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The Hormonal & Surgical Approaches to Aging - Part 2

american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery
american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association american society of plastic surgeons Fellow American college of surgeons American Board of Physician Specialties American College of Surgeons american board of surgery The Aesthetic Society American Society for Mass Spectrometry american cleft palate-craniofacial association International Society of Aesthetic Plastic Surgery

The Trillium Show Podcast with Dr. Jason Hall

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Disclaimer: The discussions on this podcast do not constitute medical advice, an evaluation, or a consultation. Nothing in the podcast episodes should be considered a replacement or substitute for a formal in-office evaluation by Dr. Hall or his associates. Explanation of off-label services and/or products do not constitute promotion and/or endorsement. Information and opinions presented here do not create a formal doctor-patient relationship. Discuss any potential medical procedures or interventions with your physician or surgeon first.

Show Notes

The Hormonal & Surgical Approaches to Aging - Part 2

I n Part 2 of this special 2 part interview, my conversation with the RevitalyzeMD team continues. Dr. Deb Durst and her nurse practitioner, Farideh Golembiewski explain how they treat common sexual health complaints, their IV therapy practice, and the role of peptide treatment in regenerative medicine.

My mind is blown by the information covered in this episode, and if you’re looking to combine hormone treatment with plastic surgery, you won’t want to miss my takeaways on how to do so effectively in the pursuit of overall wellness.

Highlights:

  • Why do women seek out internal vaginal rejuvenation and how does laser treatment help? (00:53)
  • How tummy tucks can help treat stress urinary incontinence (03:28)
  • How injections can help improve blood flow and nerve regeneration for sexual health in both men and women (07:05)
  • The differences between traditional medicine and regenerative medicine (12:18)
  • How IV therapy works, particularly in post-op patients (15:37)
  • The role of peptide treatment in regenerative medicine (22:42)
  • The role testosterone plays in hair loss and common treatment options (30:15)
  • The biggest takeaways for combining plastic surgery with hormone treatment including recovery & downtime (41:04)

Transcript

Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I'm your host, Dr. Jason Hall.

Dr. Hall: Welcome back to The Trillium Show. So, this is part two of a two-part series with Dr. Debra Durst with RevitalyzeMD, and we are talking all about hormones, hormone replacement, lasers, and other interesting topics which are coming up in this show.

So, if you missed part one, please go back and check it out. You don't have to listen to it to get the gist of what's going on in part two, but it's certainly interesting. It was certainly interesting for me to do. Please enjoy this conversation with Dr. Debra Durst and Farideh Golembiewski, her nurse practitioner.

Dr. Hall: External labiaplasty is something that we do a lot of, and are doing more of all the time. What do women who are looking for internal vaginal rejuvenation, what are the symptoms that bring them in? And then how does the laser help with that?

Dr. Durst: So, it's interesting because, like, the hormones and the sexual vaginal rejuvenation—

Ms. Golembiewski: They cross over a lot.

Dr. Durst: —cross over a lot because—so if somebody comes in with hormone complaints, like, the whole list of questions also goes through a lot of sexual questions. You know, vaginal dryness, pain, orgasms, whether it's clitoral, whether it's vaginal. So, you know—even what their drive is, you know, all of that because they cross over. So, if they're coming in with hormone complaints, we're almost talking to him about sexual wellness, too.

And if they come with sexual wellness, again, we've already talked—

Ms. Golembiewski: We're always talking to them about hormones.

Dr. Durst: —about that cell optimization. So, if they want vaginal rejuvenation, we talk to them about, like, how to optimize again, results and lasting results. So, they tend to complain about urinary incontinence. So, a lot of them had children, you know, so just the weight of the pregnancy obliterates, like, the supported—

Dr. Hall: Mm-hm. [crosstalk 00:01:58].

Dr. Durst: —urethra. So—

Ms. Golembiewski: That's our younger women.

Dr. Durst: Urinary incontinence.

Ms. Golembiewski: Urinary incontinence, and—

Dr. Durst: —vaginal laxity—

Ms. Golembiewski: Yeah, laxity from pregnancy.

Dr. Durst: —decreased orgasmic strength is a huge one in perimenopause and menopause. And so, it's going to go down with time. Men and women both have changes with time, different changes.

Ms. Golembiewski: Absolutely.

Dr. Durst: And so, vaginal dryness, pain with—

Ms. Golembiewski: Pain with intercourse. Yep.

Dr. Durst: —sex. All of that. So laxity, urinary incontinence, pain, vaginal dryness, and orgasmic changes. Those are the big things that they're complaining about. And it depends on the age, depends on the patient. Even if they're young, they've had one pregnancy, they don't tolerate urinary incontinence anymore. Like, it's unacceptable to, you know, accept something as part of the process, like childbearing.

Ms. Golembiewski: It's crazy how many women come in and they say, “Well, my doctor just told me to wear a pad for my stress incontinence.” Like, “What? Why, why is that a solution?” Just wear a pad. Or an adult diaper. So, we'll get a lot of—

Dr. Hall: [laugh]. At 35 years old?

Ms. Golembiewski: I mean, right? You'd be surprised—

Dr. Hall: You're kidding me?

Ms. Golembiewski: How many women are like, “My doctor told me to wear a liner.” Like, what? [laugh]. That blows my mind that women are being told that. And we looked at a study not that long ago, and that was the number one—

Dr. Durst: Like, 80%.

Dr. Hall: Yeah, like, 80% of physicians are recommending adult diapers or pad as a solution.

Dr. Durst: For urinary incontinence. For stress urinary incontinence, 80%.

Ms. Golembiewski: And that was like—

Dr. Durst: And that was the top recommendation.

Ms. Golembiewski: 2019. Like, it wasn't that long ago that—

Dr. Durst: Mm-mm.

Ms. Golembiewski: —it was—that survey, it blew our mind. We're like, that is the most ridiculous thing when there are so many options out there.

Dr. Hall: Yeah, absolutely. You know, it's you brought up urinary incontinence. One of the things that we do that kind of has the side effect of helping stress incontinence is a tummy tuck. Because part of that stress incontinence is—yeah, is loss of, you know, abdominal pressure from increase in domain, so the fascia, the muscle layers stretch out—

Dr. Durst: Interesting. I never thought about that.

Dr. Hall: And so, by fixing you know, your rectus or your six pack muscles, you increase that pressure and can help for mild urinary incontinence, can treat it.

Dr. Durst: Wow. I didn't even think about that.

Ms. Golembiewski: I didn't either. We talk a lot about platelet-rich plasma, the O-Shot; we talk a lot about radiofrequency. So, we do Votiva for—and we talk about microneedling, internal and external. So, that's one thing we've never really—that's crossed my mind for women.

Dr. Durst: Yeah.

Ms. Golembiewski: We even talk about Kegels, right?

Dr. Hall: Yeah.

Ms. Golembiewski: So, there's lasers out there to help do a HIIT workout for your vagina, like, muscular stimulation. I mean, there's all kinds of things out there. We have probably a full suite of things for women's health, but that's one thing I've never really thought it for them to address.

Dr. Durst: Yeah. I didn't know that. I was almost thinking it would lift overall. But you're talking about your containing—

Dr. Hall: It's—yeah.

Dr. Durst: —and so it's going to improve all of that.

Dr. Hall: Yeah, it's a pressure, it's a pressure solution.

