← Skin Anarchy
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- [00:00]
A
Hey, guys, welcome back to another episode of Skin Anarchy. I'm really excited about our episode today because we're going to be talking about the world of aesthetics and techniques that have been around, and we don't really get to speak about much on the podcast. So I'm really excited to introduce you guys to PDO Max. And we have the founder here with us, Giovanna McCarthy. Welcome, Giovanna. I'm so excited to host you.
- [00:20]
B
Thank you, Dr. Ekda. I'm very excited to be on here and to speak all great things. Aesthetics.
- [00:26]
A
Yeah, no, I'm. I'm really excited to dive in with you because you've really seen this industry. You've been kind of a trailblazer here, and I'd love to learn more about your journey and what really got you into the world of aesthetics like, to begin with.
- [00:37]
B
Well, interesting story. My mom was burned as a child. So my whole life we dealt with her having surgeries, cosmetic plastic surgeries for her burn on her face. So I got introduced really young to plastic surgery, cosmetic surgery, and. And how to mitigate scars and things like that. And that really built my love for skincare. Plus, we're European, and if you know anything about Europe, they're much more into skincare in this country. We are just now starting to see the younger generation really get into skincare, but we were always into skin care there. So I did a lot of my research through the European market back in the days when they were doing mesotherapy. I studied up on that way before there was any type of quote unquote, medical aesthetics in the United States. I fell in love with it in Europe.
- [01:30]
A
Wow. Yeah. You opened the first day Spa in 1990. Right. It was a. It was a while ago. You really seen the industry before it became trendy?
- [01:38]
B
Well, there was no medical. I mean, I go to these conferences and I see all these injectors, and we're not realizing is the whole injector world is relatively young. It's medicine of aesthetics is young. So when I'm at these conferences and you're hearing science based this, science based that, the reality is we're here today because of what was done in Europe and Asia for years. And you're talking. There was no real medical aesthetics until fillers came along. Right. We had Botox and back in the day, really at. In aesthetics, estheticians, we could do lasers, we could do all that stuff. As it became more medical, it became more regular as it should have been, not saying it shouldn't have been. And that's when I went from a day spot to a med spa and had to bring in a medical director and all that stuff. So no, you. I have literally seen the field from day one. And there's not a lot of us that are that og old school aesthetics.
- [02:46]
A
Yeah. Honestly, it's crazy because even for me, when I look at it from the consumer side. Right. And it's like exactly what you said before. People started talking about fillers a lot more about Botox, a lot more about just a lot of the injectables. We didn't really know much about the aesthetics field as general consumers. I mean, it wasn't out here in the open. And so you would hear that someone went, they visited their dermatologist or they did that, but it wasn't spoken about at all. So this is.
- [03:12]
B
Yeah, in fact, you know, I tell the story all the time. I worked pretty close in hand with some surgeons here in Syracuse, so I would refer all my skin care clients to a specific surgeon. And one time, I remember sitting with him, he came to one of my open houses and he saw how many microderm packages I sold and he literally looked at me and said, and we're talking 20 years ago, right? Where I was one of the only. I had my microderm machine imported from Italy because you couldn't even get one here in the United States. And it took me a while to get it through the FDA and couldn't do deeper than a certain amount because I was in aesthetics, yada, yada, yada. And he looked at me and goes, I can't believe you're getting $250 for microdermabrasion. But we can't, we can't sell that service. And I'm like, well, I can tell you why you're somebody back then was coming to you and paying $7,000 for a facelift. They expect their skin to look good. People didn't even correlate that bad skin gave bad surgical outcomes. Now we're seeing that all these plastic surgeons are integrating lasers, other skin care services before they even do a facelift. That was not the thing back then. They would just cut out the skin and snatch you back and you still had terrible sun damaged skin. And the reality back then, the. Not the success rate because obviously the surgery was good. It wasn't that the surgery was bad, but when people looked in the mirror, they still saw bad skin. So they feel that their facelift did what it needed to do. But what they weren't understanding is just taking away extra Skin doesn't make the skin better. You'll find that people who maintain their skin quality throughout their life are less likely to get a facelift young.
- [05:01]
A
Yeah, no, that's actually huge. That's a huge topic that you've brought up. And I think now we've also seen this burst of like post treatment care, pre treatment care. All these skin care lines that have popped up because of this idea that you need to do something, you should be taking care of your, your skin. You need to actually understand that your skin is the way it is. And whatever you get done to it, it's just, it's going to enhance it, but it's not going to like take away the core problems that you're facing. So, I mean, that's a very, very interesting concept, kind of wrap our heads around because I think oftentimes we do go in. If you're looking for any procedure, just go in thinking this is a quick fix. I'm just going to fix all my problems. But you still, your skin is your skin. At the end of the day, that.
- [05:42]
B
Is what it is. And that's the people I referred to out for surgery because I was taking care of their skin pre surgical and then post surgical. I would wait the month, then mitigate their scars with microdermabrasions, stuff like that. Those patients by far were happier than with their results, than patients that didn't get that. And he noticed that. I hate to say some of the love that estheticians don't get. They really can prepare a person for great surgical result versus mediocre surgical result. And the, this constant back and forth isn't what we need. We need to work together to keep the patients and clients happy.
- [06:26]
A
Absolutely. Now I want to learn more about PDO threads because I've heard about obviously threads in the past and like think vaguely we hear about their use. But I'd love for you to kind of dive in into some of maybe the, the myths or the misunderstanding that's out there or anything that you've noticed that maybe is a big space where people don't understand the true purpose of using something like threads.
- [06:49]
B
Well, I started the thread company back in 2014 and we go back to why did I start this company when I saw what threads did for skin quality. I used to call them threads on crack because you see such. And we're talking PDO threads. I'm not talking PLLA permanent threads. I'm talking PDO sutures that dissolve within a year and are out of the body. They just create some Good quality turgor to the skin. And the problem is in the trainings. As a company, we have really focused more on training than just selling a product. We find that clinically competent injectors get fantastic results. With that being said, somebody who's not clinically competent that isn't doing a great job gives a disservice to the industry. And that's where you see all the TikTok stuff. You don't see the great results out there because at the end of the day they're subtle. We're not removing skin, we're just making skin quality better. But after being in. I'm 60 now, I've been in the industry 43 years. I've been in the industry since I was 17. And when you see something that changes skin quality to the the extent the threads can, it's too bad that the plastic surgeons and I get it, threads not in the proper plane can cause maybe issues if somebody goes to get a surgical intervention, but if everybody would wait a year after any procedure, whether it's sculpture threads, that would cause less problems. But there are a lot of surgeons, we've trained surgeons, we have plastic surgery offices that use our products. So threads are a great adjunct in aesthetics. They're not the end all, be all, but they're a great tool in the toolbox that adds to filler services, Botox services. The reality is, Even back in 2014, when I got into the threads, I could see that we were going to be killing the filler industry because there were so many overfilled faces. And what we liked about threads is how natural people looked after they had procedure. I mean, you can go out the night after you've had it done if done properly.
