Fill Me In: An Aesthetics Podcast
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
Fill Me In: An Aesthetics Podcast
Secrets to a Younger-Looking Neck | Episode 22
In this episode of Fill Me In, Jon and Nicole discuss the latest FDA indication for Botox to treat platysma bands and how to achieve a more youthful appearance through neck and lower face treatments. They delve into techniques like the Nefertiti neck lift, micro Botox, and the use of wrinkle relaxers. The conversation also covers the importance of early treatment to prevent aging signs and the potential complications from incorrect Botox and filler procedures. Watch to learn about effective methods to rejuvenate your neck and lower face, and hear their thoughts on popular beauty devices and practices. Don't neglect the neck!
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
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https://exhibitmedicalaesthetics.com/
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https://toxandpout.com/
Jonathan LeSuer, MSN, NP-C
Jonathan LeSuer graduated from Le Moyne College with his Bachelor’s in Nursing in 2014 and a Family Nurse Practitioner degree in 2017. He began his career at St. Joseph’s Hospital as a Registered Nurse on a cardiac medical-surgical unit. He transitioned to the Nurse Practitioner role in 2017, working for Hospitalist Medicine, where he became the coordinator for the team’s Physician Assistants and Nurse Practitioners. In 2020, he started his career as an Aesthetic injector and quickly found out that this was his passion. On March 15th, 2022, he opened Tox & Pout Aesthetics. He is now a Master trained injector & National trainer for Allergan Aesthetics, offering Botox, Dysport, Hyaluronic acid fillers, Kybella, SkinViVe skin booster, and Sculptra. Jonathan is known for his empathy, profound bedside manner, and outgoing/warm personality. He has a deep love for aesthetics, and his patients’ confidence is his main priority.
Nicole Bauer, MSN, APRN, FNP-BC.
Family Nurse Practitioner
Nicole graduated with her Associates in Applied Sciences and began her journey as a registered nurse 10 years ago in 2014. She worked hard to combine her love for beauty with her passion for caring and healing others, attending aesthetics school while working as a hospital night nurse. After graduating as a licensed aesthetician, Nicole left the hospital where she had been for 3.5 years and began working as a registered nurse for a plastic surgeon. An experience of over 6 years that would leave her with so much knowledge and respect for the aesthetic world. It was during those 6 years that she pursued her Master’s Degree and obtained her license as a Family Nurse Practitioner, leading the way for where she is now; owning a state of the art medical aesthetic practice and being a national Allergan Trainer. Nicole takes pride in treating her patients holistically, focusing on facial balancing and enhancing one’s natural beauty. She believes education stands as the cornerstone of aesthetics and is why she is dedicated to both training others while always focusing on expanding her own knowledge as well.
Producer of Fill Me In: Joseph Ginexi
#aesthetics #Botox #filler #NeckRejuvenation #PlatysmaBands #Injectables #SkinCare #YouthfulSkin
All right, guys, welcome back to another episode of the Fill Me In Podcast. I'm Injector John.
And I'm Aesthetic Nurse Nicole.
And we are gonna dive deep into the world of Aesthetics, actually. We have a new FDA indication for Botox, which is the platysma bands. We've been doing that for years, but officially we have an on label use for it.
And we're going to talk about that. And I think a lot of you that are listening are probably already doing it. If you're not, maybe after you watch or listen today, you'll be doing it more. So that's the goal. Yeah. So how long have you been treating the platysma bands, Nicole?
Oh God, probably at least four or five years.
Yeah.
And I feel like in the past. Two or three years, the lower face has gotten so popular.
Why do you think that is
Instagram for one tick tock, but two, it's kind of with time we're seeing the aesthetic world kind of evolve and we are seeing much more research and we're finding that if you are only treating the upper face, you know, the lower face could eventually potentially kind of take over for that.
lack of movement. Um, so it's kind of taking that holistic approach and making sure that you're treating the patient as a whole and giving them the best result.
And it's going to be a giveaway if you're just treating your face and not your neck. I mean, we always joke about this with celebrities and like housewives.
I'm like, hi, your face looks great, but we can tell how old you are with your neck. Or your hands, your hands, the back of your hands. Yeah. Um, don't neglect
the neck. That's right. Don't
neglect the neck. And I think too, it's such a great way for patients to kind of introduce them into treatments of the lower face by doing, you know, platysma bands and doing nefertiti neck lifts, doing DAO, because there's some patients are so hesitant about getting filler and I'm like, okay, well we can do something for you and that's doing a Nefertiti necklift where it's putting Botox superficially injected along the jawline here from kind of where the DAO ends and then back towards that gonial angle of the jawline.
