Will Tariffs Make Your Botox More Expensive? Are Micro-Infusions the Real Secret to Glass Skin? Plus More Esthetics News You Can Use with Board Certified Physician Assistant Gabby Garritano

24:44And I also do have like mild rosacea. So I have that in my T-zone. So this all sounds great, except I do have a question about the vitamin C, because my skin cannot tolerate topical vitamin C. So we wait to add the vitamin C and we ask every patient if you have any incisivity. So we would just not add the vitamin C. And it's nice because you can customize it. You can put PRP into the device. There are other options as well. But that's kind of, I would say the neurotoxins in the device is definitely the gold standard because that's where we really see the shrinking in the pores and that glass like skin.

25:21And so we see this a lot. throughout the summer where there's no downtime, a lot of brides before weddings coming in. And once you try it, like I want to do this all the time. It's amazing. Well, that's actually, how often do you need to do it to get, to maintain that result? So if, if we did one today, so the results would kick in, you would start seeing it improve each day, but it kind of peaks at that like seven day mark. And we typically recommend doing it about every six weeks. okay wow it's kind of like with your Botox injections the longer you do it kind of longer it lasts so I would say you know you could do a series of three every six weeks apart and then go to like a quarterly aqua gold what I actually got done when I went in was the nefertiti lift so that that was interesting I hadn't heard of that but you know this was to deal with all of the like hanging skin that I have under my neck but maybe you could explain more formally what is the Nefertiti lift.

26:18So the Nefertiti lift is actually named after an ancient Egyptian queen for a very graceful and slim neck. But what it is, is a lower face injections of Botox or any neuromodulator that of your choice. And so we are using it to inject the platysmal bands, which is a large muscle around the neck and the lower face. So that would be the DAL muscle, the depressor angularis oris, typically the mentalis muscle, and just a little bit along the jawline as well. So the concept behind that is the platysma is a depressor muscle. It pulls things down. Whereas when we inject our neuromodulators, it causes the opposite reaction, right?

27:03So we're going to get a little bit of a lift in that area. And so that's where we're seeing really nice and even like jawline improvement of jawline definition is just, I think when patients haven't had the lower face injected and then they do it for the first time, they're like, wow, this is really a game changer. I love this. And I think too, from a surgical perspective, I tell my patients, if there's anything we can do to help prevent or prolong that surgery, and you notice these bands or you can see I've been injected. So, you know, you see those bands popping out, it could be stretching the skin, right?

27:37So think about it as a preventative perspective too, to really kind of stretching out that next skin and causing laxity as well. Yeah. So I do, I do notice an improvement. I mean, I think just for transparency, like, so people know it's not like a lower face lift, right? It's like you get kind of like a reasonable amount of improvement. And so that I'm guessing would be just like other forms of neuromodulators where I would be going back every like three months kind of thing. right to maintain the result yeah yeah and it's nice i mean maybe going back we're going to take some after photos then perhaps next time increase your dose a little bit and so that's what i tell people too like this is a journey right and so it's gonna it may take some time to get like your perfect dose and we know dose is tied to duration this is a big muscle so sometimes you may need to increase that dose a little bit as well yeah i'd rather start low and build up on it exactly So I appreciate that.

28:38Back to the motto idea, low and slow. Exactly. Yeah. I was recently reading in the cut that tariffs could make Botox or neuromodulators more pricey. So that was, I was kind of surprised to hear that. So is that accurate in your business? So I actually called my contact at Allergan this morning because I'm like, I want the most recent data that I can find. And so as of this morning, they are saying that it is not going to affect our pricing. It's a pharmaceutical drug. And so to their knowledge, they do not see any price increases coming. The one thing I'll say on the business side is I do have a little concern on our medical supplies and some of those supplies like gauze and gloves, things like that, even the water or normal saline that we make some of our products from can be coming from China.