- [09:00]
A
Yeah. Now what do you mean when you say done properly? I want you to really dive into that because you've worked so closely with surgeons and you've worked with the. Even on this training side and you've seen this world. Where do you think we're lacking when it comes to understanding how to do a procedure involving threads?
- [09:15]
B
I mean, I will, yeah, I will tell you right now, when we first started, I'd see all these big 20, 30 people in a class. There's no way you're going to get clinically competent by going to a training where there's two or three instructors training 20, 30 people. We're pretty big on a small group training. We prefer your first training to be completely one on one eight hour day, really diving into understanding the plane you need to be in. We've Gotten so good at our trainings that I very rarely get complications from the people we train anymore. It's no different than a filler nodule or something. You're going to have times when things don't go 100% no different than anything surgical. But the really important thing with threads is to be in the proper plane, that subdermal plane, that subdermal fascial plane that repositions that tissue nicely without puckering the thread and those types of situations. It's really just about understanding where you need to be in the tissue to get the results, for those results to last and for to not be where you shouldn't be. When they're going in to get surgery. We shouldn't be deep, we shouldn't be below the muscle, we shouldn't be in that level seven plane where we're in the area surgeons are trying to get a clean cut in. So it's really about education and most people who become really good thread injectors are the people who want to work at it. It's not the same as Botox and filler. It is a definite skill set. I always say that I look at Botox and fillers more as treatments nowadays, but this is not surgical, but it's a skill set.
- [10:58]
A
Yeah, it's very, very precision based. Like at the end of the day, this is what's fascinating to me is that they're self dissolving sutures. So like what are some things that people should know about when you get them done? And then if you want to get any other procedure on top, maybe not surgery, not something like a facelift, but if you go and you get Botox, you get an injectable, should you be even be doing that or what is the education around that?
- [11:24]
B
So our philosophy as a company is if you're going to do a tox, you want to do it about two weeks before you get your threads. Filler, we say two weeks after you do your threads. And why? Because if there is an issue, we want to know is it the thread or is it the filler? So I'm not a fan of doing multimodalities in one day. So let's say somebody gets an infection, was it from the filler, was it from the thread? I'm not going to know if I've done two procedures in a day. So mitigating adverse events is easier if we separate the procedures. But I definitely feel the threads should be done before filler. And why you're going to use less filler, you're going to use your filler more to contour rather than reposition tissue. Because you can't lift with filler. We all know that. And the little bit of repositioning of tissue that we do, we try to go into the fat pads and put those back where they were. One of the misconceptions. And I hear this all the time. I hear it at every conference I go to. I hear it from doctors where they say fat pads descend. Well, fat pads don't descend. They're not. There's not a pocket that opens up and the fat drops down. Right. It's more that that fat pad herniated out. There's no structure to the skin, so it's weak. And that fat pad is sort of pushing out. That's what we're seeing. So we like to go into those fat pads. And what happens when you go into the fat pad is you literally tuck it back in. It almost creates, like scaffold to hold the fat pad in. So we're putting the fat pad back so now you don't need as much filler.
- [12:55]
A
That makes sense.
- [12:56]
B
Yeah.
- [12:56]
A
That's really fascinating. So it's almost like you can use threads in so many ways then as adjunct also. Right. To like the.
- [13:03]
B
Oh, 100.
- [13:04]
A
Yeah, 100. It's.
- [13:06]
B
It's creating. When we talk about what they're for, is they're there to create structure, to put back almost like restraint in the ligaments that have, over time, weakened. It sort of brings their blood flow back to that area. It reinforces those ligaments. And when you know what ligaments you're working on in which area, when people get their thread lifts, they'll talk about hearing pops. And that's what it is. We're going through those ligaments, and by doing that, we're reinforcing the ligaments to hold everything back in place.
- [13:40]
A
Yeah, that makes sense. And I think this is very interesting because when you think about aesthetics, rarely does this conversation come up where you approach it from a very structural viewpoint, where it's talking about anatomy from this structural framework, where you have to understand your anatomy does. If you're going to get drastic procedures done, there needs to be something there to help support what you're getting done. It's reinforcement.
- [14:07]
B
That is exactly it. We want to bring back turgor to the skin. So if you do plastic surgery on somebody that has bad turgor, that's not going to look as good as doing plastic surgery on a patient who has really good turgor. And what do we mean by that? We mean the skin isn't sharp. I call it Shar Pei. Shar Pei. Lot of wrinkles, lot of laxity. That doesn't look as good as lifting skin that has a nice thick dermis.
- [14:37]
A
Right. And you know that. I don't know if you can explain this, because a lot of times when people get facelifts done, at first it looks great in the beginning, like, looks amazing. Swelling, perfect. But then you start seeing those lines, especially around the cheekbone area, you start seeing the lines. You start seeing where the skin is pulling, almost like too taut. That's what I always say. It looks like it's too taut.
- [15:00]
B
And then they look great because of the swelling. Right. Because they'll even say that about threads. Oh, it looks really good at first because of the swelling. Yeah, that's the point. When that skin looks plump, it looks good. But, yeah, six months down the road, if they didn't have good skin quality to begin with, or you didn't start them on a good skincare regimen, so you cut them up, you lifted them, and you washed your hands with them, they're not going to get the same results as somebody that maintains or teaches their patient how to take care of their skin.
- [15:31]
A
Absolutely. And I want you to dive into maybe some of the cellular benefits of getting PDO threads, because we've talked so much about structural. Like, what is something that people can expect from this exact point you brought up. Someone with a thicker dermis is going to have better end results. Is this something that we can help happen in terms of, like, collagen production or whatever?
