Jonathan LeSuer (00:01)
All right, guys. Welcome back to another episode of the Film-E-In Podcast. I'm Ejector Jon. Thanks for tuning in. my god. We kind of were delayed a week. We had you guys listen to an old podcast episode last week, but it is the peak of the start of busy season for us. I think there's been so much going on. ⁓

Nicole (00:06)
and I'm aesthetic nurse Nicole.

Yeah.

Yes, do a little refill moment.

Mm-hmm. Yeah, lots happening.

Jonathan LeSuer (00:25)
my God, like all good things, but I feel like anybody who's a practice owner gets this. Like I feel like your practice, your malpractice insurance is due. You know, your general liability, all this crap. Like there's just so much, your taxes. mean, there's so much that goes into it. Yes. And yeah, thank God. Mm hmm. A hundred percent. Yeah. ⁓ okay. So we.

Nicole (00:33)
Mm-hmm.

Yup, tax season. Plus it's getting nice out and like, I feel like you want to get out and do things too. Feel human again.

Jonathan LeSuer (00:53)
We wanted to talk to you guys about a couple of things coming up. We're excited because this is like the start of conference season. And Nicole and I are going to be going to AMWC Monaco and it's our first time in Europe and we're going together. We're going together. I don't think, huh.

Nicole (00:57)
Hmm.

Yes. Yeah, both of us. Do you know what my mom said this morning?

She was like, ⁓ no, I am afraid to see your credit card after this trip with John. We're going there with zero on the credit card, coming back with too much on the credit card.

Jonathan LeSuer (01:15)
⁓ mm-hmm, mm-hmm. I'm making sure everything's paid off.

Oh God, I'm trying to be

good, I'm trying to be good. Oh, for sure, for sure. So we're making a little trip out of this. We're making it kind of like business, but also pleasure. So we are flying together. Me and Corey are flying down to Newark and then we're going to meet Nicole there and then we're gonna take a flight over to Milan and then we're gonna hop on a little in a little Sprinter van.

Nicole (01:26)
We'll definitely be doing some shopping.

Mm-hmm.

Jonathan LeSuer (01:50)
and then we're gonna take a trip to St. Moritz for the first leg of the trip. And I never knew what St. Moritz was until the past couple of months. But now, it's like every time I go on my Instagram, the algorithm is showing St. Moritz. the furs and the skiing, so we're gonna be in the Alps. We're gonna be doing a little skiing, apres ski. When's last time you skied, Nicole?

Nicole (01:58)
No, literally, I didn't know what Monica was until the basketball was. It's terrible. Mm-hmm. Yep, the furs, the furs. The snow, mm-hmm.

about 16 years ago. I was a very good skier. I have family in New Hampshire and Vermont and we would go every year. But I had one good wipeout and I was like 16 years old and I was like, that's enough. I'm getting too old for this. Let's hope, let's hope. ⁓

Jonathan LeSuer (02:19)
Great, it's been about 10 for me. ⁓

Mm-hmm.

Mm-hmm.

It's like riding a bike, Nicole. It'll come right back to you. Yeah.

I just am wondering if the slopes in Europe are just a little different than here. It's going to be great. Great. Great. So we'll be doing bunnies the entire time. I think my husband, my husband's obviously coming too. And then Olivia Salmon's also joining us, which we're so excited. it's going be the four musketeers together.

Nicole (02:40)
I'm they are. I'm sure their bunny is like a blue here.

Mm-hmm. Yes. Yes.

Jonathan LeSuer (02:58)
And then after St. Moritz, we're headed to Monaco for AMWC, which is for three days. ⁓ We're all staying in the same hotel room and we it's going to be so fun. ⁓ We have some dinner scheduled and then Olivia, we wish you we wish you were coming with us, but she's staying back. Where is she going after that? Is she going?

Nicole (03:07)
It's gonna be a party.

you

I know.

I don't, is this, I think we're the end of her trip. Yeah, yep. So she's like on, or it could not be, but she's gonna be away from home for like two months. She's in Australia right now.

Jonathan LeSuer (03:23)
Is it the end? Okay. Okay. ⁓

Yes, I know. So me,

Corey and Nicole are leaving Monaco and then ending our trip in Paris. So we're very excited. Yeah. So we'll be sure to shoot all the content. Yes. I'm, are you excited? I'm excited to see what like an international conference is like.

Nicole (03:38)
Very excited. I'm so excited. Yes, yes, we'll be vlogging. You guys will be tired of us.

I've

only been to obviously like the biggest conference I've been to is Amspa, which I feel like is probably like one of the bigger ones here. ⁓ But I'm no, I'm so excited to see what an international one is like, because I feel like they can talk about so much more. And I feel like we're going to learn a lot more like regenerative side stuff too, which I'm excited about. I'm hoping to see some I'm hoping there's some ultrasound stuff too. But we'll see. Yeah.

Jonathan LeSuer (03:54)
Yeah, yeah. Yeah. Mm-hmm.

Mm-hmm.

I agree.

Mm-hmm.

Mm-hmm. Mm-hmm. Yeah. Yeah.