Dr. Durst: Yeah. And I almost want to get on into that abdomino—plasty or surgical options, but also even body contouring, but I don't want to take away from the sexual just yet. Because it's interesting, because people come to us with, like, a weight loss issue or, you know, an issue that needs more than just body contouring—and body contouring is awesome, but there's an extent, you know—it's beyond a level sometimes and they need surgical. And we could talk about that, too, because I'm always very realistic; we are here. You know, you can spend a lot of money doing body contouring, but if it's a circumferential thing, and it's like skin excess, it's not something—

Dr. Hall: That's—that—

Ms. Golembiewski: We're not fixing that.

Dr. Hall: And skin excess and skin laxity. You know, if you're seeing that patient, that hormone-deficient patient with poor collagen and just floppy skin, even if it doesn't look like they've got a lot of excess, I see a ton of unhappy patients from CoolSculpting, or whatever the—

Dr. Durst: Oh yeah.

Ms. Golembiewski: Oh, we see a lot.

Dr. Hall: Non-surgical body contouring, where they're not like you are where you're looking at the skin and kind of making that assessment, but saying, “Oh, yeah. Just toss them on the machine and we'll get rid of some of that fat,” and then they end up either with no change or looking worse.

Dr. Durst: Yes, correct. Absolutely. And I think addressing that comprehensively, just like the sexual wellness or hormones is important. So like, again, we'll do a lot of things. Like hormone optimization is going to already increase muscle mass metabolism, help them lose weight, they're more energetic for workout. We have peptides we can do, you know, so that then you're controlling all the other aspects of it. So, we do that way before we ever got into body contouring if there was weight loss that needed to happen first. But again, skin excess and laxity is not something, you know, that can always be corrected.

Ms. Golembiewski: And those patients were saying this is surgical.

Dr. Hall: Yeah.

Dr. Durst: Yeah. Well, and just making it again, it's about them getting the results they want, and if you can't provide it, we need to tell them.

Ms. Golembiewski: Exactly.

Dr. Durst: Because otherwise they're unhappy, and you don't want unhappy patients; they want results. So, if they decide to proceed with something despite you telling them, that's one thing, but you got to be transparent.

Dr. Hall: Yeah. Yeah, I think in our industry, honesty is—is as with anything, honesty is, kind of, first priority with everybody. Farideh, again, you tried to sneak another one by me.

Dr. Durst: [laugh].

Ms. Golembiewski: [laugh].

Dr. Hall: Okay, the O-Shot. What did—you hear—what is that?

Ms. Golembiewski: So—

Dr. Durst: I can't imagine [crosstalk 00:07:14] try to [crosstalk 00:07:16].

[crosstalk 00:07:19]

Ms. Golembiewski: —throw those things out there.

[crosstalk 00:07:20]

Dr. Hall: Just, like, rolls off your tongue. I'm like, “Wait a second. What is that?”

Ms. Golembiewski: Yeah, so we take platelet-rich plasma so we take your blood, spin it down, take the platelet-rich plasma from there and then we re-inject that into the clitoral hood and into the G-spot, so we are helping build collagen elastin, supporting that urethra, and it helps a lot with stress incontinence for women. So, we get that orgasmic improvement and strength and then we also get to help support that collagen elastin build in between the anterior vaginal wall and the urethra so it helps help some of that incontinence and laxity there.

Dr. Durst: And, like, nerves and blood flow.

Ms. Golembiewski: Nerves and blood flow. Of course.

Dr. Durst: [crosstalk 00:07:50] with everything, so PRP started in orthopedics, you know, with all of the growth factors and PRP and platelets. So, when we take that injected vaginally, we're doing it right through the G slot and into the clitoris. So, you're going to get nerve regeneration and blood vessel regeneration. So, you have increased blood flow, which is lubrication, increased sensitivity, and again, collagen elastin in support of the urethra. So orgasmic, the O-Shot, you know, so just, I mean, women love the O-Shot and I love—we'd love to pair it with—

Ms. Golembiewski: It's like a double-whammy.

Dr. Durst: Yeah.

Ms. Golembiewski: Orgasmic strength and stress incontinence.

Dr. Durst: And stress incontinence.

Ms. Golembiewski: [laugh]. Yeah.

Dr. Durst: And it's not going to do an overall tightening of the vaginal walls. So like, when you're talking about laxity, we're not going to be addressing that with an O-Shot, but we love to pair O-Shot with our vaginal rejuvenation because you're going to basically do something to the vaginal canal, usually it's heating in some way. So, we have three different devices. So, it's either RF heating; RF heating but we're penetrating so, like, a microneedling in the vaginal canal; or we're doing the Erbium, you know, which we're penetrating with heat, telling it it's injured, so you get collagen elastin stimulation tightening, and then blood flow and nerve sensitivity. And then we dump a bunch of growth factors in with the first treatment so that we have the O-Shot going in the first treatment. With amazing results. So.

Dr. Hall: How do you do anesthesia for that? Because I would imagine that just sounds like it would hurt.

Ms. Golembiewski: No. Topical and a little bit of lidocaine.

Dr. Hall: Really?

Dr. Durst: A clitoral block.

Ms. Golembiewski: A clitoral block, yeah. It's just like with the P-Shot for guys. We do a penile—

Dr. Durst: Yeah, we do a P-Shot, too.

[crosstalk 00:09:25]

Dr. Durst: Guys say a zero, maybe one from that initial injection from the Lidocaine for the penile block. Maybe a one, but most men say, on a pain scale of zero to ten, a zero.

Dr. Hall: Okay. And what does that do? What does the P-Shot do?

Ms. Golembiewski: Same thing for women. Increased blood flow, right; elasticity, build that collagen elastin; help with erectile strength, blood flow, all of that. And we're usually pairing it again, like, we pair women with Votiva or Morpheus V, we're pairing it with, like, a GAINSWave treatment. So, we're trying to improve that blood flow, and then trying to get that vessels, right, to repair and hold all that blood flow in.

Dr. Hall: And then what is GAINSWave? I not familiar with that.

Ms. Golembiewski: Oh, we're just opening your world to all the sexual wellness—

Dr. Hall: [laugh]. I am learning so much.

Ms. Golembiewski: This is what we do here.

Dr. Durst: So we, again, talk about sex all day long—

Ms. Golembiewski: All day long.

Dr. Durst: —[crosstalk 00:10:18]—

Ms. Golembiewski: Sex and hormones.

Dr. Durst: With hormones, we're talking about sexual stuff. And so—because again, people don't have a lot of places to go, right, men or women. And we all age, we kind of talked about that earlier, we're all going to experience aging with time. So, with women, it's laxity, decreased orgasmic strength, urinary incontinence, especially with hormonal changes or pregnancies, where men, it's inevitable too that eventually, they're going to have decreased blood flow, decreased erection quality, decreased reliability, so they might lose, like, morning erections, or nocturnal erections, or they can't consistently keep an erection.

Ms. Golembiewski: Right. Women can hide it, but men can't.

Dr. Durst: Yeah, so everyone in the room—

Ms. Golembiewski: Everybody in the room knows what's going on with you [laugh].

Dr. Durst: So, they have different things. But GAINSWave is an acoustic shock wave that basically is telling the tissue it's injured, versus the laser for women. And so, it's telling the tissue it's injured, so you get blood vessel repair. And again, the penile vessels are the smallest in the body, so they're one to two millimeters. Coronary artery is three to four; carotid is even bigger.