- [15:50]
B
That's exactly what they do. They create microvascularity. So what you're doing, when you're doing a thread lift, a. You're doing mechanical damage. Cannula is going in. You're getting a little bit of mechanical disruption. So the body has to heal that. Then the threads in there. And really think about the thread almost. We call it sugar molecule. So the body's eating that thread up. While it's eating that thread up, it's laying down collagen and elastin, and it's hydrophilic, so it's bringing hydration to the area. So those are the mechanisms of actions of threads.
- [16:28]
A
Interesting. That's very interesting. Yeah. Because I think that's something that. Yeah. You don't really hear about what you can do. I mean, I know topically there are solutions, and people have created great skin care lines. You know, I know elastin is one of them. They tell you use this continuously, and you Want to support topically, but there's not much you can do topically, to be honest, in terms of deep dermal regeneration of tissue or like just plumping.
- [16:52]
B
Well, and that's, that's where pdomax is accompanying. We have been studying that and we have segued into micro needle products. You can micro needle in or put on top of the skin, put post microneedling, post laser post, any procedure that will help the body absorb topical agents. We came out with a PDO Glow within our practices that use. It will tell you that if they were microneedling before and have added either PDO Glow or Lumen V to their or mix the two to their protocols, the clients see the difference. Perfect example is my son is a late adopter and when I first introduced PDO Glow, he probably waited three or four months to bring it onto his practice. When he did, he just added it in as a gift to the client. And the clients were actually calling in saying, oh my God, what did you do last time that we didn't do previously? Because I see the difference and that's my goal with anything I do in our company is for the clients to see the difference, to feel the difference, to look in the mirror and see that their skin is changing back in age.
- [17:58]
A
Right? I mean, that's the goal, right? With aesthetics is like this is why the field is so fascinating because you actually do get, get the results, the drastic result, the really game changing results. And, and that's where I feel like this industry has been so vague for someone looking in because a lot of times people will go get stuff done and I'm like, I don't even know what you got done. I can't tell.
- [18:19]
B
I can't tell.
- [18:20]
A
Yeah.
- [18:20]
B
And you know what? In good aesthetics, starting young, I hate to say it, that's the way it should be. When I hear surgeons talk about before and afters in the aesthetic injector realm, well, it shouldn't be drastic. We should have been maintaining all along. We should look as good at 40 as we do at 60, skin quality wise. So it should be like I just said that the client calls my son and says, I know that there's a difference, but it's not mind blowing. It's not back in the day when they did full CO2. I mean, talk about how the industry has changed. When you talk about, I've been around a long time. I remember when they were doing full ablative CO2s that were scary. People looked like a burn victim and yeah, their skin looked crazy Sort of good afterwards as being working in my spa though. I notice that when we do too much too fast, their skin ends up looking like vinyl. I don't know how to explain it. Rubbery. I'm really starting to worry about what's happening in the industry of. I'm all for stacking treatments, but if we're stacking so much that we're breaking down that collagen in the last and to the point of. Of making people look vinyl, that's not good. Because as what I've seen as those people age, they get. They don't have. I don't know how to explain it, but they have deep wrinkles.
- [19:47]
A
Yeah.
- [19:47]
B
It's destroying your.
- [19:49]
A
It's destroying your tissue very deep. And you can't repair that. That's trauma.
- [19:52]
B
That's trauma, yeah. When they traumatize it to the point that I'm like, woof. So we see how in the last 20 years things have changed. We've gone to more of a fraxel fractalated thing. But what I'm seeing happen is people stacking four or five things and it's like, do we want to over inflame the skin to that point? But that is why we brought out Lumen Be. I know that you're probably aware of the whole pdrn.
- [20:20]
A
Yeah.
- [20:20]
B
Salmon sperm. The reason I love it and the reason we introduced it. We were one of the first companies to introduce it. Not as an injectable, as a post service product. Because it was. It really is great. So the studies have been done in burn clinics and things like that. If you can help burn skin.
- [20:37]
A
Right.
- [20:38]
B
And again we go back to. My reason for being in the field was my mom's burn. So I've always really paid attention to what goes on in the burn units. And PDRN helps revascularize the skin. It helps make the skin healthier. After you've had a procedure, it doesn't have to be injected to get the results. That's what's really mind blowing because as you can see in the industry, everybody's going back and forth about injectable. Not injectables doesn't need to be injected to get the results. It just needs to be put on skin that's been disrupted. Not injected necessarily.
- [21:12]
A
Yeah.
- [21:12]
B
I mean in every other country they're injecting it. We can't because it's not FDA cleared here.
- [21:16]
A
Yeah. But I think it's. It's kind of absurd to be injecting it. If you ask me, from the immunology perspective, if what you're doing to your body's immune response when you do something like that is kind of insane. I mean, pdrn, I think what you said is very valid. If you have something that, and this is across the board, if you have a skin that's already compromised, you put something on top of it, it's going to absorb it pretty much in the same capacity that it would if you injected something into it. Because that everything's open. So the whole skin is. It's open to receiving anything that you put on top. I've worked with burn patients in trauma care. I've seen this results go from like before we had nothing that we could do from them. Go to like within a day or two, you're healing. Serious, serious heels. Yep. Yeah, exactly. And it's because of the skin, how receptive it is. Yeah.
- [22:03]
B
So it's almost counterintuitive to inject because if it's healthy tissue, what are we doing? So it has to be almost into unhealthy tissue. That's why you want to use it as a topical and it works. The results we're getting, the downtime reduction in laser is pretty mind blowing. So everything's here for a reason. And when you do things because of your passion and you don't want to make people worse, you want to make them better, right?
- [22:31]
A
Absolutely.
- [22:32]
B
That is the goal and has been my goal. And I don't know, I've seen skin for 40 years and I can tell you that we have some really great products nowadays that actually work. Yes, we used to clean skin, we used to massage skin, but now we have topical products that are changing the industry.
- [22:51]
A
Now. What do you think about all of the PDRN lines that have popped up like Medicube and like all these different.
- [22:58]
B
Lines, I mean we go back to do so much of the studies were done in Asia. You know what pdrn, there's a difference. There's farm raised and there's wild. Our line is wild salmon. And being somebody who likes. I'm not crunchy by any means, but I'm a farm to table girl. You can't tell me. The thing to do is find out if your the product you're using is either farm raised or wild raised. There's definitely more benefits from the science of wild PDRN versus farm raised for the same reasons that there is why I choose my salmon from Norway versus a farm raised salmon. There are differences. I think they're all probably good if they are from a good lab that is ISO certified, has all the Korean. Korean. FDA is pretty advanced. They keep their eyes on stuff.