Um, and what that does is basically just relaxes that pull down a little bit and it will gently just kind of lift. That kind of sag there that little jowl there a little bit just to improve the appearance of the jawline a little bit, which is really nice.
I tell people to think of the patissier muscle, like a hand coming up and over the jawline and any kind of expression you might make or, you know, even we don't even realize chewing drinking all those things.
It pulls the face this way and that's actually over time what's creating those marionettes and those jowls. So like you said, doing that, the little micro droplets kind of along the jawline, treating the DAO and then coming into each band to really kind of. you know, relax that pull down and
you're going to relax those muscles there.
You're going to have some muscles that compensate. It's like your viscerous muscle, which is responsible for, you know, pulling the corner of your mouth, you know, giving you that nice big smile, right? Um, also your zygomatic major minor muscles, there's going to be a few muscles in the upper face, right?
That can compensate and help to almost lift it up as well.
Exactly. And on that same note, you have to be careful when you're doing something like an effort TD lift, because you don't want to come too high. And, and hit those muscles. Because of that rhizorus. Yeah. Mm hmm. And you want to make
sure your, your injections are more superficial.
Right. Not deep. Right.
You don't, you don't want to aim for any of those smile muscles because you will have a very unhappy patient.
Yeah. And a way to kind of prevent this is if you can, if you literally take like your white pencil or marker and draw a line from the oral commissure all the way back, right?
to like the lower part of the tragus. Yeah. And then stay below that, then you should be okay. Cause that's normally where that line is. That's kind of where that Rosarius muscle sits. Um, if you do hit that, then sometimes what happens is, is that someone will smile and one side will. obviously expand and smile.
The other side will be relaxed and it won't, it'll almost look just like an uneven smile.
Right. Right. And it
will be there for the three to four months. Yeah.
And exactly. And we can treat the other side to kind of try to make them a little bit more even. So at least it doesn't look like they're walking around having a stroke 24 seven.
Right. Right. Um, but some patients do opt to leave the other side. They're like, you know what, I don't want to mess with that. Um, but I always suggest if you do end up with a complication like just treat the other side. Yeah. You're going to feel very safe. stuck and you feel like your smile is not the same, but it's going to be much less noticeable to people.
The other way to write Nicole that someone can hit the brazorius muscle is if you're doing the masseters. So
that brazorius muscle is coming back and it's sitting right on top of the front of that masseter, pretty much at that top. So that's why we always say keep the masseter injections a little bit lower, or if you're going to be higher to keep them very deep.
Yeah, deep. Yeah. And keep it, do it lower and posterior injections. Yeah.
Right. Yeah. Yeah.
I love it. So, you know, platysma is great because we're going to improve the overall appearance of the neck. But basically what, like Nicole said before is it's going to relax those bands, right. That are seen here. And then, so that way Everything is kind of, kind of lifted up just a little bit.
The other thing that you can do, which is off label with Botox is do micro Botox, um, to the neck as well, to help with some of that loose crappy skin, kind of like the gobble that some people say it can help to improve the appearance of that as well.
And that is the most asked about thing. I say in my practice, you know, people come in and they're like, I'm just so bothered by the laxity in the center of my neck.
And unfortunately that's due to a bunch of things, sun exposure, sometimes weight loss, um, just loss of collagen with age. And there's not a ton. that we can do for that non surgically. So it is tough. It is a tougher thing to treat, but I think treating the platysma bands, the lower face, doing the microtox is huge,
but
other modalities, you can really look into microneedling and really honing in on that area or things like skin tight, uh, more of like your resurfacing lasers, moxie, things of that nature too can be very beneficial for boosting your collagen.
Uh,
but it is non surgically one of the more difficult areas. And,
you know, it's, it's even after like three rounds of RF microneedling, we can make it better. It's never going to be perfect. You know, it's, you can make it 30 to 40 percent better. Um, if it's severe, severe, you know, I it's, uh, it's just so hard, you know, it's, it's, it's, it's, it's, It could take six to 12 treatments and maybe it's, it's finally looking better at that point for someone who has severe, um, you know, laxity there, but, um, but yeah, sometimes, you know, just telling your patient and being honest with them and saying, listen, you know, you could spend all this money here, but why not try a surgical consult and put your money towards getting like a neck and lower facelift?