So, it's a barometer of vascular health. So, they're going to notice erection changes before they notice anything else. So, you can do—so the earlier the better. So, if it's like, you know, I'm maybe drinking, maybe losing an erection can't keep it but then maybe I'm not drinking, it's happening a couple of times. That's the time—

Ms. Golembiewski: Erections start changing in morning.

Dr. Durst: —to start treatments, noticing minor changes. So, you basically are doing it over the penis, over the scrotum, to tell the tissue it's injured so blood vessels and nerves. And then the smooth muscle, the corpus cavernosum, you know, you're going to improve the health of that, collagen elastin, so when we get the blood flow, and we want it to stay, so the P-Shot kind of focuses in on the penis and all the regeneration there. So likewise, we GAINSWave, pair it with the P-Shot.

Ms. Golembiewski: Dump all those growth factors in.

Dr. Durst: No man left behind. We can't do women and not men.

Ms. Golembiewski: We do women and men.

Dr. Hall: Mind is blown. Yeah, I was reading your website—which is beautiful, by the way—

Dr. Durst: Thank you.

Dr. Hall: I was looking, I was like, “I don't know what half of this stuff is.” Like, I've got a lot to learn.

Dr. Durst: But we don't like learn, like, again, we don't learn hormones in traditional medicine. We're been traditionally trained and you don't learn it. And I think endocrinologists don't even know it because they frequently don't have people—like, don't have women as they age on estrogen or on the right thyroid replacement. So, you have to almost branch out and learn it.

But like, what we're doing is on the realm of regenerative medicine. So, lasers are regeneration, so now we're starting to talk about how to regenerate, and I think that's the next step. Like, that's almost like a revolution in and of itself, not the sexual one; this one might have boundaries, but this one is awesome because you're using—you're basically regenerating tissue instead of sometimes you need cutting or using medicines for it, if it can. So, if it's mild, so if they're coming for—I mean, it's almost as if med spa versus surgical. Like, your filler is augmenting what you're doing surgically and they're working together, and so that's frequently what we need for tissue function, too, and sexual function is we need everything to work together.

Dr. Hall: Yeah. And that's what—you bring up the surgical part of it. And it's—plastic surgery is moving—you know, has been moving in a regenerative direction for a long time. And you know, we're seeing more and more regenerative treatments kind of take over. You know, it's unusual for me to do a facelift now without paring it with fat injections. Fat grafting to the breast, to the buttocks, all over the body has kind of become really standard in a lot of practices.

Dr. Durst: Or even more contouring probably with filler, you know, all of that, or regenerating with lasers, so it's like more comprehensive treatment—

Dr. Hall: Exactly.

Dr. Durst: —than it ever was before. So, they went to surgeons for surgery, and now that's a comprehensive treatment.

Dr. Hall: Right.

Dr. Durst: And it's almost as if that's all that's offered, you know, they're probably going to not be as completely happy with the results because you're going to pair, you know, some contouring, so that looks great, but let's add some contouring or laser regeneration, all that. So, it's kind of the same with us. It's the hormone and the [crosstalk 00:14:27]—

Ms. Golembiewski: And again, back to [crosstalk 00:14:28], too, we got to add those hormones back in, we need to treat that base function of that cell. We've got to make it as healthy as possible, make it as healthy as possible so that when we're doing these treatments, we're not seeing regressions sooner than we should.

Dr. Durst: Yeah. And then actually when you're talking about building bones, so like, again, when it comes to—the earlier women are on hormones, so as soon as they can be, the better. So perimenopause, 40 to 55, seeing it younger now because we don't produce hormones like we used to, toxicities that were exposed to. But the earlier you replace progesterone and testosterone in the perimenopause, the better because the only thing that maintains or even builds bone.

So, if they have, like, low DEXA scans, and they're osteoporosis or osteopenia, you can actually build bone with hormones, and hormone optimization, and vitamin D. So, that's the other thing we don't ever think about. It's a pro hormone, but it actually builds bone, too, and supports bone health so they get less bone resorption with time. You're still going to have aging; you can't correct everything, but at least you can support.

Ms. Golembiewski: And slow it down a little bit.

Dr. Durst: By optimization. Yeah.

Dr. Hall: Oh, absolutely. Absolutely. Another question that to kind of, not to shift gears a lot but shift gears a little bit is you've got a really comprehensive lab in the back of your clinic for IV therapy. And that's been something that has been talked about a lot recently.

How can IV therapy help in kind of the post-surgical period? And I'm kind of being selfish thinking about my patients recovering from, you know, 3, 4, 6-hour operation? What do we use? When do we start? What do we need a partner to help optimize post-surgical recovery?

Dr. Durst: Yeah. So, get on that recovery in? And so, high dose vitamin C has been shown in lots of studies to promote healing after, mainly because it's an antioxidant. So it's, you know, decreases inflammation, oxidative stress, all of that is happening, post-surgery, right?

If they can do it before, and almost immediately after, there's no complications, it doesn't increase bleeding rate, nothing, so it's not going to make anything worse with surgery or in the recovery period, but can significantly improve recovery times because it's anti-inflammatory. And so, you get that inflammation and that's mainly what causes swelling and pain, right? And at least I'm thinking they can't decre—or they can't move like they used to because it's a lot of pain and swelling. And so, that's why I suggest vitamin C, all the way—in fact used for cancer therapies, or at least preventing side effects with chemotherapy you know? So, there's lots of benefits to just IV, promoting healing and making your patients get better, faster.

Dr. Hall: Absolutely.

Dr. Durst: Maybe come wobbling into the post-op appointment, that's probably a very hard appointment, you know—

Dr. Hall: Yes.

Dr. Durst: —and lots of pain with it. So, here we put together all the drugs so you can actually even talk a little bit more about that.

Ms. Golembiewski: So, we do a ton of different IVs. We do, like Dr. Durst said, the high dose vitamin C. We do kind of like a souped up Myers' cocktail. So, all of your B vitamins and minerals, we do glutathione added on to a lot of our IV drips. There's alpha-lipoic acid, so a lot of things to help with antioxidants, healing, just overall to feel better getting the energy back. We do NAD drips. So, that is also DNA repair. Just quite a bit. We customize a lot of stuff, so even for our athletes, so post-workout, for recovery we do amino acids, we add glutamine, arginine, lysine, valine, and I'm missing one, but there's another one and that— carnitine to help with recovery after working out. So, we have a pretty extensive IV lounge here that we are sitting in today that our patients can come and be any be here anywhere from an hour to six, depending on the drip.

Dr. Durst: It's a pretty comfortable place. If, like, they're pissed off and a little uncomfortable, we have some rooms too, but the history of IV therapy—because it's interesting because it's been used for a while too, but because nothing is drug company sponsored or supported, you don't—yeah, no, it's all about the money, and if you follow the money, it's so easy. But now they're actually I think, in 2021, or maybe the early part of this year, they just came out with high-dose vitamin C as part of cancer therapy. Like, not just preventing side effects, but cancer therapies.

So, some studies recently—and just using a high-dose vitamin C for cancer therapy is not just in, like, an adjunct to cancer therapy or preventing side effects. So, it's been around for a long time, but because drug companies don't support, can't do studies, it isn't as promoted as it's going to start being I think. So, what typically would happen is regenerative medicine doctors, the ones that are doing, like, all the sick—the functional medicine doctors, and again, that's not us, that's doctors that are doing, like, really sick patients with, you know, Lyme disease or something big and they're working through it. And it's a lot of work to get through that they need to—

Ms. Golembiewski: Yeah, a ton with the gut health and the microbiome and all that. Very extensive.