- [23:53]
A
It's.
- [23:53]
B
It's hard to judge because nobody's going to put the money for testing unless you're trying to save somebody's life. Nobody's putting that kind of money into testing skincare products.
- [24:04]
A
Right? No, no. I mean, they don't simply.
- [24:07]
B
They don't.
- [24:07]
A
They don't. Yeah.
- [24:08]
B
It's hard enough to get funding to test things that save lives, let alone something that's.
- [24:14]
A
Exactly. Yeah. No, the NIH is the unfunding oncology research is what I was going to say.
- [24:18]
B
Right. You know, we're not funding important things. We're not in the medical community. Let's face reality. Aesthetic medicine is considered frivolous. That's why the inviting between the surgeons and the injectors, it's like. But there's a place for everybody. And unfortunately, most of the things in aesthetics are correlation versus testing. We've used these things for years in Korea. They're proven safe. Let's see how we can use them topically.
- [24:48]
A
Right, right. No, I think it's interesting, the craze around pdrn, the way it's been. I don't doubt that the efficacy, because the concept it cellularly makes sense, but I do have my doubts about every single skincare line out there that's selling a PDR and serum. That's where I'm just kind of like. I don't know, because it's a whole different world, what you're talking about. Right. Like you're creating something that's supposed to be used in a clinic and you're, you're using it in a, in a setting where it's supposed to be used. But then if you're selling things over the counter that I don't even know where they were manufactured, I don't know where your lab was, that kind of thing. That's where I get a. I get very, like, reluctant as a consumer. So that's very interesting.
- [25:28]
B
And that's where we were from the medical side and we've come over. So we make sure anything we bring to market has that clinical efficacy, even though it doesn't need it.
- [25:39]
A
Right. Right. Now, what does. If you can kind of educate us on, like, what. What does PDRN actually do? What are the results we can actually realistically expect from this?
- [25:49]
B
Well, it's been used in burn units for. To revascularize to. Used in my cardial perfusion. So it's definitely opening up those blood vessels. And what happens the minute you open up blood vessels it creates healing. You get that healing cascade. And to your point where they're now injecting everything and anything, you're never going to get that tested for FDA approvals because it cost hundreds of millions. So why inject something when you can create it to work on disrupted skin and help heal?
- [26:23]
A
Yeah, that's very true. I mean, it's interesting because I think that's the main missing piece is to figure out where should we be pairing treatments. You've brought this up where you said people are stacking treatments, and I agree with you. It's very difficult when you do that because you don't know if something goes wrong. You don't know where it stems from. And there's a huge gray zone that you've created now in terms of, like, where did your results actually come from? If you get good results, same thing. So what should we. Realistically, if someone comes to you and is asking, like, what should I get done? I want to. Maybe not something drastic. You want to just look better. You want to look more youthful, what would you recommend?
- [27:02]
B
It all depends on how much downtime you want. So if I have. If today is Monday and I had a wedding on Saturday, I would probably. My favorite stackings are microdermabrasion or hydrodermabrasion and then an IPL right over it. Okay, that. I know stacks well. I sure as heck wouldn't be doing infrared. Deep infrared IPL and a fraxel. They're going to need about two weeks of downtime. And my problem with all that much heat is if somebody's a really major histamine reactor, they're going to swell up like a balloon. The more you do, the more they're going to. And I'm a histamine reactor. Let me tell you, if you saw pictures of me doing a chemical peel, you'd be shocked. I mean, I have to go on steroids after getting a chemical peel. So what's crazy to me is how people will think something as innocuous as a chemical peel is safe. I'd rather do laser. I know that it's a heat treatment. I'm gonna, quote, unquote, get a slight burn. I know it's gonna heal. I'm healthy. I know it's gonna heal. But to me, microneedling with a pbrn, post PDRN or post PDO glow, the results are stunning. Softens fine lines. It just gives the skin such a youthful glow. My other thing that is driving me crazy, I'm all about glass skin, but holy cow, lately I'M seeing such glass skin that it's like, is it oily? That's literally.
- [28:29]
A
I was gonna say, is it? Yeah.
- [28:33]
B
I just want hydration. I'm not into this crazy glass skin that looks like you put olive oil on your skin and you took a picture. We go to such extremes in this industry. It's insane to me. How does. I'm not a makeup wearer, so My big thing, Dr. Ekta, is to make sure whatever I do makes my skin look good. It doesn't have to look like an oil slick for it to look good. So there's a lot going on that I'm. I just sit back and go, great. It looks great on Instagram. But how is it really for an everyday approach to walking down the street?
- [29:12]
A
No, but I. You know what? It's crazy to see this, because I remember even, like 10 years ago, we had a huge plethora of makeup products launch just to combat oily skin. We. We went through this. So now to see everybody is like, oh, I want glass skin. No, you just want a bunch of shine on your skin. And we went through. I mean, we went through so many things as a beauty industry, like before, where we were like, we want to avoid that.
- [29:39]
B
Well, it'. You know, it's all cyclical in this industry. And like I said, my biggest worry right now is when I see these extreme stacking procedures, people going to Korean, getting 10 treatments at once. Like we just said. How do we know that one of those treatments wouldn't have given you all those results anyways?
- [29:56]
A
Exactly. No, that's a really, really valid point. And I think, I mean, I also am very reluctant. I mean, for me, as I can't speak for anyone else, but for myself as a patient, as a consumer, when I go and get anything, even with skincare, I'm like this. I don't know how many people can relate, but I want to see what this thing is going to do. So I give it at least a week. Give yourself a minute, you know, like, let your skin react to it. I think people are just chasing fast results so much now, more so than ever, that we have forgotten that the human body has. It has.
- [30:28]
B
It has to heal. It has to heal, and it has to heal. So if we're creating trauma on top of trauma on top of trauma, I can tell you, like I said, I've been in the industry 40 years, not five, not 10. I can tell you that sometimes, like I said, we saw it with the full CO2 ablation, they look great for a few years. Now I see those patients back and their skin has these deep wrinkles that aren't. No, they're not normal. They're from having degraded that elastin and collagen so much it doesn't even know how to reform anymore.
