Bold Claims or BS? Biohacking Beauty with Regenerative Medicine

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. I'm Dr. Kat Gallus, and you're listening to All the B's with myself and Bri.

Bri (00:17):
Good morning.

Dr. G (00:18):
Happy New Year.

Bri (00:19):
I was going to say happy Monday, but happy New Year as well.

Dr. G (00:22):
Yeah. You weren't with us for the last recording. We talked to Dr. Chao, or I did because you were in Mexico for a wedding.

Bri (00:32):
Viva la Mexico.

Dr. G (00:35):
Okay. Well, today we're going to, we're be talking about regenerative medicine, but we also want to touch base on some of the latest headlines. The first headline, which I'm dying to talk about is Brooke Shield's reveals doctor performed shocking procedure without consent during labia surgery.

Bri (00:57):
I read this article and I cannot tell, I don't want to undermine her feelings by any means, and I need more information on what exactly was done. I'm thinking about the laser, I'm thinking about the vaginal rejuvenation laser, and I would be thrilled. I'd be like, perfect, thank you.

Dr. G (01:18):
Yeah, so I understand that it happened a while ago, and probably if she didn't do anything like sue or complain that you can't just call out the doctor or give super specifics. And then I also understand as a patient, you might not be able to medically explain what happened, but she had a labiaplasty, which she said her gynecologist recommended. She was shocked to find out that it wasn't covered by insurance, which I mean 10 years ago.

Bri (02:01):
Not generally.

Dr. G (02:02):
Maybe I would be shocked. I think today we all know stuff that obviously needs to be covered by insurance isn't covered by insurance, so I don't think anyone would be surprised now that labiaplasty, in general, is not covered by insurance. It's considered for aesthetics, even though it does have some functional improvement as we know. But overall, the OB GYN population does not endorse doing labiaplasty anyway, and they considered it an unnecessary procedure. So let's start there. So she had to leave her OB GYN, whom she trusted to go to a plastic surgeon, which we do, I would say the majority of labiaplasty. And afterwards, she said that he proudly told her that he threw in a little twofer vaginal rejuvenation. I don't think that could be any less specific.

Bri (03:01):
Right. I need to know was there actual,

Dr. G (03:03):
What does that mean?

Bri (03:04):
Right. Were there more incisions made that she was not aware? Because I know when we do our process and why wouldn't he say that prior to doing the procedure, we go through consents, you go through markings, you confirm markings with patients. There's a lot of things that are done prior to the procedure. Why wouldn't he just be like, Hey, I'm also thinking about doing this. He was just in procedure and was like, oh, we're just going to laser up here, or whatever he chose to do.

Dr. G (03:33):
Yeah. I mean, also we do these mostly on patients that are awake, so it'd be hard to do something like wheel in the laser for vaginal rejuvenation.

Bri (03:42):
Yeah.

Dr. G (03:44):
I think vaginal rejuvenation is such a nonspecific term, and actually our national organization has moved away from it because it's so nonspecific. So does that mean, like you said, laser to the internal wall of the vagina to tighten things up and improve laxity and moisture content and all that stuff? Or did he do a vaginoplasty where he actually tightens up the vaginal where he actually,

Bri (04:14):
That's a whole other, that's an intense procedure. Yeah, that is a, I don't feel like that's a quick throw in a twofer. I feel like that's a whole other ball game they're talking about. There's no way he did that.

Dr. G (04:28):
Yeah, and I think she does say that it was irreversible invasion. That's the only reason I was like, well, maybe he did do a vaginal or perineoplasty, but if he did, that is extremely invasive. And you would notice if you were having that done at least immediately afterwards. I don't know. It's odd.

Bri (04:52):
I'm sure in his mind he was trying to be the good doctor, but just get consent. Talk to your patient prior. There is absolutely no need to throw in twofers when patients are asleep.

Dr. G (05:04):
And also why do I mean what Beverly Hills plastic surgeon is doing stuff for free.

Bri (05:11):
Yeah. We have more questions. Please reach out.

Dr. G (05:15):
I know. Please let us know what exactly he did so we could speak to it because the laser is not irreversible. So it would be invasive because they're sticking the laser as a probe into your vagina, but it's not irreversible. It's CO2 laser or radio frequency energy to your vaginal canal. And after a year or so with the aging process, you're just aging. So it would not be irreversible. I don't know. Anyway, I feel bad for her because no one should ever feel like they were violated by their plastic surgeon or any physician, to be honest.

