Ep 180 - What’s New in Medical Esthetics

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0:01:36.6 Ella Cressman: Hello and welcome to ASCP Esty Talk. I'm Ella Cressman, licensed esthetician, certified organic skincare formulator, and Content Contributor for Associated Skincare Professionals. 

 

0:01:47.8 Maggie Stasek: I am Maggie Stasek, licensed esthetician and ASCP's Education Program Manager. 

 

0:01:53.1 EC: And we have another shoutout. Hey, Deanna Travis of Shelbyville, Tennessee. Thanks for listening. We're glad that you like it. Today is gonna be a really fun topic. I'm excited to chat with you about it, Maggie, because I think we've talked before about a lot of things and one of them is the influence of medical aesthetics in our profession. But we also have medical aesthetic opportunities as an influence for our culture. 

 

0:02:24.1 MS: Yeah. 

 

0:02:25.0 EC: Big time. And I think in my lifetime, that has changed. And it seems like in the last 15 years, the opportunity for that influence has exponentially grown. 

 

0:02:38.3 MS: Yeah, I think it kind of ebbs and flows, right?  

 

0:02:41.7 EC: For sure. I think when we have that overlap too with aesthetics and medical aesthetics, there's some interesting things that happen. The other thing that happens is trends come and go, and it seems like some people attach to trends normally and it makes sense. And then other people attach to trends and then turn up the volume. 

 

0:03:05.8 MS: Oh, yeah, totally. 

 

0:03:07.1 EC: So I have always had big lips, beautiful, big lips. It's a thing. People would tease me about it in elementary school. But little did I know that there's a lot of things about me now that are very on trend. 

 

[laughter] 

 

0:03:19.7 MS: Embrace it, girl. 

 

[laughter] 

 

0:03:20.9 EC: One of them is my lips. But at 44, 43, 44, I started to notice the volume loss. Normal aging, they're still pretty for my age. But I did have... I'm like, talk to my injector, I'm like, "Can I get a little bit? Do you think it's time?" 'Cause we've had that conversation for a long time. "Tell me when it's time. So do you think it's... " She's like, "Yeah, I think you can do a little bit." "Little bit" keyword. 

 

0:03:43.0 MS: Yeah. 

 

0:03:43.7 EC: I got them done. They swelled up after you get them done; just a little, little bit, ugh, so much. I'm like, "What did I do? This is crazy." But then once the swelling went down I'm like, "I should have done more," which is what she told me, "You're gonna want to do more." But I was like, "Stop there. Stop there." So I can see the desire for more once you're in it. Now, I haven't had it done for a while, but I had it done. I thought I was being undetectable when my sister-in-law asked me, and I'm like, "Dang it." [laughter] 

 

0:04:11.4 MS: Yeah. I mean, people that look at you every day, I think they notice those little tweaks or enhancements that we do. And I wouldn't put filler in the category of plastic surgery. But to your point, you hear about these people that become addicted and then they can't stop. And they look weird. 

 

0:04:27.4 EC: Yeah. And that's, I think, easy when you're doing those little tweaks, like you said. The little tweaks add up to big tweaks. And I think that a lot of people found that to be the case with their dermal filler. And then now you hear a lot about dissolving of the dermal filler. So first, let's talk about what is a dermal filler. 

 

0:04:47.3 MS: Yeah. So dermal fillers, they're like a gel or jelly that get injected under the skin, and it's meant to just smooth out the appearance of the skin or give it more of a full appearance. 

 

0:04:58.9 EC: And there's a lot of different types of fillers, mostly hyaluronic acid. By the FDA, there's only one that is not temporary. It's a silicone of some sort, and I don't remember what it is. But there's only one type that's permanent. The rest are temporary. Because they're made of hyaluronic acid your body slowly absorbs them, but sometimes not quick enough. So the way that they're dissolved is by injecting the enzyme hyaluronidase, and that catalyzes the hyaluronic acid. So it speeds up the degradation or the absorption of it. So in effect, neutralizing it. But people have, like celebrities all over, have been getting this done. Courtney Cox, we saw. But did you think she was getting odd-looking?  