Cause in the long run, I think you'll save a little bit of money and be happier.
And, um, Dr. Subio just said his, he does those free lives. All the time on his Instagram. Mm-hmm . Uh, he just had one on like, I guess ultrasound therapy or like radio frequency therapy. Okay. Uh, but the non-invasive version, so not like microneedling, like a, I guess like a soft wave.
Oh, soft wave. Yes. Or um, um, alt therapy, things like that. Yep. Um, and he did post the result and there, in my opinion, was a slight difference, but he was kind of. Alluding to the fact where, you know, this cost the patient 3, 000. If you were a patient, how, how would you feel about this result? You know, there's, there's other options out there.
Um, unfortunately for some surgery is really the only answer, but for others, the Botox is a great, great option. Alternative.
And I think that earlier you start these treatments, the better. Like, I'm sorry, if you're coming in and you're 55, 60, 70, and you already have severe laxity there, it's so hard to treat it non surgically.
Right. You know, we can make it look 30, 40 percent better if that, but at that point you probably are going to need a neck or lower facelift. But if you start using like a good neck cream, if you're doing some microneedling to the neck, whether it's skin, even just skin pen, I feel just simulating that collagen in your, you know, early thirties to late, you know, the late thirties, early forties, that's going to help you tremendously down the road.
And I think help to prolong you or even possibly in some cases prevent you from getting a facelift.
And that's what Botox truly we've been learning is more of that prevention.
Yeah.
rather than waiting to the lines are there or waiting till that laxity is there. If you're preventing that pull of the skin down all day, every day, you're going to have much less chance of marionettes, jowls and laxity in the neck because of that.
You're not going to stretch the skin. Right. Yeah. And, um, God, what was I going to say? Oh, Sculptra, Sculptra biosimulators. So like hyper dilute radius and Sculptra are very hot, um, right now, especially for improving the treatments of the neck and also the decollete. I treat Sculptra all day long in the neck too, just to help to stimulate collagen, um, you know, improve the skin laxity, give that overall youthful glow to the skin.
It does help. I think a lot. Yeah. Um, it can sometimes be a little bit pricey. For patients. I mean, it's 1400 a session. Usually I, at my office, we charge 700 a vial. So I usually like to do a vial per side of the neck, have them come back in 68 weeks, do another session. Sometimes they need three sessions.
But the best thing about sculpture is it lasts 2 to 3 years. But yeah,
and that goes hand in hand kind of with your micro needling and stuff like that, things that are going to boost the collagen, because really that lack of collagen, we, unfortunately, after 25, we start to lose it.
So
that lack of collagen is really what's kind of causing all these issues.
So things that are going to boost that are going to be huge.
And also, you know, a lot of you guys are seeing all over social media, platelet derived growth factor, which is PDGF. I'm telling you guys, if you have a provider around you that has it. Yeah, go to them. Okay? Because to add that on to your microneedling right now, the on label use for PDGF is topically over compromised skin after like a CO2 or erbium skin resurfacing laser over RF microneedling with skin pen microneedling.
And what that's doing is compared to PRP and PRF, there's 8, 000 to 300, 000 times more growth factor concentration. in comparison to that. I mean, it's incredible. Um, and the healing properties are amazing. The college and production is even more. And if you're looking for good risk and rejuvenation, PDGF is, I think is going to become a really big treatment of 2025.
Yeah. It's going to be a staple.
If
you're getting something like micro needling or something like that, that you can use it topically in that
area. Do an add on whether, even if you don't do PDGF add on PRP, do something because Obviously it's going to speed up your recovery time, but you're also going to increase your collagen production.
Right. Those growth factors are extremely important.
Yes. And ladies, I can't tell you like any ladies listening, like so many patients come in and they're like, oh, I hate the lines between my breasts, like the decollete area. And what is that normally from side sleeping, but also sun damage too.
Sun damage is a big one, but side sleeping, for our women with a little bit bigger breasts, we'll see that quicker.
Um, I'm starting to see it now that I'm pregnant, the boobs are growing and the lines are starting. You need that
pillow that prevents you from the side sleeping.
Yes, exactly. Well, now, you know, they say you have to sleep on your side when you're pregnant, so I can't win. Yeah. Um, but definitely microneedling there, avoiding that sun exposure.