29:32So we are bringing on a new operational system. It's a software system. And so it'll vet each morning and tell us this is the most competitive pricing and this is where we should order this product or supply from. And so that's something that we are bringing on in the next few weeks. Wow. Fascinating. So potentially some cost increases for services, but sounds like kind of nominal would be passed on to the customer. Yeah, totally. These are definitely nominal costs when compared to something like Botox. Mm-hmm. Now we talk about these terms, we use the word Botox, like we use the word Kleenex, but of course there's a bunch of different neuromodulators now.

30:11There's Dyspor, there's Daxify. So what are the ones that you like to work with the most and why? I think sometimes people can almost have like a negative stigma against like, oh, there's more spread to this one or less spread, but we actually use that to our advantage. So an example of this is maybe for a male patient with a very large forehead, we love that Dysport may have a little bit more spread and isn't as precise, which is Botox is kind of branding and the most precise toxin, right? So we may use Dysport to our advantage for someone that may have a larger surface area. I find that Javot, which is kind of known as the new tox made by Evalis, to be the most precise.

30:55And we love using that in the lower face because we don't want to see any of that spread in the lower face. And so I would say in some patients, we could be using multiple different drug names throughout the face, not in the same area, but in different areas like upper face and lower face. And so I think like anything else, the more competition in the market, the better for us. It's yielding better results. And so I think it's actually great that we have multiple different drugs. Yeah. Which of them do you actually think in practice lasts longer? This is a great question. There is a clinical trial.

31:30I was like trying to find out it's already published. It's not published yet. I will send it to you the minute I have it. That is doing a head-to-head clinical trial on longevity of all these products. So with that being said, I think, so this, for example, a patient will come in and say, I do not want Daxify. It did not work on me. And then I'll say, you know, well, how much dose did you get? And they're like, oh, I just asked for the baby Botox. He's half the dose. So, you know, I think we have to, there's a little bit of a caveat to this. I think, unfortunately, the drug kind of gets a bad rep when a lot of it has to do with the injection technique and the dose of the drug.

32:13We know the dose is tied to the duration. So if you aren't getting your longevity on a certain drug, you may want to increase your dose. And also one drug that works really well for me may not work as well for you. And so I think also making sure you're going back at your two weeks, you're taking your after photos so we can monitor the progress. And maybe we're using today, we may want to mix it up in a year and do something new. I personally have been using Javot the last few years. I love it for myself personally, because I find that I don't have that like frozen type of feel afterwards. We've been able to increase my dose and I still have some nice movement afterwards.

32:53So it's nice. I really enjoy having some movement after my injections. Some patients are like, I don't want to move at all and that's fine too. But I think it is somewhat patient specific as well. What can you tell me about Letybo? So it's spelled L-E-T-Y-B-O. And I just read it's a neuromodulator that was just approved by the FDA about a month ago for treating the globular lines or the 11s. And from what they're saying and what I've read in other publications, it's 30 % cheaper and lasts longer. So have you had any experience with this product yet? So the first thing I will say, any product is leading with, hey, I'm cheaper.

33:35I typically raise an eyebrow, no pun intended there. So I think we learn this through Javo coming to market, Daxify coming to market, any new product that's coming to market, we proceed with caution. There needs to be an internal clinical trial within the practice. So our medical director is actually doing that right now with Latibo. Latibo, okay, thank you. I pulled up their PI this morning because I just wanted to look at the clinical trial that they have actually in the insert in the box. And they studied it at four weeks. So I'm not finding any clinical research that has proven Latibo lasts longer.

34:19We know that Latibo was the first drug to market in Korea. And so I think K-Beauty and some of these Asian trends are really on market right now. So I would say there's probably some excitement from that. But I think just being mindful, Botox was the first drug that came to market in the US over 20 years ago. We have like millions of people that have been treated with it. It's very safe and effective. And so I think because we have so many great options right now, I just wouldn't race to use a new product and start injecting it in my patients. And sometimes it's nice to let your colleagues test it out and let them use the cheaper product and then let you know.