Bri (05:55):
Yeah, that's crazy.

Dr. G (05:57):
So moving on, America's Next Top Model winner, Adrianne Curry cried nonstop after having breast implants removed.

Bri (06:06):
It's a huge change. I would cry nonstop too.

Dr. G (06:11):
That's what happens.

Bri (06:13):
Yeah. Luckily.

Dr. G (06:14):
I don't know. What are you talking about?

Bri (06:16):
I will not have to deal with that.

Dr. G (06:17):
She wanted her breast implants removed, she had them removed. So the first year she cried nonstop because she didn't like the way it looked after her implants were removed, I guess? I mean, she's much flatter and fit now than prior. I can't remember. I think there's a picture of her maybe pre, oh, right, that's right. Yeah. Of course, her implants, at least in this photo, don't look that large.

Bri (06:52):
It just has to be a huge shock.

Dr. G (06:55):
I think it can be challenging to have implants removed and adjust to what it looks like afterwards. But I do tell patients to wait a year before they start trying to do anything else because your breast tissue will change and adapt to the fact that the implants are no longer there.

Bri (07:16):
Right.

Dr. G (07:18):
Yeah. What do you think, Bri, have you seen anybody cry after having their implants removed?

Bri (07:23):
I have not seen anyone personally cry, but it usually is just a big change going from having, depending on what size you are, to not having a lot. Generally it's like losing a part of yourself and then clothes fit differently. You have to be more careful about things you wear or scarring. I think people are just, they're like, oh, so excited to get their implants removed. I feel like that's been super popular lately. Do a lot of explants and I feel like it's almost kind of a little movement. And then they take 'em out because small boobs are in and then they're all upset and they're like, what did I do? And I feel like there is a percent of people that are like, I want to put 'em back in.

Dr. G (08:11):
Yeah. And then there was a couple of things that she mentions that's interesting. She had lost over 90% of her natural breast to necrosis, so I'm not sure. That's not typical. Your breasts shouldn't have died with the explant. Her husband had to cut out all my stitches due to remote living and the weather.

Bri (08:31):
That's bizarre.

Dr. G (08:33):
We don't have stitches to cut out, so

Bri (08:36):
Yeah.

Dr. G (08:36):
I dunno.

Bri (08:37):
Yeah, I feel like that could have been tailored a little bit better, do absorbable sutures.

Dr. G (08:41):
I know.

Bri (08:42):
Also, I think it's hard because she's a model. People are criticizing her and looking at her even more than probably most people. If I took mine out, I can't tell you there's a lot of people that are looking at it, but if she's

Dr. G (08:55):
Scrutinizing you.

Bri (08:55):
Yeah, that's what she's doing for a living and she has to wear certain things and I guess that would be hard. I don't agree with where she says, I wouldn't wish plastic surgery on my worst enemy.

Dr. G (09:10):
I mean, if you didn't want the plastic surgery, it's not great. But for those who want it and have made an educated choice about what, I just think a lot of this has to do with making sure the patient understands. I mean, that's the most common question when patients come in and want their implants removed is what is it going to look like afterwards?

Bri (09:29):
Yeah.

Dr. G (09:29):
I think we spend a lot of time talking to them about that.

Bri (09:35):
And you can prepare 'em as much as you want, but it is always a little bit shocking to actually see it yourself. Most of our patients though, are just super happy and are just absolutely relieved to have them out. I mean, last week we took out implants that were 800 ccs, and I mean, that has to feel so amazing on your back. Most patients are pretty happy getting them out.

Dr. G (10:00):
Again, a personal choice, an elective surgery, and at least if you are well educated and maybe as prepared as possible for what it's going to look like afterwards, then you can enjoy the fact that you no longer have to deal with implants and you're back to your natural self if that's what you had wanted, if that was your goal.

Bri (10:20):
And if you have saline, definitely get them deflated first.

Dr. G (10:24):
Yeah. It's a great way to figure out what it's going to look like.

Bri (10:28):
And then you can make other informed choices such as, oh, maybe I need a little lift, or oh, maybe I need a fat transfer. Oh, or I'm okay with this.

