Episode Transcript
[00:00:21] Speaker A: Hey, this is Lacey with Smartcast and I'm here today with Dr. Eason and we are going to talk about some semaglutide and treatments for your skin to get you ready for fall and sun damage and hyperpigmentation and getting your skin in check before the holidays.
So thank you for Joining me today, Dr. Eason.
[00:00:39] Speaker B: Glad to be here.
[00:00:41] Speaker A: So we're hearing that semaglutide conversation is on the rise again. People are getting ready to get in shape, make healthier lifestyle choices. So let's talk a little bit about semaglutide and some of what you look for in a patient when trying to determine whether or not that's going to be a good fit for them.
[00:01:02] Speaker B: So, you know, the starting point for me is to tell them that semaglutide and that entire line of medications, class of medications, is really fascinating and more successful than any other weight loss drugs that we've ever seen on the market by multiple times.
But that I do not think that it's a miracle drug, meaning that I don't think that someone can take it with the expectation that that is the only change they make and be successful.
Now there are certain instances, there are hyper responders that have some particular situations like inflammatory changes that really can cause things to reverse quickly.
But then I think there are under responders that don't respond to it as well. So there's something there with the physiology that whether it's inflammation or insulin sensitivity that do alter how we respond to that medication. But in general we need to use that as a tool in the overall healthy lifestyle changes that we're going to make.
It does a remarkable job at changing our behavior around food and controlling our cravings. I mean especially here in the south, we are social eaters.
I myself am a huge social eater, but really affecting how we interact with those foods by how it modulates the receptors in our brain and then also keeps us fuller longer by interacting with the receptors in our GI system.
So great medication, but I do promote that what we do feel like eating, that we are focusing on the high protein and high fiber choices that help us stay fuller longer but also help us to stave off the side effects.
Certainly we don't want to lose weight too quickly because then we, our body will draw from whatever energy stores that it has. Muscle is an energy store that it can break down for, for use in our just energy expenditures. We want to hold on to that muscle. So we have to do that by providing the muscle building blocks which are protein and then Also using that muscle through exercise, including weighted exercises and weightlifting, I think that's very important to tell our body, you have to hold on to that muscle. I need it.
I need it for every day. And that also imparts the improvements. When we talk about, well, can I come off of this medication having a higher muscle mass, which we can track through the body scan at the office, having that higher muscle mass is going to help us have a higher metabolism even when we come off of the medication. And obviously, higher metabolism is what we're all shooting for.
[00:04:12] Speaker A: Yeah, well, I mean, like you said, too, with just the mental aspect of it, too, I think that being on the medication for a specific amount of time does help to kind of retrain your brain to create healthier eating habits, too. So I think that that is something that helps with the longevity of the weight loss that you're going to see. Now, are there any patients that come to you requesting this medication that you don't think are a good candidate for it?
[00:04:38] Speaker B: I think anybody looking for a quick turnaround, you know, I need to lose 10 pounds in a couple of weeks, that's not a good candidate. Someone who is not ready for the lifestyle changes or maybe only has a few pounds to lose or already has an unhealthy balance of they're actually on the thinner side that, you know, they certainly should not be a candidate for that. But someone who is looking at this as a piece of their journey to lose 15, 20 or more pounds and is ready to make those lifestyle and eating changes that we just discussed. I think there are varying degrees of that, and certainly that can be translated to how long we're on the medication, but that those are the good and bad candidates there, that we go over goals in our first discussion, and I go over all of those things that we just discussed about the expectations for the medication and to not think of this as the magic pill that we're all looking for, but to use it as that.
That tool in an otherwise global change.
[00:06:06] Speaker A: Yeah. Is there any reason why. I know that some offices do like a blood panel or anything like that. Is there any reason why they should or shouldn't, why it's not necessary to do that?
[00:06:16] Speaker B: I think if you're utilizing it in the conservative way that we do, that there is not a high risk of seeing those liver changes that would be indicative of a higher dose and prolonged and higher dose or rapid weight loss, that would certainly be of concern.
But the more conservative side think that unless they are having clinical symptoms of low blood sugar or otherwise, which certainly we want to discuss in more detail.
Then I think in general, it's those lower doses. You're just really not at risk of those, those concerns.
[00:07:04] Speaker A: Yeah. Do you think that most people are going to do this for a short period of time and then come off of it, or are you seeing that most people are kind of staying on it long term at a lower dose?
[00:07:15] Speaker B: For the most part, I'm seeing patients complete their cycle and wean themselves off of it. I mean, that can be due to the changes that they made, the financial aspect of it.