- [31:01]
A
See, that is the body's natural reaction when you inject, inflict a certain, like there's a threshold. I always say this, I've said it before on the podcast even about skin care. Like, you know, people have those ridiculous acid treatments that are over the counter and you just, I see these 30 aha. Treatments or whatever they are, and I say, I'm like, your skin's going to get to a point where it's going to say, I can't take this anymore. And so the body's response is, okay, how do I shut this down? How do I stop it from happening? That's when you get scar formation. That's when you start going and kicking into those, that kind of tissue remodeling where your body is now not remodeling for healing, it's remodeling to protect. And so the protection is the scar. And so that's where I think the education is very much lacking in the aesthetic space. Patients are not being told, listen, this is how the skin works, this is how it reacts, this is the limit, et cetera, et cetera. We don't do that. And I would love for you to speak on this a little bit towards, especially for any, all of my ethics estheticians listening in, that if you do work with skin and you are seeing this day in and day out, what should they know and how should they prepare for their own practice so that they can really prep people for whatever's coming next for them in the aesthetics.
- [32:11]
B
World, I would say, like I said, I would limit the amount of heat based treatments. If they're seeing their patients swell and swell to an extreme, I would definitely. Microneedling, to me is the gold standard. And here's the crux. Not deep. We don't have to be deep. What we're learning is for a few years there, people were going, the deeper the better. Well, that's not necessarily true. When we're talking epidermal, you want to just affect that epidermal layer. That's what's going to give you the hydration, the gentle glow. Maintain good skin care. And here's my other pet peeve, overuse of retinols or too strong of retinols and you're using a retinol product and you're always Always, always red. That's not good because you're constantly having that skin in healing mode. Well, we want it healed and then we want to affect it again. Don't want to keep it in a hyper reactive state. Right.
- [33:13]
A
Constantly inflamed, constantly angles itself. Yeah.
- [33:16]
B
I mean, yeah. There's some skincare lines out there, like you said, that are mind blowing at how strong retinol is for at home use.
- [33:24]
A
It's insane, isn't it?
- [33:26]
B
And they're buying them without seeing a skincare professional, without seeing their injector. So the injector isn't seeing. Well, not everybody needs. Some people can really. Well with 0.25, we don't. Some people don't need 0.5 or a full 1% retinol product. Let's buffer this down a bit. You don't want the skin constantly trying to fight to heal. We should let it heal then do another procedure.
- [33:51]
A
Absolutely. I love that you brought that up and I, I could not agree with you more. I think I've been saying this to just my friends or anybody because I've been actually against retinol for a long time or you've seen this. Talk about vitamin A. Vitamin A, it's very heavily used in leukemia. Why? Because it turns over cells so fast. And so when you're using incredibly high percentages, you're. Are you really doing at that point doesn't need to be turned over at ridiculous rates. It's exactly what you said. Some, sometimes you do need the 0.25 more than enough.
- [34:22]
B
Yeah. With once a week. It's. And what's interesting to me is you'll hear this whole dialogue in the industry that retinol doesn't thin the epidermal layer. I can pick out somebody that an older woman that walks in that has retinol for 20 years and hasn't metered down at all. Their skin looks fragile.
- [34:44]
A
Yeah.
- [34:45]
B
And, and we go back to us because it's always in that heightened state of damage. Yeah.
- [34:51]
A
It's that it's chronic inflammation. Yeah. And it's, that's what, that's what breaks down everything. And that's. I'm so glad you're saying this because.
- [34:59]
B
Well, it's different if you have somebody who has really thick dermal skin. Got people that have people who had acne, bad acne when they were younger do have a much thicker dermal layer. So they might be able to handle stronger retinol. But somebody like me who is getting, my skin's getting thinner, you know, hormones all that good stuff. I'm fully HRT hormone replacement therapy and my skin's doing much better. But if I keep exfoliating my thin skin, where am I going not allowing it to thicken at all.
- [35:32]
A
Exactly, exactly. No 100%. I totally trust me. I, I'm right there with you on this. I think that at the end of the day it just comes down to education introduced such a large amount of products and options to people now and services and that we are now bombarded as a society with all of this stuff and we think that everything's meant for us and it's not. You would think when you create options for people, people start shopping smarter. But your less logic dictates. But unfortunately we've somehow ended up in a world where same person who's going and getting Y Z done, they're going to opt in for the most extreme version of it. People don't want the middle ground. They don't want because always say most expensive thing is the best option. And that's not true. People always say this about every everything that you buy. If you buy the most expensive thing like you're getting the best. But it's not true. And I feel like that's the world we live in now where crazy going on.
- [36:29]
B
I agree 100%. And what's happening in the industry? What I'm seeing happen in the industry. My son owns now four med spas and we keep it very aggressive. I said he's not a first adopter. And we do the basics. Basics. And that's what people need. We need to start with basics. What's mind blowing to me is how many different lasers have come on the market in the last 10 years. And what's interesting, they can call these things whatever they want. It's light based technology. So we know what technology does affects chromophores. So doesn't matter what the name of your machine is. I need to know what chromophore and people like you said, there's so much information out there that people don't even know what a chromophore is today. Yeah, that's what they need to be affecting when they're using these technologies. So it's important to make sure that the people you go to aren't always bringing in the newest. The craziest is not always the best. How's that? Let's get these things proven before we move on. Yeah. If you got laser done 20 years ago you would have regretted it. So they've tweaked them and the good Thing about it is they have somewhat, that I call it monkey proof them. They have a lot more safety features that anybody can turn these on nowadays and get some results. But if they don't know what they're trying to affect, they're not going to get the results they want. If they're, if they don't know that that machine targets reds and they're trying to target browns, they're not going to get the result they want because the brown's not getting affected.
- [38:01]
A
Right. No, that's, that's a great point. I think it's, it's really, really high time that we focus on the education component. I think that that's where aesthetics, in my opinion, needs to go. But I don't know. We'll see. I guess, because I won't lie, even for me, I don't know about most of these procedures. Like, I will be very real. And for everyone listening, I'm scared half the time because people, all my friends are like, yeah, I'm gonna go get this laser done. I'm gonna get this treatment. My initial response, no, I'm gonna pass. Because I don't know, I just feel like there's not enough data for me to be convinced that these things work in the long run. And again, that might be mised part.
- [38:39]
B
I've been in the industry long enough to tell you they work. Yeah, in the right hands, they work exceptionally well. But to your point, I think that we all need to do a better job understanding what these technologies are good for. I am excited about all these topical treatments that do work. That, like I said, I know I've been in the industry 40 years, and when I see. See real results from a product used once I get excited, there goes the other problem. As a company, we're really big on metering out. We don't want people coming in every two weeks or something. Yeah, they need a game plan. You want three months of this, two months of this maintenance. Once we get you, we want to get you to maintenance, you shouldn't constantly be looking at. I'm going to say it again. Damaging that epidermal layer. To get your results you want to do. It's not a marathon. Yeah, it's not a sprint. It's a marathon.