35:01And, you know, I just, for me and at JACT, we really want to make sure that our product, because we're treating so many patients every single day, that we want to make sure every patient that's being treated today is going to have the best result possible.

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37:12So what are the questions you'd recommend that somebody should bring to the table to ask a practitioner to really get the best results and just not have any surprises? Like what are some red flags? Maybe should they be asking for before and after? Should they be asking for credentials from the injectors? I would say some red flags. If the pricing is too good to be true, it's probably a red flag there. And also, are there any products that they're using that aren't FDA approved? I think for me, if someone's okay injecting something that's not FDA approved, I would have some concerns about maybe what else are they doing that's maybe not something they should be doing.

37:54and you know i think overall really taking your time asking the questions that you need to as far as their background their credentials of course looking at before and after photos if you haven't already looked at them on the website or on their instagram and you know asking what type of pre-care post-care what how often should i be doing this treatment maybe some financial obligations you know, how often do I need to do this? And, you know, everyone has, you know, their different expectations. And so I think it's, I will say to my patients who like, this is an open space. There are no silly questions here.

38:30I really want you to feel like you can ask anything that you have on your mind. And so, you know, whatever that may be, feel free to ask. Once you're at home and you are letting your Botox settle in, do its thing, what's your recommended aftercare? Once you get a neuromodulator, maybe something people might not think of. Are there do's, there don'ts? Yeah. So I get this a lot where patients will call in and like, I have a headache. Can I take Tylenol before? And like Tylenol is okay. It's not a blood thinner, but any products that may thin the blood like aspirin or Aleve typically try to avoid 48 hours before if possible, as well as alcohol.

39:09Alcohol is a blood thinner. So I think it's also people think, oh, this is what I shouldn't do after. But it's also important the night before that you're not drinking a bunch of alcohol because it does thin the blood and then you come in and you may get some bruising. Now that doesn't affect your overall results from the treatment, but who wants to walk around with a bunch of bruises on their forehead? And I get really upset when I bruise patients. So let me try to do everything we can to avoid bruising. Also we'll avoid exercise the day of. I'm fine with the next day. And I would say, ask your specific provider because everyone has different preferences here, but no laying down for about four hours afterwards.

39:47And then any of those at-home devices, I try to avoid for about a week after too. And I think the one thing, I know we just talked a lot about Botox, but I think the one thing I was going to mention too more on pricing is really thinking about this from a holistic approach. And so not just doing Botox and that's all you're going to do. Like I would much rather use less Botox and maybe less frequently and be able to sprinkle in some laser treatments throughout the year, use some Sculptra, get some collagen stimulation. So I think the real beauty is, and the real magic is being able to do a multi-modality approach throughout the year and not just only focusing on Botox injections.

40:34Right. Yeah, I think it's a little tougher for people to wrap their head around because it's a bigger number. But I understand what you're saying. It's like really thinking in terms of continuity, like what is my budget for the year? And then maybe that's like an easier way to look at it because then you can really space things out and say, okay, well today we're going to do this. And some treatments aren't good for the summer and it's almost better. So I've had patients come in around tax season and be like, my financial advisor told me that my budget this year is X amount of dollars adject. And I'm like, wow, that is amazing.

41:13And it just shows how just women are so amazing and plan these things throughout the year, which I think is great. Yeah. Yeah. I need to speak to my financial advisor.

41:26Yeah. Let's, let's get some wiggle room here. Yeah. And I, you mentioned at home devices, like I have a radio frequency device for at home and I was surprised to read on the instructions that I couldn't use it if I had had Botox and it wasn't just like 48 hours. It was like within months. It was like, if you've had Botox in the last like three months, don't use this. So I was kind of surprised by that. My role is typically seven days after injections, please avoid any of these devices. And it's kind of like if, if your Botox didn't kick in or didn't don't work and then you use this device, would we be worried?

