November 5, 2024 • 37 mins
Welcome to the first episode of Dr. A Explains It All! Join New York City's top cosmetic dermatologist, Dr. Arash Akhavan, as he dives into the truth behind some of today’s most talked-about beauty treatments and skincare trends. This week, we’re covering Botox essentials, the bizarre world of “salmon sperm” facials, and a dermatologist-approved oil-control product you need to know about!
Curious about Botox but overwhelmed by all the information (and misinformation) out there? Dr. A clears things up with a deep dive into what Botox really does, the differences between Botox, Dysport, Xeomin, and Daxxify, and why Botox is so much more than just a wrinkle reducer. You’ll learn about “baby Botox,” why some treatments look natural while others leave you frozen, and how Botox can be used for TMJ, neck rejuvenation, and even the popular “Barbie” look.
And yes, we’re tackling the weird and wild “salmon sperm facial” trend that’s all over social media! Dr. A explains the science (or lack thereof) behind this viral skincare fad and why you might want to think twice before diving into it.
Finally, we share Dr. A’s thoughts on a new oil-control face moisturizer that promises to banish shine without drying your skin. Perfect for anyone with oily skin looking for a simple, effective product.
If you’re ready to separate fact from fiction, get insider tips from an expert, and learn what really works in skincare, this episode is for you. Stay tuned until the end for Dr. A’s recommended over-the-counter products and the best ways to achieve a healthy, glowing complexion.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Arash Akhavan (00:04):
This is the Dr A Explains it All podcast.
A podcast about cosmeticprocedures, skincare,
dermatology and everything inbetween.
I'm board-certifieddermatologist, dr Arash Akhavan.
Let's get started, but first aquick disclaimer.
Announcer (00:19):
Medical disclaimer.
The information provided onthis podcast is for general
information and educationalpurposes only.
It is not intended as medicaladvice, diagnosis or treatment
and should not be relied upon assuch.
Listening to this podcast doesnot establish a
physician-patient relationshipbetween you and the host or any
(00:40):
contributors.
If you have specific medicalconcerns or questions, we
encourage you consult directlywith a licensed healthcare
provider or physician in yourarea.
The views expressed in thispodcast are solely those of the
individuals and do notnecessarily represent the views
of any affiliated institutionsor organizations.
Always seek the advice of yourphysician or other qualified
(01:02):
healthcare provider with anyquestions you may have regarding
a medical condition ortreatment.
Never disregard professionalmedical advice or delay seeking
it because of something you haveheard on this podcast.
Arash Akhavan (01:22):
Hello and welcome to the Dr A Explains it All
podcast.
I'm Dr Arash Akhavan.
I'm a board-certifieddermatologist in Manhattan, new
York, owner of the Dermatologyand Laser Group.
As this is our first podcast, Ijust wanted to introduce the
concept to you.
We're basically going to bediscussing cosmetic procedures,
skin care, dermatology all withmyself and a special guest.
(01:45):
On each episode I'll be joinedby members of the practice, by
patients, by other colleaguesthat are experts, and we hope to
bring you sort of honest, nofluff, no BS input on all these
different topics.
And for this first episode I'llbe joined by Ashley Greenstein,
(02:06):
who is our office manager andone of the cosmetic coordinators
at the Dermatology and LaserGroup.
She fields a lot of thequestions from people like you,
whether online or by telephoneor email, and I think it'll be
great.
She'll bring in her perspective, patient perspective and
hopefully I can add my input andkind of round out the topics.
(02:29):
We decided to start with BotoxCosmetic as our first topic of
discussion, just because it'sthe most asked about procedure.
It's the most completedprocedure in practices like ours
and we thought that that wouldbe a great thing to kick us off
with.
And we thought that that wouldbe a great thing to kick us off
with.
We'll also discuss differentTikTok and Instagram trends, as
well as skincare tips andproduct reviews.
Ashley (02:53):
So, without further ado , let's get started.
Arash Akhavan (02:59):
So let's get down to it Botox.
What is it so?
Very simply, botox is aninjectable medication.
It's derived from botulinumtoxin.
It's a medication.
It's injected into the muscle.
It's injected into the muscleand it actually gets absorbed
into the nerve that's feedingthat muscle, and when the nerve
tries to send a signal to themuscle telling it to squeeze,
(03:21):
some of that signal gets blocked.
So the muscle can't squeeze asmuch as it's used to squeezing.
So it's basically getting themuscle not to flex as much and
that's the way it works.
So we're using it in dynamicwrinkles like the 11s over here
in this glabella area.
You're squeezing that area, butwhen you have the Botox there,
(03:42):
some of that signal to squeezeis blocked and, like any muscle,
that's not working out.
Like, let's say, every dayyou're using a 20 pound dumbbell
to do curls for your biceps andnow you go down to a five pound
dumbbell.
You're still doing the movementideally, and still here.
You want to have movement inplaces.
You're getting Botox to have anatural result, but you're not
squeezing it as much.
(04:03):
So this muscle, for that timethat the Botox is active, is not
developing and we don't wantthese muscles to develop.
These muscles are causing thesewrinkles, these furrows between
the eyebrows, the lines on theforehead, the lines by the eyes,
and we want to relax them.
So that's the way Botox worksit's a medication injected into
(04:23):
the muscle, preventing themuscles from contracting as much
.
Ashley (04:27):
As much, ideally, ideally, ideally.
All right, I guess we touchedon this a little bit, but in
terms of Botox, botox isessentially now this overarching
word that we use forneurotoxins, right?
So are there other brands ofBotox?
(04:48):
What's the deal with that?
If you're going into a doctorand you're saying I want Botox,
are you getting branded Botoxevery time, or are there some
options to choose from and youknow what kind of sets these
different products apart fromone another?
Arash Akhavan (05:01):
Yeah.
Ashley (05:18):
So there are multiple brands.
Arash Akhavan (05:19):
Yeah, so there are multiple brands.
We use Botox to kind ofjustysport there's Xeomin,
there's Jevo, um there's Daxify,there's Botox.
So there there are differentbrands and they're they all have
the same active um part of themolecule that does what I just
explained the relaxing of themuscle.
(05:44):
But they have slight littleadjustments, um, in what are
called accessory molecules,little extra pieces that are
slightly different between them.