Dr. Durst: They need to have all of I mean, they're very good at what they do, which is why because it's so detailed, and so, they have to specialize in it, but they would do drips to treat those patients over, like, maybe four hour periods. So, I did my training and learned these long, very complex drips and multiple trainings. And then I realized nobody's staying here for four hours to get an IV therapy drip. So, I basically took and reformulated those to go over an hour and it's based on osmolarity and blood and so, like, if you're giving lactated ringers, normal saline, it's like approximately 300 milliosmoles per liter. So, your drip has to be close to that, too. So, that's the nice thing about it. Now, it took a long time. It took me about a year to formulate prior to even this being open, and then making—

Ms. Golembiewski: She does have a pharmacy degree. She doesn't talk a lot about that.

Dr. Durst: So, I'm like—

Ms. Golembiewski: She is also a pharmacist—

Dr. Durst: —so I mean—

Ms. Golembiewski: —before a physician.

Dr. Durst: So, I got very—

Ms. Golembiewski: [laugh]. She talks about it, like, “No big deal. I just created these.”

Dr. Hall: Just make a 300 milliosmole solution.

Ms. Golembiewski: Yeah. So. [laugh].

Dr. Durst: So, I mean, a lot of learning. But it's very—like, I loved it. And as I learned what you could do with IV therapy, like, again, there was no way I wasn't putting an IV therapy lounge in this place because it just an adjunct to everything we do. And so, we do formulate, customize, so we can change because we know the science behind it. So, high-dose Vitamin C is technically 25 grams, but we can do 50 grams, we can do 75 grams if we wanted to. So, we can customize, which is nice.

Ms. Golembiewski: And those might take a little bit longer, just because the side effects. And then our NAD bags do sometimes go four to six hours, but the majority of of them—

Dr. Durst: And it is a great, like again, it's used for, like, addiction, alcohol drug, you can titrate up and titrate down but it's great anti-aging mitochondrial support, too. And then I think the big thing for us for beauty is if you put glutathione in anything—so for you, like, recovery post-op, you know, as soon as they can get in, and they should always do on before because it improves it already. Because every—like, vitamin C in high-dose concentrates in the white blood cell, so your immune support and anti-inflammation is highest in that perioperative. And then if they can get one after it's even better, but a lot of times they're in pain and it's hard to do. But then glutathione because it's the master antioxidant. So, all of Hollywood is doing, like glutathione drips, like, just for skin brightening and, you know making everything brighter and lighter. And so, that's a big selling one, too. People come looking for it because—

Ms. Golembiewski: Great for aesthetics, but also just because it's an antioxidant.

Dr. Durst: Yeah.

Dr. Hall: Yeah.

Ms. Golembiewski: It's wonderful for the body.

Dr. Hall: How long before surgery for some of these—you know, glutathione and vitamin C infusions, how long before. Or how close to their surgery would you recommend somebody come here—

Dr. Durst: So, I would do it within 24 hours—

Dr. Hall: Really?

Dr. Durst: —of their surgery. Like, right before. It's not going to interfere with your surgery?

Dr. Hall: Okay.

Dr. Durst: It's no—

Ms. Golembiewski: And of course, everybody out there, talk to your surgeon before you go and get an IV. I feel like we have to say those things of course.

Dr. Durst: Yeah. I mean—yes, absolutely. I mean, you don't want to let your surgeon not know what you're doing.

Ms. Golembiewski: Exactly. Very important.

Dr. Durst: Then you might find out they won't do surgery when you show up.

Dr. Hall: Right.

Ms. Golembiewski: Exactly. Gotta throw that little caveat out there. I would always double-check with your surgeon before you do that, but we do see patients here pre-op and post-op.

Dr. Durst: And the other interesting thing is, like, peptides. Like, so again, there's, like, two peptides in particular that come to mind with this. And so, it's all part of that regenerative, and once you hear about it, you'll be learning—I know you.

Dr. Hall: Oh yeah.

Dr. Durst: You'll be like, “Yeah.” You'll be, like, reading all about the peptide—everything. Like, and again, as that regenerative medicine thing just expands and blows up, like, you can't help but get excited to learn more about it. And I think Tony Robbins' Life Force book is, like, kind of bringing that to the public.

Ms. Golembiewski: Sums it all up nicely.

Dr. Durst: So, if we don't keep up, they come in asking us about a certain things that we don't know anything about, so you almost have to stay up. But—and I know you—it won't. Yeah. It'll be on the way home.

Dr. Hall: Oh, yeah. You mentioned Tony Robbins' book. It's like on my Kindle. It's, like, next up. So.

Dr. Durst: Yeah yeah—

Ms. Golembiewski: Yeah, you've got to read it.

Dr. Durst: Yeah. I just started listening—I've had so many patients come in, and they're like, have you read it? And so, as soon as I hear that, and I started listening, and it's exactly what we would love to learn about. But peptides are, like, again, one of those regenerative medicine type of things you can do. So VPC, CJC, have you heard anything about this?

Dr. Hall: No. I've—only the letters. But yeah.

Dr. Durst: Us peppering it in—

Dr. Hall: Yeah. Yeah.

Dr. Durst: —here and there in conversation?

Dr. Hall: Yeah, but talk to me a little bit about the peptide.

Dr. Durst: So, growth hormone, for instance. Like, the growth hormone thing is, like, in the '90s started to be more restricted. So, before that, it was being used for injury. And a lot of athletes with injuries, they would go on growth hormone and obviously it has great benefits.

Ms. Golembiewski: —for strength and endurance.

Dr. Durst: If it could be a drug, it would be perfect. It'd be a perfect drug because it has decreased inflammation, healing, it does everything that testosterone does, but better. So libido, brain fog, energy, healing, decreased inflammation, endurance—

Ms. Golembiewski: Decreased lipid profiles.

Dr. Durst: Yeah. Decreased injury. Now, it's restricted and you can't use it much, but now there's a peptide that can increase growth hormone. So, CJC 1295 and Ipamorelin is a peptide we use—

Ms. Golembiewski: Well, the body increases its own naturally, so we're not giving it external, so we're not shutting down the body's production, which is so important. We're just supporting its own natural production. So, it is not something you have to worry about being on long-term. A lot of these drugs that shut down the body's natural functioning, you've got to take that into consideration when you're starting a patient on that cause you don't want to do long-term damage. This is one that it will permit the body's own natural increase in growth hormone and mimic its natural rhythm at night and in the morning. So, it's pretty cool.

Dr. Hall: Interesting. So, it's like Erythropoietin, or EPO, for the audience who's kind of heard about that, increased blood production—

Ms. Golembiewski: Absolutely.

Dr. Hall: —it's the same thing for growth hormone?

Ms. Golembiewski: Mm-hm. Absolutely.

Dr. Hall: Very cool.

Dr. Durst: So, now you can optimize not only hormones—and I always recommend hormone optimization first and then we'll add growth hormone optimization. So, CJC 1295 is growth horm—it looks like growth hormone. It's a shorter segment of growth hormone releasing hormone, so it goes to the pituitary, has - so the pituitary increase growth hormone production. And we still have small spikes as we age, but it peaks at 20. And so, then it starts to go down.