 

0:05:45.2 MS: I guess I haven't been looking at her. But in any photo that I've seen, I've never looked at Courtney Cox and thought, "Oh, she's weird-looking." 

 

0:05:52.2 EC: What about Melanie Griffith?  

 

0:05:54.0 MS: Yes. Yeah. 

 

0:05:54.8 EC: Okay. She is the one that got hers. Simon Cowell had his removed. Danica Patrick, Khloe Kardashian, and Kylie Jenner. And then Blac Chyna is one who is like most recently everybody's talking about hers. So she got her facial fillers, and then she had other fillers put throughout her body because that's something else that can be done. What I thought was interesting about hers, I, oh, never realized she had facial fillers. But her face was always very angular, and I cannot wait to see what she looks like normally. 

 

0:06:30.3 MS: Oh!  

 

0:06:30.9 EC: So some of those things like the angular look, that big cheeky look, another one that had hers done was a celebrity in my world is on The Real Housewives of Miami. And hers was the same thing. It started to get where they all look the same. These really high cheekbones makes the eyes look squintier, like almost alien. 

 

0:06:49.2 MS: Yeah, I feel like it's like this cat face almost. But what's weird is that there's this trend now to take out buccal fat, which I feel like is also giving almost that same appearance where you have really high prominent cheekbones, but no cheek. 

 

0:07:05.3 EC: Well, what's the long-term... I wonder what the long-term effect of removing that buccal fat is because that's one of the things... Well, it migrates with gravity, but also in this one indication of like age advancements is the movement of that. 

 

0:07:20.8 MS: Oh yeah, you get the sagging jowls. 

 

0:07:22.8 EC: What's the long-term effect of not having that? And I think that is another important thing. Recently, I saw an interview with Blac Chyna where she was talking about her plastic surgery journey and why she's going through all of this. So she had her dermal fillers in her face dissolved, but she had also had her body modification, let's call it. So she had in 2007, at the time was before Brazilian butt lifts was a thing, but she had injections into her rear end. And she said that at that time, she was 19 years old, in her environment the people around her where she was working, that that was her ideal of beauty was this large backside. And so in order to get it at 19, that she had these injectables. But the thing is that at 19, she wasn't fully developed yet. And so she's dealing with these modifications that have potential long-term consequences. 

 

0:08:17.0 EC: I thought that was so important because we see people now, "I'm an adult, I want to have an augmentation of my breasts, or I want my lips done, or I want this dermal filler." These young girls wanting dermal filler in their face to have this trendy look without the foreshadowing or the looking-at-the-consequences, the long-term consequences. I thought that was a very interesting point that she made. 

 

0:08:42.2 MS: Yeah, totally. And I got two things to say about that. First, I remember, I don't know, maybe this was like five-ish years ago where like the duck lips was trending. And young girls were specifically getting injections in their lips to have that pout, which I thought looked ridiculous, by the way. And it was also when selfies really became a thing. And then also, I know a lot of injectors and young girls who were coming together and doing like Botox and things of that nature on people who were like 19, like Blac Chyna at the time, and saying that this was preventative care for aging. 

 

0:09:22.8 EC: That's just crazy to me. I mean, a little bit. Like I started... Let me tell you guys a story of the first time I ever had Botox. I went to my still injector, still go to her. I was in my early 30s, okay? Not 19. [chuckle] I was in my early 30s. And I had these two little baby lines close to my hairline. And they were baby lines and I knew they were there, and I wanted them to stay baby lines. So I said to my injector, "Should I get... Should I get a little bit up here?" She's like, "Ugh, God. I guess," like, "I don't know why you're doing it. You're so young. It's not even showing up. You have nothing." She went through this whole spiel pretty much literally rolling her eyes. You know my injector, so you know exactly her personality. And then she's like, "Fine. And I'm gonna do your chin." And I was like, "What's wrong with my chin?" [laughter] They have a different eye, but I think a responsible injector would not... I mean, would take those into consideration. 