42:02Is it the device? Is it something else? And so we just know, okay, you haven't put anything on the skin. There's nothing that can affect it. But I think what I will say is Botox are injecting into the muscle and these devices are treating the skin. So it's very unlikely that it would actually impede the results, but Botox, let's not forget it is a protein. And if we are heating it up, if we're putting it in a different environment afterwards, it could affect these proteins. And so I'm always like, let's be more conservative and just, you know, try to avoid these things immediately after your treatment.

42:36What about exercise? Yeah. So exercise next day is fine for me. Knock on wood. I've never, ever dropped a brow in my practice. So, you know, I say I've been injecting people until nine o 'clock at night and they go home and go to bed after. And like, thankfully we've never had any issues eject, but I think, you know, let's be a little bit more conservative and go back to exercise the next day and we've not had any issues that. Right. Okay. And how do you know when your Botox has worn off or what's your recommendation for the frequency? Like, do you let it completely crash and burn or what, what's your recommendation?

43:12Yeah. So once we start seeing those wrinkles reappear at rest, the lines reappear at rest, this is typically when you know you're due for your next treatment. I think the one thing is to remember, it's not like a pill where, you know, just wears off the next day and you need to go in. Your body is metabolizing the injections. And the moment you get injected, it kind of peaks at that two week. And then it's slowly wearing off over the next several weeks. And everyone is different, right? Everyone has different metabolism. And I tell patients, even at six to eight weeks, you start seeing some of that activity coming back.

43:44That's completely normal. But I think it's funny. It's almost because it comes like an emergency where patients like, oh my gosh, it's worn off. I need to come immediately. So it's funny how, you know, you do kind of like it kind of hits you hard when you notice it, the wrinkles may start to reappear around your eyes. And I find that patients like, I just look tired recently. I'm like, oh, we haven't had your Botox in four months. It's probably why. Why do you think that people are kind of souring on fillers in particular? And do you think that's more lip service or like, what are you actually seeing in practice?

44:16And I will say that most of our patients coming into JECT, even today, they are getting a combination of rinko reducer treatments and their filler, whether that's Sculptra or hyaluronic acid injectable filler within the same appointment. I'm very curious about lips specifically. What are people getting down to their lips right now with injectables? So I just had Restylane in my lips about eight weeks ago. And so I would say for lips, most commonly is injectable hyaluronic acid. It could be Juvederm, Restylane, there's RHA products out there. There is a new filler that actually just launched. And so what I would say for lips is it's kind of like if you have a balloon and you're overfilling the balloon, it could pop in and overfill, right?

45:06So same thing with the lips. We only have a certain amount of volume we can fit into that tissue. And so using a filler that's designed, and that's why we now have fillers that are for lips, like wrestling kiss. It was designed for the lip and using a filler that these fillers are varied by G prime. And so think about like the thickness of the jelly. So something that we put in the cheeks or the jawline or the chin, maybe a higher G prime, more thicker product, but that's great, right? Cause we want that for, for those areas. Whereas we would use a lower G prime product for an area like around the mouth, the pair of oral lines, the lips.

45:44And I think what is really amazing is we can use these fillers or hyaluronic acid to help hydrate the lips. And so if your lips are very dry, we're seeing those like vertical lines, they look kind of like raisins. This is a really great option to just even just hydrate them. It's not even, Hey, I want to plump my lips. So I was like, I want them to look more smooth and rejuvenated, we can use dermal fillers to improve the lip. Yeah. Is there a way to avoid, like, sometimes you see where people will start to lose, like, their lip line, I find, from injectables, where it starts to get really blurred.

46:22Is that about technique or the type of filler or what? It can be a little bit of both and even just so many injections over so many years. But we have a magic eraser for this. We have Hylinex. We can dissolve it. Usually immediately after then the Hylinex injection, it's already improved. And so we tell patients, okay, we're going to do a little dissolver around the lip. I see a tiny bit of migration. Could have been from a thicker product that was used years ago, kind of migrated because there's just, you know, throughout the years and that could happen, but it's okay. We can dissolve that area and then you can come back and get your filler to lips.