But they're still there, they just need to be stimulated, but not over stimulated. And growth hormone, if you're giving it, it's during the peripheral effects and then shutting down your own system. Where this increases your growth hormone, goes to the liver and produces IGF1 which does all the effects, you know, all the positive effects of it. So, it doesn't shut it down and it also doesn't overstimulate if it's dosed appropriately. And of course, you have downregulation of receptors if you take it on a continuous basis.

They used to cycle out every three months and come out of it for a month. But now you can do it. It's an injectable at home. Most of the peptides are, if they're really effective, five days on, two days off, five days on. And so, it just stimulates enough, doesn't overstimulate, doesn't shut down, but now you have growth hormone optimization and all the positive benefits without the downside.

Ms. Golembiewski: Without the negative side effects.

Dr. Hall: Now, is this another, you know, we talked earlier about being able to measure hormone levels. Is this something else that you measure and kind of track when they're on the peptide treatments?

Dr. Durst: So, you don't with this.

Dr. Hall: Okay.

Dr. Durst: So, it's a small segment. So, even measuring growth hormone is expensive.

Dr. Hall: Yeah.

Dr. Durst: And so, this is growth hormone releasing hormone, but it's a small segment of it. So, it's like 29 amino acids. So like, you're not going to ever be able to measure that. But even then it was expensive. You can measure IGF1 levels baseline, and you can measure them post. The only issue.

Ms. Golembiewski: Pre and post. We do it pre. Finding that initial, always, on the screen.

Dr. Durst: The big issue is, like, pre, you want a baseline that tells you it's at least at a level you're going to produce so that your pituitary is working enough and those somatic tropes are working enough that they're going to work for production. But you're not going to get sustained, so by the time they're in here getting blood levels, honestly, you're not going to see a sustained because the halfway is 30 minutes, just like growth hormone releasing hormone. Goes to the liver—

Ms. Golembiewski: It's in and out.

Dr. Durst: —produces IGF1, does the effects, and it's gone. And Tesamorelin was a third generation. So, if anyone ever asks, like, Sermorelin was first generation, so it has—

Ms. Golembiewski: Those are the Arnold days.

Dr. Durst: Yeah.

Dr. Hall: Yeah. [laugh].

Dr. Durst: What, the Sermorelin?

Ms. Golembiewski: Yeah. [laugh].

Dr. Durst: Yeah. Well, and I think some places still use it, but it does have effect on prolactin and cortisol, and so it effects—

Ms. Golembiewski: It has more negative side effects.

Dr. Durst: —the hormones, so you have side effects with it. And then you have CJC, which is second generation, which I think is ideal—

Ms. Golembiewski: Ipamorelin. Yeah.

Dr. Durst: —for use. I take on more later. Yes, Tesamorelin was a third generation; temporarily not available, but because it wasn't a regulatory—I think something to do with Covid, honestly. Most of the peptides if they went away for a short period of time was because somebody was using them, you know, in the Covid scenario, and—

Ms. Golembiewski: Somehow or another and they've been pulled.

Dr. Durst: Yeah. But it does get you sustained results with that, which is really not what you want. So, it was used in a more short term for somebody with maybe, like, abdominal—like, metabolic syndrome. So, if a man comes in—or a woman—again, like, with metabolic syndrome, you know, then that was a better peptide to use.

Ms. Golembiewski: Short-term, though.

Dr. Durst: Yeah.

Ms. Golembiewski: Not long-term.

Dr. Hall: Short-term.

Ms. Golembiewski: Or CJC, Ipamorelin, we can stay on long-term.

Dr. Hall: Okay.

Ms. Golembiewski: And you actually see better results, long-term.

Dr. Hall: When you say long-term, what's a treatment course?

Ms. Golembiewski: At least six months before—we tell everyone give it at least three to six months to start seeing sustained benefits.

Dr. Durst: So, six months is ideal. Like, is you're going to get your biggest strides, like Farideh said, in three to six months, but you can stay on it indefinitely if you want. Because it optimizes growth hormones that prepares your body not to get injured, and your, like, endurance is better, your muscle building is better. So honestly, for women—and you can cycle them off and back on—but without tumor history, then there's not that contraindication.

But for muscle, for women as we age, you know, again, one of the biggest complaints is weight gain and body composition change. So, that's why you know, all of a sudden we're seeing sagging in one's arm, surgery, you know, even the thighs, which I'm not sure there's a big—

Ms. Golembiewski: Top of the knees.

Dr. Durst: I don't know how much you can do for, like, above the knees, and abdominal. And so, this actually does a great job of body composition changes. But again, it's a slow process over time because you're growth hormone, again.

Dr. Hall: That's really interesting. I didn't—I was totally unaware that you would start seeing surface changes—

Ms. Golembiewski: Oh absolutely.

Dr. Hall: —with peptide infused. That is really cool.

Dr. Durst: Well, and then Ipamorelin is paired with CJC typically, and Ipamorelin just inhibits the negative feedback on the pituitary. So, basically they're both increasing growth hormone, but they're used together, usually. So, cool stuff.

Dr. Hall: Very neat.

Dr. Durst: Yeah.

Dr. Hall: Well, as you were talking, you kind of mentioned the testosterone, and I had a question about testosterone and some of these, like, Propecia. Because I know a lot of guys who are in my demographic are concerned with hair loss or thinning. And, you know, how does testosterone and Propecia work to get—can you get testosterone supplementation if you need it and still be taking Propecia for your hair. Do you need to?

Dr. Durst: We can go on forever about the [crosstalk 00:30:49]—

Ms. Golembiewski: Forever and ever and ever.

Dr. Durst: —but I know—

Ms. Golembiewski: So, testosterone converts into dihydrotestosterone, which is ten times more anabolic. And so, when we're seeing our patients for testosterone, male and female because females can see that same, because it's the same pathway, we're always looking at those DHT levels. So, there are medications that can slow that conversion so that we're not seeing that excess hair loss and there are some natural supplements, like, Saw palmetto, right? So, we put—patients on—

Dr. Durst: Minerals.

Ms. Golembiewski: Minerals, we put patients on some supplements sometimes to help with that. But Spironolactone is great to slow that conversion of testosterone to dihydrotestosterone. We can also hit those follicles at the site and do topicals to help minimize that DHT response at the hair follicle site. So, there is a lot of options there for men and women that we watch on the front-end.

So, we grab those DHT levels on the very front side of it. Some of the patients we see that have come from clinics that are just running shots weekly, right, they're not looking at any of that, so we're correcting that when we come in.

Dr. Durst: So, I think it's almost, like, dosed appropriately, treated appropriately, followed appropriately—

Ms. Golembiewski: Exactly.

Dr. Durst: —you can prevent any side effects that you're going to get in, you know—and dosed appropriately so that you don't get also not just side effects, but adverse long-term effects. So, I think getting more data points at the beginning, like, a DHT level, what's your free testosterone, your binding globulin, like, all of those are important, dosing is appropriately done so that, like, again, pellets, you know, is something that you make a small incision and you insert pellets under the skin that slowly release. And so, that slow release keep your levels up and keep them up versus injectable, so that once a week at the low T clinic in—

Ms. Golembiewski: Your slacking hormones.

Dr. Durst: —in and then down. In and down. And creams don't work. I mean, nobody feels better creams with their, like, a variation. And so, the more that you go up and down, we went test to say testosterone.

But if you're going up and down, you're getting those variations. When you're peaking, you're converting, so estrogen for men, man boobs. Like we're very—because again, I want men to know that there's options and so the once a week is not a good option. I mean, we do injectables; we dose it differently because once you get an adverse effect, it's harder to treat, like, hair loss or bone—

Ms. Golembiewski: Or playing catchup.

