast Host (likely Amitai Eshel or Co-host) (2:46)

Maybe, Joel, we should start by talking about kind of what exactly is microneedling and how. How does it work?

Joel Marshall (2:54)

Okay.

Podcast Host (likely Amitai Eshel or Co-host) (2:54)

On. On a. On a cellular level, how does it work in the skin?

Joel Marshall (2:59)

Well, I mean, first of all, I guess we got to describe the actual technology a little bit. Right. Because, I mean, microneedling has been around for a long time. I mean, from anything from using needles for acupuncture and other, you know, other ideas. The concept of microneedling as it is today, maybe even.

Podcast Host (likely Amitai Eshel or Co-host) (3:17)

Maybe even bloodletting in the middle ages.

Joel Marshall (3:22)

With really big needles. The modern day version of microneedling actually was started in the 90s. And there was Professor Kamaran, I think it was. He was actually working on repigmenting hyperpigmented areas or where there's scars and things like that. So he was using like a tattoo needle and just trying to repigment the hypopigmented scarred area to blend it back in. And then over time, he actually saw great changes in the collagen structure and the actual look of the scar and everything. So then that got them thinking, well, you know, needling seems to work to produce new collagen. So then they started with, like, little stamps so that have this little stamp and you'd stamp the needles into the skin. And obviously with more holes, they got improved results.

Podcast Host (likely Amitai Eshel or Co-host) (4:21)

Yeah.

Joel Marshall (4:21)

Eventually they moved on to rollers. So you get this drum with all these needles sticking out of it and roll it across the skin, making more holes again. And then in 2009, we looked at what was available in the technologies and saw the, I guess the tattoo guns or the particularly for permanent makeup, where they clumped together needles and thought, hey, if we move those to separated needles and have like a plate of needles that are vibrating in and out very fast, we're going to create a lot more holes than a roller possibly can. You can then have other technologies where you can actually change the depth of the needles to get different. To create different results. So we've developed the first micro needling pen, which is the dermapen.

Podcast Host (likely Amitai Eshel or Co-host) (5:07)

Yeah. And it's crazy as far as, like, how many different. Like, you know, the competition you have right now is even as far as, you know, look alike products. Definitely using the same verbiage, Right? Definitely using the same. Which is. Which is crazy.

Joel Marshall (5:25)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (5:26)

Before that, I think, like, before we get into, you know, the actual device and, and how it works. Really?

Joel Marshall (5:32)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (5:33)

I think it's important to explain why collagen is, like, so important in. In skin health and. And anti aging for sure. Because at the end of the day, what we're doing is we're, we're. We're introducing injury, which, which collagen is in. Is in collagen production is increased there.

Joel Marshall (5:49)

Right, exactly. So, I mean, it's I mean, collagen is the building block of a skin. So without collagen, everything just goes flat and droopy and not very nice.

Podcast Host (likely Amitai Eshel or Co-host) (6:00)

Yeah.

Joel Marshall (6:00)

So the whole process of what micro needling does is just think of. And just take it away from micro needling for a second. You damage the skin, right? You cut yourself, you. You do any. Create any sort of damage to the skin. The first reaction your skin does is to send in macrophages and take away the dead, like take away all the dead cells. And then from there, once you've taken away the dead cells, it's going to start this immune response and wound healing response where you start to then create new cells and you create new collagen. Right. So, so basically that is the wound process is you get the wound and then your body does this natural. Has this natural event where it starts building up its own collagen. So if that's what happens every time you cut yourself, whether it's a large cut or it's a pin prick, you're getting that same response. So the whole thought about microneedling is if I can increase the amount of pinpricks I'm making, I'm going to get that initial response times how many pin pricks you're making. So. But we're not creating any linear scarring or we're not creating a linear line which will leave scar, creating these tiny little controlled pin pricks which will heal completely.

Podcast Host (likely Amitai Eshel or Co-host) (7:17)

Yeah.

Joel Marshall (7:18)

And you just times that by like a million holes and you get this amazing increase in collagen. And. Yeah, and you can break up scar tissue because you're breaking up that, that, that tissue that's already left there and that culture and that's been, you know, not laid down properly. So you break that up and then you can create new, fresh skin.

Podcast Host (likely Amitai Eshel or Co-host) (7:40)

Yeah. It's interesting because at the end of the day, you are like communicating the language of repair or of injury, but you are introducing that injury in the way that the skin has the easiest time to recover from it. That's kind of the principle of not creating a continuous injury, Right?

Joel Marshall (7:59)

Correct. Correct. Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (8:01)

Very cool. How would you contrast it to. Because you are, I mean, when we meet is normally at conferences where we see, you know, last time we met, you had literally in front of your booth, more or less the big site on, I believe, like booth, where they have like Halo and other. Other lasers. Right. Or, you know, we had chemical peels there, for example. So how would you compare microneedling to other skin stimulants, other skin rejuvenation procedures like lasers or chemical peels and things like that.

Joel Marshall (8:40)

I mean there's, there's so many different platforms or ideas for different treatments and I believe each of them have their place. So if you're looking at a chemical peel, you're really stripping back the whole top layer. Yeah. And obviously it depends on the chemical peel as well. If you look at lasers, they definitely have their place because usually a laser, it's particularly a laser, it is designed to have one wavelength or a couple of wavelengths. And those different wavelengths will create different effects in the skin or in the body. So if you have a wavelength designed to attract to blood, for instance, then that's going to heat up the blood and it's great for treating say capillaries, broken capillaries. If you have a laser that's designed to heat up melanin, there's, if you do a superficial approach, you can, you can get rid of sunspots. If you have a slightly deeper approach to that melanin, like that attraction to melanin, you can get hair removal. Then you can heat up the hair follicle and destroy the structure at the bottom.

Podcast Host (likely Amitai Eshel or Co-host) (9:43)

Yeah.

Joel Marshall (9:44)

Of course when we're looking at more what we're doing, the comparisons would be more of your ablative and non ablative lasers. So when you get to that level, you are now attracted to water and you're either denaturing the tissue in little pockets or you actually ablating the tissue in little pockets, depending on, on that than the length. So it's great, they work. The issue that we see is once you start using heat is you also can create other complications.