Some patients have been able to come off and have not had to restart it.
I've been contacted by a good many patients that say I've been off of it for several months. I'm seeing things creep back up. I do think I need a maintenance dose.
And certainly we can individualize that based on their success of weaning off.
It can be spacing out, dosing it can, it can be decreasing the dosing. And certainly when people are able to come off of it and be able to maintain that, that's the ideal.
[00:08:06] Speaker A: Yeah, for sure. And then how soon should people notice changes once they first begin their treatment?
[00:08:16] Speaker B: So we start at a relatively low dose. It certainly wouldn't be considered microdosing as some, some aspects, Some groups of people are utilizing it, but at a, at a lower dose to make sure that you tolerate the side effects of it and to see how your body responds. Some people will start to notice a little, little decrease even at that starter dose, and that's fantastic. And if we're in that, that safe range of weight loss, where we're seeing a little bit of movement, but of course not too much in any given week, then we can, we can even stay on that, that first dose.
Most patients are going to, to increase the dose after four weeks of being on that basal dose. But that initial dose, but that initial dose is so important because some patients will particularly have some GI side effects, including constipation or nausea and vomiting, generally limited to when they start the medication or when they change dosages of it. So it's so important to start at that lower dose, even if their hope is that they lose a great amount of weight. We need to make sure that that individual person responds in the way, in a safe way to the medicine before we go to those higher doses.
So some patients will lose weight within that first month.
I would say the bulk of patients will start to see it in that second month.
But it's really incredible how the side effects of the medicine really do diminish even within just a few weeks of being on that medication. And so they can tolerate that higher dose by that point.
So Semaglutide is a GLP1 agonist. We also do have access to tirzepatide, which is a GLP one as well as a gip.
Spoke with a patient earlier this week that she is not seeing the movement that she was hoping to see, even though she's within, in that second dosage, that second strength.
And so we're going to try the dual agonist to see if she responds better. But, you know, we reiterated lifestyle modifications and certainly tried to try to boost that effect from the medication in other ways as well.
[00:10:56] Speaker A: Yeah, so you hear a lot of talk about people having like ozempic butt or ozempic phase from semaglutide and nozempic and tirzepatide and things like that. Is there anything that you would recommend to patients to prevent those things from happening or if they have experienced that, some of the things that we can do here in the office to mitigate those things to help improve them.
[00:11:18] Speaker B: So there are two pieces to that.
So number one, let's talk about the muscle piece.
Rapid weight loss. As I said before, the body is going to pull that calorie deficit, that energy deficit, from whatever energy stores it has, muscle being one of those.
So we need to lower our expectation of rate of weight loss. My recommendation that it's no more than one to two pounds per week, because if we are losing three to five pounds in a week, we're losing muscle. And that is just the end period.
So decreasing our expectation for rate of weight loss, the protein and utilization of the muscle that we discussed before, and then, you know, particularly the face, we're going to see those changes. If we are losing muscle in the face, that's a hard place to exercise and certainly you're not doing weighted exercises. So that's when we can utilize something like the M phase to increase that, that muscle, tone that, that muscle mass and restore some of that structure to the face.
The second large component of that is fat. And what we know about aging is that we lose our beautiful fat pads, particularly in the face.
But you also mentioned the backside. We all like a nice bubble booty.
[00:12:48] Speaker A: So.
[00:12:51] Speaker B: There we're seeing an acceleration of hopefully the fat loss there. But that seems to accelerate or gives the appearance of accelerating the aging process because some of that extra fat was actually cushioning, pun intended, cushioning some of that aging fat loss.
So that's when we can talk about fillers or biostimulatory agents to help improve that plump appearance using either hyaluronic acid or again, those biostimulatory products that help build our own collagen and elastin to help improve that soft tissue structure over.
Over the muscle structure.
[00:13:43] Speaker A: Yeah, well, Emsculpt Neo really helps too. Skin tightening, especially for the booty in combination with the liquid BBL biostimulators to build that booty back up.
And then using the bio stimulator in combination with EM face as well.
[00:13:59] Speaker B: Exactly.
[00:14:01] Speaker A: Well, that is all great information about semaglutide. And you know, that's not even everything that we have to offer to enhance their semaglutide results here at Smart Skin. But, but let's talk a little bit about getting rid of some of the sun damage from the summer. You know, people every year want to get rid of their sun damage and all of their stuff and then they work all winter to get rid of it. And then of course they go back out in the sun again next summer and we have to start all over again. But talk to me a little bit about some of the things that you love to do to treat sun damage and hyperpigmentation from the summertime.