For the most part it doesn'treally make that much of a
difference.
Most people could get Botox,xeomin, dysport, have exactly
the same response.
There are some slightdifferences, just like any
medication.
(06:04):
Like if you take a cholesterolmedication, you take cholesterol
medication A and you do okaywith it and you get switched by
your insurance company to B andit's not as good, even though
it's in the same class.
You know when you're talkingabout medications, human bodies
react differently to things.
So you'll have somebody come inand they'll say nothing else
works, just ZMN works.
And you'll have somebodythat'll say nothing, but Botox
(06:26):
works.
So there may be some truth tothat.
Maybe it was their injector didsomething different, or it was
a different injector, maybe theygot more units, maybe they got
less units, or maybe it's real.
Maybe the medication has somedifferent reaction for that
particular person.
The only one that stands out isthere's a newer one called
(06:46):
Daxify that came out where thataccessory compound and they
added a peptide where it wasdesigned to last longer and it
has FDA approval to last longerand before it came out I was a
little skeptical.
You know, is this justmarketing?
We have found that our patientcells it does last a little bit
longer, you know, probably like25% longer than Botox.
Ashley (07:09):
And we've been hearing that it kicks in a lot faster as
well.
Arash Akhavan (07:12):
Yes.
So, um, you know, typical forthis class of medications you
start to see some activity a fewdays.
Four or five days full activityby two weeks.
This is slightly faster.
So even at two days, we'vestarted to see some of the
muscles reacting to Daxify.
For our patients, that's whatthey've been telling us- it is
cool.
Ashley (07:33):
People are loving it In terms of Daxify lasting 25%
longer.
What is the typical sort oftimeframe that we can expect for
Botox to last?
Last time?
Arash Akhavan (07:46):
we get it.
I think reasonable is somewherein that three to four month
range, um.
So if you want to have the sameum level of muscle relaxation
throughout the year, most peoplehave to do it about three times
a year.
I don't think that's necessary.
I think you definitely can justdo it twice a year and let it,
(08:06):
let your muscle come back alittle bit.
You don't need to be thatobsessive about it.
With Daxify I think it's closerto around five months, maybe,
plus some people it's been sixmonths.
Um, so just a little bit longer.
Ashley (08:19):
Amazing, um, in terms of when you should get started
on this.
Um, you know you, you hearyoung people in college saying
I'm going to start getting Botoxat 19 because it's going to be
preventative and I'm never goingto get those lines.
Arash Akhavan (08:39):
What's the truth here?
And we do get patients comingin and they say my friend got it
.
They're just like 20 years old,they're on break from college
and they want to start on Botoxbecause they've heard about
preventative Botox.
I think that's excessive.
I don't think there's oneanswer.
I think the you know your lines, your face, your genetics, your
(09:03):
sun exposure, yourexpressiveness, all that should
dictate it.
Um, I think if I were to, ifyou were to force me to pick an
age where, for most patients,it's time to get started to
prevent the wrinkles from reallysetting in, it's probably
somewhere around 25, 26.
Um, but it could be more, itcould be less.
Um, the, but it could be more,it could be less.
(09:28):
Um, the.
The signs to look for are whenyou're starting to see the lines
, even a hint of the line atrest.
That's a good time to getstarted.
That's not too early.
If you're not seeing that atall, I think you're wasting time
and money.
Ashley (09:39):
I would agree.
And what about?
Like you know, we're gettingready to go out and halfway
through the night we go to thebathroom and our makeup is
creasing on our forehead, butyou don't necessarily realize
that you have lines at rest.
Is that a decent time to start?
Arash Akhavan (09:52):
Yeah, absolutely, I think that makes sense, I get
that question often.
Ashley (09:56):
Yeah, that makes sense, like I don't see the lines when
I'm not wearing makeup.
But I put makeup on and twohours and I've got creases.
So if you're thinking about it,that that might be a good time
to start.
Um, baby Botox yeah, if I hearthis term one more time, what
the hell are people referring towhen they say they only want
(10:19):
baby Botox?
And if we won't offer babyBotox, they won't even have a
conversation?
What is baby Botox?
Arash Akhavan (10:26):
Yeah, I mean, in the end it's marketing.
So you have so many doctors,non-doctors injecting and having
little injection clinics andmed spots and this and that, and
unfortunately, with all thesethings, everybody is looking for
a little marketing angle, sothey'll.
And with social media, thingssort of explode.
Unfortunately, with all thesethings, everybody's looking for
a little marketing angle, sothey'll, and and with social
(10:47):
media, things sort of explode.
So you start talking baby Botoxand you make a couple of videos
saying you should not get Botox.
It's bad.
When you're young you shouldget baby Botox.
And everybody starts talkingabout baby.
There.
There's obviously no such thingas baby Botox.
That's just random, not adifferent molecule.
Ashley (11:04):
It is not such thing as baby Botox, that's just random.
Arash Akhavan (11:06):
If you had, to define it, you'd say baby
amounts of Botox, um, which alsothere's no such thing.
So you know you, you have toput in enough Botox for it to
have an effect, otherwise you'rewasting time and money.
Um, you should ideally put inenough units so that somebody
doesn't have to come in everythree weeks to get it.
Um, you should ideally put inenough units so that somebody
(11:27):
doesn't have to come in everythree weeks to get it.
Um, you know, if I put in onelittle unit of Botox over there
and you think you are relaxingthat muscle, maybe you are, but
not for very long, maybe just acouple of weeks.
Um, so it's kind of a waste ofmoney in the end.
You don't want to be thinkingin terms of a set number of
units.
(11:47):
Everybody's face is different.
Everybody's muscles aredifferent.
You could have a 25-year-oldwith thick, thick muscles that
require a certain number ofunits, right for their baby
Botox.
And you could have a 40 yearold and they have a delicate
face with delicate littlemuscles and we actually use less
for that person, even thoughtheir lines are a little bit
(12:07):
thicker.
So it does need.
It does come down to doing atailor-made sort of approach for
each patient, making sure thatyou're going to someone who
knows what they're doing andisn't just following some sort
of formula or something theylearned in some weekend course,
telling them to inject fiveunits here, seven units there.
There is no such thing.
(12:28):
Everybody's muscles are sodifferent.
