Episode Transcript
[00:00:20] Speaker A: Hey, this is Lacey with Smartcast. And I'm here today with Doctor Irma Higginbotham, one of our amazing injectors at Smartskin. And she's also one of our co medical directors here at the spa. I'm so glad we were able to finally have you come and be a guest speaker on our podcast. And Doctor Irma was a patient at Smartskin before she was an injector here. So she got to really see firsthand our business and how we do things and kind of what we all have at Smartskin available for our patients. So when she asked to be an injector for us, it was such an honor and such a privilege to have her come and be a part of our team because she already knew how great smart skin is. So we're so thankful to have you with us.
[00:01:04] Speaker B: Well, thank you, Lacey, for inviting me. Yes.
[00:01:08] Speaker A: So, Doctor Irma, you have a lot of experience in injectables. Tell me how long you've been doing cosmetic injections.
[00:01:15] Speaker B: Okay. I started about ten years ago. If you look back at Allergan company, they have my file from probably since 2014. That's when I started buying products from them.
And I started very slowly.
First I learned about botox neurotoxins and started doing it on my nurses because I'm a general practitioner, so I work with the nurses and I practice on them. Then I slowly added fillers to, you know, my practice. And then from fillers, I started going more and more advanced and picking up more other products. And now aesthetics actually have such a wide variety of options that you can use. And so once I became comfortable, and it was about maybe four or five years ago, and my, all my friends and all my nurses, everybody kept telling me, you need to go out and do it outside. You don't need just to do it on us. You need to start doing it outside. And so first I decided, okay, I will just create a little company like aesthetic touch, being a contractor, start doing it. But then slowly from doing it just by myself, I moved on and started doing outside. And it will be almost a year since I came to smart skin. Yes, last August, I believe so. And I was thrilled when you invited me.
[00:02:57] Speaker A: Yes. We have loved having you at smart skin, for sure. All of our patients love you, our staff loves you. I love you. So we're so thankful to have you a part of our team. We think that you do an incredible job with our patients. They feel heard by you and they are so happy with their outcomes that they're receiving.
I know that you also specialize in PDO threads. That's one of your favorite things to do. Exactly. So talk to me a little bit about PDO threads and how you like to incorporate those in with your treatment plan. And how would you incorporate that in with some dermal fillers? Who's a candidate for it? So you just tell me about some of those things.
[00:03:44] Speaker B: Okay. Yes.
The simple way, probably, to explain what is pediatrics is it's a suture, which is basically what surgeons use to do surgery, and it's dissolvable.
If we go back to the history of pedio threads, they've been on market for about 2025 years. Okay. Yes. United States is behind. South Korea is big, Brazil is big on it, Europe, eastern european countries, Russia.
And actually, the one who created video threats was a cardiologist. He did surgeries on heart, and he needed a suture which can dissolve without making a knot. And that's how they, and then they picked up and they looked at it and they found out that it actually can rejuvenate tissue. And so that's how they moved from that area to cosmetics, to aesthetics. So in the beginning, they used non dissolvable PDF threads.
They had complications which you cannot solve if then non dissolvable. So they came up with dissolvable absorbable sutures.
There's different types of sutures, different types of threads, let's say threads, because there's a PDO threads, which made from polydioxin, and that's what usually surgeons use, the same material. There are plll threads, plla threads, which is polylactic acid.
And it's very similar. Basically, it's a sculpture, the same product, what we use in injections, sculpture, and has their own benefits, of course. And PCL, which is polycolactone material. And it's a little bit different threads, similar last longer up to two years. That's the longest to dissolve. Pedial threads last about one year. Takes about nine to twelve months to dissolve. And it depends again, what kind of PDO threads. And mostly I work with PDO threads and I work with pllA threads.
They have different structure, but they have a lot of benefits.
The reason why I like video threads, because it's one of the part of rejuvenating by stimulating medicine, which really goes now more and more popular and goes away from the like we called fake faces. Now we go to naturally looking faces. We want people to look natural but beautiful.