[00:14:41] Speaker B: A number one, it's gotta be sunscreen.
[00:14:44] Speaker A: Yes.
[00:14:44] Speaker B: You know, I've, I've heard people state and it is just, it is so profound, yet so simple. If you're not wearing sunscreen, all the other stuff we are doing, you were just working directly against it. Right. Not only that, but when we were at the scale conference, they were presenting data about not only does sunscreen help shield from additional damage, but there are some data now showing that it actually reverses, helps reverse some of the damage that we've experienced in the past.
And we know that some of the damage that we're seeing is from a long time ago. So it just really is.
We just have to be so diligent about that.
In addition to wearing sunscreen, I also wear a hat. I'm very fair. I just, you know, and I know that, that I, that I miss spots when I'm applying sunscreen, so might as well be extra covered up there.
I, I love NuvaDerm. I'm a big, big fan of IPL for discoloration. I've seen a huge improvement in my skin with ipl.
And then you would have to tell me, microneedling, does that reverse some of that? It does break.
[00:16:09] Speaker A: It breaks up the sun damage and hyperpigmentation. I really love to do A multi level approach with sun damage and hyperpigmentation in combination treatments of microneedling, IPL and NuvaDerm and then sometimes layering in some chemical pills. I'm not personally, I do not love to do a chemical peel, but I love the results of a chemical peel and a lot of our patients love chemical pills. I just don't like to have the social downtime of peeling unless maybe it's Halloween because that's the only dressing up at Smart Skin you're gonna see is someone peeling from a chemical pill.
But the chemical peels that we have here are really great for that. But then just layering those different things together are gonna give you the best end result. And then of course our melanin inhibitors and for like our melasma patients, making sure that yes, you're wearing an spf, but you're wearing one that is going to help to calm the skin down from when you get hot too. Because being hot, even if you're not exposed to the sun is going to release that pigment to the surface of the skin. So like a skin medica, total defense and repair is going to be your best friend when it comes to protecting your skin from intrinsic factors with the heat. We also have some even and correct. We've got even intensive. We've got lots of really great melanin inhibitor products that you can pair while you're on these treatments to get rid of your sun damage and hyperpigmentation too. So using those is just going to reduce the redness and inflammation, calm everything down and it's going to get you a more effective treatment too.
[00:17:45] Speaker B: That's great stuff.
[00:17:46] Speaker A: So Nuvaderm, tell me what you love about the Nevaderm.
[00:17:52] Speaker B: Oh, I mean, what do you not.
[00:17:54] Speaker A: Love about the Nevaderm?
[00:17:57] Speaker B: Well, number one procedure, treatment length like it is, it is such a, a quick treatment, even though it is impactful.
I, I have really seen improvement in, I've had some breakouts recently and I came in and I was like, ooh, you gotta hit this, gotta get this calm back down. And that was very helpful.
[00:18:29] Speaker A: Yes.
[00:18:31] Speaker B: I think the profile that we can treat from a little glow up when you cannot tolerate downtime, all the way to a more ablative treatment where you can tolerate a little bit of downtime for five to seven days.
You know that customizability for patients and for the estheticians and the providers to be able to make those decisions in an individual manner is amazing.
[00:19:05] Speaker A: Yeah, I love the fact that we can treat all skin types with it. It's not attracted to the melanin in the skin, it's attracted to the water in the skin. So super hydrated skin is going to be your best friend when you're treating with nuviderm.
But being able to make such a difference in our fits, four, fives and sixes with this has been really rewarding for me to be able to see them get the results that they're getting from the neupoderma as well. So I'm really excited about that. And I love that you can treat larger areas with it too. So, like, we have a lot of patients that have sun damage on their chest or their arms or their legs and KP on their legs or their arms. And we can treat all of that with this laser so quickly because the spot size on it is.
You can change out the spot size to be more customizable for where you're working. And that way you can treat those larger areas to where before it was they were having to purchase multiple bottles of chemical pills or they, you know, were having to not be able to treat their chest because our IPL spot size is so small that, like, it just wasn't going to be financially advantageous for them to do that. But with the nuviderm, we can resurface that a whole leg in a few minutes, which is really. And I have, yes, yes, I've had.
[00:20:20] Speaker B: My, my hands and arms done.
[00:20:22] Speaker A: So I was having some pretty bad KP on the front and back of my legs and we treated with the nuviderm and it, it made such a big difference for me.