And if you're going to be in the sun, SPF everywhere, oh my God, please, yes, yes. And also they do make bras now. That have a pillow
shut up
in between the company sleep and glow that makes the pillow that I always talk about makes a bra that has a pillow in between so that you don't smush together so much.
Q is it presentable?
It could be better
under a sweater. Like, what is this? Like, I. It's like, how, how practical is this? Yeah.
I'm like, I don't know how comfortable it would be, but it's to keep, it's to keep the gap so that you don't crease so much in the, in the deck. Let's say it makes sense. Yeah. Yep. Yep.
But, um, and you know, they, they have the silicone patches on Amazon, which I've personally tried with pregnancy now, which does make a difference, but you have to be consistent and you still have to do your college and boosting treatments to create any change. Hey guys, just popping in. If you're enjoying our podcast, please subscribe.
And don't forget to follow us on Instagram, Injector John and Aesthetic Nurse Nicole.
Nicole, we just, I know you have BBL, um, with Cyton, right? And I have IPL at my office and we actually just treated this patient, face, neck, chest, um, face, neck, decollete, whatever, um, with IPL, which is intense pulse light for hyperpigmentation and sun damage.
Oh my God. So we did three sessions spaced out four to six weeks apart. It's like night and day. Yeah. It's insane. And like her overall like skin appearance just looks healthier. Her skin laxity looks better. Her pigmentation is less like, I think she's going to be doing her shoulders and arms next just because it was that good.
And that's a true thing. So Saiton actually came out with a new filter for the BBL. So BBL for those listening, it's broadband light. It's pretty much exactly the same as IPL, which is intense pulse light. Uh, they're just different. Companies in a sense, a little bit more
even I feel like, like, you know, like with IPL, it's like a flash of light.
You have to remain very systematic. Yeah, yeah. Right. Or else, you know, if you miss a spot, you'll see that line. Yeah. Whereas I feel like bbl l it's more,
it kind of does it for you, where you don't have to worry about your overlap quite as much. Um, but they came out with a new filter called six 40 s. they created because they were finding such a change in the skin quality after BBL treatments.
Um, and they were finding cause you're heating up the skin. You're actually causing the collagen induction. Yep. So they created this filter that we could just go in after the fact and do even more of that because people were seeing such a decrease in the lines and they were seeing such a like luminosity to the skin and a little bit tighter.
And so that's something you can do, you know, decollete neck, even, even the face. forehead you want to be careful with just because it creates so much heat. But yeah, that is something that, um, that they found, you know, from doing all these treatments over and over and it's a new filter now. So it's exciting.
That is really exciting. So yeah, I think the moral of the story is to start the neck and decollete treatments younger if you can. So if you're watching and you're in your late twenties, thirties, late thirties, early forties start like right away. Um, once you get into your like mid to late fifties, sixties and you haven't done anything, that's when it's really hard, um, to see like miraculous results with non surgical treatments, like we're saying.
Right. And if you're doing your microneedling, you're already doing your face and neck. Add the, just add the chest on, you're already there, you're already dealing with it, just
do it.
Exactly. Just don't neglect it. And I think too, when it comes to skincare, you know, I do, I love neck correct is a one product that I've used that I've actually noticed changes in my own neck, um, specifically like my horizontal lines, but I do think there's benefit in just bringing your face skincare down the neck and chest.
I don't really think you need anything quite specific. Uh, but definitely making sure that when you do your skincare, you just bring it down. You know, you don't, you don't have to do extra pumps or anything, but just kind of let it travel down.
I have never treated my neck with Botox until this past November.
And I completely know what the hype is now. I just started having some platysma bands. Like I've started seeing them way more when I was making expressions, but I was smiling really hard. Um, You know, the Botox glow that you get to your forehead and face, like when you do it, you honestly, your neck glows as well.
Like the skin actually looks more youthful after I was like, wow, it even like my tech lines look softer and I didn't treat, I didn't do microtox to those neck lines, but they did look softer because everything was just a little bit more lifted
Yeah, exactly.
Now
for the horizontal lines, I personally use a lot of skin.
Veve in those. So love people with, we call them necklace lines, tech neck, but it's those horizontal lines that come across the neck. Um, and you don't need a lot, very small amounts to just pop it out. And that too, sometimes in certain people that can actually, you know, Give the illusion that they have a lot of laxity, but really it's just like a fold.