Dr. Durst: —[crosstalk 00:33:01], and so—

Ms. Golembiewski: Or we're sending them to surgeons.

Dr. Hall: Yeah.

Dr. Durst: But again, you can. So DHT, even if not high can concentrate in the hair follicle, like, Farideh said. So, putting a topical on, like Propecia, but you never want to take—the most important takeaway from all of this is you never want to be on Propecia without testosterone optimization. Because there are lots of studies that show erectile dysfunction that they report to be irreversible.

So, if you're not optimized, so self-treatment, over—you know, the internet treatments, like, “Hey, I went testosterone,” right?

Dr. Hall: The Hims treatment?

Dr. Durst: Yeah.

Ms. Golembiewski: Yeah.

Dr. Durst: Not a good option—

Ms. Golembiewski: No.

Dr. Durst: You know, because that's when you run into trouble. You want to go to somebody you trust, testing everything, but also, even if it's concentrating at the hair follicle, if you want to use finasteride, that's the way to use it because you're just using it topically and it prevents that conversion at the hair follicle. So.

Dr. Hall: That's good to know.

Dr. Durst: Yeah. I mean, it's complex and, like, we—again, it's what we love, but, like, you have to know and manage it well to prevent because—and even then sometimes we'll run into issues that's a problem, troubleshooting, problem solving—

Ms. Golembiewski: Absolutely.

Dr. Durst: —you know? And a lot of that can be based on the conversation.

Ms. Golembiewski: And then good relationships with compounding pharmacies because those pharmacists have all kinds of fun little concoctions—

Dr. Durst: Oh, they do.

Ms. Golembiewski: They can make us.

Dr. Hall: Oh yeah, I bet. Yeah.

Dr. Durst: Yeah, yeah. And there's a couple really good ones locally—

Ms. Golembiewski: Absolutely.

Dr. Durst: —that are a wealth of knowledge if ever, like, you have questions about dosing or a different route or—it's all good.

Dr. Hall: I'll just, I'll just send it to you.

Dr. Durst: It's all good. [laugh].

Ms. Golembiewski: Right. You send us the hormones, we'll send you the surgeries.

Dr. Hall: I'll just send those to you. That is above my paygrade. You can tell by the questions I've been asking.

Dr. Durst: Yeah. No, I think it's a great conversation to have because like everything that you're doing, you know, is a comprehensive approach to it. And knowing—

Dr. Hall: Yeah.

Ms. Golembiewski: We want to treat the inside and the outside.

Dr. Durst: —what's best for them. Yeah.

Dr. Hall: Yeah, I think that's kind of the takeaway. That's what I've gotten from this is that aesthetics, kind of, you know, they say beauty is skin deep; it actually isn't. It goes—

Ms. Golembiewski: It goes deeper.

Dr. Durst: Much deeper, yeah.

Dr. Hall: It goes way deeper, and probably the best treatment is a marriage of, you know, the surface treatments, what we can do with our lasers, injectables, things like that, surgery, and then hormone treatments, peptide treatments, IV infusions. I mean it's just—

Ms. Golembiewski: Absolutely. Overall wellness.

Dr. Hall: Yeah. It is. It's overall wellness.

Ms. Golembiewski: Want every patient to be the healthiest version of themselves they can be when they walk out these doors.

Dr. Durst: Mm-hm.

Dr. Hall: Absolutely. I couldn't agree more.

Dr. Durst: There is one that we haven't talked about—

Dr. Hall: What?

Dr. Durst: —you know? I'm like—

Ms. Golembiewski: I know.

Dr. Hall: What?

Ms. Golembiewski: It's our favorite.

Dr. Hall: What's that?

Dr. Durst: So, BPC is a peptide that we haven't—and this is actually a great perioperative—this is one more—the two peptides that really work are CJC for growth hormone. And again, for even us, like, using peptides to optimize and, you know, we want to be our best selves for our patients, too—

Ms. Golembiewski: Absolutely.

Dr. Durst: —I mean again, we're living examples; they want to live it too, so like, they want to see their providers doing the same things, right?

Ms. Golembiewski: Or having personal experience they can talk about it.

Dr. Hall: Yeah.

Ms. Golembiewski: So, BPC-157. BPC stands for Body Protective Compound, and it actually decreases inflammation, wound healing, it helps with tendon healing, and ligament healing. It is amazing. We see this for patients with acute and chronic injuries.

We see a lot post-operative. We have some local physicians that will send their surgery patients to us for BPC to help expedite the healing process, the recovery process, post-surgery.

Dr. Hall: Now, is this something that you can do before surgery to—

Dr. Durst: Mm-hm.

Dr. Hall: —help?

Ms. Golembiewski: Absolutely.

Dr. Durst: And the quicker you can do it before, like, definitely 30 days before, but if you can be on it even longer… once you learn a little more about BPC, you'll love it as much as I do. Like, it's again just—

Ms. Golembiewski: Out of all the peptides, that's probably the one that—you know, nothing in life is, like, immediate gratification, but this is a peptide that within two to four weeks, patients have relief of pain.

Dr. Hall: Wow.

Dr. Durst: Mm-hm.

Ms. Golembiewski: That is amazing. It changed my husband's life. So, personal experience. My husband was walking around with pain of seven, eight every single day on a ten scale with chronic back pain. He was a very active athlete, very hard on his body. With BPC, he's down to a zero, one.

Dr. Hall: Wow.

Ms. Golembiewski: Because of inflammation and the compression on nerves, and just overall just that pain in the joints.

Dr. Durst: Even if they come in with an acute injury—so a lot of patients remote with BPC because it's hard to get peptide physicians and appropriately prescribing physicians nationwide. So, they will reach out remotely, even if they have—like, so if it's local remote, they have an acute injury that they want—and again, they're on the internet, right, searching, so they're like, BPC—like, “What helps with—” There's so much have you heard of Ben Greenfield?

Dr. Hall: Oh, yeah.

Dr. Durst: Yeah. So, he does, like, a blog on it and basically says this shit should be illegal, it probably will be soon because I had improvement of this and this. Everyone's talking about it. There's tons of stuff on the internet, so when they reach out if they have acute injury that we're treating, if they have some chronic pain, it's gone too.

But for surgery, the quicker you can use it before, and definitely 30 days is a good timeframe, you're prepping the body, you can do it perioperatively. Again, no drug interactions, it's not a drug; it's not going to affect surgery. And then post-op, it allows inflammation but not too much. So, most of the healing, you know, that takes so long is because they're inflamed, it's painful, they can't move. And the orthopedic results are phenomenal. And so, as orthopedic surgeons start to use it more and more, you know, sometimes they don't need to do surgery, but if they do, they're getting faster recovery times.

Dr. Hall: Can you combine the BPC injection with a vitamin C infusion?

Dr. Durst: Yeah. Mm-hm.

Ms. Golembiewski: Absolutely. You can combine it with CJC, you can combine it with testosterone.

Dr. Durst: Yeah.

Ms. Golembiewski: And use it really in conjunction with any of the therapies that we do here.

Dr. Hall: That's very clever and I'm definitely going to looking more into that. That is definitely cool.

Dr. Durst: Like one of my favorite—

Ms. Golembiewski: It's probably my favorite.

Dr. Durst: Mm-hm.