Even just the way they'reshaped the muscles are different
.
In the end, somebody who wantsbaby Botox is probably what
they're talking about is they'relooking for natural Botox and,
yes, all Botox should be naturallooking Botox.
Ashley (12:42):
Yeah, but it isn't.
So what's the differencebetween this Botox treatment
that we would do here versusthat real shiny, very frozen
forehead that doesn't seem tomove at all, which is really the
only people that people reallynotice have Botox.
So they see that shiny forehead.
(13:03):
They say that is what I don'twant, I will never get Botox.
However, the contrary stillmoving um is also true, and it's
way less detectable.
So what would be the differencebetween?
Is it the injector?
What's going on here?
Why do some people have thosecrazy shiny foreheads and other
people?
It's virtually, you know,undetectable.
Arash Akhavan (13:25):
I mean, it does come down to the injector and
what it is exactly.
It's probably a combination ofthings.
So just putting in lots ofBotox is a bad idea in general.
So overdoing it, if you'reparalyzing someone completely so
that they're frozen, um, theyare going to have that sort of
classy, thin look, um atrophied.
(13:48):
Look to the muscles, um.
The other thing is moreimportant than probably the
number of units is the placementof the Botox.
So, like I said, there's nocookie cutter approach.
I remember when I firstgraduated I was working in a
practice where there was a olderdoctor who had just started,
(14:10):
had no training in Botox, hadjust wanted to get into it, and
every time he was about to go doBotox he wasn't doing much of
it He'd do a couple here orthere.
Every time he was about to go doBotox, he wasn't doing much of
it.
He'd do a couple here or there.
Every time he was going to go,he'd come and ask me to draw on
a piece of paper how many unitsto put for the patient who was
about to go see.
I kept explaining to him likethere's no such thing.
(14:32):
You can't, I can't just tellyou without seeing the patient
examining the patient put thismany number of units.
Every single person's sodifferent, but it's the
placement.
So somebody's frontalis muscle,this muscle over here that makes
up our forehead, may gostraight up, somebody else's may
go at an angle.
And if we're doing, if we'renot taking that into account,
and we're paralyzing differentparts of that muscle that
(14:53):
shouldn't necessarily beweakened, they're going to have
a weird look.
Their eyebrows are going tomove weird their, their
expression's going to look weird, um, and not only that.
We can.
Actually the weirdest thing iswe could actually be aging them
instead of being a preventativetreatment and anti-aging
treatment.
(15:14):
With poor placement it can lookvery unnatural that that sucks,
um, but we can actually, in thelong term, be causing more harm
than good.
So we could be paralyzingmuscles.
That would be, you know, overtime leading to a more aged
appearance, um, and that'sthat's something that I mean.
(15:39):
Like I said'm an, I'm aninjection trainer for Algin.
I would say the majority ofpeople who haven't had good
formal training don't know thatthat they could actually be
harming the patients in thelongterm.
Ashley (15:51):
It's definitely good to know.
So if you need training, youshould call it.
Arash Akhavan (15:56):
There's so many amazing trainers throughout the
country.
Ashley (15:59):
And well, I have a father that flies here on a
plane every four months becausehe will not let anybody touch
his face except you.
Arash Akhavan (16:06):
Well, that's nice , but yeah, like I said, there
are there's so many greatinjectors out there.
Ashley (16:13):
Very humble of you.
Um, uh, another one interestingone that we get is you know, we
see these Botox bars and thesemed spas kind of popping up
everywhere, of concept behindthem.
Um, a lot of these places do.
However, you know, personallyat least, I have friends that go
(16:35):
to these places.
Maybe they don't want to paywhat they think is a premium to
come to somebody like you.
Uh, likely they're savingsaving $100 in the end but it
feels like they're going to getsomewhere, something that
they're going somewhere a littlebit cheaper.
However, all of my friends thatdo those also say that it lasts
(16:56):
only about a month or twomonths.
So what is the differencebetween getting injected by a
board certified dermatologistand going to somewhere like a
med spa or a Botox bar where youfeel like it's great for a
month and then it's kind of gone?
Is that the baby Botox?
What's happening?
Arash Akhavan (17:17):
No, I mean there's multiple things
happening there.
First of all, I mean I don'tthink you know you could have a
great experience at a med spa ora Botox bar.
You could have a greatexperience with a physician.
You could have a horribleexperience with a Botox bar.
You could have a horribleexperience with a physician.
Um, with most things, the moretraining the person has in that
(17:42):
procedure, the more educationthey have and everything
surrounding that procedure,chances are they're going to do
it better.
I, I'd rather.
The person flying my nextflight to Florida is a trained
pilot, ex-air Force pilot who'shad the maximum amount of
(18:05):
training.
Could somebody from flightschool land it?
Most likely, I'd rather it wasthat pilot.
Certified dermatologist.
Most modern dermatologists,plastic surgeons, have had
formal training on all theanatomy of the area that you're
(18:30):
treating.
They've had very formaleducation on the toxins.
They've had years of courses,years of experience, years of
procedures.
There was a vetting processthat occurs.
Just that's inherent to thosefields.
(18:50):
You know they were at the topof their medical school class.
They went through a veryrigorous training period and
were at the top of that and nowyou're going in and you're
seeing them for the Botox the,the average injector at a med
(19:10):
spa or Botox clinic has not hadthat.
Maybe they were trained by theowner of that med spa.
Maybe they went to a fewweekend courses here or there.
Maybe they did 20 weekendcourses.
They probably didn't, theyprobably did three.
But if they did a hundred, it'sstill nothing compared to the
(19:30):
training that somebody who'sboard certified in those fields
has gone through.
So is there a place for that?
Yes, I mean if, if, when I wasfirst graduated and I was
practicing in upstate New York,there were so few dermatologists
that by my, you know, by myfirst week out of training, I
had like a three month wait forpatients to see me because
(19:52):
there's nobody to see.
So if you're in a place likethat and you're desperate for
Botox, you know there's a placefor non-physicians to be doing
it.
Hopefully they're trained,hopefully as trained as they can
be, hopefully they have lots ofexperience, hopefully they have
a good reputation that you cancheck and that's the best you
could do.
Um, typically a med spa willcharge less if there's economic
(20:15):
um considerations.