 

0:10:19.3 EC: Which is another point. We're gonna quickly move on to this next subject. But I did want to point out the other thing that people... Speaking of body modifications and when you're younger, some people are also removing their breast implants either completely or sizing down. So that's an important consideration. When you're young and want that, think about it. Even though they say they're like 10-year lifespan. You ever heard that?  

 

0:10:42.8 MS: Oh, yeah. For the breast implants?  

 

0:10:44.0 EC: Yeah. Somebody said that to me. "I'm gonna get them. I'm gonna get them." "Well, go, they're good for 10 years," they said. 

 

0:10:48.2 MS: Oh, my mom's had them for 40. It comes with a 10-year warranty. 

 

0:10:51.8 EC: [laughter] Yeah, it's crazy. But the other thing is this Michelle Kay. She had surgeries, a bunch of surgeries, and blood transfusions in 2018 because she had illegal butt injections. And she had... I don't know exactly where she went, but she had them done. You know this story too, right?  

 

0:11:13.9 MS: Mm-hmm. Yeah. 

 

0:11:14.9 EC: So she had them done. And where they were, they were inhibiting some blood flow. There was too much volume. It wasn't sustaining. There was a lot of problems, but it was affecting her health. So I think I would want to encourage people before they're... If they're younger or if they're going to another country, as we kind of talked about before, think about where you're going and if they're reputable because that's potentially dangerous. 

 

0:11:43.5 MS: Yeah, for sure. I mean, really scary. And I think all of this, you know, whether it's the butt injections, breast implants, also even with the facial filler. This is in line, I think, with a lot of the topics we've had in this year. And even the end of last year, we're seeing this "clean and green" and everybody going back to "all-natural" and "accepting aging," this "pro-aging," as opposed to trying to stop it, if you will. And I think that... I'm hoping that pendulum swings for body... I mean, we see a big, big movement on body positivity. But if we look at the trendy body from our youth, mine and yours, because we're about the same age, if we look at the '80s ideal body. 

 

0:12:26.4 EC: Oh yeah, I was gonna say Baywatch. 

 

0:12:28.1 MS: Yeah. No back. All front. You know?  

 

[laughter] 

 

0:12:32.1 MS: Thin eyebrows, like that. 

 

0:12:33.9 EC: Yeah. 

 

0:12:34.9 MS: Tan. 

 

0:12:35.8 EC: Yeah. 

 

0:12:36.1 MS: Gauntly sometimes, right? And then we look at the ideal body, the trendy body right now, the body-ody that is feminine with hourglass shapely, even though there's extremes. There was extremely skinny and straight, and now there's extremely curvy, whether they're enhanced, modified or not. But I guess what I hope is there's some healthy pendulum swing. Because you can have those things naturally. You can be disposed for a certain body type and then do squats or certain things to change. I can work out my midsection and increase my hourglass, you know? So there's opportunities for natural body modification. And I think it's okay to have some surgical, some aesthetic assistance, but just make sure that you're doing it responsibly, I guess. 

 

0:13:25.9 EC: Hold that thought. We'll be right back. 

 

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0:14:53.8 EC: Okay, here we go. Let's get back to the podcast. Now let's talk about another really cool, I think, an exciting development in the industry. And this is an alternative to Accutane. This is the AviClear from Cutera Lasers. But first, let's talk about what is Accutane. 

 

0:15:11.0 MS: Accutane has been around for a long time. And it is... Accutane is the trade name, but it's known as Isotretinoin. It's a powerful drug. Really, it should be reserved for those grades 3 to 4 cystic acne. I think, unfortunately, you do see people that are prescribing it for 1's even, 2 grades acne. And it is for patients who have failed to respond to other treatments, failed to respond to the benzoyl peroxides, the antibiotics. That's gonna be things like your tetracycline, your clindamycins, things of that nature. And it has many, many side effects. And so I just want to say, this is according to American Osteopathic College of Dermatology. So many side effects, but in some ways it is safer than long-term antibiotic usage. And most other acne-controlling medicines are antibacterial agents, which are effective only if used daily. I think that's interesting. There are over two million people that have taken this drug, probably more. And there are a lot... So a lot is known about its safety and effectiveness. That, I think, is an interesting statement because Accutane is known to have a ton of side effects that are not safe. Really, what it's doing is reducing sebum production and it also dries up all, really, the mucous membranes in your body. That's in your nose, in your mouth, in your digestive tract. And I think it is the devil. 