Podcast Host (likely Amitai Eshel or Co-host) (10:14)

Yeah.

Joel Marshall (10:14)

And so if you've got darker skin types becomes more difficult. If it's the summertime, it becomes more difficult. If you're, you know, it just, it's. If you're trying to treat something like melasma or something like that, then there's a chance you can make more melasma with the heat. So that when I contrast that with microneedling, then we're not creating heat. Right. So we don't have all of those risks. Have a risk with different skin types because of the way that the pan performs. I can make probably 10 to 100 times as many holes as a laser can.

Podcast Host (likely Amitai Eshel or Co-host) (10:56)

Yeah.

Joel Marshall (10:56)

So I can break up scar tissue at a much greater level without creating the, the downsides of the issues that you, that you may or complications that you'll have with some of those performance. And then that also means that the downtime post treatment is much less.

Podcast Host (likely Amitai Eshel or Co-host) (11:13)

Yeah.

Joel Marshall (11:13)

You know And I think, yeah, I.

Podcast Host (likely Amitai Eshel or Co-host) (11:15)

I love what you explained. And I think, you know, a lot of the times we explain that, you know, light and temperature, which here when we talk about the laser, we actually talk about both are kind of master communicators in the body. The body is going to use mainly temperature. It's going to get cues from light. Right. But it's going to use temperature to affect many, many systems at once. And within that approach, even if you're trying to introduce temperature and light for that matter, very selectively, it has the ability to kind of connect to a few mechanisms at once that go into the skin. And actually unfortunately it has the ability to connect to itself. And that connects to what you said about the amount of entry points that you can have. You can't have the entry points too close to each other because they will connect like electricity, if you would, or something like that. And I think microneedling going from a holistic type for functional approach is a more fundamentally correct way to introduce injury. Injury to the skin, specifically. Yeah, I think it's a more, it's, it's. The skin is designed to communicate injury through entry of a foreign object, top down, if you would.

Joel Marshall (12:34)

Yeah, well. And it's really the most natural approach when we look at the industry as a whole. I think for a long time it was getting out of hand, you know, like with like people getting bigger lips, bigger, bigger everything. And it's just the focus now really across the board of the industry is to have a more natural look, a more natural approach and just to look younger and healthier. So there is nothing out of all the treatments out there. There's really nothing more natural than creating that micro damage that, that the body and the skin is healing itself.

Podcast Host (likely Amitai Eshel or Co-host) (13:11)

I couldn't agree more.

Joel Marshall (13:12)

So I mean the body wasn't designed to fix itself over with heat based treatment. Right. And of course then we go into another whole discussion about rf.

Podcast Host (likely Amitai Eshel or Co-host) (13:22)

Well, you know, that is a big discussion because the, I think the biggest disservice long term, long term, if I, if I talk to, if I have this conversation maybe like 10 years in the future, I think the biggest disservice microneedling is going to have, professional microneedling is going to have, is radio frequency microneedling. Because as I've said many times, I think that's, that's something no one should do. You said things have their place and I agree with you. I think radio frequency microneedling and high frequency ultrasound, both of them actually communicate in a way that the skin cannot understand. And the fascia cannot understand. And it creates only scarring. Basically, it is the most linear type of damage you could introduce to the skin.

Joel Marshall (14:10)

And a lot of people that won't like this conversation. But yeah, I agree.

Podcast Host (likely Amitai Eshel or Co-host) (14:14)

And unfortunately, a lot of them are Israeli. I know a lot of the companies are Israeli. So for a long time I wasn't speaking about it. But unfortunately that's the truth. And we have shout out to amazing doctors that we have and listen to this podcast that are doing radio frequency microneedling. And it pains me to say that, but this is the truth. I don't think anyone, anyone should do that.

Joel Marshall (14:37)

Yeah. The way I look, I try to take a scientific approach to it. So when you use heat, you will get some of that collagen contraction. Right. So it does look like it's getting results. It does. So first of all, I don't like to call it radio frequency microneedling because it's not really microneedling.

Podcast Host (likely Amitai Eshel or Co-host) (14:54)

Exactly. It's introduced via needles.

Joel Marshall (14:57)

Exactly, exactly. It's not true microneedling. All it is is using needles to bypass the epidermis to deliver the heat. It's a radio frequency machine. It's not a microneedling machine. Yeah, number one. But looking at the science, what we just talked about a minute ago, when we talked about selective using light to selectively be absorbed in different chromophores, you had melanin, blood, water. Right? What does RF do? Yeah, it's on the same part of the electromagnetic scale as microwaves. So when you think about microwaving your food, how does it, how does it heat up? It literally vibrates every cell together. When they vibrate together, they heat up. That's what you're doing in the skin. There's no selectivity, there's no nothing. It's literally heating up every cell to create that heat. Therefore, I do agree with you 100% that the resulting collagen that it leaves is not great and it's not good for. Which is, which is why also plastic surgeons don't like to, to do plastic surgery after someone's had radio.

Podcast Host (likely Amitai Eshel or Co-host) (16:02)

Yes. This is. No one talks about it. And again, we've known each other for, I would say, let's say just eight years, you know, probably more. But I mean, looking back at like 2016, Becker Gordon Conference, I don't know when was the first time I was in Becker Gordon Conference, but I remember plastic surgeons talking about how much they hate opening up someone's face and just encountering what is basically a multiple, a Skin that has been subjected to multiple series of wave based rejuvenation devices. Whether it is radio frequency, again, high frequency ultrasound, like all therapy or anything like that. How. How they said, you know, it's basically cosmetic smoking. Right. Like for. For the. For as far as a patient.

Joel Marshall (16:51)

I like that.

Podcast Host (likely Amitai Eshel or Co-host) (16:52)

And a friend of mine, Dr. Cameron Chestnut, equates it to. Instead of like opening a book and then being able to live through the pages, it's like opening a book and the book was subjective. Someone poured water on the book. So all the pages are clumped up and they're very brittle, basically.

Joel Marshall (17:09)

Interesting. That's a very cool analogy. I like it.