[00:06:49] Speaker A: Right.
[00:06:50] Speaker B: And that's why we go more and more Dermoid PRP, which smart skin has great.
[00:06:56] Speaker A: Love it.
[00:06:56] Speaker B: Yes. Or general PRP, that's a bio stimulators, rejuvenating means and sculpture and radius. Radius. And then we go to pedial threads. So pedial threads has a lot of benefits, and one of them is rejuvenation. So when we talk about PDO threads, it's lift, it's tightness and rejuvenation. That's what it gives you.
[00:07:24] Speaker A: So I know that you can treat several areas with PDO threads. What are some of your favorite areas to treat with PDO threads?
[00:07:33] Speaker B: Of course, I would say it's face, but actually you can place PDO threads anywhere on the body. You can work on cellulitis, for example, the dimpling skin on the body make it more tighter.
[00:07:49] Speaker A: Knee lifts.
[00:07:51] Speaker B: Knee dies around the belly button bottom. Okay. But of course, my favorite is face, because everybody can see your face. So on the face, you can see in different areas also. And it depends what kind of thread you will use. So now we go to the direction. Okay, what kind of threads we have on market, we have, let's say, mana twisted threads, it's smaller, threads, thinner, and we have barbs or cog lift threads. It's a different type of threads. Okay. So if we use mana or twist it threads, those especially mono threads, those are mostly for rejuvenation. You can use them for, to treat scar tissue. You can use them for acne on the face, for example. Great. Just rejuvenate skin. Neck under chin is great. Okay. Twist it similar to mana will give you a little bit volume. So you can use those type of threads on the lips. People ask me, what? How can you. Yes, you can use PTO threads for lips.
It doesn't give you such a big volume like fillers, but it will rejuvenate and make your lips look more healthy. It gives you very good crusty border, for example, on the lips.
[00:09:26] Speaker A: So someone that has like smokers lines. Yes, they would be a good candidate for PDO threads and libs. And based on the different types of threads and the different makeup of what the threads are made out of, it sounds like you can do a very customizable treatment for each individual person based on their specific needs and what they're wanting to achieve.
[00:09:47] Speaker B: Yes.
[00:09:48] Speaker A: So I know for a really long time, most of the manufacturers of our medical devices were saying that they needed to wait three to six months after PDO threads before doing any of these treatments. Now, you recently have come across some new science based studies that are suggesting that that's not the case. Anymore. They've done more studies and realized that you don't have to wait that amount of time to do your radio frequency treatments or your other energy based treatments after having PDO threads. So tell me a little bit about that study and what your treatment protocol would be now for someone post procedure with PDO threads.
[00:10:29] Speaker B: Yes, because we ran into that question, like, when can.
[00:10:37] Speaker A: Because we have a lot of patients that do radio frequency treatments, they were all kind of unsure about adding PDO threads into their treatment regimen. And so now that we know that that's not necessarily the case, then that's great news for our patients.
[00:10:52] Speaker B: Yes. Yes, I agree completely. So I think it is a good news because. So that question made me start looking and researching a little bit, and I had to do that and read some medical articles, and I found that in a journal of Cosmetic dermatology, which is international journal, I found an article where brazilian doctors did studies and they discovered that actually, you don't need to wait so long. The takeaway point of that article, number one, to dissolve a pediatric thread, you need over 100 degrees celsius to destroy it. Okay. It has to be like 110, 115 celsius degree. But most of the technology machines, radio frequency, ultrasound, laser, they operate on maximum 60 to 75 degrees, so it's impossible to destroy the pediatrics.
[00:12:07] Speaker A: And then a lot of those treatments, too, are not even in the same, like, plane as the threads as well. So a lot of those treatment modalities aren't even reaching the depth of where you go.
[00:12:19] Speaker B: Exactly to the very good direction. Okay. When I place PTO threads, I go to smas. SMAS is a level of superficial muscular paneurotic system. It goes under the skin and it goes even under. And then we go with skin, it's superficial. Then we go to fat, superficial fat. And it's on the superficial fat, that's where it's the smosh.