- [39:36]
A
It's this marathon. Yeah. No, it's. It's really, it's important, I think, to understand that. And I, I really like your approach. And I. Having so much experience with this industry, I think we can learn a lot from a lot of the things you've shared here. Because at the end of the day, the people I worry about the most are the ones that are 21 years old, you know, and they're 22 and they're just.
- [39:57]
B
We're talking 12 year olds. 12 year olds getting. It's insane to me. And what's awful is, like I said, it's different if you're going to somebody who understands skin, whether it's an esthetician, a dermatologist, whoever. But these kids are buying this stuff at Ulta and Sephora with no guidance. We're going to see some weird stuff in the next 10 or 20 years. I don't doubt it. Because at 20, how much collagen do you need to induce? None. They still have it. It's still happening. You shouldn't be doing a lot of the stuff till you're 35. That's when really it starts taking a downturn and you'll do more of it as you hit 60. But at 20, the only thing that you should be working on is sunscreen, a good cleanser. And if you have acne, go get some good acne treatments.
- [40:44]
A
Right.
- [40:44]
B
I shouldn't be looking at wrinkle reduction at 20. Even when I hear that 20 year olds are getting Botox. It's just, how much are we going to atrophy that muscle for you?
- [40:54]
A
Yes. Thank you. Oh, my gosh. I don't know why we. No one speaks about this. And this is what I was saying. All these injectables, before the injectables came on the market the way they did and blew up the way they have in the last five, 10 years, maybe I didn't even know, honestly, like the world of aesthetics was a big gray box for me and I didn't even know. And now every 21 year old has lip filler. Every single one of them. And when did this happen? How did this happen?
- [41:21]
B
And you know what? I'm okay with lip filler. It's one of those things, the right amount, it creates hydration. But what 21 year old needs to cheek filler, what 21 year old needs heavy duty micro needling. Maybe they need at the lowest at that point, 5. The mentality shouldn't be more at 21, it should be less.
- [41:41]
A
Yeah, exactly. What treatments do you think are the best then? Because there are. If there's anybody listening in that maybe.
- [41:47]
B
Of all the treatments I absolutely love are thuleum. I don't know if you know what thuleum is. It's a type of laser. It's awesome, not overly aggressive. It's, it does deep heat. I love a good yag for appeal. If I had to pick between, unless you're a melasma patient, then you don't want any heat, then you want to stick to microneedling. But honestly, microneedling, microdermabrasion. I love microdermabrasion. I mean, and microdermabrasion has fallen out of favor. I still love it with the original corundum crystals because they were antibacterial, antimicrobial. That's the other thing I don't like about the industry sometimes is what's tried and true and probably doesn't cost a lot for a place to bring in because it's old technology works and we're constantly looking for this new and better. And God, lasers are now costing. I can't even tell you how much lasers are costing nowadays. It's just mind blowing where they might get just as good of a result doing microneedling and microdermabrasion. So I think the thing to do is understand that when you're young, when you're under 30, you don't need a lot of intervention, you need a lot of maintenance. And the only thing I think everybody should be using is sunscreen on the face, whether they use it on their body, whatever. But if you don't want wrinkles, you definitely need some sunscreen, some good quality sunscreen. I'm a fan. I'm a big fan of micro needling with skin boosters. I really am seeing what I see on an everyday basis. And you're talking, I go into, God, probably 100 med spas a year, if not more. I see a lot. I see a lot out there and I see a lot that I don't necessarily am starting to not agree with. When I, which was not the way it was for me five years ago. I am glad to see the reduction of use of fillers. Fillers have a place, but not to the extent that was going on in the last seven years. So I think Botox, it'll be something that will always have. I think that people do like not having wrinkles, less movement. It's nice to walk into a room and not have you read my face. But like I said, I think my biggest, biggest fear of the industry is that we hop on new things too quickly.
- [43:57]
A
Yeah, no, I think that's a really, really strong point. And I fully agree with you. I think we haven't even fully caught up with education on like what you were saying, like microdermabrasion. How many people Know what that even is really how it works? Not a lot. I'll tell you. Because.
- [44:11]
B
Yeah. Which is. Which is mind blowing to me, Dr. Ekda, because I still have my microderm machine and I still use them that I still microderm myself once a month. And that's honestly what I think has kept my skin as good as it is over the. So I start. I got my microderma machine delivered when I was 35, when I was starting to see fine lines around my eyes. And I'm now 60. And if you were to see me. Yep. I get Botox. I don't get it. Crazy. Like, I'll go four or five months without it. I don't mind a little movement, but it's that I'm gonna go back to that millimeter, very small millimeter of skin damage so that my body heals that without causing too much inflammation.
- [44:50]
A
Right. No, I. I think that's. That's actually very smart to stay with these, because microdermabrasion. Yeah. I mean, I can get behind that way faster than I could get behind some of these really now invasive lasers that we have. It's not something that scares me nearly as much. And even when it first came out, I mean, it was very fascinating for me to read about it as consumer. And we're being very interested. And. And I think we do have to do a deeper dive into some of the older treatments. I'm. I fully agree with what you said. I think that we are in this world where it's like, we're gadget happy.
- [45:22]
B
Gadget happy.
- [45:23]
A
Yeah, we're gadget happy. And. And I'm all for scientific curiosity. Don't get me wrong, just like the next person. But you do have to go come back to the basics with skin. It's a very versatile organ, but it has its needs. The needs that it has are going to be the same now that they were like 500 years ago, a thousand years ago.
- [45:40]
B
The skin has to change.
- [45:42]
A
It hasn't changed. Right.
- [45:43]
B
It hasn't changed.
- [45:44]
A
And if it works, why are you breaking what works? Stop reinventing the wheel over and over.
- [45:49]
B
Exactly. My biggest complaint, I think today is that consumers. Consumers think they know what they need.
- [45:58]
A
Yeah.
- [45:58]
B
Versus taking the guidance of people who actually do it every day. So my needs, because I'm a melasma patient, are going to be different than your needs. Needs. So me watching TikTok and choosing my procedure based on somebody else's skin is not the way it should be. I think we got to go back to trusting the injectors that don't hop on every bandwagon to some degree. You want to go to somebody who's knowledgeable in the field and you shouldn't be basing who you go to on the level of followers of a person.