Podcast Host (likely Amitai Eshel or Co-host) (17:13)

Yeah, he's a good surgeon. And it's funny because again, it's like not microneedling. And we've done, I think, the most viral clips of this podcast for sure. Or of me being on different podcasts is my approach, my kind of me poo pooing. Microneedling. Sorry, radio frequency microneedling. And then in the comments, the number one question is, so is microneedling. Okay, so it's, it's. We should stop calling it my radio frequency microneedling.

Joel Marshall (17:44)

It's just, it's just, it's just radio frequency.

Podcast Host (likely Amitai Eshel or Co-host) (17:47)

Yes.

Joel Marshall (17:48)

Really what it is, you might want to just add in like radio frequency mn or something just to give you. Or radio frequency needling. I don't know.

Podcast Host (likely Amitai Eshel or Co-host) (17:56)

But radio frequency stamping.

Joel Marshall (17:58)

There we go. Radio frequency stamping.

Podcast Host (likely Amitai Eshel or Co-host) (18:00)

Yeah.

Joel Marshall (18:01)

But yeah, because it's just, it's confused the market for me a lot.

Podcast Host (likely Amitai Eshel or Co-host) (18:05)

Yeah, I bet.

Joel Marshall (18:06)

Well, people go like, oh, I've got a micro needling device. Okay, what, what have you got? And they're like, oh, we got a scarlet. I'm like, okay, that's a completely different system. Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (18:16)

I've got Morpheus 8.

Joel Marshall (18:17)

Yeah.

Amitai Eshel (18:21)

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Podcast Host (likely Amitai Eshel or Co-host) (19:49)

Yeah, so, so do people try and ask you, hey, do you have one with radio frequency also?

Joel Marshall (19:54)

Yeah, yeah.

Podcast Host (likely Amitai Eshel or Co-host) (19:55)

That's hilarious.

Joel Marshall (19:56)

Yeah, of course I said and of course you're not going to be spending a hundred, two hundred thousand dollars on a, on a proper micro needling device. So yeah, the, the affordability of micro needling, true micro needling is much, much better.

Podcast Host (likely Amitai Eshel or Co-host) (20:10)

Yeah. And also to the patient at the end of the day. And look, that's another thing I've seen in the industry, especially for, in the derm industry. It's the derm. And actually if you look at some, some companies like Fotona, which really, you know, there are two major markets are like derm and dental. I think in both derm and dental we, I see a common thread which is like cosmetic dentistry, dentistry which is I'm buying a device for a lot of money and I need to justify it. I'm running through my existing clientele or existing patient population if you would, which they would only go. So I can only sell them so many treatments. Right. And then I've run out of the device ability to kind of justify itself. And a lot of the times these devices are not returning the investment. A lot, a lot of the times we see companies like, which, you know, like M Sculpt Mphase for example, which is, which is a radio frequency saying hey, we're going to pitch in marketing wise, we're going to give you a 30,000 marketing budget because they understand that that's the only way that the device is going to repay itself. But at the end of the day it creates a pressure on the doctor to profess to set to sell the results of an equipment. The promise of a 3, 4, 5, $6,000 worth of results when the only, the only indoctrination they've gotten is from the device company. So they're parroting the device company's alleged results and the patient gets it as a, as a foregone conclusion that this is, these are the results that they're going to have. And at the end a lot of people obviously are disappointed by the results.

Joel Marshall (21:57)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (21:58)

But the, as we said, the show must go on.

Joel Marshall (22:01)

So I mean the, the basic idea of what you're saying is instead of trying to promote an actual treatment that's going to be super beneficial for the client, they got to pay for their machine.

Podcast Host (likely Amitai Eshel or Co-host) (22:12)

Yeah.

Joel Marshall (22:12)

That's what they're going to push. Right. Whether it's, whether it's good, bad or not the best, maybe there's a better option. But they push that because they need to get their return on investment and that's. That at the end of the day is not great for the industry as a whole because you. Because it's not great for the customer.

Podcast Host (likely Amitai Eshel or Co-host) (22:31)

Yeah.

Joel Marshall (22:32)

This whole idea and it's like our mission and our vision as a company, our mission is to create skin health for everyone. And so if it's just about how can I sell this particular treatment to get the money back, then then it's no longer about skin health, it's about hitting that bottom dollar 100%.

Podcast Host (likely Amitai Eshel or Co-host) (22:57)

I agree with you. There is a lot to be said about that. But I do want to connect to what you said about skin health and I do want to talk about a little bit because you have so much experience and so much mileage in this field. I'm wondering from your experience what ingredients. Let's talk about enhancing results a little bit or product and pairing things like that.

Amitai Eshel (23:19)

What.

Podcast Host (likely Amitai Eshel or Co-host) (23:19)

What ingredients pair best with microneedling, whether it is in office or as a post treatment care. What have you seen that work really well?

Joel Marshall (23:30)

I think it's gonna be dependent on the indication you're trying to look at. So I have to be careful with what I say here. Because microneedling in the U.S. it's FDA cleared for only certain indications. Outside of the U.S. there's. We can see so many results for so many different indications. Right. And can talk about it.

Podcast Host (likely Amitai Eshel or Co-host) (23:52)

Yeah. So let's assume we're talking about a global, global capability.

Joel Marshall (23:56)

So these statements have not been evaluated by the FDA is what I'd have to say. Right.

Podcast Host (likely Amitai Eshel or Co-host) (24:02)

Great.

Joel Marshall (24:03)

Yeah. So.

Podcast Host (likely Amitai Eshel or Co-host) (24:04)

And this is not medical advice.

Joel Marshall (24:05)

This is not medical advice. So if you're looking at pigmentation, for instance, and you look at some of the lasers that have been, you know, use for like for getting rid of melasma or helping melasma. That's fractional lasers. Right. So they're not. Those actual devices aren't being, they're not being absorbed by the melanin. It's actually just trying to break it up with lots of holes. Yes, right. Because it's. Because some of that melanin's deeper down. So you don't have that. That superficial like a solar lentigine or something that you're trying to treat. So you really have to do lots of holes to break up that. Melanie, that pigment to get rid of it. So if you think about what microneedling can do, it's going to do a lot more holes, like 10 times the amount of holes. So you're going to break up that pigmentation to a greater level and then you've got. Then you don't have the heat to make it worse. But now if you compare that with ingredients that act as tyrosinase inhibitor, so stopping the production of melanin, then you're going to have an even greater effect. So we worldwide things like hydroquinone are pretty well banned.