Dr. G (10:36):
I think for those that have saline and can deflate first, that is a great option. And then also I tell patients, if you don't have that option, if you have silicone implants and you're just looking to get them out, then you should wait at least nine months before moving on with your next procedure if you absolutely hate it because there is a transition where the pressure that implant is compressing your surrounding tissue, and when that comes out, you'll get a little fluffing of the breast tissue, a little expansion of the chest wall, a little shrinkage of the skin, like a little contracture. So maybe you decide that you're good, but immediately afterwards, yeah, it's going to look stretched out and deflated. If you're electing to just have them removed and nothing else. You have to be patient, which none of us are. Absolutely. We are not the people that tell you to be patient, but be patient. Moving on. Let's talk about Botox is surprising, and I'm going to air quote that influence on mood and sex because nobody's surprised. This is my surprise face with Botox on board.

Bri (11:43):
Oh yeah. This is so, oh, I think I saw movement. Uh-oh.

Dr. G (11:48):
I know. Time to get back on that. So a study found that Botox treated participants reported reduced sexual function compared to those without treatment, which is crazy interesting. But I also feel like I did read this article and it's so poorly done. So it's based off the fact that if you can't scowl or frown that studies have shown that you are happier and the people around you are happier. And it creates this feedback loop where because you're not scowling or frowning and you're smiling more, we all know if you smile more and you feel happier, and then people around you feel happier and then reflect that back at you. So it's just a win-win for everyone. So somebody decided and got funded to see, well, okay, if you can't make weird faces while you're having sex, does that impact your ability to orgasm?

Bri (12:51):
What? The first one I agree with the husband's not being able to tell if we're angry or mad at Sure, of course. I mean, it's not going to affect the tone of our voice while we're saying it, but yeah, I don't want 'em to know my facial expressions.

Dr. G (13:05):
I was like, are people having sex in daylight or what's happening here?

Bri (13:11):
I don't know if this is podcast appropriate, but if that's an issue,

Dr. G (13:13):
It never is.

Bri (13:14):
Just do it doggy style or something. Don't look at her face. There doesn't need to be face-to-face contact, if that's the issue.

Dr. G (13:28):
I don't know. We might have to scroll down, but I feel like first of all, who's going to do this study? Who volunteers for this? 24 women and 12 controls.

Bri (13:38):
They got bamboozled.

Dr. G (13:40):
There's so many.

Bri (13:44):
One guy did this study and he was like, I just really need to see.

Dr. G (13:48):
Yeah. So I think they were like, maybe if you can't make faces, the idea is that the findings were striking. I'm not sure. It's self reported, so they didn't actually tape their facial expressions or anything, but the 24 women who had Botox reported reduced sexual function compared to those who did not undergo treatment. But that is,

Bri (14:11):
I think you just need to find a new man.

Dr. G (14:13):
There's so many variables, I can't even with that. Right.

Bri (14:17):
Right. You need a new dude.

Dr. G (14:20):
As per usual, they didn't evaluate men. I don't know. The whole thing is it's a lot to unpack and it seems like a very click bait and it's in psychology today, so not exactly peer reviewed, but

Bri (14:34):
Close your eyes or something. I don't know what to tell you.

Dr. G (14:39):
I don't know. Turn down the lights there. Please, please don't try and tell me Botox is going to ruin my sex life.

Bri (14:47):
I feel like this was made by a man who doesn't want to pay for his wife's Botox. Also, the same people that created elf on the shelf for moms, they just hate you. Don't get Botox, don't put out the elf. Don't get sucked in

Dr. G (15:02):
To these lies. Lies

Bri (15:04):
Absolute lies.

Dr. G (15:06):
Alright, well let's talk about regenerative medicine. So I actually didn't believe this and then I had to do some research about period blood being,

Bri (15:17):
I did not do research. So enlighten me.

Dr. G (15:21):
There are stem cells I guess in menstrual blood. So I just remember originally when stem cells came out, it was associated with embryonic stem cells. So that was the controversy. What embryo are we using to get these stem cells? It had to do with IVF, so many politics involved. And then finally someone's like, there's stem cells in fat, there is stem cells and all kinds of other things. And I somehow skipped over the part where there's stem cells in menstrual blood. Because again, the whole controversy about stem cells was a little bit related to the fact that you had to get 'em from embryos, which didn't sit well with a certain political and religious opinions, but now that we can just get 'em from your bone marrow or your fat or apparently your menstrual blood, then that takes that out of it. So I just think

Bri (16:23):
So do I need to be collecting it in a cup or what's the

Dr. G (16:27):
Yeah, you're like, what do I need to do? I think it has to get processed. So I just think it's funny that in 2007, scientists discovered that menstrual blood contained stem cells and anybody in charge of research granting was like, no, absolutely not. They hear fat is okay. This is no.