 

0:16:45.9 EC: I think it's a very dangerous option too. And it scares me when that seems to be an option for some of my clients or patients because when... That's a last resort. But there was a time that I was working for someone else down in Cherry Creek, here in Denver, for the people that don't know. So that type of person that is in Cherry Creek is very demanding. This is generalizing 'cause there's a lot of nice people there too. So before I get any emails... 

 

[laughter] 

 

0:17:15.8 EC: It's a lovely place, that Cherry Creek. [laughter] But this person in particular, she probably had milia, right?  

 

0:17:22.1 MS: Yeah. 

 

0:17:22.8 EC: We live in Colorado. It was probably dry. And she was dead set she was gonna get on Accutane. I said, "I don't think that's the right thing for you." And, of course, she came in about a month later, even more broken out than before because her problem wasn't oil production. It was underproduction. So here she's taking this drug to reduce production and she's having an adverse effect. Oh, I could have told you that. Oh, I think I did tell you that. But anyways. Then my assistant, my long-time assistant, she had been on Accutane before she came to work for me. But she has joint problems. She has digestive issues, all these problems. And her mom was on it too. Very similar things, long-term problems. Her mom was on it 30 years ago and is still suffering through side effects. 

 

0:18:08.8 EC: So it's not... I mean, I think it can work really well for some people, but it's not a quick fix. 

 

0:18:14.7 MS: Right. 

 

0:18:15.2 EC: But the way it works is to reduce the sebaceous gland or kill it, in essence. So the difference between Accutane and this AviClear is that this is the first FDA-cleared energy device for the treatment of mild to severe acne, which is awesome. And what it does is it freezes the sebaceous glands. What's different here is that you're doing it in a direct way, so not a systemic way where you're not worrying about your knees or your reproductive tract. You don't have to take a pregnancy test as you would with Accutane. And the after effects, because when you're... I won't treat anybody for a year. 

 

0:18:56.4 MS: Oh yeah. 

 

0:18:57.2 EC: You know, some people say six months... 

 

0:18:58.1 MS: Same. Same. 

 

0:19:00.1 EC: But about a year after they've been on it, just because their skin is so fragile. So fragile. So I think this is really exciting. Some of the pros are that it's targeted towards those specific areas. It's FDA-cleared. And some of the cons though, is that it's young technology. So there's no long-term studies. The cost, they say it's about a treatment series of three. And the series itself is around $3000 depending on where you are. So it's mighty spendy, but I think some people may pay that. What do you think?  

 

0:19:36.2 MS: Totally. I mean, when you have a client who is suffering with that cystic acne, it's scarring both physically and also mentally. And to have a treatment like this that's going to clear them up and have long-term benefits, absolutely. You're gonna have those people that are willing to pay. 

 

0:19:55.1 EC: I think it sounds so exciting. I'm very encouraged with this as an option. Like you said, there's physical scars but also the emotional scars too. And I think this is a really cool advancement. And I hope that the long-term studies are enforced with this result. So I'm very excited about that. Another really exciting thing, I know you've seen the commercial for this new prescription for vitiligo. So before we talk about that, let's talk about what is vitiligo. 

 

0:20:24.2 MS: Yeah, what is vitiligo? So this is a condition that involves loss of pigment. It's hypopigmentation in patches. And it is considered an autoimmune disease. Generally, this de-pigmentation, this is occurring at the face, the neck, the scalp, areas where there might be friction. So it could be hands, creases on the arms, or in the groin area. And again, considered to be an autoimmune disorder. So people who have vitiligo may also have at least one other autoimmune disorder. 

 

0:20:57.8 MS: I was surprised to learn this. I was surprised to learn that there's flare-ups, that there's vitiligo flare-ups, in my ignorance. And we studied this. Maybe we skipped it or touched on it. Just another illustration of all of the things we learn after we get out of school. But I thought you were born this way. In my mind, certain patches of your body had albinism. That's what made sense to me. I didn't understand that this could be a flare-up from stress, and you'd start to lose pigment in other places. It's almost like the melanocytes just die. 