[00:12:44] Speaker A: And the only thing that we have that goes down to this mass is our ulthera.
[00:12:48] Speaker B: Exactly.
[00:12:48] Speaker A: And it's not using heat.
[00:12:51] Speaker B: Yes. And so when I read that, I said, well, you know what? I think we can do it. And plus, I did read some articles where they say that actually, combination of the treatment, video, threats and radio frequency, all therapy, laser, IPL, everything, all together. If you work together with all that, you get even better results.
So I think the patients will benefit from that. It will be great. So we can bring them hopefully back to, you know, 1020 years back, if it's possible.
[00:13:33] Speaker A: Well, I mean, in someone who maybe is wanting to prolong having to have a facelift or if they want to get even better results from a facelift. Once they're ready to do that, it's just going to increase their overall outcomes if they're able to layer these treatments together.
[00:13:50] Speaker B: Yes. Yes.
[00:13:51] Speaker A: So tell me, whenever you're doing a patient consultation, what are some things that you're looking for to determine who's going to be the best candidate for PDO threads and kind of walk me through a little bit of what they can expect that treatment to be like from as far as, like, their downtime, what the procedure is involved in. Like, tell me, like, what the patient can expect.
[00:14:19] Speaker B: I will say the best candidate will be patient in their forties. Okay. You have to start taking care of yourself earlier.
35 and above 50 is okay. Of course, after 55, a little bit more difficult. But I tell you, Lacey, I really never say, almost never say no. If somebody comes and asks me about video threads, and they already kind of, like, researched about it and they want it to be done. And you mentioned about people after plastic surgery, I had probably a couple of them who had the plastic surgery done, and then ten years later, let's say they already touch up.
They don't want to go again through the surgeries they need. So when I see a patient say, that's the best candidate in forties, fifties will be good. A little bit more difficult to work when you have to 55, 60. And I look at the skin quality. Okay. So often, actually, when we talk about the combination treatment, for example, often I see somebody who comes and they have very saggy skin, but they still want pediatric. They want a little bit lift. I say, okay, let's work with you. Let's put some diluted, hyper diluted radius. Okay.
And come back in about two, four, six weeks.
Let's improve the quality of your skin, and then we can place threads. Ideal patient, of course, will be with mild to moderate ptosis. We're talking about, you know, on the face skin, for example, on neck, mild to moderate. But even with moderate, severe, I probably will not take. But moderate, we can work, we can improve the quality of the skin and then place pedio threads and give them a little lift. And when we talk about the speed of threads with the lift, it's barbs, cogs, cog, live threads, which have this. That's why they call them barbs, because they have barbs like hooks on the thread suture. And that's what actually grabs the skin. When I place it, it grabs the skin, holds it, and then I also even mechanically lift it. Sometimes I tell people it looks like skin hanging on the hook.
You lift.
[00:17:04] Speaker A: Is that painful?
[00:17:06] Speaker B: The procedure is we make sure to make patients comfortable. And so I do use topical anesthetic.
It's almost like a dental procedure. We give them pro nox, nitric oxide for them to make feel comfortable and unknown entry points. So again, with lidocaine, they don't feel it. And it's one day, it's 1 hour procedure.
I place them and I tell people, no downtime, really. You can go in shops the same day. Okay. You're only going to have a little bit entry points on the face where I enter it inside and place the thread, and then you can go outside and do whatever you want. Recovery is usually very easy. I mean, just a little bit of soreness. Soreness. I do ask patients to sleep on their back for about two, three nights for sure.
No dental work. Because when I place those barbs, I want them to stay in the place that's very important. I want them to pull that skin, hold that skin. So no dental work. I would say at least two weeks, but better one month.
[00:18:30] Speaker A: And that's the same even with dermal fillers too.
[00:18:35] Speaker B: Okay. And then tell them no big facial expressions. And if you smile, maybe hold a little bit with your hands. Just small precautions, just to make sure that the thread, it takes about one or two weeks for that thread. Engage with the skin and stay in a place where I want it to stay. We don't want displace them. Yes.