Yeah. The other option too, that I do a lot is sculpture there. It does help a lot as well, just because sculpture is basically realigning those collagen and elastin fibers. So it's basically thickening that skin and giving more support to it. Um, so that also can help as well.
Do you kind of go in like subsize first and then drop the sculpture?
Kind
of. I do use a cannula. I'll just go right underneath that line. I'll fan it. I'll do whole fanning. And then obviously you do your massage after. Right. Um, but yeah.
Yeah. Kind of. I think that always helps to to kind of break it up a little. Oh yeah. Yeah.
To stimulate more collagen and neocollagenesis.
Yeah. Yeah.
Yeah.
Yep. A hundred percent. Um, I just brought on SkinCeuticals to my office. And for those of you that love SkinCeuticals, I love it as well. And I have never used their tri peptide neck repair cream until just recently. I
love it.
I love it. I love it. It actually says on the bottle to use it every other day.
Interesting.
But I use it every day. Yeah. Um, but. And
you, you've been fine.
No. And it's actually, it's really, really nice, Nicole. Yeah. Like, it's nice. I would say out of all the neck creams, my faves are the Tecto Neck Cream with Skin Better. And so far, I love this Tripeptide Neck Cream with, um. with, uh, SkinCeuticals.
But if you're just gonna rely, like your first, if you're like in your 50s, 60s and you're starting to use a neck cream, you're probably going to not see a huge result. I'm sorry. It's true, right? Right. You know, so
yeah, it's, it's that prevention. It's starting young. Yep. It's preserving as much collagen as you can.
Yeah. Yeah. You definitely have to think ahead because once you have that laxity, there's really no tightening besides surgery. Unfortunately.
Yeah, and what causes a lot like what causes the sagging people always ask, they're like, what causes this? And it's basically when we're younger, our muscles are nice and tight, right?
They're all lifted. They're keeping those fat pads, you know, in their own compartments in the, in place. But as we get older, everything starts to relax. It's gravity, right? Yeah. Our muscles get tired and that's part of what contributes to the jowling and also to the platysma bands showing more of the neck.
Yep. He's kind of from the side. You start to see that double chin a little bit more because
God,
the bands, even from the side, I don't know if you can,
yours aren't bad. Shut up. But you can see
that pull here, which over time can cause that, that turkey neck that we call gobble. Yeah.
God. Yours are not bad.
Nicole. Thank you. I really
focus on not using my neck.
Oh, see, I make my faces with my patients. Right. I almost feel like I gave myself bands because I was like. Try to make them make that face.
You strengthened it.
Yeah.
It's not good. Oh my gosh. But yeah. So what would you say is like a typical dose of the lower face?
Oh,
that's a good question. So usually, you know, with the nefertiti, like doing, you know, the along the platysma muscle here. I usually do. I do it. Eight units along the jawline. Sometimes I'll do 10. It just really depends on sometimes the patient's budget, but obviously I hate even talking about budget because dose equals duration.
And if we microdose it too much, you won't see a good result. So at minimum, I usually do eight units for the nefertiti bilaterally. I usually, um, hit the DAO, um, upper up towards the oral commissure and then also lower towards. So I usually do a total of eight units total for the DAO. Um, for platysma bands, I usually do 10 to 15 units per band.
What do you normally do?
That's exactly the same. So I usually do about six per DAO.
Okay.
Um, but I, same thing. I separate it into two. I keep the lower one very low because. I keep the top one by the oral commissure and then the other one very low because if you're in the middle, you have that potential of hitting the DLI.
Um,
and for those listening, it, that is a muscle, a little bit more medial to the DAO muscle, which is like the marionette muscle. Um, and if you hit that, what can happen is again, a little bit of a crooked smile. So it pushes the bottom lip up and in. So when you smile, You're uneven. Again, that's a much easier fix than the rhizorius or the zygomatic major minor.
Treat the other side. You'll be good.
No one will even notice. You'll feel a little tight, but it'll wear off. Um, but yeah, I do six per DAO and then eight. For the, for the jaw line. And then yeah, 10 to 15 per band. And it makes
such a difference. Like if, and anytime I do platysma bands, I'm always doing a nefertiti neck lift.
Like just the two together. Oh, chef's kiss. So beautiful. And even the DAO, sometimes I'm like, ah, but then if you relax the full platysma and then you don't relax the DAO, then the DAO compensates. So you have to treat the DAO. Yeah. Yeah. Cause you don't want to give your patient new lines or new indentations.