[00:20:34] Speaker B: That's great.
[00:20:34] Speaker A: And then I love too that you can customize it and do it like I, I love to do dermaplaning, diamond glow and Laser Genesis or Anuva Glow together.
And then specifically my middle school daughter had some breakouts like you were just talking about, and we did a diamond glow and Anuva glow on her and her skin was cleared up within two days.
[00:20:56] Speaker B: And correct me if I'm wrong, starting with that hydrating treatment actually helps the anuvaderm because of that water targeting.
[00:21:09] Speaker A: Yeah. So doing like a diamond glow with ha serum or doing an aqua firm.
Excuse me, doing the aqua firm with those exosomes in it is going to just prep that skin to give a perfect result with the neupoderm. And then, you know, a lot of our treatments require good hydration. Our Emsculpt, Neo, our mphase, those things, radio frequency, those all travel through water and it's going to give you a better result.
So it's super important that you're staying internally hydrated, but also you're doing treatments that are gonna hydrate your skin as well.
[00:21:43] Speaker B: Absolutely.
Have you had personal.
Our client population treatment success with the hair rejuvenation protocol?
[00:21:57] Speaker A: We have done a handful of hair rejuvenation clients with several different things that we have. We have the derive take home. We have derived exosomes. They actually found in studies that you get better end results by ultrasounding in the derived exosomes than even microneedling or injecting them in. So I thought that was pretty fascinating.
[00:22:20] Speaker B: That is fascinating.
[00:22:21] Speaker A: Yeah. So we submit a couple of our before and after photos. It's just, it's a very long process to treat hair restoration, so you have to be really invested. And so finding the right fit of patient who's willing to make that commitment is a little bit more challenging because, yes, we can treat it, but it's not. And you're going to get results, but you do still have to maintain it as well. So it's a journey.
You're not going to be a one and done. When we're talking hair restoration and going back to the lasers again at Scale, last year or the year before last, they had done some studies showing that people that were doing regular laser treatments were less likely to have skin cancer.
[00:23:10] Speaker B: That I. That makes sense to me.
Yes, I think they did discuss that within one of the. We. We had a lot of laser lectures, but I do think they mentioned that briefly in one of our lectures this year at scale as well.
I remember them stating that, but it makes sense. I mean, you're. You're targeting some of those old senescent cells and trying to get rid of. To get rid of that and to get those new healthy cells to be.
To be more proliferative.
So it makes complete sense. It's fascinating and exciting, but yeah, it makes sense.
[00:23:52] Speaker A: I love that we're making people feel better about themselves and making their skin beautiful. But when I heard that, it was just a different level of reward that I feel like, oh my gosh, we could be saving someone from getting skin cancer.
[00:24:05] Speaker B: Yeah, absolutely.
[00:24:07] Speaker A: That was so exciting. My husband's even asked me in the past, like, could this cause cancer? Could this contribute to someone? And so when we found that out, I went straight home and I was like, you're not gonna believe this.
So he was like, that's really interesting. So he likes to nerd out on that kind of stuff.
[00:24:22] Speaker B: Oh, yeah, absolutely.
So.
[00:24:25] Speaker A: And then you and I got to do something fun today.
[00:24:28] Speaker B: We did, we did.
[00:24:29] Speaker A: We did a 0.25 microneedling with skin pen with our exosomes and 30 units of Daxi. We mix that together and then you microneedled that in. So I'm super excited. I took before pictures and then on Monday or Tuesday next week, I'm going to take follow up pictures. So the point of this is to help with shrinking the pores, brighten the skin, tighten the skin and just give it overall little, little glow up. So I'm really super excited, especially with.
[00:25:02] Speaker B: That daxify having the peptide component of it.
And I know on the podcast you cannot see Lacy. We did it about what, an hour, hour and a half ago. She's not red.
[00:25:13] Speaker A: I didn't even use numbing.
[00:25:15] Speaker B: She's glowing.
There's so an hour of downtime, 30 minutes, especially with that 0.25, but superficial.
[00:25:24] Speaker A: You don't want to go deep with the, with the toxin because you're not trying to get it deep into the skin. You just want it to be very superficial.
[00:25:31] Speaker B: And microneedling in general is just one of my favorite treatments to have done because I know it is so impactful.
Just.
Just makes me feel so refreshed.