Podcast Host (likely Amitai Eshel or Co-host) (25:12)

Yeah.

Joel Marshall (25:13)

As a company, as a worldwide company, we don't use it. We use high levels of kojic acid, licorice root and other tyrosinase inhibitors. More natural to. To get a better effect with I.

Podcast Host (likely Amitai Eshel or Co-host) (25:27)

Guess vitamin C in a. Vitamin C. Yeah, definitely.

Joel Marshall (25:30)

Yeah, we do use vitamin C too. Yeah, Vitamin C is great.

Podcast Host (likely Amitai Eshel or Co-host) (25:34)

I'll give you an anecdote, a product that's not out yet. We've followed there's a new study from 2024 on increasing fibroblast activity through NAD boosting and many companies. So now it's a hot topic. Boosting nad. I'm sure you've seen it. I mean again, I've been talking about this for a long time, but now it's going to be coming popular and one of the things that compares like really well with just adding NAD into the skin is a licorice root. Licorice root extract for. To. To kind of supplement NAD boosting and it actually raises total NAD levels. So we're connect. There's something here about licorice root extract that I guess is good for many type of indications in the skin.

Joel Marshall (26:22)

Interesting. I mean we do use that in some of our products, but I haven't heard that correlation before. So I have to. I'd like to see more on that.

Podcast Host (likely Amitai Eshel or Co-host) (26:30)

Yeah. Send you the study.

Joel Marshall (26:32)

Yeah, I know you have some wonderful products.

Podcast Host (likely Amitai Eshel or Co-host) (26:35)

Yeah, yeah, yeah. We again, the approach is very, very similar because at the end of the day what we're trying to do is to make sure that the skin is functioning more youthfully, which then obviously would perform better when you're talking about. When you're talking about stimulating repair. Right. You guys have been using exosomes for, for a long time.

Joel Marshall (26:55)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (26:55)

At least like four years.

Joel Marshall (26:56)

I think, I think it's five now. Yeah. But what we've managed to do. So originally we had because our original exosomes knowledge was pretty low. Right. So we, so we, you know, we didn't want to recreate the wheel ourselves. So we partnered with a company which had a lot of expertise in that area as things happen, didn't end up working out longevity wise, no pun intended. So we searched the world for a new partner and we found a lab in Korea that's been working with exosomes for over 20 years. And you know, Korean companies and the K beauty is definitely a big thing right now. But particularly when it comes to exosomes, the Koreans have been on the forefront of that technology. And so this particular lab has been working a lot with cancer treatments and again, not fda. They've been doing a lot of cancer treatments very successfully throughout Japan and Korea and other Asian countries. And we've seen the technology that they use and we've been able to partner with them and invest in them and then head up their aesthetic vision. So beautiful to take that knowledge has given us the ability to offer what we think is the best exosomes on the planet currently.

Podcast Host (likely Amitai Eshel or Co-host) (28:21)

I love it. Yeah, very similar. When we were very afraid of FDA regulations for a long time we were advised that the FDA is going to come after some things that it would see on the label and would be human derived. For a long time we held off, but we decided to kind of jump in about two years ago. And yeah, we partnered with the Korean lab which is now, which we're now part. Which we're now heavily invested in. And to see the way that they work, the way that they think is inspiring, to be honest. It's very cool.

Joel Marshall (29:00)

Well, I'm going to rephrase my last comment. To say one of the two best exosomes in the world.

Podcast Host (likely Amitai Eshel or Co-host) (29:07)

Let's not doubt it. So here's maybe the flip side of that. What should you never use after microneedling?

Joel Marshall (29:17)

Why do you just. Okay, so you've opened up the channels, right? You, you've, you have open up the channels in the skin and damage the skin. So stay away from anything that's going to create some sort of bacteria or problem in the skin afterwards. Right? So don't put on your makeup that you would normally do that aren't designed, that isn't designed to go over compromised skin. Definitely do not use your makeup brush with all the bacteria and stuff inside the makeup brush. Only use specific. If you need to use makeup. Only use specific products which have been designed to use post microneedling. Don't use anything. If for instance, if you've Used exosomes, don't use a product that has a different ph balance, which will kill the exosomes as well. So it's very important when you're using exosomes to make sure that your, that your product, any other products you'll use after that won't cause a reaction or problem with the exercise.

Podcast Host (likely Amitai Eshel or Co-host) (30:11)

Yes.

Joel Marshall (30:12)

I would just. I wouldn't use anything that's going to then compromise the treatment that you've just done.

Podcast Host (likely Amitai Eshel or Co-host) (30:19)

Got it.

Joel Marshall (30:20)

But also, also, we try to never use anesthetic cream. Right. So most every other microneedling company will tell you to use anesthetic cream before a treatment. We say, do not use it. And we have technologies in our pens which makes. It gives the ability not to have to use anesthetic cream. But you think about the idea of what we're doing. We're trying to regenerate the skin.

Podcast Host (likely Amitai Eshel or Co-host) (30:43)

Yeah.

Joel Marshall (30:43)

And the first thing you go and do is put on this horrible, horrible chemical. It's like completely counterintuitive. So that's, that's the first thing that I say. Don't use an anesthetic cream.

Podcast Host (likely Amitai Eshel or Co-host) (30:53)

Interesting. Can you talk a little bit about how you prevent the. How do you circumvent the anesthetic cream?

Joel Marshall (30:59)

Yeah, it's, it's in the technology with a pen and then the technique of how you do it. So part of that is our needles are thinner and sharper than any other needle on the market. So already you're going to get better penetration without as much pain, because you're not going to get that superficial, you know, basically bludgeoning of the skin. You're going to get real penetration. A lot of devices when you use them and you move it across the skin like this, because some of them are. Some of them you can't even do that. Some you can only stab. And then you're getting just a fraction of the amount of holes that you can create. But the idea is you want to move it across the skin.