Ms. Golembiewski: Just, like, across the board with our patients.

Dr. Hall: You waited until the end to talk about it.

Dr. Durst: I know. [laugh].

[crosstalk 00:39:05].

Dr. Durst: Hey, she snuck a lot in—

Dr. Hall: She did.

Ms. Golembiewski: I did. [laugh].

[crosstalk 00:39:10].

Ms. Golembiewski: I'm like, “Oh BPC, CJC”—

Dr. Durst: Yeah, yeah. She [crosstalk 00:39:10].

Ms. Golembiewski: —“Testosterone, P-shot. You're good.”

Dr. Durst: Yeah.

Dr. Hall: Yeah.

Ms. Golembiewski: [laugh]. There's your order.

Dr. Durst: Exactly. Yeah.

Dr. Hall: What was the order again? [laugh].

Dr. Durst: [laugh].

Dr. Hall: I'll have to listen to the recording.

Dr. Durst: Yeah, exactly. So, anything else you think we need to, like—for hormone or Dr. Hall, anything?

Ms. Golembiewski: For healing, definitely, we've kind of hit the two main ones—for surgery—were peptides, is that CJC Ipamorelin and BPC. But you would—it is amazing, the BPC results. The feedback we get from patients just, it's been so life-changing for so many of our patients. I think that's why it's probably my favorite because you get quick results.

And nothing in life is quick and I feel like a lot of times we just put Band-Aids on things, steroid injections, right? Let's just stick some cortisol in it and then we're just breaking down bone versus a functional change.

Dr. Hall: That was really—yeah because that is, you know, in a lot of—a lot of Western medicine is putting Band-Aids on things.

Ms. Golembiewski: Yeah.

Dr. Durst: Mm-hm.

Dr. Hall: And so, this exciting to—

Ms. Golembiewski: Functional change is pretty cool.

Dr. Hall: —hear about.

Dr. Durst: And just knowing that there's so a small percentage of patients that you're—your surgical patients that are even hormonally optimized, and knowing decreased healing time, you know, anti-inflammatory effects, the healing times, the immune support, you know, just hormones alone, just knowing, as your patients, you know, listen to this, and, you know, are prepping, and as you're talking to them, I'm sure they have a period of time, everything's a wait time now, right?

Ms. Golembiewski: Mm-hm.

Dr. Hall: Yeah.

Dr. Durst: You know? So, they can't—so they have that time where they can at least start thinking about it beforehand and help you, you know, get results that are quicker—

Dr. Hall: For sure.

Dr. Durst: You know, more sustained, better, all that.

Dr. Hall: Yeah. Boy, that is certainly true. Like I said, I've learned a lot today.

Dr. Durst: Mm-hm. [laugh].

Dr. Hall: This has been a lot of fun. Is there anything you have that your patients would want to know about surgery as it relates to hormones or just in general?

Ms. Golembiewski: I think the biggest ones are kind of, do we need to come off, right? That's always a finding a surgeon that is not going to freak out that they're on hormones, right?

Dr. Durst: Mm-hm.

Ms. Golembiewski: With pellets, we can't really remove the pellets.

Dr. Hall: Yeah. You can't do anything about that.

Ms. Golembiewski: Right. So, if it's something where if we're doing an estrogen pellet, if we need to wait, what does that look like for the patient? Can we go to a transdermal if we have to.

And then downtime. I think that's always, like, the biggest thing with patients too is, well, if I'm doing XYZ with you all and then I'm doing surgery here, what's my downtime look like? How much time would I have to be off hormones? How much time to I have to wait till I get to the gym? Because that's big.

A lot of our patients are doing a lot of just self-improvement. They're in the gym, they're working out, they're doing all that, they're working with a trainer trying to get those body composition changes along with surgery.

Dr. Hall: Sure.

Ms. Golembiewski: So, what does downtime look like with most surgery's timeframes?

Dr. Hall: So, and that's a question that I get a lot, you know, we kind of go over in the consults. And for most surgeries, that—I guess a general rule would be, you're pretty much off of anything for about two weeks. After about two weeks, then it's kind of light exercise, thinking treadmills, walking around the block, maybe walking up and down hills, get your heart rate up a little bit. But really, six weeks is kind of the cutoff for intense exercise. And I tell, you know, tell a lot of patients, whether it's tummy tucks, breast surgery, facelift surgery, typically no lifting and no bouncing for six weeks.

Ms. Golembiewski: No bouncing.

Dr. Hall: Yeah. Yeah. [laugh].

Dr. Durst: [laugh].

Ms. Golembiewski: Of any kind. [laugh].

Dr. Hall: Of any kind.

Dr. Durst: Stay off the trampoline.

Dr. Hall: Yeah. Yeah, you determine what bouncing is for you.

Dr. Durst: [laugh].

Ms. Golembiewski: [laugh].

Dr. Hall: But yeah, so six weeks out of the gym, for sure. I want patients to be up and moving the day of surgery. You know, laying around is where your complications happen, and so up and moving to a point.

Ms. Golembiewski: For someone that's getting a facelift or doing fat grafting into the cheeks or into the the face, how soon can they do laser resurfacing?

Dr. Hall: It—

Dr. Durst: Great question.

Dr. Hall: It's a really good question. So, it depends on what else was done. Injections, typically do laser resurfacing same time.

Ms. Golembiewski: Yeah.

Dr. Hall: Where you—the tricky part is with a facelift because you don't want to… you have to lift the skin up to reposition the muscles and do all the work that's needed to get the result and you don't want to stress the skin by lifting it up and then set it back down and blast from the top with a laser. And so, you have to be really careful over that skin that has been elevated. And so, it's a matter of matching the right procedure. You know, if we're doing a deep plane facelift, that is typically really limited skin undermining, you know, above the jawline and so I can be more aggressive with laser resurfacing, doing that is if we're doing a smaller facelift with less muscle tightening that relies on a little bit more skin undermining.

Dr. Durst: Okay. Got you.

Ms. Golembiewski: What about treatment for scars? How quickly for treating with either creams or lasers for scars post-surgery?

Dr. Hall: Really, almost after the tape has come off.

Dr. Durst: Love it. Yeah.

Dr. Hall: Yeah. It is right after. You know, because that—you're looking scars essentially healed less than a week. If the skin edges are put together right, you know that skin has healed over in about 48 hours. We want to let it, kind of, thicken, but then, you know, once that tape comes off, whether it's a week or two weeks, you can start—

Ms. Golembiewski: Get after it?

Dr. Hall: Laser treatments right then.

Dr. Durst: I love it.

Dr. Hall: But again, talk to your surgeon before—

Dr. Durst: Yeah. [laugh].

Dr. Hall: Lasering a surgery scar.

Ms. Golembiewski: Yeah, [laugh] gotta throw that caveat out there, always.

Dr. Hall: [laugh]. Yeah.

Dr. Durst: Because we just—that's what they just said. We were a little surprised at the most recent conference we were at. They're like, “Soon as everything's off.” And we're like, seems so—

Ms. Golembiewski: Even, like, vaginal treatments are, like—

Dr. Durst: —so quick, so I'm glad to hear that, yeah.

Ms. Golembiewski: —the day the baby comes out. I'm like, “What?” They're like, “in other countries...”

Dr. Durst: Well, they were talking about more— also, stretch marks. So, if you have stretch marks, as soon as you deliver—

Ms. Golembiewski: Come on.