[00:25:42] Speaker A: Yeah, well, it's so good for your skin too. I mean, I always tell people, patients, it's kind of like aerating your lawn, you know, and then you get to put in the good stuff and it just makes your skin quality so much better overall. And then like little Peyton with us has done some microneedling. She had a scar on her face from a dog bite. And the difference in the scar for her is night and day. I mean, it has made such a huge difference in her skin. And even having just like any other type of like post acne marks or anything, all of those are gone. And that's such a big deal to people because it's on your face and you see it every single day. And whenever you can soften that up, it's just really rewarding to be able to have them feel more confident in themselves.
[00:26:29] Speaker B: And the perioral lines, that can be really challenging.
We have a lot of clients that come in asking about injectable options around the mouth. And those lines can be, especially in older patients that have done a lot of sun worshiping, you know, those lines can be really challenging to treat with injectable options.
Certainly we do have some of those options. But when you can have a wider spread treatment like microneedling and nuviderm as well, I think the benefit they see is going to be larger jumps, even if we utilize the biostimulatory along with it.
But getting to treat those larger areas with each treatment is really more impactful, I think. And they get a lot more treatment efficacy than injectables alone.
[00:27:36] Speaker A: Well, I rarely hear of anybody that's done a microneedling series with us that's not super excited about their results.
[00:27:43] Speaker B: For sure.
[00:27:44] Speaker A: They may not love to get numb and sit there and get needles poked all in their face for an hour, but they come back and do it again.
[00:27:53] Speaker B: Yeah.
[00:27:53] Speaker A: And they love the way that it looks. I mean, we had one patient that came in even while she was pregnant without numbing cream, just because she loved the microneedling treatment so much and how it changed her skin and made her. I mean, she was like, I can't go without it.
[00:28:07] Speaker B: Yeah.
So, yeah. Which.
[00:28:09] Speaker A: I mean, she's beautiful anyway.
[00:28:10] Speaker B: She.
[00:28:10] Speaker A: She could certainly go without it, but it has made a big improvement in her skin overall, too.
[00:28:16] Speaker B: Yeah, I agree. One of my favorite treatments.
[00:28:18] Speaker A: Yes.
So, well, we are super excited. We are going to be going to the Amp Owner Summit next weekend so that we can see what new goodies they're going to be dropping. You know, every year that we go, they launch a new device. So we always like to. To be the first to know what's going on and hopefully collect some awards again. Because last year we won, I think, three awards. So I'd love to come home with at least three awards again, if not more. You never know.
And then we get to just learn from the experts in the industry and learn more about Derma and learn more about nuviderm and Aqua Firm and what people are doing and innovating with it. All of those things were pretty new and they have protocols and standards and all of that, but just the more you get to play with it and work with it and try different things, we're learning more and more about it every single year. So I'm really excited to see what people are coming up with for it and just bring home some fun little nuggets.
[00:29:20] Speaker B: Fantastic.
[00:29:20] Speaker A: When we come back. And then, of course, we've got our holiday open house coming up. The first week of November, we're gonna have our holiday open house at our home location on Monday, Tuesday and Wednesday and our Ross Bridge location on Thursday, Friday, Saturday. That's the first time we've ever done it this way. We normally do Thursday, Friday, Saturday, and then in another week or two, we'll do the other location. But this year we're doing it all in one week.
And we're gonna try the Monday, Tuesday, Wednesday, because Tuesdays are late night, so we thought that that would be a really good way to check it out. And then Thursdays are late night in Ross Bridge. So we'll be having some really great promotions, some really exciting opportunities for people to try things that maybe they've never tried before.
Do some micro needling, some nuviderm. We're gonna have some really great injectable promotions that we're doing.
And then just overall patient education. So if there's something that you want to learn more about, you can come in during our open house and we'll be able to tell you all about it and then you can test it out why it's on promotion.
[00:30:23] Speaker B: Yes, that's always a great time to try new things and it'll be really fun. I can't believe we're talking about Christmas right now, but it's still hot outside. Yes.
[00:30:36] Speaker A: Not in this building, but yeah, this building is freezing. And always having construction going on. So we could always hear some banging in the background. It was the ambulances for the longest time and now it's construction noises.
[00:30:48] Speaker B: Yes.
[00:30:49] Speaker A: Last time I think we did the podcast, there was like jackhammers going on in the background and Sage was having to, like, muffle it out some. But this time they've been relatively quiet. You can still hear it, but not too terribly bad.
But. Well, we're excited to go to the Amp Owner Summit. We'll come back with some exciting information about what we learned.
So thank you so much for joining us on today's episode of smartcast. And we'll see you next week.
Sa.