Um, you know you have to do whatyou've got to do If you want to
get your Botox fix.
You gotta, you gotta get it.
You know you have to do whatyou've got to do If you want to
get your Botox fix.
You got to, you got to get it,you know.
So I understand it.
You know, but you know I thinkthere is something to be said
for expertise, you know I, youknow, as a physician trained in
everything, I can deliver a baby.
(20:36):
I have been part of heartsurgeries and colonoscopies.
You don't want me deliveringyour baby, you don't want me to
your ex colonoscopy.
Could I do it?
Will you probably be fine?
Yes, could you go to a med spaand get great Botox?
Yes, um, but it's not your bestchoice.
(20:56):
So you know, if you've got thealternative, you have the means
choice.
So you know, if you've got thealternative, you have the means.
Then then yes, you can't gowrong with going to a board
certified dermatologist, boardcertified plastic surgeon.
Ashley (21:08):
Obviously I'm biased yeah, me too, but I would say in
new york the real truth of itis you're really not saving much
when you're going to a men'sbarbers.
The prices, have gotten.
Arash Akhavan (21:19):
actually, over time they're more in line with
each other.
You know it's it's not like, uh, we don't charge that much more
for Botox, we didn't chargethat much more for laser hair
removal.
In some cases we're right inline with the other, with the
other people.
So you know, to each their own.
You know, I honestly don't wantto knock anybody, and there are
horrible.
(21:39):
There's dermatologists that arehorrible at Botox and horrible
at what they do.
And there's med spa people thatare amazing.
Um, I mean, I, I go out thereand train at the med spa.
I've I've seen it all.
I've seen people I'm like, ooh,you know, that's not the best.
You know, I hope my friends seethis person.
Ashley (22:00):
And then I've seen people I'm like, okay, yeah,
they're fine, yeah it makessense, um, in terms of getting
Botox and being worried thatyou're going to look so
different or women don't wanttheir husbands to know things
like that is Botox going toreally change the way that you
look?
(22:20):
Is it going to change the shapeof your face?
What's the truth there?
Arash Akhavan (22:24):
It shouldn't.
If it's done correctly itshouldn't.
That's more of a concern.
Obviously, with fillers,sometimes you're trying to
change the shape of a person'sface.
You're trying to make theirlips bigger, trying to give them
more of a cheekbone or more ofa chin.
Make their lips bigger, tryingto give them more of a cheekbone
or more of a chin, um.
So you know, with fillers itcan be a lot more obvious.
(22:46):
Plus, there's a swelling period.
Um, so we we do get that quitea bit, with people saying I
don't want my significant otherto know.
And with filler we say goodluck, yeah, um, but with Botox
you know you wait 15 minutes.
But with Botox you wait 15minutes.
The little bumps from the Botoxgo down.
(23:06):
You should be good to go.
The two sort of exceptions thatone is master Botox, which is a
lot of people get it in thismuscle over here that's involved
in chewing.
People will get it because theyclench in that area and it
causes tension, headaches, teethgrinding, tmj.
Some people do it because theywant to slim their masseter.
(23:26):
It's a big muscle.
If we weaken that muscle youare going to get a little bit of
slimming in that area.
I think that's one of thethings that, even if it's done
perfectly, it is going to causean element of not anti-aging but
pro-aging.
So it, uh, it does age you alittle bit.
By just softening that jaw linea little bit, of that, um sort
(23:51):
of the volume is holding up yourjawline and the skin in this
area.
It's one of the reasons we canget into it in a later episode.
I hate that buckle, fat removal, um, but yeah, you just do need
to realize that it is aging inthat area and does change the
shape of your face.
So it'll soften your jawline alittle bit Softens it, so the
skin isn't going to be held upby as much.
(24:12):
And there's ethnic preferencespreferences, um, so we'll have
patients that, um, maybe Koreanor Chinese, and they actually,
in their culture, typically, um,prefer a slimmed jawline.
Um, so those are the peoplethat you know.
That's an acceptable trade off.
(24:33):
The fact that maybe it is alittle aging in the skin in the
jowl area, um, they'd like thatsort of slimmed jawline.
Ashley (24:41):
Look, yeah speaking of the jowls here, botox just got
fda approved for the neck.
That's not to say that peoplewere not treating the neck for
many years prior, but it is nowofficially fda cleared.
We're big rule followers, sowe're happy about this.
What does?
Does it mean?
What kind of patients are goingto get Botox injected into
(25:05):
their neck?
Arash Akhavan (25:07):
I mean, we've been doing it for the last
decade.
So the primary reason is thereare these vertical bands they're
called platysmal bands, anddoing injections along the
platysmal band so it's basicallyyou'll see people where the
skin kind of sticks out overhere, and injecting that relaxes
this muscle, that's like asheet across the neck and it
(25:27):
just kind of has it settled downso you don't see those bands
and just doing it along thejawline also can define the
jawline a little bit and giveyou a little upturn in that area
.
Good side benefit but yeah,with Botox we've been using it
off label for years.
Even what I just mentioned,that uh, tmj, not not FDA
(25:48):
approved, but something wecommonly do.
Um, I think if, if you're doingit when you've been
well-trained on it, youunderstand the risks and
consequences of all of that,that a lot of that stuff we can
use off-label safely.
Nice, all right.
Yeah, that is actually hot offthe presses.
Ashley (26:07):
I mean, I think it's like a week or a week ago.
It's just hitting TikTok.
Oh, okay, there you go, so Isee it everywhere.
Okay, I feel like we, you knowwe pretty much got to the basis,
basics of Botox.
Arash Akhavan (26:27):
Yeah, there's so much to discuss with both.
I mean, we could literally talkabout it for hours and I'm sure
we'll do other episodes.
I do.
Ashley (26:34):
I have so many questions, lip flips, these
people who are taping their faceat night instead of getting
Botox, isn't working.
He's Botox in a bottle, likewe'll get to all of that at some
point.
But pivoting here a little bit,I want to talk about something
else that I'm seeing on socialmedia.
Can you tell I'm addicted toTikTok, the salmon sperm facial.
(26:57):
Yeah, what's going on?
Arash Akhavan (27:00):
Yeah, we've been getting lots of again just
social media.
Like you said, we do get lotsof patients asking about that, I
think over the last month.