- [46:35]
A
Oh my God, that's like an entire conversation I could have with you for hours. Because this, I feel so strongly about this. I, I honestly, at the end of the day, no hate. Okay? I no hate. No hate, no hate. But like, honest to God, for all the, the famous, whatever injectors and derms and all these people out here, you guys got to check them. Okay. You got, and I'm honestly saying this to our audience, like you need to start fact checking people. It's one thing to say, okay, I have a degree in this and I feel I'm qualified to speak on it. But it's a whole different thing to assume that whatever's coming out of someone's mouth just because they have 500,000 followers on Tik Tok the guy, the God.
- [47:12]
B
Honest truth about it, the end all.
- [47:13]
A
Yeah.
- [47:14]
B
Because I'm going to be honest to have that many followers. How much are they working and who's sponsoring me? That's good question.
- [47:23]
A
Who's sponsoring me behind the scenes that I'm not telling you about? Not every. See, this is the thing. People have all these videos and some of them are blatant ads, but a lot of them are ads and you don't even know that they're know about it.
- [47:36]
B
No, because they're being paid by the manufacturer and you're not being told they're being paid by the manufacturer. And I am going to give you a point.
- [47:41]
A
Point.
- [47:42]
B
The difference between the United States and Europe, okay. Physicians in Europe or injectors in Europe don't have the presence the US people do because they can't show before and afters. They can't hop on every bandwagon. They are very science based. You go to conferences in Europe, they are science based. Here it's like whatever my feel is for the day. So it's very different if you really think about it. Can you even think of a European influencer?
- [48:12]
A
No.
- [48:12]
B
Exactly.
- [48:13]
A
Oh no. And I like that. I honestly, I like that a lot. Maybe for me, as a, as a doctor myself, I have always been against before and after pictures being on social media. I think it's. My personal opinion is. I think it's a breach of privacy laws. I think it's unnecessary. And I think it also sets. There's this thing we have to Manage patient expectations. I'm sure, like you've, you deal with this a lot in your work. Patient expectations have completely changed. Changed since this whole garbage started.
- [48:39]
B
They're unreal patients.
- [48:41]
A
Yeah, they're unreal.
- [48:41]
B
Patients are very much biased by who they're following. And then they go get the treatments and they don't, they don't resemble what they're seeing. They think it's the injector's fault versus, well, if it's a good injector. They're not. I'm going to go back to. You shouldn't look completely different when you leave an office. You should look like you, you refreshed. That's it. Nothing more.
- [49:05]
A
Right, right, exactly. I feel like that's what it used to be. Because, I'll be honest, when I was growing up, you'd heard about things like the big name Botox, any kind of plastic surgery procedure, you heard about them, but you knew that the people who were getting them done, patient age range, like you kind of had an idea of it and you understood like there was a real need. And then they went and they got some work done and that was fine. And that's, that's, that's okay. But nowadays you don't even know half the time. It's kind of become this whole different world than it was meant to be, I think. And it scares me to see that because the lines of medicine are blurring here.
- [49:40]
B
To think that we have surgeons out there doing mini facelifts or full facelifts on 35 year olds, I mean, that's crazy. If you're going to full disclosure, I had a lower facelift by an awesome doctor in Chicago two years ago. Go just lower face. I'm at that. I was at that point where it's like, okay, I've done skincare my whole life. I've done all the non invasive. I'm gonna be 60 soon. This is when I want it, because it'll get me through to 80. To think that we're getting one at 35. What you're going to do another one at 45, 55, 65, 75. And how distorted are you going to be? Because I don't care. The surgeons can scream how the non invasive stuff is bad, but at the end of the day, every time you do a surgical procedure, there's gonna be real scar tissue. And after a while, when does it become deforming scar tissue?
- [50:28]
A
Right, exactly. And also you can't predict how they're going to scar. That's my biggest argument with Surgeons, I've gone through surgical training myself. I'll tell you right now, you don't know how a patient is going to heal, okay? There's not a surgeon in the world that can tell you that. And if they pretend to tell you that they're lying to you. Straight, blatant face lie. And that's my biggest problem with plastic surgery. And I've always had this problem with it. There's again, patient expectations. You guys are straight not disclosing this information to your patients. You don't know if someone is predisposed to keloid scarring, okay? And you can get keloid scarring for anything. You could have a little abrasion tomorrow and keloid scar from that. That's the truth. And if you go and you get a procedure done, your surgeon doesn't know how to train you and to prepare you mentally for the healing process. This, you're in for a ride. I'll tell you, you're going to be.
- [51:18]
B
In for a ride and I'm going to go back to that's where they should be working hand in hand with a good skin care provider. Because that was the difference. I would help my clients mitigate their scars. I knew what setting my microderm machine needed to be at. The clients I helped my surgeon with would have barely noticeable scars. And at the end of the day I, I really think this glamorization surgical procedures young. I mean obviously if they need it, if there's a deformity, if they have a hump in their nose, if there's a reason other than anti aging, okay, I'm all for it. But when we're talking, how is it possible that a 35 year old, unless she lost a lot of weight, has so much sagging that she needs a lift? Yeah, I'm big on, we need to be accountable to really watching these things and going this is not okay. This is not the message we should be sending 12 year olds, 20 year olds, 25 year olds. The message we should be sending them is you need good skin. If you have good skin, you'll be happy.
- [52:19]
A
Exactly. No, I couldn't agree more. And it's, it has been so such a breath of fresh air to talk to you. Giovanna, thank you so much for all of your knowledge and for sharing with us. I honestly, we should do a part two because I feel like this is something that we don't get to hear about. No one from this industry, and this is the sad truth about it is, and I love aesthetics. Okay. Honestly, I Love the field of aesthetics. I think it's fascinating. But we got to get education, we got to get it, we speak up. Yeah, yeah.
- [52:49]
B
And that's why as a company that's been in the thread part, now that we're doing the skincare part, we're also skincare products I'm bringing to market are things I know work. It's not fluff, they're not super expensive, but they actually give results. And if you continue them, it'll give you long term results. But that, I hate to say this because we focus so much on education, it probably holds us back as a company. And that's the honest to God's truth. The fact that I don't want to have room full of people teaching them something that they shouldn't be learning in a half day hurts us as a company because that's that many less people I have in front of me to teach. But we have never veered from that.
- [53:30]
A
That.