I love how they framed the AMWC conference too. It's like they kind of start with like the upper face, then they go into the mid face, then they go into the lower face, and then there's like a lip like session too. So I'm excited to see what their techniques are like as opposed to Americans. Yeah. Mm-hmm. Yes. Yeah.

Nicole (04:18)
Mm-hmm.

Mm-hmm.

Absolutely. And what products they're using and what

we may be getting in the future.

Jonathan LeSuer (04:37)
Well, and we all know that there are five years ahead of us. So,

you know, all of this regenerative talk that's been happening here in the States. mean, it's been ongoing over there for years before this, right? Like skin boosters and PDRN and, and PDGF and all that stuff. So it's really exciting. Mm hmm. yeah.

Nicole (04:45)
All right.

Yep.

Yeah. Yeah, yeah, I can't wait. So we'll share everything and I we're gonna do like fun little videos. I think we should do a video a

day of like, you know, the five top things we learned today. Like I think that would be fun. Yeah. Yeah, just share it all. Yes, and am spa. John's John's gonna be so sick of me.

Jonathan LeSuer (05:01)
Yes, that would be so fun. And then you and I are going to Modern Beauty Con. Yep. And Amspaw. my God. We're look... I'm really

not because I haven't seen Nicole. I haven't seen you in a long time.

Nicole (05:14)
I know, even getting on

today, I'm like, my God, it feels like it's been like weeks since we chatted. It really hasn't, but it feels that way.

Jonathan LeSuer (05:19)
I know, I know. I know, but still. ⁓ Okay, and so it'll be fun. ⁓

I'm excited for Vegas. If you guys are going to Amspa, please find us. We'll be there. Say hello. I'll be doing a Moxie talk at Amspa and doing a shopping event with them. Nicole, you need to come to that. ⁓ And then Modern Beauty Con. I'm excited. Your aesthetician's actually speaking at it.

Nicole (05:32)
Yes. Mm-hmm. Say hello.

Mm.

I will be there.

Yes, Brittany will be speaking at Modern Beauty Con. So we're so excited for that. Yeah, she's speaking on like collaboration and how the spa side is so important for a med spa. You know, injectables are great, but skin, skin is everything. So she's talking on collaboration. So that's gonna be it's gonna be really I heard it's a it's a good speech. So you guys should be excited. Yeah.

Jonathan LeSuer (05:49)
Yeah.

Yeah, so that'll be great.

Mm-hmm. It is.

I love it. That's good. ⁓

Okay, so now we're gonna shift this over just to like Q &A. So Nicole and I are just gonna be asking each other questions and then that's just probably gonna spark a tangential conversation on whatever.

Nicole (06:12)
Mm-hmm.

Questions,

Well,

do you would you like to touch base on why you're so red today?

Jonathan LeSuer (06:29)
Oh my god, so yeah, so yesterday Leslie Fletcher flew all the way from LA to do one of her advanced PDGF injectable courses. It was absolutely amazing. I mean, she's the queen of research and making sure you're doing things the right way, but her didactic was so good, Nicole. It was...

Nicole (06:42)
Mm-hmm.

I can only imagine.

Jonathan LeSuer (06:49)
It was just so there's so much research, so much fact based information and a lot of debunking. Like there's obviously a lot of talk on PDGF going on on social media. So it was really nice to hear the truth. And I think that there's a lot of people that are injectors that are just excited about what PDGF and they just want to start injecting it. But really.

Nicole (07:01)
Yeah.

Mm-hmm.

Jonathan LeSuer (07:11)
I mean, there's no actual certification and this is actually not a certification course for PDGF for her. It's a training course, but either way, I think this is a step in the right direction for PDGF. ⁓ and it'd be regenerative, you know, medicine. ⁓ but I think before anybody just hops in and starts injecting PDGF to consider taking Leslie's course, ⁓ it would be really beneficial. I think Julie Kaplan has one or is working on one, I believe. ⁓ so that'll be good.

Nicole (07:16)
Right.

Absolutely.

great, okay, good.

Yeah.

Jonathan LeSuer (07:41)
But anyway, but it was very beneficial. ⁓ so my under eyes. I had PDGF under eyes done. This is my third session. So I have some redness, which is the angiogenesis. It's just basic, which is normal. This redness is normal and I'm more reactive anyway. ⁓ But.

Nicole (07:43)
Yeah, good. Yes, explain.

Jonathan LeSuer (08:00)
the redness and the puffiness. The puffiness is from the uptick in hyaluronic acid production that happens within the first 24 to 48 hours. And then the redness is just the new blood vessels forming, which is gonna regenerate new skin tissue. So really excited about that. It's gonna help with hollowness, dark circles, fine lines under the eyes. ⁓ It's obviously a great treatment or a great ⁓ procedure for someone who is not a candidate for filler.

Nicole (08:11)
Mm-hmm.

All right.

Jonathan LeSuer (08:25)
or an

alternative treatment for someone who's not a filler candidate. So there's that. I had my forehead done, my frontal bossa done, just because I felt like I've had a lot of volume loss right in the center part of my frontalis and I felt like my Botox wasn't lasting as... it wasn't that my Botox wasn't lasting as long, but my fat pad. Yes! I needed more support in the frontalis area, so it's definitely working. And I had my smile lines done too. So, yep.