Bri (16:51):
Yeah. How are they going to do this study?

Dr. G (16:54):
I mean, now you could just put in a menstrual cup and

Bri (16:57):
The diva cup,

Dr. G (16:59):
The diva cup.

Bri (16:59):
And then collect it into it to a lab?

Dr. G (17:04):
I think that's part of the problem. I mean, I think fat's a lot easier to harvest and spin down and get stem cells from.

Bri (17:12):
Interesting.

Dr. G (17:13):
The idea of stem cells is that, two things, they have the potential to turn into other cells, so you can use them to literally regenerate other cells in your body. So they're called pluripotent. And then also they come with growth factors and things that signal the cells around them to kind of rejuvenate. I love that they have a pad.

Bri (17:43):
Bring your pads with you.

Dr. G (17:45):
You're not going to extract it from a maxi pad.

Bri (17:48):
I think it would be better for your parents to just take what cord blood at your birth, keep those stem cells for your life?

Dr. G (17:55):
Yeah, that's expensive actually. And that's a whole racket that I don't want to talk about. I've read articles about how people went to go then get their cord blood and they're like, oh yeah, actually that's not, we turned the fridge off or whatever, and it's not available.

Bri (18:13):
No way.

Dr. G (18:15):
Yeah. So banking stuff I think is always a little sketchy. Are you really checking up on them, keeping track of that? What were we, oh, we were talking about having cadaver bone in the office for rhinoplasty, and it is, it's a process, right? Dr. Chao was talking about adding that to her repertoire versus getting rib from the patient. And it involved a conversation with me and involved a conversation with you because you need a fridge, you need a fridge log, just like our Botox fridge. We need to make sure that it has a backup generator so that the power goes out.

Bri (18:51):
And how much more expensive would that be?

Dr. G (18:54):
I mean, I'm just saying to just keep something that has to be refrigerated is a big deal. So your cord blood, I'm going to bank my menstrual blood where who's paying for that to not go out with the power grid when we get a fire down here or something. It's just expensive maintenance. So I say, if you can pull PRP or PRF, if you can draw the blood, spin it down quickly, process it and use it, that is ideal. Versus collecting menstrual blood and bringing it to a lab.

Bri (19:30):
Everyone bring your blood into our clinic and we'll,

Dr. G (19:33):
Oh, please, yeah.

Bri (19:34):
Stamp it into your face. Spin it down, get all the good stuff.

Dr. G (19:40):
We can talk about that. That is a much simpler way of just drawing blood and spinning it down and centrifuging it so that you can then have it ready for injection. It is not as robust as actually getting stem cells, but, in a lab. So a lot of it has to do with processing. So I would say the most common thing that we process in real life is fat and blood, because those are easy to do. No one's harvesting bone marrow for a quick procedure because it's painful and usually reserved for bigger problems. But I do think it's interesting, even the menstrual blood, I mean, that's something you could do maybe to ward off dementia or Alzheimer's. That would be fantastic. That's like a long game where if they could figure it out would be helpful. I think, let's talk a little bit about John Cleese who says he is spending 17,000 pounds a year in his battle to stay young, forking out for stem cell therapy.

Bri (20:52):
That's crazy. Also, I don't know how much 17,000 pounds is, but I assume

Dr. G (20:57):
It's equivalent.

Bri (20:58):
Equivalent. Okay.

Dr. G (21:01):
15 to $20,000 depending on the value of the dollar.

Bri (21:06):
So are you actually buying yourself a few extra years or is it making you look a few extra years younger?

Dr. G (21:14):
He's basically, I think he is implying that he's using it to make himself look and feel younger.

Bri (21:21):
Okay.

Dr. G (21:21):
So it's true the stem cells are supposed to help repair liver cells or cartilage cells. There's an orthopedic surgeon who I know really well who injects it into joints and it does help with arthritis and joint pain and helps postpone maybe a surgical procedure or joint replacement. So I think that's what he's talking about. I don't know how much stem cell therapy is doing. In the US, the FDA prohibits us from advertising stem cell therapy cuz the science is a little murky. So we can say regenerative, but you can't say that you're giving somebody stem cells, which is why a lot of people will travel, I don't know, to Panama or something for stem cell therapy. So you're traveling

Bri (22:10):
Switzerland.