Right. Right.
right? You don't want things to kind of compensate for the other.
Yeah. And I feel like, you know, people always ask, well, how long, like, you know, how long does this last? I mean, obviously three to four months, but I do feel like sometimes the lower face can last a little bit, a bit longer at times.
Don't you think?
Yeah, I do find that. Um, I do have some patients where I'm only doing it twice a year, whereas everything else I typically do three to four times a year. Uh, and I, I think maybe too, that's with how much we may trigger the area to like, you know? So I think it just depends. Your people that exercise more are big, you know, big exercisers and worker outers, like they're going to trigger these muscles more because if they're doing crunches or if they're lifting, you're going to, you're going to trigger that more.
So those people are probably more three to four times a year. But.
All right. I need to ask you. So what do you think of like the new face and what do you think of these? Like I almost just said utensils, but these little devices that people are getting on Tic Tac Toe that
you're seeing all over Tic Tac Toe.
You know, people ask us all the time, what do you, what do you say to them, Nicole?
So I actually did look into this and I looked into the research on it because of the fact that I can't do Botox right now for those listening that don't know I'm pregnant. Um, so I've had to stop pretty much all of my treatments.
Um, so I actually did pull some research articles on this and. They really found that the only benefit is the patients with Bell's palsy, because it's only stimulating the muscle. There's really no
So it's strengthening the muscles a little bit.
Right, right. So I guess in a sense in like your brow, lifted area and things like that.
If you're strengthening the muscle and training it to be higher, could it do something maybe, but it's not doing anything for the lines. It's not doing anything for, have you seen this
ad of that, of that girl doing like that thing to her brow? Look at my brow and her one brow is like way up here. I'm like,
that's because she's able to, I can't do one eyebrow, but the people that can do an eyebrow,
I go, okay.
Are you lifting it? Like, there's no, there's no way that high. No. And
it's, it's
false advertising to me. It's not, there's nothing,
there's nothing that it's doing to strengthen the skin in a way. Like obviously the skin is what you're more worried about. Um, and that's what people buy it for because they think it's going to take care of their, their lines and wrinkles, but it's only affecting the muscles.
So unless you have an affected muscle or Bell's palsy, There's really no research backing any of it besides if you were to have that kind of injury.
Yeah. And I think people also talk about Gua Sha, you know, I think that's huge right now. Oh, what do you suggest with Gua Sha? I think it's great. I think it's great for just like increasing circulation within.
I think it's good for lymphatic drainage. Do I think it's going to give you facelift results? No.
Yeah. And I think, I think with the new face and products like that, it's actually a lot of the Gua Sha. like the lymphatic drainage rather than what the device is actually doing to underneath the skin. It's more of you're massaging and you're pushing fluid out of the way and people don't realize what a difference lymphatic drainage can make.
You know, there's, there's true research behind ice rolling under your eyes. Oh
yeah.
It can absolutely help. speed up lymphatic drainage and make you look less puffy. Oh my God. Yeah. You know, there's just
think about like when you have too many margaritas or too much salt, right? And then you wake up and your eyes are puffy, you know, try, try doing like an, you know, an ice roller doing gua sha.
It does help. It aids in lymphatic drainage. It's great.
I did gua sha on my sister after she gave birth. Oh, did you? Cause you know, their face swells and we, we did it a couple of days after to help kind of clear that fluid out.
Yeah. But no, I think gua sha, I think like that's, I think it's very calming. I think a lot of people love doing it because it's like, it's very calming.
Like it might make their face look more sculpted, which I think it can just because you're getting rid of that lymphatic fluid, which is great, but it's not going to lift and tighten your skin. It's just not, it's not, Okay. In my opinion.
Well, now that we're on the topic of lymphatic fluid, this is, this is what we see a lot with patients who get too much Botox around the eye that might not have been a good candidate or even under eye filler that might not have been a good candidate.
So if you treat too low in the under eye with Botox, you slow the muscle down, which if you think about it, you blink how many times a day it's helping your lymphatic. So if, if you're not. able to trigger that muscle as much, it's going to slow the lymphatic sound. So that's why some people can feel baggier in the under eye.
Um, and that's why some people too, if you're not going to the correct injector or a well trained injector, especially in the under eye area, it can lead to kind of clogging that lymphatic drainage and lead to puffiness and things that need to be dissolved in the future.