Nicole (08:38)
Mm-hmm.

The anatomy wasn't letting it. Yes. Yep.

Yeah. Interesting. Oh, see, this

is so cool. like, and I hope they touch on some stuff like this at the International Conference too, because I just feel like, know, filler's great. And obviously we use filler all the time and we won't stop using filler, but I just think it's so cool to see kind of how things are changing and, you know, what we can do at a younger age to help produce the collagen and produce the cells so that maybe we don't need as much filler in the future. I'm excited for it.

Jonathan LeSuer (08:57)
yeah.

Mm-hmm.

Yeah. Yeah.

I

think there's going to be some talks on PDGF at AmSpa and Modern BeautyCon too, I think. And I think Leslie is actually doing a PDGF course in Vegas. Yeah. Yeah, just saying. Yeah, and it's $1,700, which I honestly, to me, very affordable. She gives you a whole...

Nicole (09:18)
Great. Awesome.

⁓ during the time of ANSFA. that's good to know. Yeah.

Yeah, it's very fair. Yeah.

Jonathan LeSuer (09:39)
training manual which has all of the slides from that day and then like today she said she's sending us a bunch of white papers which is like ⁓ research articles on pdgf ⁓ today which is all a part of it and we get the consent as well the updated consent to make sure that we're covered yeah so yeah it was a great weekend any day getting injected is a great weekend

Nicole (09:40)
Mm-hmm.

Mm-hmm.

Nice, Yes, exactly. Yep, yep. That's incredible. So you had a good weekend. That's so true,

so true. So I mean, now that we're on the topic of PDGF, right? The shift that we're kind of seeing into the regenerative space.

Jonathan LeSuer (10:07)
my god. Yes.

Mm-hmm.

Nicole (10:17)
I think we definitely are entering into regenerative era. think more patients, and I think now too, it's social media, I think patients are just a little bit more educated themselves, and they might be like, you know what, I'm not opposed to filler, but I might not wanna start there yet. I might wanna focus on my skin quality, things like Sculpture, Hyperdilute Radiesse, or PDGF, before I get to that realm. What are your thoughts on that?

Jonathan LeSuer (10:20)
Mm-hmm. Mm-hmm.

Yep.

Mm-hmm. Mm-hmm.

Mm-hmm.

Yeah, think honestly, I think regenerative medicine is should be used in conjunction with HA fillers and especially for facial balancing every face is so different. There's some patients that need more regenerative treatments first just to tighten that skin ⁓ first and so that way the skin can support HA fillers. ⁓ But I think HA fillers are not going away in my opinion. They never will. And I think that it's so nice to have bio-stimulators.

like Sculptural, Hyperduralate Radius, PDGF, know, whatever you want to use, right, in your practice, just to ⁓ use it in conjunction with your HA fillers, right, just to make the fillers look better.

Nicole (11:17)
Mm-hmm.

Yeah, and the difference being so like regenerative when we speak regenerative terms, that's your, so Sculptra, Hyperdaily Radios, PDGF, PDRN, those types of things are to PRP are basically growth factors. They're to stimulate a response to build your own collagen. So it's not like you're placing a hyaluronic acid in there, a filler in there to give volume. This is more for the quality of the skin. ⁓

Jonathan LeSuer (11:29)
Yeah.

PRP, PRF, mm-hmm.

Mm-hmm

Nicole (11:50)
One thing I like to always tell my patients is like, it's building your own collagen, sometimes a little bit of scar tissue like sculpture is to kind of cause a response, an inflammatory response in there to cause the collagen induction, but things like that. it's not like filler where it's reversible.

Jonathan LeSuer (11:57)
Mm-hmm.

Yep.

Mm-hmm

Nicole (12:08)
but it's also not like filler where you're

gonna have this huge change where you may feel like you wanna reverse it. But I just always explain that to patients. Hyaluronic acid is for volume and we can dissolve it if necessary. Sculpture, hyper dilute radius, things like that are more for quality, texture, things like that, strengthening of the tissue, firming of the tissue, and you're not gonna be able to dissolve it.

Jonathan LeSuer (12:13)
Yeah.

Yep.

Well,

and that's why like if we have any patients that are tuning in and listening to this like truthfully, you can't just depend on PRP, PRF, Sculptra, hyperdilute radius to give you the results that you want. Like if you need a more augmented cheek, if you need to treat your recessed chin or recessed jawline, we have to use HA filler, right? And it's not, don't ever be scared to get HA filler. Make sure you just do your research. Look at your provider's Instagram, look at their reviews to make

Nicole (12:36)
Mm-hmm.

Mm-hmm.

Right.

Mm-hmm.

Jonathan LeSuer (12:59)
make sure they're good, and look at their website and just schedule a consultation. I've had more people lately just coming in for consults and they've told me, I've gone to three other places, you're my last stop, just to see if I connect with you or if I should go to someone else and I said there's no pressure and you just have that conversation. ⁓ But your goal is to really connect with that patient so that way that you can keep them. But sometimes patients aren't meant for us, they're meant for other people. So it just really depends.

Nicole (13:07)
Yeah.

Mm-hmm. Great.

Mm-hmm. Right.