You know that I don't reallyhave mixed feelings with.
I'd say if this were a take itor leave it question, I'd say
leave it.
This, you know, it's a, it's a,it's, that's all it is.
(27:25):
It's really just a social mediatrend.
So there's claims that thesalmon sperm has nucleotides
like little RNA and DNAfragments, that when they're
injected, all sorts of things,great things happen.
You know, you, you generatescollagen and tightens pores.
There's no such thing astightening board tightens pores
(27:48):
and all these things.
You know.
There I have a couple of issueswith it.
Primarily, who got the salmonsperm?
You know, know, where's itcoming from.
There's no FDA clearance for it.
There's no U S companies, youknow, unless you're, you know,
collecting that sperm yourself,which you know I, I, you know,
(28:09):
you don't know what the sourceis.
It's not something that'sregulated, so that's, and it's
being injected into the, the,into your skin, not only your
skin, your face skin like.
No, thanks, I would rather not.
The other thing is you knowwhat are all the other
ingredients that they've mixedin with that salmon sperm.
(28:31):
You know, I saw like one of theleading brands.
One of its main ingredients ishyaluronic acid and then
patients are saying it'shydrating, giving them a glow
and plumping them up.
Are you just doing some sort ofweird hyaluronic acid,
unregulated not to be injectedinto the face and now you're
injecting into your face Justjust?
If you want to do that, justget a little filler, get a
(28:54):
little skin beaver, somethinglike that.
You know, something that's FDAcleared for that purpose and is
sterile and clean and made forthat purpose.
There's a lot of trends andhopefully we'll discuss them in
coming episodes that areharmless, you know, and if it's
fun, do it and no big deal.
(29:15):
Then there's some that arepotentially not safe.
This would be one that I wouldsay don't even do it and no big
deal.
Then there's some that arepotentially not safe.
This would this would be onethat I would say don't even do
it for fun.
There are better things thatcan generate collagen.
There are better things thatcan hydrate you.
There's better things forrejuvenation that are also FDA
cleared and made in our countryand safe.
Um, leave it, leave it.
(29:43):
Leave it.
It's a leave it.
So that is, our social mediasort of discussion of the day.
Ashley (29:45):
I think those things are good to discuss.
Yeah, for sure.
I mean a lot of stuff that youyou'll hear on tech talk is just
positives about it.
Nobody's really getting downinto the nitty gritty of what
this stuff is.
Arash Akhavan (29:55):
Yeah, I mean, I've been seeing now this
interesting thing wheresomething will come up in Tik,
tok, everybody's positive on it.
Then I'm like, just wait.
And then, like six months later, everybody's negative.
It ruined my face, it melted myfat.
Oh, I don't want to discuss thespecifics of what devices I'm
(30:15):
talking about, but there wasthis device that was all the
rage because the Kardashians didthis, that and everybody was
doing it, and my patients wouldask and I'd be like Nope, and
maybe we'll get into anotherepisode, but I don't know, I
don't know about the legality ofit, let's hold on, we'll get
into it, we just maybe won't.
Ashley (30:32):
Won't say the name.
Arash Akhavan (30:40):
But and then they ?
You know, now everybody'stalking all the posts about this
thing all.
Whenever you see this hashtagor mention of this one device,
it's always melted my face,melted my fat.
Ashley (30:46):
I was like see, ya, see , I told you yeah yeah,
especially for younger patientswho really you want to keep that
healthy facial fat as we age,and introducing something like
that to kill it, it's not great,um.
Next topic would be our at-homehero product of the week.
(31:07):
This is a new one, um.
It was just dropped off to us afew weeks ago and I've been
using it ever since.
It is the CeraVe oil controlmoisturizing face gel.
Arash Akhavan (31:24):
Yes, you, you were kind enough to drop one off
for me.
I used it for a couple of weeksand what do you think?
You can go first.
Ashley (31:33):
Obsessed.
Yeah, for someone who, at theend of the day, is just like
feeling so oily.
We're running around a lot here, you know we're, we're touching
our face, we're explainingthings to people, um, and by the
end of the day, every day, I amso oily.
There's just no if and or butsaround it.
Um, um, with this moisturizer,I kid you, not no oil, like I
(32:00):
and, but I'm not dry, not drywhatsoever.
I'm moisturized, I'm smooth, Ifeel hydrated, but I'm not shiny
and I'm not slick to theforehead and it's amazing and
when I say I've now startedusing this as my makeup prep,
this is now my skin prep.
Your makeup doesn't get thatshiny, crazy hue after wearing
(32:22):
it for a few hours.
It actually stays on so nicely.
It's got like a little bit of agrip and I'm pretty much
obsessed with it.
I know it just came out.
I'm not sure if it's on shelvesyet, but it should be
relatively soon.
If it isn't yet, I didn'trealize it was that new.
Arash Akhavan (32:45):
I think it is brand new and it's amazing.
So I just full disclosure.
I mean, we want to be honestabout everything we talk about.
I.
I like it, not obsessed.
Um, I thought it was okay.
The you know.
It just kind of shows differentthings work for different
people and different skin types.
Uh, I think I'm probably justtoo oily.
I'm like an oil slick and Ifound it helped for an hour or
two and then I just want to washit off because it was my oil,
(33:06):
was mixing with the moisturizer.
So you know it's everybody'salways looking for that miracle
oil control.
I haven't found it yet there's.
I'm so bad.
There's a La Roche-Posayay likematt.
I don't know the name, um, butsomething matt.
Somebody dropped off for methat I do use um.
I'll get the name for that andmaybe we'll discuss it on
(33:27):
another episode.
But as far as the surveyproduct you mentioned, it was
good, it was, uh, it was a.
It was fine it was.
It was a moisturizer.
I could definitely see myselfusing.
Um did not give me the amountof oil control.
You'd kind of really hyped itup.
I was so excited to use itsorry, I'm gonna do better next
time.
Ashley (33:47):
No, no, this is good.
This is good we should.
We should love this product yeah, but yeah, definitely just goes
to show like what works foryour best friend is not going to
work for you.
This is a huge thing on allsocial media is you know the
perfect skincare routine andinfluencers saying you need to
use these three products andyour skin is going to be amazing
.
And guess what?