 

0:21:33.4 EC: Yeah. 

 

0:21:34.2 MS: And so there have been previous treatments was to implant melanocytes into the basal layer. Which I think is so fascinating. 

 

0:21:45.0 EC: Yeah! How did they do that? And how much was it? Wow. Do they grow from there? If they're implanting them, is it painful? I have a lot of questions. [chuckle] But now, there's a certain type of vitiligo called non-segmental, which is the most common form. And in July 2022, the FDA approved this medicine for the treatment of addressing re-pigmentation in patients 12 and older. So they had gone through all of the testing, all of the clinical trials. They did two clinical trials. And they found that there was positive advancements or positive results from this. The medicine is called OPZELURA. And it was showing... They're applying this cream twice daily for 24 weeks and then 28 weeks of the actual medicine. And at the end, 30% of the patients had at least a 75% improvement of the facial area, and compared with 10% of placebo patients. So this is really exciting. The most common adverse reaction that they found were site acne, itching, or a common cold, headache, urinary tract infection, application site redness, and fever. And I'm wondering if it's because this would be immunosuppressant, potentially. 

 

0:23:05.8 MS: The cream itself?  

 

0:23:07.0 EC: Mm-hmm. 

 

0:23:07.2 MS: That's interesting because if we're saying vitiligo already is an autoimmune disorder, applying cream... Yeah, maybe. I don't know. It's something to study more. 

 

0:23:19.4 EC: Yeah, very exciting. But I think what this could bring as far as relief for people who suffer from this, 'cause I can't imagine. I know that I have hyperpigmentation. I know that I know how to soften that, whether it's with makeup or with creams or treatments. I can't imagine just none... It's not being there, you know? It's one thing to know how to turn it off... 

 

0:23:43.0 MS: Right. 

 

0:23:43.5 EC: But if it's dried up, oh my gosh. 

 

0:23:46.9 MS: Yeah. 

 

0:23:47.0 EC: So I can imagine very similar to acne, that there would be emotional scars with something like this. 

 

0:23:52.2 MS: Yeah, absolutely. It's very interesting. I think the science is very interesting. I've seen the commercials. What I think is interesting with the commercial is that they do show a after photo, but there is text on the screen that says, "This is an illustration." 

 

0:24:10.4 EC: Ooh. 

 

0:24:11.1 MS: Yeah. 

 

0:24:11.9 EC: Ooh, hawk-eye. 

 

0:24:12.8 MS: Right, right, yeah. 

 

[laughter] 

 

0:24:14.1 MS: And so I'm really curious. I mean, when you think about just pigment in general, there's different types of pigment and what the melanocyte is able to produce. And I'm very curious to know if this drug is so effective clearly by their studies, are you producing pigment evenly? And is it the same tone, if you will, as all of the other melanocytes that are actively producing in your body?  

 

0:24:44.0 EC: Like, are the melanosomes the same size?  

 

0:24:46.0 MS: Yeah, yeah. 

 

0:24:47.0 EC: Yeah, that's a very interesting question. From what I can gather, it's peppered, is the best way I can describe it. It would be like peppered pigment. 

 

0:24:54.1 MS: Right. 

 

0:24:55.3 EC: Because that's how they're coming back to life. 

 

0:24:58.0 MS: Yeah. 

 

0:24:58.1 EC: But, yeah, I guess let's see. Let's watch and see, and maybe we'll have an update. But lots of exciting advancements here. So listeners, we really want to hear from you. What are your thoughts on these latest medical aesthetic trends, devices, medications? Be sure to let us know. Comment on our social media posts, or send us an email at getconnected@ASCPskincare.com. We want to know all the details. In the meantime, thank you for listening to ASCP Esty Talk. For more information on this episode, or for ways to connect with Maggie or myself, or to learn more about ASCP, check out the show notes and stay tuned for the next episode of ASCP Esty Talk. 

 

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