Mm-hmm,

and as a patient you have every right to interview providers, you know, and you should and you should absolutely Yeah, as I love that when people come in and sit down and they tell me that they're nervous I'm like you have every right to be nervous, you know, I'm about to touch your face like absolutely. I'm not gonna discredit that But I can promise you you're in good hands ⁓

Jonathan LeSuer (13:28)
Yes, gosh yes. It's your body, it's

Yes!

Yeah, I agree with you. Let's

see here. Let me ask you a question. Why do you think more patients are dissolving filler?

Nicole (13:47)
Yeah.

Okay, I think back in the day, eight or nine years ago when I got into this, I was so old, oh God. But when I first entered this field like eight or nine years ago, everyone was still learning, you know? And it was really like you kind of just learned on one filler, you gravitated toward that filler and you kind of did it everywhere. Or you were kind of taking...

Jonathan LeSuer (13:58)
Mm-hmm. You're so old, Nicole. Ugh, back in the day.

Mm-hmm.

Nicole (14:18)
these fillers that we didn't know too much about yet and putting them in areas that maybe we wouldn't do today. So I think maybe, not that there was a lack of research, but a lack of education. We didn't have as much trainings and as many conferences as we do now, and definitely not as many trainers, know? Like even Allergan, we have, I think, over 500 trainers now, but back then it was probably 50 or 100, you know? So I think it was more of...

Jonathan LeSuer (14:22)
Mm-hmm.

Mm-hmm

Mm-hmm.

Nicole (14:41)
that practitioners weren't fully educated or trained on how to use the product. So we might have the wrong products in the wrong layers. ⁓ Also trends. And we learned that now, like we should never be trend followers. know, we should never follow TikTok trends. We should never do any of that. But when I got into this field, it was the big lip trend and everyone wanted those big puffy pouty lips. And then once we did that, we had to make sure that

Jonathan LeSuer (15:04)
Mm-hmm.

Nicole (15:08)
Maybe the chin was balanced or, you know, we had to fill the laugh lines because you had all this volume here and you were thin here. And so as you build, build, build, sometimes there is a necessity to take away. But I do think it had a lot to do with kind of same thing. Like we're hearing about PDGF now, right? Like it's exciting. We grab it and we just go like it was kind of with filler back then like that, you know? So now there's just so much more education, so many more research articles and proof in how we should be doing things differently.

Jonathan LeSuer (15:18)
Mm-hmm.

Mm-hmm.

Mm-hmm. Mm-hmm. Yeah.

⁓

Well, and I think people too are seeing their, know, admire, like they're people that they follow on Instagram, like they're celebrities or social media influencers, like their favorite influencers getting dissolved. So they're like, ⁓ I want to be like them. I need to do that, you know, but just make sure you talk with your provider for your injector, you know, like

Nicole (15:45)
Mm-hmm.

I need to.

not

always necessary. ⁓

Jonathan LeSuer (15:57)
It's not always necessary.

it is necessary, I mean, anytime a patient comes into our rooms, like I know with Nicole, you're the same way. I'm assessing their lips. I'm looking in their wet board or their lips. I'm looking at their overall face and I'm seeing if there's anything different or, especially before they're coming into the room, I'm looking to see what we did before just to make sure that it looks good. And if there was any issues from what we what we did. So and if there was any issues, I mean, you're a product of us, right? And, you know, we want to make sure you look good.

Nicole (16:07)
Mm-hmm.

Right. Mm-hmm.

Right.

Mm-hmm.

Jonathan LeSuer (16:27)
that way your friends say, I want to go where you go. You look so natural, right? You're what you're exactly. So I think too, it's, it's people following along with what their social media influencers are doing. And just like you said, following a trend and it's just so important not to hop on a trend and do that, which I think people, huh? Yeah.

Nicole (16:30)
Right, right. You're walking billboards,

Yep.

Mm-hmm. Absolutely. Like, look at Avery Woods. I love her. ⁓

But same thing, she dissolved and then, like, a year or two went by and she recently just got refilled by Skins and Needles and, like, her lip filler, you know? So it's, like, it's just funny. Like, she might not have liked... Because, again, she probably went a little too far and she was overfilled, which we all have been at one point. And she started fresh, but then she was like, you know what? I want a little something, which is fine.

Jonathan LeSuer (16:55)
Okay, okay. Yeah. Uh-huh.

Sir, Mm-hmm.

Yes,

it is fine. Yeah, and people that are listening in and know that I've been injecting pdgf since November of 2024 they're like well john you hopped on a trend like pdgf became so big i'm like well it's a remarkable drug number one it's safe to inject

Nicole (17:11)
Yeah.

Mm-hmm.

Jonathan LeSuer (17:26)
You have to provide good standard of care. I'm just saying, like, PDGF patients are the happiest patients. They want more. It's the gift that keeps on giving. And it's one of those procedures that honestly doesn't make the patients look overdone. It makes their skin look better. It makes them look more youthful. And yeah, I'm just that obsessed with it. I would bathe in it if I could. I got four syringes of it yesterday. I want more.

Nicole (17:31)
Mm-hmm.

Mm-hmm.