For 90% of other people, thatjust doesn't happen.
(34:09):
And so it really is.
It's so subjective and it socomes down to your skin and what
your skin likes.
My skin likes CeraVe oilcontrol.
Okay, there you go, but maybeyours won't.
You should try it.
Leave it at that.
Yeah, yeah, um, and I feel likethat's it.
Yeah, it's sort of everythingthat we wanted to talk about
today.
Yeah, um, oh.
(34:30):
I do have one last thing.
Yeah, barbie Botox.
Just to kind of bring it backreal quick, because that was
huge Barbie movie came out and,I kid you, not beginning the
next day, we had 30 reach outs aday to our office wanting to
come in for Barbie Botox.
So can you just quickly explainwhat it is?
Arash Akhavan (34:50):
Yeah, I mean that was just sort of like clever
rebranding of something we'dbeen doing for a while trapezius
Botox.
So there are these muscles overhere on top of your shoulder
towards the back, and they canget overdeveloped in some people
, especially people with, like,desk jobs and things like that,
because we're holding that areaunder tension.
Some people overuse them intheir gym, like misuse them
(35:13):
almost, and it can be a sourceof neck tension for a lot of
people.
And that's a reason why peoplerelax the muscle for the with
the trap Botox.
But the, the Barbie Botox angleof it is, if you can get this
muscle to shrink down a littlebit, it creates more of an angle
(35:34):
between your neck and yourshoulder, so it gives you the
illusion of elongating your neck.
It makes sense, it works, it'seffective both cosmetically and
for symptom relief, and a lot ofpeople love both of those
benefits.
It's just another use.
It requires more units than weuse in the facial muscles.
(35:54):
These are much bigger musclesbut it works and people like it.
Ashley (36:00):
Love it.
Yeah, it's been huge.
I think that's good, right Ithink that's it.
Arash Akhavan (36:05):
So the one thing I wanted to kind of reach out
and ask is if you have anyquestions or anything.
Our email address and ways tocontact us will be listed at the
end of the podcast.
Please reach out with thingsyou'd like us to discuss and
we'll definitely incorporatethose into future episodes as
well.
Absolutely.
Ashley (36:26):
Looking forward to next week.
Arash Akhavan (36:28):
Sounds good.
Ashley (36:29):
I'll get a better product Okay.
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(00:40):
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Always seek the advice of yourphysician or other qualified
(01:02):
healthcare provider with anyquestions you may have regarding
a medical condition ortreatment.
Never disregard professionalmedical advice or delay seeking
it because of something you haveheard on this podcast.
Arash Akhavan (01:22):
Hello and welcome to the Dr A Explains it All
podcast.
I'm Dr Arash Akhavan.
I'm a board-certifieddermatologist in Manhattan, new
York, owner of the Dermatologyand Laser Group.
As this is our first podcast, Ijust wanted to introduce the
concept to you.
We're basically going to bediscussing cosmetic procedures,
skin care, dermatology all withmyself and a special guest.
(01:45):
On each episode I'll be joinedby members of the practice, by
patients, by other colleaguesthat are experts, and we hope to
bring you sort of honest, nofluff, no BS input on all these
different topics.
And for this first episode I'llbe joined by Ashley Greenstein,
(02:06):
who is our office manager andone of the cosmetic coordinators
at the Dermatology and LaserGroup.
She fields a lot of thequestions from people like you,
whether online or by telephoneor email, and I think it'll be
great.
She'll bring in her perspective, patient perspective and
hopefully I can add my input andkind of round out the topics.
(02:29):
We decided to start with BotoxCosmetic as our first topic of
discussion, just because it'sthe most asked about procedure.
It's the most completedprocedure in practices like ours
and we thought that that wouldbe a great thing to kick us off
with.
And we thought that that wouldbe a great thing to kick us off
with.
We'll also discuss differentTikTok and Instagram trends, as
well as skincare tips andproduct reviews.
Ashley (02:53):
So, without further ado , let's get started.
Arash Akhavan (02:59):
So let's get down to it Botox.
What is it so?
Very simply, botox is aninjectable medication.
It's derived from botulinumtoxin.
It's a medication.
It's injected into the muscle.
It's injected into the muscleand it actually gets absorbed
into the nerve that's feedingthat muscle, and when the nerve
tries to send a signal to themuscle telling it to squeeze,
(03:21):
some of that signal gets blocked.
So the muscle can't squeeze asmuch as it's used to squeezing.
So it's basically getting themuscle not to flex as much and
that's the way it works.
So we're using it in dynamicwrinkles like the 11s over here
in this glabella area.
You're squeezing that area, butwhen you have the Botox there,
(03:42):
some of that signal to squeezeis blocked and, like any muscle,
that's not working out.
Like, let's say, every dayyou're using a 20 pound dumbbell
to do curls for your biceps andnow you go down to a five pound
dumbbell.
You're still doing the movementideally, and still here.
You want to have movement inplaces.
You're getting Botox to have anatural result, but you're not
squeezing it as much.
(04:03):
So this muscle, for that timethat the Botox is active, is not
developing and we don't wantthese muscles to develop.
These muscles are causing thesewrinkles, these furrows between
the eyebrows, the lines on theforehead, the lines by the eyes,
and we want to relax them.
So that's the way Botox worksit's a medication injected into
(04:23):
the muscle, preventing themuscles from contracting as much
.
Ashley (04:27):
As much, ideally, ideally, ideally.
All right, I guess we touchedon this a little bit, but in
terms of Botox, botox isessentially now this overarching
word that we use forneurotoxins, right?
So are there other brands ofBotox?
(04:48):
What's the deal with that?
If you're going into a doctorand you're saying I want Botox,
are you getting branded Botoxevery time, or are there some
options to choose from and youknow what kind of sets these
different products apart fromone another?
Arash Akhavan (05:01):
Yeah.
Ashley (05:18):
So there are multiple brands.
Arash Akhavan (05:19):
Yeah, so there are multiple brands.
We use Botox to kind ofjustysport there's Xeomin,
there's Jevo, um there's Daxify,there's Botox.
So there there are differentbrands and they're they all have
the same active um part of themolecule that does what I just
explained the relaxing of themuscle.
(05:44):
But they have slight littleadjustments, um, in what are
called accessory molecules,little extra pieces that are
slightly different between them.