Podcast Host (likely Amitai Eshel or Co-host) (31:34)

And to one, to people who are listening, you're basically gliding it left, right, up, down, right.

Joel Marshall (31:40)

Correct. So you glide it and I've got 16 needles on the tip and it's going up and down at 120 times per second. So it's creating almost 2,000 holes per second, over a million holes in under 10 minutes. So if you're stamping, you can't do that.

Podcast Host (likely Amitai Eshel or Co-host) (31:57)

Yeah.

Joel Marshall (31:58)

So that, that you lose a lot of the effect. So you can glide across the skin. Now you have to have technology in the pen that makes this possible. So Some pens, when you do that, will catch and drag a little bit.

Podcast Host (likely Amitai Eshel or Co-host) (32:10)

Yes.

Joel Marshall (32:11)

And that's. That's horrible. Doesn't feel good for the practitioner or the patient. So we've got what's called direct drive in the pen itself, which means when you connect a tip to the pen, the tip is actually connected to the piston itself. So. So instead of pushing the needles out and just allowing a spring or something to pull the needles out of the skin, the piston is pushing and pulling the needles in and out. The best analogy I've got for that is, have you ever ridden a bicycle?

Amitai Eshel (32:39)

Yes.

Joel Marshall (32:39)

Right. And you're pushing down on the pedals. Have you ever then ridden with cleats in so. Or like, with your feet actually strapped into the pedals?

Podcast Host (likely Amitai Eshel or Co-host) (32:49)

Yeah.

Joel Marshall (32:49)

Difference in the power when you can also pull up.

Podcast Host (likely Amitai Eshel or Co-host) (32:52)

Yes.

Joel Marshall (32:52)

And push down. I mean, go way faster and smoother and stronger. It's the same deal. That piston allows us to move the needles much faster and much stronger and smoother. So you can literally go across the skin really fast without any catching or dragging.

Podcast Host (likely Amitai Eshel or Co-host) (33:11)

Nice.

Joel Marshall (33:11)

And the faster you move it, you're not concentrating on one spot, so it's less painful.

Podcast Host (likely Amitai Eshel or Co-host) (33:16)

Got it.

Joel Marshall (33:17)

There's a few different technologies and techniques which enables us to not have to use it.

Podcast Host (likely Amitai Eshel or Co-host) (33:23)

So is that. Let me ask you a question. That is something that I talk about that is a little bit of a drawback, no pun intended, with the. With the rollers. That. The rollers are innately not entering at Zenith at 90 degrees and are not exiting at 90 degrees.

Joel Marshall (33:41)

Correct.

Podcast Host (likely Amitai Eshel or Co-host) (33:42)

And there is really no way about. No way around it. I've seen, you know, Instagram, the. The ultimate authority, Instagram influencers, trying to show.

Joel Marshall (33:52)

I get my information from.

Podcast Host (likely Amitai Eshel or Co-host) (33:54)

Yeah, no, of course.

Joel Marshall (33:55)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (33:56)

That's how I live my life. But I've seen them doing things like, you know, they. They don't go back and forth, they only go one direction. Like things that. That. That don't make a lot of sense as to how they would mitigate that. Do you. Do you feel the same way about rollers or do you have a different.

Joel Marshall (34:11)

Yeah, I mean, you just. The. You think about the technique. The needles are going like this. So you're getting lateral tearing.

Podcast Host (likely Amitai Eshel or Co-host) (34:17)

Yes.

Joel Marshall (34:17)

Instead of direct leaking to the skin at 90 degrees, like you said. So.

Podcast Host (likely Amitai Eshel or Co-host) (34:22)

And it beats the purpose of. Of, Of. Of that controlled injury, which. Which is easy for the body to heal, then you're innately creating some of that scar tissue. Long term.

Joel Marshall (34:31)

Yeah. A little micro tears.

Podcast Host (likely Amitai Eshel or Co-host) (34:33)

Yeah.

Joel Marshall (34:33)

I mean, at the end of the day, the the, the skin's still pretty good at healing itself. So I won't say that it's terrible. I'm just saying you'll get less micro tearing if you're using a device that can actually do what ours does. But secondly, the rollers don't give you a lot of flexibility.

Podcast Host (likely Amitai Eshel or Co-host) (34:53)

Yeah.

Joel Marshall (34:54)

You got a roller. When those needles are put on the roller, they're at one length. So if you want to go superficially, it's really super imprecise because it's like, oh, I just push a little bit lighter. If I want to go deeper, I have to push heavier. Right?

Podcast Host (likely Amitai Eshel or Co-host) (35:09)

Yeah.

Joel Marshall (35:09)

The pen gives us the ability to actually physically adjust the depth that we're going to. So I can actually, I've got a lot more scope to be able to change the treatment that I'm giving. So a lot more flexibility also then you're only having to change the tip too instead of a whole roller. So environmentally it's much better and it's also probably more affordable.

Podcast Host (likely Amitai Eshel or Co-host) (35:33)

And I know in the US you mainly focus on the professional pen that you guys have, but you. Does that also apply to the at home pen?

Joel Marshall (35:45)

Yeah, yeah. 100 the. Yeah. Because we do have the dermapen home that's available and traditionally it's been worldwide and we have, you know, we've been in discussions or with the FDA for that to be able to offer it here. Our, our current understanding is if you, if it's below 0.03 millimeters or so. Yeah, 0.3 millimeters. Then, then the FDA don't, you know, they won't look at it so much. So, so we've had that discussion and we, we haven't had any contradicting thoughts from them. So we hope to offer that soon in the US Unless they tell us that we can't.

Podcast Host (likely Amitai Eshel or Co-host) (36:32)

So us, us based individuals right now, they, they, there is no way for them to purchase it or they can purchase it kind of internationally and get it shipped here. How does it work?

Joel Marshall (36:42)

Yeah, I mean if they're overseas or they can certainly purchase it. But we hope to actually offer it here very soon.