Yep. Well, and the

thing with you too is, mean, you did it on yourself. You did it on your practitioners. You did, yeah, like it wasn't like you just like, you know, first time using it, put it in a paying patient. Like you took your time to really learn and try it, which I think is really important too. I think we definitely shouldn't just get it and immediately start using it on patients, which is, you know, what you did too. You took your time and really learned how to use the product. Yep. Yes. ⁓

Jonathan LeSuer (17:57)
Yep, friends.

Right.

Mm-hmm.

I agree.

Now Nicole, we're seeing more

and more younger people coming in the office, like early 20s, even late teens, like 18, 19, 20. And they're asking for full face assessments. They're asking for Botox. So should people in their early 20s be getting Botox?

Nicole (18:24)
Mm-hmm.

Mm-hmm.

So I don't think it's necessary unless you have the lines. So I tell everyone there's really no age limit on anything. But you can see some people unfortunately have this hereditary, whether it be skin or their muscle movements are just really strong and at rest they have these very deep lines. And if you're 19 and you have those super deep lines, like it's okay to start, Yep, right, exactly, exactly. But if you're 19 coming into me and you look like

Jonathan LeSuer (18:40)
Yes.

Mm-hmm.

Mm-hmm.

Nicole (19:05)
a glass window, like no, there's no need to be preventative at that point. You know, I tell every single one of my patients, once we start to see a little bit of those lines, static lines, meaning lines at rest, that's when we wanna start treating. That's when we wanna start prevention. We don't wanna wait till those are really deep, but you also don't need to start when there's no lines at all.

Jonathan LeSuer (19:06)
Mm-hmm.

This Gen Z population, I mean, my God, so many mothers come in and they tell me in the chair that their six and nine year old are asking for full skincare routines, right? So do you think that they're seeing this stuff on TikTok, on Instagram? Is that what it is? Yeah, I agree.

Nicole (19:26)
Mm-hmm.

Mm-hmm.

Absolutely, absolutely. Yep. Yep, and

there was a lot of controversy actually actually ⁓ with I Think her first name's Shay. She's like an actress. She was in I want to say she was in pretty pretty little liars But anyway, she started a skincare brand for kids and like people went crazy like angry at her but

Jonathan LeSuer (19:50)
Okay.

Okay.

cute yeah

Nicole (20:04)
There was a whole other side of people like, but kids want it and like, we don't have any, they're buying drunk elephant. These kids are putting glycolic acid on their face. like we kind of need it. So like I get like, I get the frustration in it, but I also think that there is a need for it right now because these kids are on TikTok and Instagram seeing this stuff.

Jonathan LeSuer (20:11)
Yeah.

Mm-hmm.

I think so too. And personally,

my opinion about children and skincare, I mean, if it were my son or my daughter, I would get them a gentle cleanser, a good hyaluronic acid serum, and then a good moisturizer and make sure you wear SPF. Like keep it simple. Maybe during the hormonal stages when they're going through puberty, add in a salicylic acid or something like that to help. And then obviously if it's out of control acne, then obviously seek.

Nicole (20:33)
you

Yep. Yep.

in an acid. Yep.

Jonathan LeSuer (20:51)
treatment for that dermatologist or even your esthetician. mean face reality is a great line for acne. If you don't want to go the accutane route or chemical peels, yeah. but yeah, I definitely like what is the ethical way do you think to approach aesthetics with younger patients?

Nicole (20:51)
Right, a dermatologist, yes, yeah, yeah, yeah, mm-hmm. Yep. Chemical peels, yep, mm-hmm.

⁓ It's

a hard discussion and I do have a few young patients that I think truly do have dysmorphia and I think it's important to sit down with them and you have to tell them no.

Jonathan LeSuer (21:18)
See you.

Well, it's the filters too. Yeah. I know.

Nicole (21:24)
Yeah, the filters have not helped at all. And it's like you

said earlier, comparing yourself to other people on social media and then they show you this person and I'm like, I need you to understand that this is not what this person, if you met this person in person, you wouldn't recognize them. Like it's FaceTune, it's FaceApp, it's whatever it is, it's filter. Like you can't compare yourself and it's a really difficult discussion to have. I'll do like.

Jonathan LeSuer (21:29)
I know.

It's So true.

Mm-hmm.

Nicole (21:50)
subtle lips on young girls like that, know, minor things. ⁓ I've had a 20 year old that had the very, very recessed chin and I treated her chin and nothing else and like, so there are things that I think you can do for people when it's actually necessary, but I think it's, you gotta make sure that you're not feeding into that.

Jonathan LeSuer (21:52)
Same.

recession so you treated it.

Mm-hmm. Mm-hmm.

I have one for you. ⁓ Chin filler or chin implant?

Nicole (22:16)
Oof, well, I did work in plastics for quite some time and the chin implants are beautiful, but I think a lot of the time they don't give as much projection as the patient is thinking it will.

Jonathan LeSuer (22:20)
Mm-hmm.

Mm-hmm.

Nicole (22:28)
or it might settle a little bit lower than they had anticipated and it's not as much forward projection. We had a lot of patients where once healed, we might layer some filler over the implant. So I feel like even people with implants do end up doing filler. So honestly, unless it's super, super, super recessed, I would say filler. Yeah. Yeah. Mm-hmm. Mm-hmm.