Dr. Durst: —[crosstalk 00:45:09] on, you know? Because they're darker at that point and the [unintelligible 00:45:13] versus, you know, a scar tissue once it's white. So.

Dr. Hall: Yeah. Stretch marks are tough, though. I mean, stretch marks are tough to treat.

Dr. Durst: Mm-hm. Yeah. I agree. I think that—

Ms. Golembiewski: But we have some things for that. [laugh].

Dr. Durst: Well, and I think that, like, just the fractional, like, Erbium is really good as—

Ms. Golembiewski: Sooner the better.

Dr. Durst: —[crosstalk 00:45:34] impressive. Yeah.

Dr. Hall: Yeah. Fractional Erbium, and then, you know, for the purples or reds—

Dr. Durst: Mm-hm.

Dr. Hall: —you can zap those.

Dr. Durst: Yeah. Much, much more responsive, to0.

Dr. Hall: Yes.

Ms. Golembiewski: Much better than the white.

Dr. Hall: Yeah. Once they're white, your in kind of the long haul to get to improve.

Dr. Durst: Yeah.

Ms. Golembiewski: Oh, yeah. [laugh].

Dr. Durst: What about with the fat transfers, is the fat transfer, when you do it, is that—like, how long does that procedure take? Is that an in-office procedure? Is there a lot of downtime with that, versus, like, a surgical?

Dr. Hall: So really, it depends on what we're treating. If we're treating a small area, even treating an area like the backs of the hands, those are good in-office procedures. When we start talking about full-face rejuvenation with fat, it tends to be a little bit more involved. I like to do those in the operating room.

The procedure length, if I'm doing it in our surgery center, which is right below my office, a full-face fat grafting session can take 45 minutes or an hour. It's not a lengthy procedure. In the office, it tends to take a little bit longer just because you're awake, we want to make sure you're comfortable, things are a lot slower because we're making sure that every little area is properly anesthetized before we do anything. The real recovery with fat transfer is not pain; it's swelling. Because as you guys know, fat is very inflammatory, and so especially in thinner areas, so around the eyes, around the mouth, the lips especially, they tend to really swell, and so you have to budget. I tell people, you know, give yourself two weeks before you're really out in public because you'll be noticeably swollen.

Dr. Durst: Swollen. Okay. That's interesting. So, it sounds like almost if you're going to do a decent area, the operating room is a better place to be for those procedures because it's more under control.

Dr. Hall: It's much more comfortable. It's just more comfortable. And I know some people are—

Ms. Golembiewski: And that's a huge part of it. When these are all, you know, extra—nobody has to, their elective, right, we want everybody to be comfortable.

Dr. Hall: Yeah. It's surgery you want, not surgery you need.

Ms. Golembiewski: Exactly.

Dr. Hall: So, the operating room is kind of my preferred venue. But if the patient wants to, and it's—you have to have the right temperament. If you're an anxious person, having a facial fat grafting in the office when you're awake is not the right procedure.

Dr. Durst: You're doing all procedures, all operations at an independent surgery center. So like, more control over even anesthesia and—right? And patients are entering and leaving and much more private circumstance than at a hospital, right?

Dr. Hall: Right. Right. Yeah, so our office, I'm very fortunate that my office is directly above the surgery center and the only thing that the entire building does is cosmetic plastic surgery. So, we have the same OR team, we've got the same team of anesthetists, we've got the same nurses at the same building.

Dr. Durst: Everything. Yeah.

Dr. Hall: That's all we do, every day. And so, we've really over time taken great pains to make the entire experience from, kind of, start to finish as comfortable, private. You know, you're not going to run into your friends or, you know, we see a lot of nurses, a lot of health care providers, physicians, and they don't want to run into their friends as they're asleep and half-naked and—

Dr. Durst: [crosstalk 00:49:05]—

Dr. Hall: —you know, having cosmetic surgery.

Ms. Golembiewski: Exactly.

Dr. Durst: Correct. Or get to—

Ms. Golembiewski: Or go to the hospital.

Dr. Durst: —a separate registration area and then you're in a waiting room that's public. And so, there's so many downsides to doing it at a hospital based—

Dr. Hall: Yeah, it's really been a fantastic setup.

Dr. Durst: That's awesome. I love it. Now, I knew that was a huge advantage, like, a big advantage because a lot of patients—well, I mean, again just like you said, they want privacy, and that hospital experience is anything but.

Dr. Hall: Plus you're stuck with hospital equipment.

Ms. Golembiewski: And hospital guidelines.

Dr. Hall: And hospital guidelines. And you know, so—

Ms. Golembiewski: And their requirements. [laugh].

Dr. Hall: Our surgery center, to speak to that, you know, the surgery center goes through the same accreditation process that the hospital does.

Dr. Durst: Oh, I'm sure, yeah.

Dr. Hall: And so, from a safety standpoint, from all that, is exactly the same. It's just that administration is more friendly.

Ms. Golembiewski: There we go. There was a nice—that was a really nice way of putting that. That was very PC.

Dr. Durst: No, I think that. In addition, though, I think you have—like, even though you go through the same accreditation process, you probably have better treatment protocols and anesthesia protocols—

Ms. Golembiewski: A little bit more stringent.

Dr. Durst: Recovery, like things aren't controlled. So likewise, that administration.

Dr. Hall: Yeah. It's geared towards aesthetic patients.

Dr. Durst: Yes. Love it. It's a big difference.

Dr. Hall: Yeah. It's really been a fantastic setup.

Dr. Durst: That's awesome. Well, awesome. So, it sounds like we've, like, covered a ton. I love it.

Ms. Golembiewski: Yes.

Dr. Hall: Yeah, this has been a lot of fun.

Dr. Durst: Yeah, we're going to—

Dr. Hall: This has been a lot of fun.

Dr. Durst: We're doing this again—

Dr. Hall: Absolutely. Let's do it.

Dr. Durst: —at some point, for sure. So, I thank you so much for being part of this.

Dr. Hall: Oh, thank you.

Dr. Durst: And actually initiating. Like, I love it. That's perfect. We have so much to cover in the future. Like, we can talk about so many different things.

Dr. Hall: Oh, there's lots of thihngs—

Ms. Golembiewski: Different procedures, different lasers, different treatments.

Dr. Durst: And I'm sure.

Dr. Hall: Yeah, can do whole shows on this.

Dr. Durst: Yes. Yeah.

Ms. Golembiewski: Absolutely.

Dr. Durst: We might even if we're doing, like, a RevMD, you know, just an open forum and we need a guy present for, you know, the guy opinion, we'll bring Dr. Hall—

Dr. Hall: Totally.

Dr. Durst: —on, right?

Dr. Hall: Totally.

Dr. Durst: Yeah. Yeah. He'll let us know. For sure.

Dr. Hall: For sure.

Dr. Durst: Well, good. Well, again, listen, subscribe, share with friends, leave some comments, or even your experience or questions, and we're willing to deep-dive into anything wellness and aesthetics. And thank you, Dr. Hall and Farideh for making this such an interesting segment and podcast. It's been wonderful, so thank you.

Ms. Golembiewski: Absolutely.

Dr. Hall: Thank you. Yeah thank you both.

Dr. Hall: All righty, buddy. I need that little exploding head emoji. I learned a ton on that show. I hope you guys had a good time.

Please, if you haven't already, ring a little bell on YouTube, like it, subscribe it, share it with your friends, and we'll see the next show.

Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at @jhallmd on Instagram and Twitter and @DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.


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