47:03I think the only thing is people don't like having to deflate the lips. So I was like, sorry, we have to get rid of a little bit of filler and then come back in a few weeks and we can correct this for you. This might sound like a crazy question. Does it feel different when you kiss somebody and have lip filler? I've never had it. Does it feel any different? This is the start of the journey, I guess. But yeah, does it feel different as a sensation? I would say, I guess immediately after you're swollen. So I don't know if you ever woken up with like swollen lips, maybe after like alcohol or like eating salty foods, like it kind of feels like that a little bit.

47:47Okay. So maybe it feels a little bit more swollen, a little bit plumper. Yeah. Immediately after, but I would say about a week after your injections, it kind of feels like completely back to normal. I don't know. So it's something that I've actually like noticed. So I guess it's not that big of a change. Okay. Thank you for indulging me. I needed to know. And we know that you also do facial sculpting with fillers. And we had a question from our Facebook chat room about Sculptra specifically. First of all, what is it? And what should someone know about the benefits of it or the drawbacks of it?

48:23Can you explain? So I love, love, love Sculptra. So I've had about three Sculptra treatments in the last couple of years. Sculptra is PLLA, so it's different from HA filler. It is a biosimilatory filler. It comes as a powder, kind of like Botox, and we mix it with sterile water. And so I tell patients that it's almost like a fertilizer that we're injecting into the skin. And it's really amazing the benefits that you see to the skin. And we see overall improvement of the texture, fine lines and wrinkles, almost like a little bit of a glow afterwards, which is amazing. And so if we are also using it to replace volume loss, then we would use more of the product, right?

49:07We use more number of vials. So sometimes I tell patients, if you're 40 years old, we typically, it's about one vial per decade of life. And so you may need four vials, but we will spread it out. We don't have to do it all today. We could do two today, two next time. We could do one today so you can test it out and see how it is. But if you're only doing one vial, you're more going to see that benefits to the skin than actual like volume improvement into the face. Okay. Okay. And you would do that. How long does it last? I'm sorry if I missed you saying that. Yeah. So it lasts about a year. And then we typically kind of go, we call it like a Sculptra birthday vial each year, do about one to two vials a year.

49:48And then you kind of like go to maintenance. and so I personally just really love this product and I find that it's also really great for men because you can't really put a finger on it I actually saw a male patient on the Upper East side of New York last week when I was in New York and he was like I just got back from New York he was in Aspen the last few months he's like everyone was has been asking me what I've done to my face I look like you look amazing and they can't like put a finger on it and he's done probably like for vials of Sculptra. And he's like, I don't want a facelift. I'm not doing a facelift, but he just like really loves the results.

50:23Okay. Wow. And what about other biostimulation fillers? I'm really interested in this whole category because I read recently, I think it was like Harper's Broussard, but maybe in the UK about polynucleotides being a big breakthrough. Like how are you using those at JECT and what are they? So we are kind of in the investigation phase at JECT where we're testing some of these products out internally. We've been doing that all of Q1. I've actually had two microneedling treatments with polynucleotides topically applied after that. And so far, I'm loving the results. So right now, those products are not FDA approved for injection.

51:00So I do not recommend at the time until they're FDA approved to be injecting them into the face. But I do love the topical application of them. And so what we're seeing is improved wound healing and the benefits of the benefits of the skin, like texture or overall glow, improvement of fine lines and wrinkles. And so I think this whole new kind of rejuvenation medicine and skin treatments, we're still early on. I think they've been using these products in China, Asia, Europe for many years. And so we do know they've been safe over there. From my knowledge, there have not been major adverse events with the polynucleotides.