Jonathan LeSuer (22:32)
Mm-hmm.

Mm-hmm.

Same. I'm all for H.A. Filler just because it can be dissolved. I feel like it looks better in the chin.

I've seen so many implants. There might be one that I've really loved. Otherwise, I'm not going to lie. I'm like trying to use H.A. Filler to try to harmonize that pre-gel sulcus area. It almost makes them look like more masculine depending on the implant. It could feel the ridges in there. It just doesn't. I don't know. I'm just not a fan.

Nicole (23:01)
Yeah, right.

Mm-hmm. Connect it.

Mm-hmm.

I think it's

a tough spot to heal. Yeah.

Jonathan LeSuer (23:19)
Yeah, and like

doing filler over it. mean, you can't be, it's also dangerous and you have to know what you're doing. You can't puncture the implant. can't go to that. And honestly, this is a great, great segue to just say, if you're an injector and you're treating a chin, ask them, have you had it? Do you have a chin implant? Because I, there has been multiple occasions where I've, I'm about to, I have the needle attached to the Juvederm Voluma and I'm about to do a chin and I just go ahead and do you, do you have an implant? And they're like, yeah. And I'm like,

Nicole (23:22)
It's also dangerous. Yes, Yep. Yep.

You

Mm-hmm.

Like, wait

a minute. Antibiotics, antibiotics. Yep. Yep. Yeah. No, honestly, like, I would advise you, if you are an injector listening, to not send them back to their plastic surgeon if they want.

Jonathan LeSuer (23:49)
Wait a minute, wait a minute. Okay, so let's get the cannula on. Let's change things up a little bit ⁓ just because you can't puncture that implant.

Nicole (24:07)
filler over an implant to be completely honest. Unless you might, you may work for a surgeon. Like the only reason I feel comfortable is because I did work for a plastic surgeon and we did often do it. But you sometimes do want to prophylactically treat with antibiotics or something like that if you are gonna be in that area messing around because if you think about it, it's an encapsulated implant. You wanna make sure that you don't mess with it. Right, exactly, exactly. Keep it clean,

Jonathan LeSuer (24:08)
I agree.

Yeah.

It's an implant, And you don't want to seed an infection into that implant. I agree with you.

Nicole (24:38)
But no, I think you have much more, like, you can create more shape and create a couple more things, yeah, with AJ filler instead of implants, you know. I had someone ask me about cheek implants the other day and I was like, ⁓ we could do that with filler for you, don't we? You don't need to go down that route.

Jonathan LeSuer (24:45)
Contour, yeah.

Mm-hmm.

Yeah.

Who's that guy

that's in Hollywood? looks like Ken. He's ⁓ basically like a Barbie doll Ken. He literally, he's gotten like bicep implant. He goes like Ken, think. He's got bicep, tricep.

Nicole (25:02)
Yes, yeah, yeah, does they just go by Ken yeah, he's the one that had his ⁓

The the vein that runs this way and when you laugh, you know mine's so bad But he had he went to like India and they cut it out But I have patients complain about that area all the time and I'm like it's literally supplying your face with blood like we're not we're not gonna get rid of that

Jonathan LeSuer (25:16)
Yeah.

⁓ god.

Literally. Let's not get rid of that.

Nicole (25:31)
Don't touch that. Yeah, that's crazy.

Jonathan LeSuer (25:32)
don't, my God, implants in your pecs, your abs, your tricep, bicep, all I think of is infection. And all I think about is like, why would you want to cuddle with that person? Like if you go and hug them, you're going to be like, he feels, you feel like a He feels, literally, he feels like a cat.

Nicole (25:39)
Mm-hmm.

He feels like a Ken. Like a doll. ⁓

my god. This is a good one. Do we feel like providers are partly responsible for the overfilled look that became popular? Yeah. Yeah.

Jonathan LeSuer (25:55)
Mm-hmm.

You

Yes, I do.

I do. I think this comes back to ⁓ do your research on your injector. Look to see what they look like. Right. If they look overfilled. Right. That's kind of a red flag. Right. So I think that obviously, you know, we're these consumers and patients are trusting.

Nicole (26:16)
Mm-hmm.

Yep.

Jonathan LeSuer (26:27)
providers, you know, to inject their face. So if they're going to someone who is overfilled, right, there's a likelihood that they could make you overfilled. And I think they also idolize us, you know. So if they're seeing that, they think that that's normal or they automatically say, oh, that's what fillers look like, you know. So I do I do think that they're I think it's gotten better over the past two to three years, if you probably agree. And there's been a lot of. Yes, we're shifting.

Nicole (26:28)
Mm-hmm.

Right.

Mm-hmm.

Right.

Mm-hmm.

Agreed. Yep. And I think that's like the movement we're all trying to do is like bring the medicine

back into aesthetics. Yes. Like, yes. Yes. Absolutely.

Jonathan LeSuer (26:55)
Yes, we're making it more prescriptive, which it should be.

Everyone always says, oh, it's such a fun job you have. And I'm like, it's fun, but this is a profession. This is actually medicine. Like we're injecting drugs into people's faces. You can't forget that. Okay, let's see here.

Nicole (27:06)
Yep. Right.

Mm-hmm. Yeah, and can't forget that. Yeah.