[00:19:01] Speaker A: So who would not be a candidate for threads?
[00:19:06] Speaker B: Severe ptosis. Really saggy skin. Thin, very thin skin. You have to be very careful. Very thick skin, also difficult to work.
[00:19:18] Speaker A: Anybody that like autoimmune disorders, autoimmune conditions?
[00:19:22] Speaker B: Right, right. You're right. Autoimmune conditions, yes. The same way I would be probably very careful.
Even I did work with, I had a couple people who had autoimmune conditions. They didn't have any reaction, but I still usually don't take somebody with autoimmune conditions.
[00:19:43] Speaker A: Dermapr is usually what we recommend for people that have autoimmune just because it's their own PRP. And it's going to give a very similar treatment result too, as far as just like, the luminosity of their skin and helping to stimulate that blood flow in the skin. Again, it's great for under eye darkness, for people that have hollows and dark circles. The DermaPrp is great for them. We love Dermapr in the lips, especially if they've had too much ha filler and they start to get that blanching. The DermaPrp really brings that blood flow back to the lips to give that beautiful pink color. I know that I have been able to tell a huge difference from mine. Love it.
[00:20:26] Speaker B: Yes.
[00:20:27] Speaker A: Before we started, you were over here admiring how glowy my skin is, and I have no makeup on today. And it's just from doing Dermapr.
I have. I've loved it. Our patients have loved it. It's great in combination with the PDO threads.
It's great in combination with all of our other treatments at smart skin, too.
So you got to go to the masterclass with me and Doctor Jody for the Derma PRP. Tell me about that experience.
[00:20:58] Speaker B: It was great experience. It was actually first time in my life, I mean, I've been through so many trainings and went to so many countries. That was the first time when actually I got experience to more technological part of the aesthetics, how many machines now, how much it's available and how they work. That was really great. And meet a lot of people. It was great.
[00:21:28] Speaker A: And so our team from AMP were in today, and they were telling us about the owner summit that's coming up in Miami. And it's going to be a really great opportunity, too, because they're going to have several different workshops going on at the same time, and you can select to go to which ones you want to go to. And so they're going to have hands on injectables courses going on that you and Doctor Jody and Doctor Eason, if y'all are all able to come to that, you guys can go to those. And then they're going to have a marketing sector that's going to help with business development and growth and all of that stuff that if Mary Margaret and I are able to go, we will be able to go to those sectors. And so they're going to have a little bit of everything for everyone, which I think is great. And that way we can all kind of like divide and conquer and get the best of all of it. So I think it's so incredible that we have the opportunity to go and do all of this continued education and learning. And just like you saw the study that they did to show that we can do PDo threads so much faster now than waiting three to six months. It's really good to be able to do this continued education and stay on top of everything that's evolving within this industry because it all grows so, so fast. And so I think that us being able to go and be a part of that. And meeting other accounts and stuff is really priceless. So we're super thankful for our partners for being able to do that.
So aside from that, we have three different toxins. We have the xeomin from MERS, we have Botox from Allergan, and then we have Dax five from revance. Tell me about the three different toxins. Which one's your favorite? Why would you select one over the other for patients? Tell me a little bit about some of your toxin pearls.
[00:23:17] Speaker B: I would still.
My favorite still will be buttocks and zero. I mean buttocks because it's been on market for so long.
[00:23:28] Speaker A: Tried it.
[00:23:28] Speaker B: True. Yes.
It's just like an old guy.
Which.
[00:23:35] Speaker A: Did they tell you that we just bought 100 bottles of Botox.
It hasn't come in yet. Botox in every fridge that we own.
[00:23:46] Speaker B: But I kind of like old school, maybe I trust something that's been on market for a long time. Okay.
Of course I like the new.
I like Xiaomi because it's more pure.
[00:24:03] Speaker A: So for, like, younger patients.