Podcast Host (likely Amitai Eshel or Co-host) (36:49)

Amazing.

Joel Marshall (36:50)

Yeah. Because the, the FDA has not told us that they, they disagree with that comment.

Podcast Host (likely Amitai Eshel or Co-host) (36:56)

Yeah.

Joel Marshall (36:57)

So. And at the end of the day that's, it's all about a discussion with them.

Podcast Host (likely Amitai Eshel or Co-host) (37:00)

Yeah.

Joel Marshall (37:01)

And the discussion's been open and they haven't said that we're not supposed to. So what can you do?

Podcast Host (likely Amitai Eshel or Co-host) (37:08)

Yeah.

Joel Marshall (37:09)

Can't wait for a response.

Podcast Host (likely Amitai Eshel or Co-host) (37:12)

Yeah. So since we are talking about like we've mentioned microneedling at home. But even professionally, a lot of the discussion around microneedling is that micro channeling is the ability to enhance the absorption of different products. You know, exosomes would be one of them. So the question is, can microneedling truly enhance absorption of topical products? And on the second hand, is it always a good thing?

Joel Marshall (37:39)

Yeah, I mean, two very, very good questions. So the, the biggest barrier to any product getting into the skin is the skin. So if you can slightly break that barrier, then you are creating channels which then the. Any sort of product can get into. So does microneedling enhance it? I mean, yes, yes is, is the answer to that. Again, not something that's been evaluated by the fda, I have to say. Yeah, but it's just the physical.

Podcast Host (likely Amitai Eshel or Co-host) (38:11)

I mean, just think it only enhances it if you're outside of the U.S. yeah, that's right. If you're in the U.S. no, it doesn't work.

Joel Marshall (38:17)

It doesn't work exactly. But I mean it just, it's just, it's obvious, right? It's obvious the barrier is the skin. If we can create little channels in that skin, then obviously you're going to get better penetration of a product. Now, should you put any product in? I mean, no. This is another reason why we don't like to use anesthetic cream. Because you put it on.

Podcast Host (likely Amitai Eshel or Co-host) (38:38)

Exactly.

Joel Marshall (38:38)

Very difficult to get off. And now you're going to micro needle and that, that's still there and now you're actually pushing that into the skin. So yeah, there's, there's lots of things that you don't want to push into the skin as well. So yeah, it's important to make sure you're using the right product or you're going to a clinic that knows the products that they're using as well. If you're getting a treatment.

Podcast Host (likely Amitai Eshel or Co-host) (39:00)

Yeah, for sure.

Joel Marshall (39:01)

For design to be actually pushed into the skin.

Podcast Host (likely Amitai Eshel or Co-host) (39:05)

Yeah, I agree. And obviously a clinic that knows what it does also knows how to instruct home care, etc. I would argue a clinic that really goes the extra mile will tell you what to do pre. I mean again, I have a story that I tried to trademark the word prejuvenation. USPTO told me that I am delusional. But. But I think that's as important. I don't know as important, but it's pretty important. Almost as important as post care for to get the best results.

Joel Marshall (39:37)

Mm. 100%. You should absolutely pre prepare the skin before any sort of treatment. And I think the clinics find this very difficult because you get a customer that wants to come in and they're like, oh, we should get them on a treatment right away. You know, they've come in, let's not lose the customer, right? So it's very difficult sometimes to get them on that pre treatment program. But if you really want to do it right and do it the, the best for the patient is you do a consult with them, you give them specific products which are going to set them up for when they actually come for the treatment. Their skin is going to be much, much better prepared.

Podcast Host (likely Amitai Eshel or Co-host) (40:15)

Amen. Yes.

Amitai Eshel (40:19)

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Podcast Host (likely Amitai Eshel or Co-host) (42:04)

So, talking about coming and doing that, consult what is the cadence of microneedling treatments? How often should someone come to to get a microneedling treatment?

Joel Marshall (42:19)

Again, it's going to depend on on the indication. So outside of the U.S. if you're treating pigment, where's most of that pigment? It's above the basal layer. Most of it's going to, you know, so it's in the epidermis, so we don't need to go into the dermis to get a result. So if you're doing that, it's a much shallower treatment. There's going to be less damage to the skin. So you can do your treatments much closer together. You can do Them two weeks apart.

Podcast Host (likely Amitai Eshel or Co-host) (42:50)

Yeah.

Joel Marshall (42:51)

If you're going to go deeper with scarring or other treatments where you're going to see a little bit of pinpoint bleeding, you're also looking at the collagen cycle there. So you want to leave it a longer period in between treatments. We actually like to wait at least six weeks for those sort of deeper treatments.

Podcast Host (likely Amitai Eshel or Co-host) (43:08)

Yeah. What would be the ideal needle depth for anti aging versus scarring? Again, it won't work in the US but versus pigmentation.

Joel Marshall (43:22)

Well, scarring we can do. Acne scarring we can talk about, which is great.

Podcast Host (likely Amitai Eshel or Co-host) (43:25)

Oh, yeah.

Joel Marshall (43:25)

Good.

Podcast Host (likely Amitai Eshel or Co-host) (43:26)

So that works.

Joel Marshall (43:27)

Yeah, that works in the U.S. okay. Yeah. So we don't give you ideal depths because everybody's skin is different. So we train our practitioners to say, okay, this is a good depth to start on. But what you need to look at is the end point you're getting in the skin. Right. Because every single person that walks through the clinic's door is going to have different thicknesses of skin, different types of skin, different damage to their skin. So we say, all right, if you're trying to look for pinpoint bleeding, start the treatment on this depth, and if you're not getting it for that particular result, go a little bit deeper. Always do every treatment according to that particular patient. So that's why we can't talk about depth like that.

Podcast Host (likely Amitai Eshel or Co-host) (44:13)

Okay. But you're talking mainly about. So let's talk about maybe skin depth as far as, like, layers, because you're mentioning pinpoint bleeding, and that would be once you enter puncture into the dermis. Right. So you mentioned that. That hyperpigmentation is something that if someone were to treat hyperpigmentation in, they will not need to go that deep. And maybe, maybe bleeding is not. Is not required. But once you want to stimulate collagen production, are you going to the point of. Of slight bleeding that we.