Jonathan LeSuer (27:23)
Has social media made aesthetics more transparent or more misleading?

Nicole (27:31)
I think, I think both. So I think we have a lot of providers now doing their very, very best to put really good education out there and really, you know, show patients what's possible and what's not. But I do think there are still some clickbait providers and definitely still, I mean, we still see those people on TikTok with the lips that I mean, are literally out to here where it looks like they're going to explode.

Jonathan LeSuer (27:33)
Yes, same.

Nicole (27:58)
100 % sure they're going to someone that's not certified.

Jonathan LeSuer (28:00)
It's MCR Aesthetics.

Do you know what I'm talking about?

Nicole (28:05)
I do actually yes yes yes ⁓ my god whoa but a lot of the time those people aren't ⁓ medical providers when you know like there's that one god she comes up on my she comes up on my for you page on tiktok and i swear to you her lips are out to here like it looks i i will send joey a picture so he can put it in but i you would hope that that's not

Jonathan LeSuer (28:07)
Anytime they come on, I'm like, ⁓ it's like I'm like jump scare. ⁓ my God.

Mm-hmm. Mm-hmm.

Hmm.

Nicole (28:31)
a medical provider doing that to her. ⁓ I do feel like a lot of us now have tried to shift our focus into educating our patients the right way and showing them realistic outcomes and what's safe and what's not. So I think there's a little bit of both.

Jonathan LeSuer (28:43)
Mm-hmm.

There's a question on here that says has aesthetics become too normalized. I had to like think about that for a minute I was just staring at you and I was like trying to think about this question but I what I take from this question is is I've seen a lot of people that are ordering Botox, I don't know where they're ordering it from

Nicole (28:56)
Yeah.

Mm.

Jonathan LeSuer (29:09)
but they're learning how to inject themselves at home. And it's all over TikTok. It's a huge trend right now to inject your own Botox. And they're literally going on there very freely. They don't care. They're like showing their followers like, I just like watch so many YouTube videos or so many videos on anatomy and I'm marking my face right now and I'm going to spend a few more days marking my face and learning the muscles. And I'm thinking in my head, okay, you know.

Nicole (29:32)
Mm-hmm.

Yep.

Jonathan LeSuer (29:38)
And I'm not gonna lie, like I actually love, love. I absolutely love one of my patients, but she just did this to herself. And I...

Nicole (29:45)
my gosh. ⁓

Jonathan LeSuer (29:47)
She told me and I'm I'm not, I'm non-judgmental. I truly am. I truly am. And she looks okay. Nothing happened to her. I'm very, very grateful for that. But I was like, my God, like this is how normal, like, ⁓ is this becoming too normalized? I think this is what this question means is that it's almost becoming just like, anyone can do it. And people don't realize like how, like,

Nicole (29:50)
Yes, yep, yep.

Mm-hmm.

Yeah.

Mm-hmm. Yeah.

Dangerous,

Jonathan LeSuer (30:12)
how much dangerous, I mean, we have to take anatomy courses.

And then after when we join this profession, we're going to cadaver courses, we're learning the muscles. And I feel like not even like two cadaver courses is enough because it doesn't sink in until like maybe the sixth or the seventh, which might sound repetitive because there's so many muscles and it's so different to look at these muscles and on an actual person than it is like on like a, you know, a diagram or something.

Nicole (30:24)
Right.

This, yes, yep, I was gonna say at least four, yeah. Yep.

Yes. Yep.

Well, and not

to mention even like, you're not able to get actual like prescription medication as a normal person. So you have truly it's kind of like what's going on with the peptides right now. You have truly no idea where and even if they tell you and give you a little booklet that says where it was made and that it's certified and sterile, you don't know that it was there was recently I just saw actually on tik tok again. This kid got ⁓

Jonathan LeSuer (30:47)
Mm-hmm.

Yeah.

where it's coming from.

Right.

Nicole (31:07)
peptides and They tell you a thousand times how to mix these things and my husband does a few and like it's very clear, right? There's instructions that come with it But not everybody reads those not everyone not everyone has a medical provider in the house like this kid apparently mixed his peptides with tap water and was injecting tap water and I mean he got so severely sick and like it's and

Jonathan LeSuer (31:08)
Yeah.

Mm-hmm.

Mm-hmm.

⁓ no.

Nicole (31:33)
Not even that, like these vials are coming to you from wherever they are internationally. Who knows if they're being shipped on ice? Who knows if it's growing bacteria and then you're putting something in it and you're injecting it into your body. Like that's the dangerous part to me. Like I don't care if you cause yourself to have a droopy eye or a crazy eyebrow like or a crooked smile. Like to me it's like you have no idea what you're injecting into your body. could be, it could be poison. Yeah.

Jonathan LeSuer (31:38)
Yeah.

Yeah. Yeah.

Mm-hmm.

It's so true. just,

I truly am shocked at how many people are self injecting that aren't providers that are just normal people. And my patient actually told me, she goes, it's actually, she goes, I'm not doing it again. I will be going to you from here on out, you know, but I just wanted to try it. I'm okay, you know, but she's like, this site that we do purchase that they are cracking down. And I'm like, okay.

Nicole (32:11)
Mm-hmm.