And it's usually, you know, what you said about Botox around the eye It causing puffiness, right?
I think we see that more in the elderly patient. Yes. Or like the older patient, more mature, I should say, patient. Yes. Yeah. Um, just because, you know, those muscles are getting lazier. They're getting tired. And if you relax it more, like, like Nicole said, then it's not going to contract and move that fluid out.
Right. You know, appropriately. Right. So I've, I've learned the hard way with that too. And I'm very transparent with my patients. Like sometimes I'm like, yep, that totally did that. Don't worry. It'll go away in about a month or so. It's just, you know, but, uh, and then we learn not to do that again. The other thing too, though, um, if they have too much laxity under the eye and you're going under the eye, we've either even microtox, you're going to relax that skin.
Skin and almost make it look saggy. Yeah. And they're, then they're gonna hate you because you're just, then you just feel older. Right. Or look older there. Right, right. I, that's what I tell
people. I'm like, trust me, you would rather have the lines there when you smile
Yeah.
Than no line and have this crazy bag.
You know, you're gonna feel older also. Do you notice anything
different about my under eyes?
You did, um, the PDRN right under your eyes,
PDGF, PDGF, yeah, yeah, like it's, it's crazy. It's, it's almost been two weeks and I'm starting to really notice that even after one and I've had under eye filler guys, like, you know, um, I've had under eye filler twice, but I haven't had it in about two years.
Um, and I was starting to notice a little bit more hollowness and I wanted to try the off label use of PDGF in the under eye and. Loving it. Loving it so far. That looks
amazing.
Yeah. I
think
it's great.
P is, uh, PDRN is like the other, there's, there's so many different,
Oh, the polynucleotides. Yeah. Yeah.
Yeah. Like salmon sperm. Yeah.
Yeah. That's what that is. Right. Yeah. PDG, PDGF. Sorry. I always mix the two up. I
know. I know.
We just got a sample for the, I think it's the PDRN. You did? Yeah, someone's someone's, uh, it's from the brand that makes versa. So they sent it to us. So we'll see. Are
you going to get PDGF?
Yep. Eventually.
Okay, man, do we need to get it?
I know I need to hop on the bandwagon here.
You do. It's wonderful.
Yeah, no, I know. I know. And I would really like to start integrating it into like topically into procedures. And it's so
great, especially too, if you don't want to get PRP or don't want your blood drawn.
Right. PDGF. We don't have to draw your blood. Right. It's a recombinant. You know, platelet products. So it's man made in the lab. So anyway, it's wonderful. Yeah. Obsessed. Um, speak of the devil. Oh wait, not speak the devil, but um, talking about a little scandal. Did you see that? Um, I think it was like an ITV report or something.
I think it was like British news, but it was like that mom of four.
What's it with the, with the eight point facelift?
Yes, yes, yes, she's never had filler before and she wanted facelift results. So she ended up going to like, she, as they call it on the news, like this Instagram injector. Right. And they did like an eight point lift or something and she ended up pretty botched.
It was pretty sad. And she's now paying out of pocket to get her filler dissolved and all of that. You know, we've been seeing a lot of this lately, um, all over, not just in, in, in London or anywhere like that. I mean, there's a lot of people that aren't trained appropriately or even licensed to be doing these
things, or
they're not putting, Actual filler to your face, right?
FDA approved filler.
Counterfeit black market filler. Yep.
We're
seeing more
and more of it. And you think that we would, people would learn their lesson or inject. And I'm talking injectors. Like I think injectors would learn their lesson, like just get trained appropriately, right? Sweetie, like what is going on?
And at the end of the day, this is people's faces. I don't know how Oh, ethically you feel comfortable just being like, yeah, I'm gonna put this black market filler I know in your face and just cross my fingers. You know this guy that recently got caught in New York City? Yeah. Uh, he was an, he was an esthetician and he was importing counterfeit Botox from China, allegedly.
Mm-hmm . Allegedly. Mm-hmm . And, um, they, he had patients complaining to him and he was telling the patients, no, this is not the Botox. But then. When he got arrested, they pulled the records and he was texting the company like my patients are getting sick and like, it's your product and if you don't, if you don't refund me, I'm never going to order from you again.