Joel Marshall (44:50)

We would like to see that. Yeah, that.

Podcast Host (likely Amitai Eshel or Co-host) (44:51)

Yeah.

Joel Marshall (44:52)

In. When we look at the over 6 million treatments we've done worldwide.

Podcast Host (likely Amitai Eshel or Co-host) (44:57)

Wow.

Joel Marshall (44:58)

So there's a lot of. There's a lot of experience for this. We've seen getting that pinpoint bleeding generally gets a better result for that. You know, that's breaking up scar tissue and also getting that collagen cycle to begin.

Podcast Host (likely Amitai Eshel or Co-host) (45:15)

Yeah.

Joel Marshall (45:15)

Whereas not getting it is just better for just like overall toning and clearing and even. Even just enhancing the deeper treatments.

Podcast Host (likely Amitai Eshel or Co-host) (45:25)

Yeah.

Joel Marshall (45:25)

And that's the idea of the home device. It's not. It's not there to take away from the. In clinic proper device, proper treatment. The Idea is to enhance those in clinic treatments.

Podcast Host (likely Amitai Eshel or Co-host) (45:36)

Yeah, yeah, it's fun. You know, we obviously mentioned earlier that radio frequency microneedling and microneedling have nothing to do with each other. I would argue that at home microneedling and professional microneedling are two different treatments being administered by the same, you know, physical principle.

Joel Marshall (45:54)

Correct? Absolutely correct. Yeah. You got it. You still gotta go into the clinic, you still get those real, real, you know, professional treatments, then those, those. That home device is amazing at just enhancing, refreshing and keeping the skin, you know, just the cells turning over. Yeah. So it's, it's really an amazing combination.

Podcast Host (likely Amitai Eshel or Co-host) (46:20)

It would that also be like a two week cadence, A weekly cadence? What would be the.

Joel Marshall (46:24)

Yeah, I mean you can, you can literally do it every week if you want to. Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (46:29)

We talked about exosomes as far as like combining it with microneedling. And you know, here, for example, the place that we go to for our biohacking needs, they're very big into, I think they use your devices called Med House or R3 here in West Palm Beach. They are very big in introducing exosomes together with the microneedling into the skin, blanking on the name of the brand that they're using. But they, they know what they're doing. Having said that, what about other, you know, longevity biohacking treatments like red light therapy or hyperbaric oxygen therapy or I guess like cryotherapy wouldn't have anything to. Maybe it will because it reduces inflammation.

Joel Marshall (47:14)

So. Absolutely.

Podcast Host (likely Amitai Eshel or Co-host) (47:15)

What do you think about. Let's start with like infrared or red light therapy. Do, do you see any benefits in combining the two?

Joel Marshall (47:23)

Yeah, 100 we, in fact, as a company, we, we've been dealing with LED systems since 2004. So dermapen world was the first company to bring in hair removal lasers into Australia.

Podcast Host (likely Amitai Eshel or Co-host) (47:43)

Wow.

Joel Marshall (47:43)

Yeah, well, the, whatever it was called back then. But yeah, because that was before Dermapan. But the company, my family's company was the first to bring in hair removal lasers into Australia. So then we looked at other, other technologies were similar. Which is led.

Podcast Host (likely Amitai Eshel or Co-host) (47:59)

Yeah.

Joel Marshall (48:00)

So we used to sell some, some great, you know, big devices, big machines did cost quite a lot, but they were also used for not just rejuvenation, but they're used for PDT for other treatments. So when you have a wavelength, like we said before, it's going to get absorbed into different chromophores in the skin. So there's certain wavelengths which are really, really good for rejuvenation.

Podcast Host (likely Amitai Eshel or Co-host) (48:28)

Yeah.

Joel Marshall (48:28)

Just have to get enough energy into the cell to get the desired change in the cell and to get that regenerative effect.

Podcast Host (likely Amitai Eshel or Co-host) (48:36)

Yeah.

Joel Marshall (48:36)

So just holding a light bulb isn't going to do it.

Amitai Eshel (48:40)

Right.

Joel Marshall (48:40)

You need to have at least enough energy from whatever you're using. So all of those big machines that you had in the clinic, they're great. They generally are getting that result. But we also now have a face mask that. That's getting the same energy into the cells. Well, how can our home face masks do that? Well, when you have these big machines, they're generally sitting off your face like this. There's a huge amount of energy loss, correct? Yeah. So if you have a face mask right. On the skin, you don't need the same power to get the same energy into the skin, but you still need.

Podcast Host (likely Amitai Eshel or Co-host) (49:15)

A pretty strong face mask within those parameters, right?

Joel Marshall (49:18)

Yeah, yeah, Very cool. And if you're doing that, make sure you're looking for masks that don't have a variety of colors. Every time you put a different color in, you're dividing up the power. So. And you're dividing up the effect.

Podcast Host (likely Amitai Eshel or Co-host) (49:31)

So look for in the surface. Right. You know, a blue diode is not going to be situated together with a red diode. So you're basically like. Are going to have like a dead spot in your skin. Basically.

Joel Marshall (49:43)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (49:43)

Yeah. Cool. What about hyperbarics? Have you seen a lot of people combining the two?

Joel Marshall (49:48)

I think in. In wellness clinics, they do like, instead of just going to a med spa. I see there is a lot of focus now on more holistic approaches. And I really do like the idea of the hyperbaric chambers. I can't. I'm not an expert on it by any, but there's a lot of different technology, more in the wellness front, which I do believe works really, really well.

Podcast Host (likely Amitai Eshel or Co-host) (50:13)

So as far as, like, cold exposure, it's a very hotly debated topic in the bodybuilding or fitness world because research have shown significantly a significant reduction in results if you work out and then go into a cold exposure because you're lowering the inflammation you've created. And that inflammation is a positive thing because it, you know, stimulates the regeneration of muscle, et cetera. Do you think it's similar as far as, like, microneedling? Would you wait with, you know, going to a cryo chamber for a while?