[00:24:05] Speaker B: Yes. And I think it's a great option to start somebody on xermin who never was exposed to toxins. Yes. I go with Xyramin, but in dexify is. I still believe dexify can last a little bit longer, from my experience, seeing and hearing patients and then start working faster.
[00:24:32] Speaker A: It does.
[00:24:32] Speaker B: That's also a big great, you know, plus in glowing. Yes, yes.
[00:24:40] Speaker A: Because it's got the peptides in it. So I personally have been getting Dax five the last several times. I love the early onset. I love the luminosity that I get from the peptide complex that's in it. It's also a very pure toxin. I think it's also a great solution for a younger patient as well, especially somebody that maybe hasn't invested in a great skincare regimen yet because they're going to get that luminosity from the toxin as well.
[00:25:07] Speaker B: Yes.
[00:25:08] Speaker A: So what else is. So what about skincare services at smart skin? What's your favorite skincare service at smart skin since you've been a patient for so long? You see Natasha, the lovely natasha.
[00:25:22] Speaker B: Well, I like everything, what she does. I like all the products, actually. Skin, you have such a big variety of products. This is so great.
And you can pick up, like, one of every single product. Every single company has something unique and something that you can attach to and pick up and use for yourself. That's great.
Hydrofacial is still my favorite.
[00:25:54] Speaker A: You love hydrofacial?
[00:25:55] Speaker B: Yes, I would love.
[00:25:56] Speaker A: Have you done the diamond glow.
[00:25:57] Speaker B: Yes.
[00:25:58] Speaker A: Okay.
[00:25:58] Speaker B: Yes.
[00:25:59] Speaker A: Diamond glow is my favorite.
[00:26:00] Speaker B: Okay. And then I would like to try sometime. I never tried. I want to try. Try all therapy, actually. Oh, yeah, definitely in one day.
You were in school, you were in.
[00:26:14] Speaker A: The clinical training for the old therapist.
[00:26:15] Speaker B: Yes.
[00:26:15] Speaker A: You should have got a demo that day, too. So elastin transform is a topical product that you can use in combination with ensculpt neo. It's going to help a tone texture and laxity of the skin, and then it also is going to work like a little magnet to take all the broken down fat cells and put in your lymphatic draining system to flush it out faster. So you're going to get the same end results from the emsculpt neo, but it's just going to help you get your results about two weeks faster.
[00:26:41] Speaker B: Okay.
[00:26:41] Speaker A: So you just. I sold you. I sold you on the last transform. I love the transform. It's so good too, because you can use it in other areas besides just the area that you're treating with the sculpt neo. I like to put it like, underneath my arms right here to help with any crepey skin, because it's just going to tighten everything back up. It helps with the elastin so you get that snap back, which is really great. So a lot of the treatments that we have, the skincare treatments, go in combination with a lot of the surface lines that we have. So you can do your at home skincare to keep your skin in check in between your visits with us. So the skincare is going to be your diet, and then the services are going to be your exercise. So you really need both to go hand in hand so that you can get the best overall outcome. And then whenever you're able to add in injectables, that's just going to be the icing on the cake.
So it all works together.
[00:27:35] Speaker B: Lacey, you're great. You're great.
You know everything.
Yes.
[00:27:41] Speaker A: So skinmedica is having a clinical training coming up next month on a Tuesday. I think doctor Jody registered to go to it. If you're available and would like to go, you are welcome to do that. Jessica's gonna send you the information so that you can go and learn more about skinmedica and their active ingredients and how they can be used in combination with the injectables and the dermal fillers and everything that you guys are doing in the injections room. And that way, too, whenever patients are asking for your recommendations on skin care treatments, you can tell them more about those skincare products and how they're going to enhance the results of what you're doing in the treatment room, especially like Ha five, because the Ha five is going to prolong and enhance the results of any dermal fillers that you're doing. It's going to protect their investment with that. And because the Ha five is basically the ha derivative and it's able to be applied topically, it's going to help make that ha filler even better. Even better.
[00:28:46] Speaker B: Yes.