And it's just insane. Like he continued to order from them and you know, it's, it's really scary. So you just, you know, if it seems too good to be true, it's too good to be true. And if it feels sketchy, you have every right to walk out, just walk out. Don't feel
bad. It's your face. You know, it's your body.
You don't, you don't want health concerns. Occurring, you know, down the road. And, um, there's plenty of us that are well trained and actually care and do things the right way. And, you know, go on Google, look at the Google reviews, go on their website, look at their credentials. You have every right to ask them, ask the provider what you're getting.
Right. You know, all of my patients know what they're getting. I tell them what they're getting.
Yep. You know, they know the product name, the product brand, everything. Yep.
And also, you know, I draw the Botox up in front of the patient. That's really important. You know, um, I get there's some practices that, you know, don't like they probably leave.
Oh my God.
And it's me. I am the practice that doesn't, I draw it out of the room, but it's just because of I'm on a time crunch, you know, but, uh, my patients are, they're given the lot number. Have ever. Yes. Yes.
You're an elegant trainer. Yes. Yes. I promise
you all. I have my allergan.
But I think what we're trying to say is, you know, these things, especially on Instagram, if, if the picture looks too good to be true, it's too good to be true. A lot of these people are photoshopping or they're taking pictures like with the chin tilted down and the eyes looking up and then like a really good, you know, you know, chin up, eyes looking straight ahead.
There's so many different things you can do with photos. And if the photo looks doctored in any way, it probably is.
Yeah.
So just really be careful when choosing a provider because it can be very costly to fix these mistakes. And, and I,
and I hate that this stuff. I mean, it's good that this stuff is coming out for people to see, but I also hate it because it again, gives us like a bad rep for the people that are doing it the right way.
Right. Um, and I don't want that to scare people. It's just, and when you see that, don't be scared. Just get, be more educated and just make sure that you are doing your research appropriately.
Right, right. Because there's ways to do it and look beautiful. And also
that, that mother of four in London, like, did you see her?
Like, you know. Looking at her face. That's why facial assessment is so key. And, you know, she was more gaunt. She was more thin faced, you know, doing tons of filler on her might have been probably not the best approach at first. She probably needed some Sculptra to kind of thicken things up a little bit.
Thicken that, you know, the, the dermis and provide more structure because your skin has to support the filler.
Right.
Um, just every face is different. Like, you know, there's some patients that we can't do filler out the gate. Like we have to do some other things first.
Right. It's not cookie cutter and that's these people that are not trained well or not licensed and are doing it because they're getting away with it for the time being.
They don't know to not treat you cookie cutter. They're doing everything the same on every person and using the same filler and that's how you end up botched. So you just have to be careful.
A hundred percent. Okay. So our takeaway is from this episode. Yes. Yes. Treat the platysma. If you're not treating the platysma, I promise you, like I haven't had like one patient say that they were upset.
Like they've all loved it, right? I think I'm being very realistic. There's some patients that cost is an issue and yes, it is. It's more money. It's probably like what you're getting, like say if you're getting 40, 50 units in the upper face, 60 units, it's probably going to be 40, 50, 60 units in the lower face.
So it is doubling their price that day. So I think that's the only barrier I would say sometimes getting people there, but I'm very shocked at how many people. That once you bring that, you know, once you're listening to them and what bothers them, you bring that up. They're very keen and very apt to try it.
Right. And Allie is a huge thing. Allie points. Yeah. You know, they get rewards back. Um, we have memberships. So any patient that does over a certain amount, our memberships are very worth it for them because instead of 15 a unit, they're spending 13 a unit. So there's ways to like kind of help with the cost of that.
And like we said earlier, it might not be something you have to do every Four times a year. It might be something you get away with twice a year. Right. Depending on the person. So
a hundred percent. Yeah. I love it. Yes. Anything else to add?
No. I could go on and on about, I know, complications and finding the right provider, but
I know,
I
know.
I, I won't, but I'm very excited about the launch of the Patal bands because it's something that we've been doing and it's kind of been like hidden in the shadows, and I think it's gonna get, its time to shine now. So I'm very excited for people to, yeah, to try it and, and see.
The neck needs to shine.
Yes.
Yes. We need to treat again, treat everything as a whole, because like you said, the neck, the chest and the hands give it away.
They do, but I love it. Well, thank you guys for tuning in to another episode of the filming and podcast. I am injector John
and I'm an aesthetic nurse. Nicole
till next time.
Bye guys.
Don't
neglect the neck.
That's right.