51:42So I think that's very exciting. And I don't know if you know the story behind it, but I did meet with someone from Majorion, the company that makes the polynucleotides. And so it comes from salmon sperm. Yeah, this is like the salmon sperm idea. Yeah. And so there are other types of products that are coming out like PDGF. We have exosomes, biosimitory fillers. There's calcium hydroxylate that's out. And Allergan will soon be launching a combination of hyaluronic acid and biosimitory product in the next few years as well. This definitely to me feels like the future. Because if I'm going to inject my face with a filler, I want it to be doing that legwork to, for lack of a better expression, but like really stimulating the collagen and elastin, And not just simply filling with like a hyaluronic acid, which yes, helps appearances, but I want that over time regenerative aspect.

52:39Like that seems really exciting to me. I completely agree with you. I think the one thing is if a patient has any autoimmune disorders or, you know, any medical history, sometimes there can be concerns about these products and something that's, it's going to last about, you had asked me on the longevity of Sculptor is about a year plus. And so we just want to make sure from the safety component to that it's very safe for the patient as well. Jill and I used to joke when we were baby beauty editors, once we tried Botox, we were like, just use Dove soap and spend your money on Botox. Like, do you feel like all topical skincare is just trash now?

53:17Like, are you just like, what are these even for other than maybe moisturizing? Or do you think they actually make a difference? So my explanation on this is, I mean, we go to the dentist, we get a cleaning and then we brush our teeth every day. Right. So it's kind of the same concept. You know, you're spending your money on your injectables. We really should be using at home medical and say medical grade skincare products. So that would have your glycolic acid, salicylic acid, hyaluronic acid for hydration. of course, sunscreen, I would say sunscreen by far is the most important thing that you should be using at home.

53:55And of course, sun protection with a hat as well. I do think investing in medical grade skincare at home is extremely important. But what about like anti-aging quote unquote skincare? Do you believe in it? Well, I mean, I will say, so I know you did a podcast with plated skin. I listened to a little bit of this great, by the way. And so that is a product that we are now launching at Jact. And I do have looking at the clinical trials of some of these products and just the science and the history behind them. I find the exosomes in the skincare is really impressive and something that I would recommend spending money on versus like going to Sephora and just buying random things online, maybe not so much, but a lot of these products now do have amazing science and data behind them that they can show before and after pictures of like this, what the skin looks like before six weeks and after six weeks of using, I love skin better, their alpha red product.

54:56And I think using retinoids in the skin is amazing. So, I mean, even for more price conscious patients, I think having, spending on this medical grade skincare products, it's extremely important. Well, I believe in skincare too. I was just testing now.

55:15What's a common treatment? Maybe you see popping off on TikTok or something that's in the medical aesthetics community, but you personally would never do it. At home, microneedling. Okay. I really think this should only be done in a sterile environment. I cringe when I see people doing this at home. It is so scary. You're putting thousands of needles in your face, like at home where like your cat or your dog's running around. I just highly would not recommend that. And then I've had patients that have come in and had electrolysis years ago. I think I've just seen some scarring for that. And I definitely would not do electrolysis either.

55:54And our final question for you, what do you think is the next big thing in medical aesthetics? What's got you excited? Yeah, I think we already touched on it a little bit, but regenerative medicine is just super hot right now. Really exciting. I think everything from polynucleotides, PDGF, PRFM, exosomes, PRP, you know, it's, it's kind of overwhelming, right? I think also with just overall, when I say wound healing with these products, I think no one has downtime anymore. And, you know, the ability to do a CO2 laser or something that you're going to have some downtime and you can put some polynucleotides on there and have like one day of downtime.

56:35Like that is amazing. So really exciting. Awesome. Very cool. Well, congrats on all your success so far. It's all very exciting. And thank you again so much, Gabby. Thank you so much for having me. Nice chatting with you today. Thank you. Thanks for listening. You can find details on every product mentioned in today's episode, along with our exclusive promo codes on our blog at breakingbeautypodcast.com. While you're there, be sure to sign up for our newsletter. Every episode will be delivered directly to your inbox so you won't miss a single thing. And get social with us. Let us know what you think of the episode.

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