- [53:30]
B
Because you're using one of my products and putting it in somebody's face or on some. On somebody's face, that matters to me. It matters a lot.
- [53:39]
A
Exactly.
- [53:40]
B
I definitely don't want somebody disfigured with something I'm selling.
- [53:43]
A
Exactly. Yeah. You have an ethical, moral compass there. And I think that's really where I was saying this earlier. The lines have, are blurring for medicine. The lines are blurring. And that's just the honest truth. And I think anybody who's practicing, practicing in this field needs to pause and think, what am I pushing out and what am I doing? There is an entire component of practicing medicine in any field that has to do with patient education. That should not be a compromise. That shouldn't be an optional step in your process.
- [54:10]
B
Not at all.
- [54:11]
A
If you go to any hospital right now, if you, if you come into a trauma bay and I'm treating you, I have to make sure that you, as a patient, understand what you're about to go in for. That's a mandatory requirement that we have to go through. Now if you do that, if you're not doing that in something like aesthetics, you're literally not following medical rules. So that's just something to think about. Food for thought, I guess for anybody out there who's not educating their, their patients, clients, it's common sense. And also, more importantly for patients, if you're scared to ask someone questions, that's a red flag. If you can't go to them and say, hey, can you educate me on this? Tell me what I'm in for, like what does this entail. What's the science? If they can't explain the science to you, do that means they shouldn't even be doing it in the first place. That's the bottom line. And I don't know why more people don't speak up. That's where I get confused.
- [55:00]
B
Well, I think it's because. I think it's because honestly, it's. It's still taboo to some degree. If something happens because you did a vanity procedure.
- [55:09]
A
Yeah.
- [55:10]
B
People have guilt with that.
- [55:11]
A
Yeah.
- [55:12]
B
So they're not gonna speak up on it. They're not gonna complain. They're not going to tell somebody, hey, I went and got this done and I hate, hated it. That's one of the problems with this. It's an elective procedure. So you chose to sign on that dollar line, whether you didn't do your own due diligence to learn about it. You signed on that dotted line. So you feel responsible for what just happened to you.
- [55:35]
A
Right. That's so sad. It's so sad to think that. And I. I hope that. I really hope that something changes in the sense of. I hope we keep.
- [55:43]
B
Like I said, I think we are going in the right direction. We're talking more about skin quality. I can tell you that the this year's conferences I've been to have been more about skin quality than about interventions.
- [55:58]
A
So.
- [55:58]
B
And how the interventions help with skin quality. So I think we are moving in the right direction. I think that there's been enough pushback. And what I am seeing is the med spas that stick to their ethics are thriving.
- [56:14]
A
Yeah.
- [56:14]
B
So I like to see that we are seeing a lot of slowing down of the industry. No different than I lived through the 2000. I tell everybody I lived through the 2008 financial crisis. And people don't stop spending on themselves, they'll just push it out further. But they. What they do do at that point is more education because now they have more limited funds. So they want to spend those limited funds on things that work. Right. And in fact, that's why we came out with. We came out with a kit called the Glow between, which is micro infusion of vitamins, yada, yada, yada, a great skin booster. And we did that because what I found in 2008 is that people who are coming in monthly now we're coming in maybe every three months. And I'd have to start over.
- [57:00]
A
Yeah.
- [57:00]
B
They weren't maintaining. It's not like I'd have to start over way to the beginning. But now I'm like, okay, you need two or three treatments to get you back to. To where you were. So what I wanted to create, being that I've lived through it once and saw how the consumer responded, was to be able to give them a product that is not to the level of getting a treatment at a med spa, but be able to maintain that treatment so that they're not feeling like they have to spend double when they go back to spending again.
- [57:31]
A
Right. No, that's how it should be, though. You shouldn't have to feel like you have to have to get the same thing done over and over again. So that's wonderful. I love your approach, and I think that we can learn a lot from that. I think a lot of people in the world we live in, it's instant gratification. But at the same time, like, you cannot sacrifice ethics. And I love that you really stand for that. And I agree. I think a lot of times these conversations come up and everyone's throwing the word longevity around. And I think if you really want to talk about longevity aesthetic, you got to go back to the tried and truth. You got to go back to the tried and true.
- [58:01]
B
You got to go back to what works and what we can actually maintain pain and not make people worse. Because the rebound effect of some of these procedures.
- [58:12]
A
Yeah.
- [58:12]
B
Are not great.
- [58:13]
A
Exactly. And you'll end up spending more money fixing that than you will.
- [58:17]
B
Exactly.
- [58:17]
A
Getting the right work done. Yeah, I agree. Well, this has been so wonderful, Giovanna. Thank you so much.
- [58:23]
B
Definitely do a number 2. Pick a topic in this industry. I'll be happy to give you my two cents on it.
- [58:29]
A
No, I would love to do it. And thank you so much much for educating. I mean, I think that's the number one thing is not a lot of people are happy and willing to do that.
- [58:38]
B
So education so important and education, like, there are so many great. I have to say I am excited of where we're going with skin care. Not necessarily everything else, but we are really. These med spots are starting to dial in on good skin, and I'm glad to be part of that. I'm glad to. To. Like I said, I was honestly the first one to bring topical PDRN to the United States, and then everybody followed because there were big brands in Asia and stuff. But the reason I did it is because I saw how good skin looked. And if your skin looks good, you're less tempted to get overfilled. You're less tempted to do the extreme stuff.
- [59:20]
A
Yeah, exactly. I mean, that's the thing is Like, I think if people were introduced to these kind of options, what you're saying, like evolving the pdrn, making sure you're doing something like microneedling before you opt in for that crazy laser, I think people would be more happy, and I think you would also. It would stop you kind of. It's like a. It's like a check and balance going on. You'd look at your skin like, oh, no, I'm happy. Like, I don't need this. Yeah, exactly.
- [59:46]
B
And like I said, my surgeon point blank said if you hadn't been taken as good care of your skin, your results would not have been as good and you wouldn't have healed as quickly as you did.
- [59:56]
A
Right.
- [59:57]
B
So it goes hand in hand with everything. The better, the healthier your skin is, the better all your results will be.
- [60:05]
A
Right, Exactly.
- [60:06]
B
So it's. It's like literally the most important component in aesthetic medicine, right?
- [60:14]
A
Absolutely. Well, thank you so much and I hope that everybody listening in. I hope you guys learned as much as I did. And stay tuned for more.
- [60:23]
B
Thank you.
- [60:24]
A
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