Dr. G (22:12):
And in his case, Switzerland. So a lot of the wealthy in Europe go to Switzerland for both plastic surgery and regenerative medicine, and then their version of going down to Mexico or the Dominican Republic is going to Turkey. So they have the same, the cheaper version is offered there. So he goes to Switzerland and I'm sure it's lovely and upcharged, and they're apparently not banned from saying stem cells, so they can advertise however they want. But yeah, I think he's probably getting it injected. You can inject it in your scalp for staving off hair loss. We always think of it as injecting it in our skin and putting it in our face either through microneedling, the vampire facial, but you can also inject it in joints to help correct other issues with your joints if you're having early arthritis. I mean, he was already kind of balding way back when, so his hair looks pretty good.

Bri (23:19):
How often can you do these injections? Do you have to space them out or can you just do them all the time?

Dr. G (23:26):
That's a good question. I don't know since we don't do stem cell injections in the US, we do have some stem cells adjacent stuff. Exosomes are becoming really popular here, but that's all topical. And I think if you can do that to help yourself make you feel better, especially if your wife's a million years younger than you, then props.

Bri (23:53):
I think she got the real stem cells,

Dr. G (23:55):
Right? She looks like she's using them on her face.

Bri (23:57):
Yes, she looks great.

Dr. G (23:59):
Her skin looks so good. Yeah.

Bri (24:01):
Now we know why he wants to look younger.

Dr. G (24:04):
It's not going to reverse aging, but it's going to help repair your cells, which as you get older, your cells abilities to repair themselves go down, are limited, and then that's how you're slowly aging. So if the idea behind the skincare, the exosomes is that you're bringing in stem cells from elsewhere and applying that, and they're helping either your skin regenerate, which it has slowly losing the ability to do and your skin cells to make collagen and elastin, which we know that after 35 your skin stops, doesn't stop doing that, but starts decreasing the amount of collagen and elastin it can make. So if you can bring something in that says, no, no, no, we're not done. Keep making collagen and elastin, then you're going to stay more preserved. So I think that's the idea about it. And for him, I mean, what's $17,000 a year? Really? It's worth it

Bri (25:05):
Yeah. Need to start now.

Dr. G (25:07):
Even if they're just putting green juice in his IV, who cares?

Bri (25:10):
I'll take it.

Dr. G (25:12):
He's doing something that makes him feel better.

Bri (25:14):
You have to, if you're on your fourth wife, no judgment.

Dr. G (25:17):
Yes. And more than 30 years older.

Bri (25:21):
I love that.

Dr. G (25:22):
He also hired a psychic. So I mean he has money to burn.

Bri (25:26):
Yeah, he's fine. So what treatments here in office do you do exosomes with?

Dr. G (25:32):
So again, we usually use them topically and we do procure AnteAGE MD. They get their stem cells from, you remember this, the patients are 18.

Bri (25:47):
Insane. I can't even, it's like 18 to 23-year-old athletic males that don't drink alcohol. I was like, where are you finding these people?

Dr. G (25:56):
Women I think it was. Yeah. So their donor pool is like three people. So like an 18 to 22-year-old female who doesn't drink or smoke and is healthy

Bri (26:11):
So specific. Are they locked up somewhere?

Dr. G (26:18):
I want those stem cells. I don't need my own stem cells.

Bri (26:21):
They're in prison. Just kidding.

Dr. G (26:24):
So that's one of the things is if we can use stem cells that are harvested from them, actual bone marrow. Okay, so they're doing the work here. They're taking bone marrow from these patients, I'm sure they're paying them handsomely, and then in the lab they're making more from those stem cells and then they're using that in both their topical skincare products and to make exosomes. And then exosomes are a way of topically applying these regenerative medicine stem cells to your face. It's got to penetrate somehow, right? Because your skin is a barrier for a reason. It's protecting you against water loss and heat loss and all of those things. So how do you get those stem cells into the right layer of skin? Because all that top layer skin's not doing anything. So the couple ways we do it is either microneedling or radio frequency microneedling or CO2 laser. Something that's what I call aerating the lawn, poking holes in your skin so that you have a means to get that stem cell benefit from the exosomes into your skin. The other way of doing it is just straight injecting it underneath the skin like little, but that's a lot more painful. And we don't have studies that show that it's way more effective than the alternative, than stamping it in.