For the most part it doesn'treally make that much of a
difference.
Most people could get Botox,xeomin, dysport, have exactly
the same response.
There are some slightdifferences, just like any
medication.
(06:04):
Like if you take a cholesterolmedication, you take cholesterol
medication A and you do okaywith it and you get switched by
your insurance company to B andit's not as good, even though
it's in the same class.
You know when you're talkingabout medications, human bodies
react differently to things.
So you'll have somebody come inand they'll say nothing else
works, just ZMN works.
And you'll have somebodythat'll say nothing, but Botox
(06:26):
works.
So there may be some truth tothat.
Maybe it was their injector didsomething different, or it was
a different injector, maybe theygot more units, maybe they got
less units, or maybe it's real.
Maybe the medication has somedifferent reaction for that
particular person.
The only one that stands out isthere's a newer one called
(06:46):
Daxify that came out where thataccessory compound and they
added a peptide where it wasdesigned to last longer and it
has FDA approval to last longerand before it came out I was a
little skeptical.
You know, is this justmarketing?
We have found that our patientcells it does last a little bit
longer, you know, probably like25% longer than Botox.
Ashley (07:09):
And we've been hearing that it kicks in a lot faster as
well.
Arash Akhavan (07:12):
Yes.
So, um, you know, typical forthis class of medications you
start to see some activity a fewdays.
Four or five days full activityby two weeks.
This is slightly faster.
So even at two days, we'vestarted to see some of the
muscles reacting to Daxify.
For our patients, that's whatthey've been telling us- it is
cool.
Ashley (07:33):
People are loving it In terms of Daxify lasting 25%
longer.
What is the typical sort oftimeframe that we can expect for
Botox to last?
Last time?
Arash Akhavan (07:46):
we get it.
I think reasonable is somewherein that three to four month
range, um.
So if you want to have the sameum level of muscle relaxation
throughout the year, most peoplehave to do it about three times
a year.
I don't think that's necessary.
I think you definitely can justdo it twice a year and let it,
(08:06):
let your muscle come back alittle bit.
You don't need to be thatobsessive about it.
With Daxify I think it's closerto around five months, maybe,
plus some people it's been sixmonths.
Um, so just a little bit longer.
Ashley (08:19):
Amazing, um, in terms of when you should get started
on this.
Um, you know you, you hearyoung people in college saying
I'm going to start getting Botoxat 19 because it's going to be
preventative and I'm never goingto get those lines.
Arash Akhavan (08:39):
What's the truth here?
And we do get patients comingin and they say my friend got it
.
They're just like 20 years old,they're on break from college
and they want to start on Botoxbecause they've heard about
preventative Botox.
I think that's excessive.
I don't think there's oneanswer.
I think the you know your lines, your face, your genetics, your
(09:03):
sun exposure, yourexpressiveness, all that should
dictate it.
Um, I think if I were to, ifyou were to force me to pick an
age where, for most patients,it's time to get started to
prevent the wrinkles from reallysetting in, it's probably
somewhere around 25, 26.
Um, but it could be more, itcould be less.
Um, the, but it could be more,it could be less.
(09:28):
Um, the.
The signs to look for are whenyou're starting to see the lines
, even a hint of the line atrest.
That's a good time to getstarted.
That's not too early.
If you're not seeing that atall, I think you're wasting time
and money.
Ashley (09:39):
I would agree.
And what about?
Like you know, we're gettingready to go out and halfway
through the night we go to thebathroom and our makeup is
creasing on our forehead, butyou don't necessarily realize
that you have lines at rest.
Is that a decent time to start?
Arash Akhavan (09:52):
Yeah, absolutely, I think that makes sense, I get
that question often.
Ashley (09:56):
Yeah, that makes sense, like I don't see the lines when
I'm not wearing makeup.
But I put makeup on and twohours and I've got creases.
So if you're thinking about it,that that might be a good time
to start.
Um, baby Botox yeah, if I hearthis term one more time, what
the hell are people referring towhen they say they only want
(10:19):
baby Botox?
And if we won't offer babyBotox, they won't even have a
conversation?
What is baby Botox?
Arash Akhavan (10:26):
Yeah, I mean, in the end it's marketing.
So you have so many doctors,non-doctors injecting and having
little injection clinics andmed spots and this and that, and
unfortunately, with all thesethings, everybody is looking for
a little marketing angle, sothey'll.
And with social media, thingssort of explode.
Unfortunately, with all thesethings, everybody's looking for
a little marketing angle, sothey'll, and and with social
(10:47):
media, things sort of explode.
So you start talking baby Botoxand you make a couple of videos
saying you should not get Botox.
It's bad.
When you're young you shouldget baby Botox.
And everybody starts talkingabout baby.
There.
There's obviously no such thingas baby Botox.
That's just random, not adifferent molecule.
Ashley (11:04):
It is not such thing as baby Botox, that's just random.
Arash Akhavan (11:06):
If you had, to define it, you'd say baby
amounts of Botox, um, which alsothere's no such thing.
So you know you, you have toput in enough Botox for it to
have an effect, otherwise you'rewasting time and money.
Um, you should ideally put inenough units so that somebody
doesn't have to come in everythree weeks to get it.
Um, you should ideally put inenough units so that somebody
(11:27):
doesn't have to come in everythree weeks to get it.
Um, you know, if I put in onelittle unit of Botox over there
and you think you are relaxingthat muscle, maybe you are, but
not for very long, maybe just acouple of weeks.
Um, so it's kind of a waste ofmoney in the end.
You don't want to be thinkingin terms of a set number of
units.
(11:47):
Everybody's face is different.
Everybody's muscles aredifferent.
You could have a 25-year-oldwith thick, thick muscles that
require a certain number ofunits, right for their baby
Botox.
And you could have a 40 yearold and they have a delicate
face with delicate littlemuscles and we actually use less
for that person, even thoughtheir lines are a little bit
(12:07):
thicker.
So it does need.
It does come down to doing atailor-made sort of approach for
each patient, making sure thatyou're going to someone who
knows what they're doing andisn't just following some sort
of formula or something theylearned in some weekend course,
telling them to inject fiveunits here, seven units there.
There is no such thing.
(12:28):
Everybody's muscles are sodifferent.