Mm-hmm.

Jonathan LeSuer (32:24)
Okay, you

Nicole (32:24)
Nope.

Jonathan LeSuer (32:25)
know, I'm like, well, yes, and she did say it was the black market where she got it from meaning it's just not a legal place. You don't know what's in it. And I've actually seen, I've seen these boxes of where the botulinum toxin is in. It does not, I've never seen these before. It's like a white green color box. It's like, I'm like, God, what are you guys putting in your faces? Hopefully this is not making long-term.

Nicole (32:28)
Yeah, yep.

Yep. Right? It's so scary.

Mm-hmm.

Yeah. Yeah.

Mm-hmm. Yeah.

Right,

issues, right. Yep, Yep.

Jonathan LeSuer (32:52)
issues down the road. So anyway, this is happening. I mean, I

think it's funny like, it's like, I don't want to believe it. I don't, but it is happening. Mm hmm. Mm hmm. Mm hmm.

Nicole (33:01)
Yeah, yeah, it is happening. People are out there doing it and they're putting it on TikTok,

which is the craziest part. They're admitting it. Yes, yeah, yeah.

Jonathan LeSuer (33:09)
They are and I mean at least they're being honest. I mean truthfully I'm like, okay, you guys are very transparent.

You're posting I don't know if it's scary or if it's Or what? It's a little scary a little scare a little scare do you have any questions for me?

Nicole (33:19)
Well, it's a little scary. It's very scary. ⁓

Let's see. Sorry, every time I close this, it goes out. OK, let's see, let's see.

Jonathan LeSuer (33:29)
Take a good one.

My face feels hot from this PDGF.

Nicole (33:36)
Yeah, I bet.

okay, this is a good one. Are complications increasing as more people enter the industry?

Jonathan LeSuer (33:41)
Mm-mm.

Hmm

Huh, okay. This is a loaded one. I feel like because social media is so prevalent right now, more people are comfortable posting their complications. is a good thing because it's nice to see that. I love people that are okay with saying I made a mistake and this is how I fixed it. ⁓ That's great. It just makes them... I think it is too.

Nicole (33:51)
Yeah.

Yes. And I think it's good for patients to know too. Again,

like how we just said, aesthetics is getting a little bit more normalized, or too normalized. They think it's a lunch break thing that can't make them go blind. All of these things have serious, serious risks. And I think it's good that we don't just show the good and the beautiful, and these things do happen.

Jonathan LeSuer (34:20)
Yeah.

Yeah, but I would say yes. It's kind of like an analogy is if you're a provider and you're seeing...

Nicole (34:39)
Mm-hmm.

Jonathan LeSuer (34:46)
100 patients a week, like say when you first start, right? Like when we first started, I barely had any complications, right? And people would ask me, have you ever had any? I'm like, no. And then now you ask me now and I'm like, yeah, like I've had a couple people develop nodules. I've had a couple people develop other things, right? Or autoimmune like responses to things. And you know, it kind of like humbles you a little bit or like resets you. But at the same time, you have to evaluate yourself and be like, wait, I'm seeing...

Nicole (34:59)
Mm-hmm.

Mm-hmm.

Jonathan LeSuer (35:12)
100 to 150 patients a week. Like this is, it's going to happen. The more patients you see, the more complications you're going to have. So with that being said, I think yes, the more new injectors there are that are coming in the market over the past year to two years, I think yes, there has been more complications and I think providers are just so anxious to start injecting. ⁓ But I will say that I think there's a lot more opportunities for training.

Nicole (35:14)
Right. It's gonna happen. Yep.

Yep.

Mm-hmm.

Jonathan LeSuer (35:38)
Now with this new wave of injectors coming in, like you said, there's Galderma, Allergan, Previd-S, RHA, or Revanse trainers everywhere. And they're providing practice trainings and they're going over complication management usually in those trainings. I know at Allergan we do that and we provide that for them. ⁓ And obviously now with the AMI training centers, I mean, there's just so much more opportunity for training that we didn't have, which I'm actually so jealous about. ⁓ But

Nicole (35:47)
Yep. Yep.

Mm-hmm. Mm-hmm.

Yep. Yep.

Jonathan LeSuer (36:07)
Does that answer the question?

Nicole (36:08)
Yeah, absolutely.

And I think an influx of anything, of course, is going to unfortunately bring more complications. But like you said, the important thing is that we know how to take care of those. I don't know if it will come out before or after this one, but when we spoke to Kristin, she's a nurse practitioner and she recently had a temple occlusion. And we talked to her all about how...

Jonathan LeSuer (36:13)
I agree.

you

manage them.

Yeah.

Mm-hmm.

Nicole (36:34)
she

handled it and how she saw it come on. And I think it's more important that you as the provider know how to handle it than anything. Yes, very fun. ⁓

Jonathan LeSuer (36:37)
Sure.

100%. 100%. Yeah. Oh, well this was fun. Yes. Yes.

I hope you guys enjoyed this episode of the Filmian Podcast. Till next time, I'm Injector John. Love you guys.

Nicole (36:53)
And I'm aesthetic nurse Nicole. Thanks for listening.

Beautiful. Sorry, Joey, we wanted to film an