[00:28:46] Speaker A: Yes. And then the TNS is basically Botox in a bottle. It's lines, fine lines, wrinkles, tightening and toning all over skin tone and texture. Yes. TNS is the holy grail. It is the gold standard in skincare. This month, too, is their 25th anniversary, so they are doing double alley points on everything.
All of the skin medica skincare products are gonna be double points. Botox is double. No, Botox is not double points. That was the only thing that wasn't.
But they are. We also have our batu get one free of TNS right now, too.
[00:29:30] Speaker B: Okay. That's a good deal. Yeah, that's a very good deal.
[00:29:33] Speaker A: And then with our skin better, their lines is a really good treatment option, too. For someone who's thinking about getting filler and they are not quite there yet, or they may be on the fence about it. Lines is a really good product for them to start out with. It's also made up of the exact same products that dermal filler is made out of, too. So it's going to plump and pull everything up, and then it actually will work like a botox as well to smooth and help with the muscles to not be as strong. So it kind of smooths everything out. And so we usually will have them spot treat with that morning and night. So, like, around their lip lines or smile lines or crow's feet or their forehead lines. And then if they use that post procedure for injectables, it's going to enhance the longevity of those results as well.
[00:30:25] Speaker B: Okay, that's great.
[00:30:26] Speaker A: Yes.
[00:30:26] Speaker B: That sounds great. Really good products.
[00:30:29] Speaker A: Yes. We've got all the best skincare products at smart skin, for sure. Was there anything else that you wanted to add to what we're discussing today?
[00:30:40] Speaker B: I enjoy working with you guys. That's all I can tell you. I enjoy working with you, and I think I'm just blessed with everything. I love my patients.
I like those patients who what I can add, I probably can add about the patients, how I talk to them. I never force them to do anything, but I give them an option. And I do like, actually, I think I didn't tell you, Lacey. You know, I used to paint. So my husband tells me, like, you need to tell them you used to paint. And actually, 30 years ago, I used to. That was my hobby. I used to sew leather bags. And he says, now, instead of doing that, all the skills that you used to sew leather bags, it was, well.
[00:31:34] Speaker A: Injectables is an art form. And so anybody that's good at injectables, and they're passionate about it, they are artists. And the fact that you.
[00:31:44] Speaker B: Thank you.
[00:31:45] Speaker A: Truly were an artist and in painting and sewing and that craftsmanship, injectables is an art. It is a craftsmanship.
[00:31:53] Speaker B: Yeah, that's my point. So when I look at the patient, I try to look and say, and that's great that we have so much abilities now, different products, different ways.
[00:32:05] Speaker A: Not everyone.
[00:32:05] Speaker B: Size fits all is when you take all this together and put it together and create a new face, kind of like really younger looking beautiful, a refreshing, refreshed version of themselves. Yes. Because we. I mean, there's so many products, so many ways to improve appearance.
When we talk about video threads, I say improve appearance. Yes, that's the main thing.
[00:32:35] Speaker A: Yeah. And now we have our skin analysis device, too. So your patients, if they're getting ready to get started on a treatment protocol with you or with us, we definitely like to get a scan of their before pictures and it shows all the damage down underneath the skin as well. And then we can show their after photos and put do a side by side comparison for them so we can kind of give an overall comprehensive analysis of where they started and where they finished up at. So if any of our listeners would like to schedule a complimentary consultation with Doctor Irma, you can call or text our office at 205-968-1301 we do complimentary consultations and we can do a complimentary skin analysis as well. And we also have some really great welcome back promotions. Now through next Saturday, Mary Margaret's gonna be back from maternity leave. So we've got some really great injectables specials going on. And Doctor Irma has some promotions going on for PDO threads as well. Those are all customized, so we don't have those listed, but we do have specials available for PDO threads as well. So just give us a call or text the office to get scheduled with Doctor Irma or to get scheduled with one of our estheticians for a skincare consult. We offer those as well. Thank you for joining us on today's. Episode of Smartcast, and we'll see you next week.