Bri (27:49):
Right.

Dr. G (27:50):
So in our office, we use it on the face. We love it for that. And a lot of plastic surgery offices and some derm offices, they'll use it for hair restoration. So to stimulate hair growth, so inject or stamp it into your scalp. And I think the best studies that show exosomes or even PRP are effective at doing anything are with regards to hair. So there are some good studies that show that you can get increased hair growth with PRP injections and with stem cell exosome application. So that's kind of how we use it in our office. We're not injecting it into joints or anything like that. And that's not our lane.

Bri (28:36):
Nope. Side note we did, of course we have to try it, obviously what we do, because we have to know what we do to patients. We all did it on each other and we all did it under our eyes and me and Dr. G were like, oh yeah, we numbed, we numbed for 30 minutes. No problem. This other nurse that we used to work with, she did it as well and she was not numb and she was in so much pain. We're like, what's wrong with you? She was like, wincing the whole entire time, she's like, I'm not numb. And I was like, oh, that sucks. It was pretty good.

Dr. G (29:16):
And I feel like we were trying to numb multitask that day and she did not get the memo to numb. So definitely numb. But yeah, so PRP is often used to inject under the eyes. Currently you can't inject exosomes here. So the exosomes we have are topical, topically placed, but the idea is that they're going to penetrate. I wouldn't just rub them on my skin right now. I would do it after session microneedling or CO2, and then they're going to go in and kind of help my own skin to create collagen and elastin. The other way to sneak regenerative medicine in is by using fat, right? We talked about that at the beginning. Way easier than collecting menstrual blood. It's super easy to suck some fat off, spin it down, process it, and then you are adding fat cells. It's in the slurry, but the idea is that there are stem cells and growth factors and whatnot that are coming along with the fat cells and that's helping rejuvenate the area that you're injecting in. So they do do that, inject into joints, and then we again prefer to inject it into the face.

Bri (30:31):
And we do have two kind of different fats that we do, just regular fat, if you want to touch on the difference between that and nano fat.

Dr. G (30:40):
Sure.

Bri (30:41):
I know we've talked about this before, but.

Dr. G (30:44):
But I think when we are harvesting fat cells, let's say we're going to put 'em in the breast, we're trying to keep them as large little large fat cells inject them. They survive by the surrounding tissue, bringing in blood supply, and then they become fat cells in the breast and act appropriately. If you gain or lose weight, they get bigger and smaller and they add volume. In the face oftentimes we're doing that to add volume. So cheeks, lips, temples, but under the eye, you don't actually want volume, you just want the regenerative properties of the fat cells. So we will take the fat and process it through a filter and it kind of breaks it up into nano fat. So you can go from macro to micro, from micro to milli, and then from milli to nano fat. And nano fat just almost describes like a slurry of fat that Bri makes with love on the back table.

Bri (31:40):
Absolute love. It's perfect.

Dr. G (31:44):
Puts it through these little filters that are kind of chopping it up or grading it by passing it back and forth, back and forth through the filter until you get more of a slurry and that nano fat can be injected under the eyes. It's thought to be a little bit more effective than PRP. We both know you're adding volume obviously, but it's temporary volume, so that's slurry or that PRP or PRF is a cc of volume, and then over the next 24 hours it should just dissipate. And then you should over time start to see the regenerative effects of doing that, which helps with under eye bags, and thickens the skin there, improves crepiness. If you thicken the skin there, it helps dark shadows. I know we're all talking about doing it to ourselves.

(32:34):
So that's kind of how we use nano fat. Also, you can take that nano fat and stamp it in sort of the same way you would stamp in exosomes. So you have these little microneedling channels that are more like stampers. They do offer 'em, I mean, you can buy 'em on Amazon. My contention with that or those rollers that microneedle. The thing is when we're doing this in the office, those are one use only. So I'm stamping it in and then throwing it away. I think when you buy them from home, after you've used it once, you can suspect those needles are dull. You don't know how big, what the quality is of them, how deep they're penetrating. You want the needles to go in to a quarter of a millimeter. If you go in much further, maybe a millimeter, it depends on the area of your face. So when I'm microneedling, I'm adjusting that based on where I am on the face and then creating those channels so you can then let either the nano fat or the exosomes in.