Joel Marshall (50:47)

It's interesting because we have thought about that, even with led.

Podcast Host (likely Amitai Eshel or Co-host) (50:52)

Yeah.

Joel Marshall (50:53)

Like maybe just waiting a little bit longer before actually doing the LED treatment, because you, you do want some of that information. I think there's still a lot of research that Needs to be done, I would say also probably with a cryo as well. I wouldn't do it straight after a treatment. And it's interesting of the research with the, with the. Do you take cold plunges? Yeah, yeah, I, I try and do it before I work out.

Podcast Host (likely Amitai Eshel or Co-host) (51:16)

Yeah, exactly.

Joel Marshall (51:17)

Yeah.

Podcast Host (likely Amitai Eshel or Co-host) (51:18)

Yeah. My good friend Tom Sager, Professor Tom Sager, wrote a book about testosterone and increasing testosterone. And basically he writes about using the cold plunge and then. And then working out. Yeah.

Joel Marshall (51:34)

I think it's a, it's a field that needs so much more exploring and so much more research and then. And sometimes it's not as easy because it's not as much funny in an ice bath, you know.

Podcast Host (likely Amitai Eshel or Co-host) (51:45)

Yeah.

Joel Marshall (51:45)

But it's, it's, there's, there's a lot of real goodness to come in that. In that field. That's what I do, actually. That's why, you know, we often see each other at the A4 mm.

Podcast Host (likely Amitai Eshel or Co-host) (51:56)

Yeah.

Joel Marshall (51:56)

Because there's a lot of different wellness ideas and technologies being explored there that you won't see at a standard aesthetic conference.

Podcast Host (likely Amitai Eshel or Co-host) (52:04)

Yeah. Shout out to a 4M.

Amitai Eshel (52:06)

I love it.

Podcast Host (likely Amitai Eshel or Co-host) (52:07)

So let's talk about. Because we're running a little bit out of time and I. And I want to ask you a few questions that, that I think are. Are I. I'm interested in first is who shouldn't do microneedling. Is there a bad candidate for microneedling? Obviously, babies. But aside from babies.

Joel Marshall (52:27)

But I, But I have even seen it on babies if there's some sort of scarring or something. I mean, to remodel that. That scar tissue as a baby, you can end up having it almost scarless. Right. So, yeah, I mean, obviously the pain's not going to be pleasant for the baby. But I mean.

Podcast Host (likely Amitai Eshel or Co-host) (52:46)

Yeah, you're talking to a Jewish. We circumcise our babies. Yeah.

Joel Marshall (52:52)

You guys are then microneedling your babies. All full body, then. Full body. While you're doing the circumcision. If you've got. I mean, we always say, like, don't treat pregnant.

Podcast Host (likely Amitai Eshel or Co-host) (53:03)

Yeah.

Joel Marshall (53:03)

Pregnant women. It's not that it's going to cause any sort of problem, but they, you know, if something does happen to the baby, they're going to look at what they've done differently and blame it on that. I think if you've got certain immune problems, like autoimmune diseases, there are certain things that you. That you don't want to use it with. Like, we don't want to use it over eczema or things like that because, you know, you're actually stimulating the production of more collagen. So do you really want to do that with someone that's got eczema? No.

Podcast Host (likely Amitai Eshel or Co-host) (53:34)

Yeah.

Joel Marshall (53:35)

But are there other drugs in the future that you could possibly help to penetrate that with? I know that other companies have used our. Like, pharma companies have used our device to try and push their specific medicines in, just to see. See what the reaction would be. But, yeah, I would be careful with any sort of autoimmune diseases if you've got an open wound. I wouldn't be doing it on an open wound. But the great thing about microneedling is you are simply doing what we said is just damaging the skin.

Podcast Host (likely Amitai Eshel or Co-host) (54:03)

Yeah.

Joel Marshall (54:04)

So if you're like a normal human being and your skin heals and you've got any type of skin type, does it. Anyone can do it and you can get it done anywhere.

Podcast Host (likely Amitai Eshel or Co-host) (54:13)

Yeah.

Joel Marshall (54:14)

Like there is, like, in some countries around the world, there's some really interesting treatments that they do with it.

Podcast Host (likely Amitai Eshel or Co-host) (54:19)

Yeah. What are. What are the. You know, again, you have so much experience. What are the common mistakes or myths that you see circulating even with. With practitioners?

Joel Marshall (54:31)

There's a lot of technique mistakes that people. People. People have. I mean, people think that just what we talked about before, like stamping, is going to give you the same sort of result. It's not because you're just not doing this anywhere near the same amount of holes. We like to teach people not to be doing circles because it gives an uneven result. We like to also work with lymphatic drainage, so we're always trying to move the device from the interface to the outer face. Another myth is RF microneedlings. Microneedling.

Podcast Host (likely Amitai Eshel or Co-host) (55:00)

Yeah.

Joel Marshall (55:01)

I can't think of too many myths right now. It'd be interesting to have someone that has a bunch of myths to go over those specifically.

Podcast Host (likely Amitai Eshel or Co-host) (55:08)

Yeah, listen, I think we've covered a lot here, and I really appreciate the knowledge that you've shared. It's been a long time coming, this podcast.

Joel Marshall (55:17)

Yeah, it has, Joel.

Podcast Host (likely Amitai Eshel or Co-host) (55:19)

So where can people find out? Like, where can people explore the offerings that you have? You know, obviously, how can professionals get in touch or how can consumers know where to go?

Joel Marshall (55:32)

So if you're not in the US there's the dermapen world.com website. So just think dermapen world. But our US company that we distribute all of the Dermapen World Portfolio, that is DP durham.com so D&P for Dermapen. Derm for Dermatologist. Dp-dot com.

Podcast Host (likely Amitai Eshel or Co-host) (55:54)

Got it. Okay. Fantastic. We'll have it in the show notes. Thank you very much. Joel, this is been. It's been a pleasure talking with you.

Joel Marshall (56:00)

Always a pleasure. Amateur.

Podcast Host (likely Amitai Eshel or Co-host) (56:02)

Bye, everyone.