Bri (33:36):
Right. And then you have to be careful also doing it at home, how you store things. You don't want to go make a bunch of little channels with something super contaminated and then.

Dr. G (33:47):
Right. Yeah, worst case you break out. I mean, not worst case, best case you have a breakout. Worst case you give yourself some sort of skin infection.

Bri (33:55):
We do not want that.

Dr. G (33:57):
Yeah. So it always makes me nervous when I see that stuff available for home use. And it's almost always reusable, which is wild.

Bri (34:04):
I feel like it's just kind of gimmicky though. I feel like, I don't know. I wouldn't trust that to actually do anything.

Dr. G (34:12):
Yeah, because I mean, how sharp can something be that they're giving you to take home? I don't know.

Bri (34:19):
It's fine. It's going to be a no for us.

Dr. G (34:21):
And then I would say in terms of statistics that show how effective this stuff is, I mean, there is an absolute lack of data to support doing any of this. I'll say the micro channeling, there have been good dermatological studies where they've proven exactly how long those little holes stay open. And they've done studies where they'll take skin samples and they'll either microneedle it or do CO2 laser, and then they'll rub on something that has a tattoo ink on it, and then they're looking at it underneath the microscope and you can see that stuff gets in there. So it's definitely getting in there and they can tell, usually those channels stay open for up to 24 hours. So the fact that you're doing the treatment and applying exosomes or nano fat or PRP to your face immediately after we know that that is working, it's penetrating The effectiveness after that would be you'd be doing skin biopsies on people before and after to see. And a lot of that stuff is just not funded or in such a small patient population that it's hard to say.

Bri (35:36):
Also, I did do this in Mexico, just thinking about it.

Dr. G (35:40):
That's right.

Bri (35:40):
It was hands down the most painful thing I've ever done in my entire life, and I've done a lot of things. Don't do it in Mexico. That's my one advice.

Dr. G (35:49):
Did they numb you first?

Bri (35:51):
No, they don't numb you. And I'm pretty sure they have an MA draw, I don't even know if they're an MA. Probably somebody's girlfriend draw your blood and then they just stab you all over the face with it.

Dr. G (36:05):
Oh, right. They inject it, not microneedle it. Yeah.

Bri (36:07):
Horrible. Absolutely horrible. My skin did look great, but it was not worth it at all. So don't go to Mexico and numb before you do it.

Dr. G (36:17):
I mean, I just did a segment about safety and you really, even in the states, you just have to vet your med spa or wherever you're going to get treatments. There was a case in Arizona, I think a few years ago where it was not a legitimate med spa, and they were reusing needles. And so they had HIV contaminated needles that they were using for PRP and gave a few patients HIV. So you want to always look for cleanliness.

Bri (36:49):
Yes.

Dr. G (36:50):
And certification and licensed places of practice. And if it's super cheap, it's probably not worth it where you're going to be cutting corners. We just got our bill for our Quad A certification. And you're like, no, but that's what it costs. That's what it costs to stay certified and stay up to date on everything. And so when people are offering you prices that are too good to be true, it's usually because they're cutting corners somewhere.

Bri (37:19):
My sister had asked me something a couple of days ago about Botox. She found Botox for super, super cheap, and I was like, it's not worth it. It's either probably incredibly diluted or you just don't know. There's a reason it's cheap because

Dr. G (37:34):
It's counterfeit.

Bri (37:35):
Yeah. You don't know what you're getting. You don't know how long it's going to last. I was like, don't do it. It's not worth it. It's probably not even actual Botox, but

Dr. G (37:44):
Right. And then you're, it's your face.

Bri (37:48):
Don't mess up your face. But yeah, that's why I like to be the Guinea pig, so I can give everyone my testimony on

Dr. G (37:56):
Yeah, no more going to Mexico though for you.

Bri (37:58):
We are not going to Mexico. Unless it's on vacation.

Dr. G (38:00):
Yes, that's right. You don't need that kind of Guinea pig. I would go to Switzerland or South Korea just to check it out.

Bri (38:10):
I would definitely go to South Korea. I've seen some of their skincare stuff and I was like, wow.

Dr. G (38:14):
I know we need to take an office trip.

Bri (38:17):
I'm down. Say less. It will be scheduled before you know it.

Dr. G (38:21):
That's right. Well, I excuse Brianna for a minute. She's going to go schedule our trip to South Korea.

Bri (38:27):
Yeah. Last time, she brought something about Morocco, and I literally closed the office down the whole week. I put it on all the calendars. I was like, we're planning the Morocco trip. We did not get to go, but it's fine.

Dr. G (38:38):
No, we didn't get to go. So I would say exciting things that are happening in regenerative medicine, I would look towards South Korea and Switzerland for what's happening. I mean, I wouldn't necessarily jump on it, but I would say the United States is pretty heavily regulated and so things come through, we're a little bit slow to adopt here and that it has its downside but also has its good side. We're not going to be doing things that haven't been proven or are potentially unsafe to the consumer. But I think you have to push the envelope a little bit to make new discoveries. So I think, yeah, we will be continuing to explore the aspect of regenerative medicine and how we can get ourselves to basically rejuvenate on their own or stimulate them to rejuvenate on their own instead of just aging and falling apart. So that's kind of a renewal process.

(39:34):
And then things that are going to make us feel better, slow the aging process. I think GLP-1s are already starting to show some side effects that are consistent with that, with regards to, with not just losing weight or controlling blood sugar. Then I think stem cells are going to continue to be a popular place to kind of explore. And I think it's important because I think one of the differences between, I did microneedling with my own PRP and then also with exosomes. I don't know which would be better. Do I want my old ass blood smeared on my face? Or do I want that 22-year-old non-drinkers blood?

Bri (40:17):
I know that rare unicorn.

Dr. G (40:18):
Yeah, we want those stem cells and it comes up when I have patients that are older, I think I would rather do exosomes on somebody who's 65 or 70 getting CO2 laser versus using their own blood as PRP. Because we know the regenerative properties of the younger product of those exosomes is probably going to hands down, beat out her own platelet rich plasma.

Bri (40:47):
Interesting.

Dr. G (40:47):
And the same thing goes with fat grafting. I think the other thing that's going to be coming around is the ability to do large volume fat transfers with product that is harvested, harvested from humans, and then de-identified essentially so that we can use it in ourselves to stimulate collagen, elastin and fat in growth versus having to take it from ourselves. Which I think when you're 25, it's going to do great, but I have some older patients that are taking their implants out and I'm harvesting their own fat and putting it in their breasts, and it just doesn't have the same take as somebody who is 25. So if I can boost it with an off the shelf fat product, that would be lovely. Right now there's one on the market that comes in really teeny tiny syringes.

Bri (41:39):
Did you say it was like one cc?

Dr. G (41:40):
Yeah. So there is something coming supposedly 2025 that's going to be in larger volumes that would make it more useful for body.

Bri (41:50):
That's exciting. That would be nice because there is a lot, I mean, even in some really skinny patients that want fat, their fat is just, they're not good.

Dr. G (42:02):
Yeah, I agree.

Bri (42:03):
It's just small.

Dr. G (42:05):
It's small.

Bri (42:07):
It's not Taco Bell fat.

Dr. G (42:09):
Yes. We love that orange Taco Bell fat.

Bri (42:12):
Yeah. There is a difference.

Dr. G (42:14):
It's not robust.

Bri (42:16):
Not all fat is the same.

Dr. G (42:18):
That's for sure. And so that is like when you're harvesting stem cells from something like fat, definitely, there's so much variability. I mean, as you can imagine. So processing variability, who's getting injected into, so I think there's a lot of work that's coming down the pike.

Bri (42:36):
Agreed. Exciting.

Dr. G (42:37):
I know.

Bri (42:38):
Very exciting.

Dr. G (42:39):
Needs to hurry up so I can

Bri (42:41):
Try it.

Dr. G (42:42):
Right?

Bri (42:45):
Well, we're going to look like we're 12.

Dr. G (42:48):
Yeah, that's what we're working on.

Bri (42:49):
It's the goal.

Dr. G (42:50):
Any day now. If you're listening today and you have questions about regenerative medicine or anything that we talked about, need info about scheduling, financing, want to take out, check out our reviews or photos, then click the show notes for links.

Bri (43:08):
Yes, click, like and subscribe.

Dr. G (43:13):
See you later.

Bri (43:14):
We'll be back.

Dr. G (43:20):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.