Even just the way they'reshaped the muscles are different
.
In the end, somebody who wantsbaby Botox is probably what
they're talking about is they'relooking for natural Botox and,
yes, all Botox should be naturallooking Botox.
Ashley (12:42):
Yeah, but it isn't.
So what's the differencebetween this Botox treatment
that we would do here versusthat real shiny, very frozen
forehead that doesn't seem tomove at all, which is really the
only people that people reallynotice have Botox.
So they see that shiny forehead.
(13:03):
They say that is what I don'twant, I will never get Botox.
However, the contrary stillmoving um is also true, and it's
way less detectable.
So what would be the differencebetween?
Is it the injector?
What's going on here?
Why do some people have thosecrazy shiny foreheads and other
people?
It's virtually, you know,undetectable.
Arash Akhavan (13:25):
I mean, it does come down to the injector and
what it is exactly.
It's probably a combination ofthings.
So just putting in lots ofBotox is a bad idea in general.
So overdoing it, if you'reparalyzing someone completely so
that they're frozen, um, theyare going to have that sort of
classy, thin look, um atrophied.
(13:48):
Look to the muscles, um.
The other thing is moreimportant than probably the
number of units is the placementof the Botox.
So, like I said, there's nocookie cutter approach.
I remember when I firstgraduated I was working in a
practice where there was a olderdoctor who had just started,
(14:10):
had no training in Botox, hadjust wanted to get into it, and
every time he was about to go doBotox he wasn't doing much of
it He'd do a couple here orthere.
Every time he was about to go doBotox, he wasn't doing much of
it.
He'd do a couple here or there.
Every time he was going to go,he'd come and ask me to draw on
a piece of paper how many unitsto put for the patient who was
about to go see.
I kept explaining to him likethere's no such thing.
(14:32):
You can't, I can't just tellyou without seeing the patient
examining the patient put thismany number of units.
Every single person's sodifferent, but it's the
placement.
So somebody's frontalis muscle,this muscle over here that makes
up our forehead, may gostraight up, somebody else's may
go at an angle.
And if we're doing, if we'renot taking that into account,
and we're paralyzing differentparts of that muscle that
(14:53):
shouldn't necessarily beweakened, they're going to have
a weird look.
Their eyebrows are going tomove weird their, their
expression's going to look weird, um, and not only that.
We can.
Actually the weirdest thing iswe could actually be aging them
instead of being a preventativetreatment and anti-aging
treatment.
(15:14):
With poor placement it can lookvery unnatural that that sucks,
um, but we can actually, in thelong term, be causing more harm
than good.
So we could be paralyzingmuscles.
That would be, you know, overtime leading to a more aged
appearance, um, and that'sthat's something that I mean.
(15:39):
Like I said'm an, I'm aninjection trainer for Algin.
I would say the majority ofpeople who haven't had good
formal training don't know thatthat they could actually be
harming the patients in thelongterm.
Ashley (15:51):
It's definitely good to know.
So if you need training, youshould call it.
Arash Akhavan (15:56):
There's so many amazing trainers throughout the
country.
Ashley (15:59):
And well, I have a father that flies here on a
plane every four months becausehe will not let anybody touch
his face except you.
Arash Akhavan (16:06):
Well, that's nice , but yeah, like I said, there
are there's so many greatinjectors out there.
Ashley (16:13):
Very humble of you.
Um, uh, another one interestingone that we get is you know, we
see these Botox bars and thesemed spas kind of popping up
everywhere, of concept behindthem.
Um, a lot of these places do.
However, you know, personallyat least, I have friends that go
(16:35):
to these places.
Maybe they don't want to paywhat they think is a premium to
come to somebody like you.
Uh, likely they're savingsaving $100 in the end but it
feels like they're going to getsomewhere, something that
they're going somewhere a littlebit cheaper.
However, all of my friends thatdo those also say that it lasts
(16:56):
only about a month or twomonths.
So what is the differencebetween getting injected by a
board certified dermatologistand going to somewhere like a
med spa or a Botox bar where youfeel like it's great for a
month and then it's kind of gone?
Is that the baby Botox?
What's happening?
Arash Akhavan (17:17):
No, I mean there's multiple things
happening there.
First of all, I mean I don'tthink you know you could have a
great experience at a med spa ora Botox bar.
You could have a greatexperience with a physician.
You could have a horribleexperience with a Botox bar.
You could have a horribleexperience with a physician.
Um, with most things, the moretraining the person has in that
(17:42):
procedure, the more educationthey have and everything
surrounding that procedure,chances are they're going to do
it better.
I, I'd rather.
The person flying my nextflight to Florida is a trained
pilot, ex-air Force pilot who'shad the maximum amount of
(18:05):
training.
Could somebody from flightschool land it?
Most likely, I'd rather it wasthat pilot.
Certified dermatologist.
Most modern dermatologists,plastic surgeons, have had
formal training on all theanatomy of the area that you're
(18:30):
treating.
They've had very formaleducation on the toxins.
They've had years of courses,years of experience, years of
procedures.
There was a vetting processthat occurs.
Just that's inherent to thosefields.
(18:50):
You know they were at the topof their medical school class.
They went through a veryrigorous training period and
were at the top of that and nowyou're going in and you're
seeing them for the Botox the,the average injector at a med
(19:10):
spa or Botox clinic has not hadthat.
Maybe they were trained by theowner of that med spa.
Maybe they went to a fewweekend courses here or there.
Maybe they did 20 weekendcourses.
They probably didn't, theyprobably did three.
But if they did a hundred, it'sstill nothing compared to the
(19:30):
training that somebody who'sboard certified in those fields
has gone through.
So is there a place for that?
Yes, I mean if, if, when I wasfirst graduated and I was
practicing in upstate New York,there were so few dermatologists
that by my, you know, by myfirst week out of training, I
had like a three month wait forpatients to see me because
(19:52):
there's nobody to see.
So if you're in a place likethat and you're desperate for
Botox, you know there's a placefor non-physicians to be doing
it.
Hopefully they're trained,hopefully as trained as they can
be, hopefully they have lots ofexperience, hopefully they have
a good reputation that you cancheck and that's the best you
could do.
Um, typically a med spa willcharge less if there's economic
(20:15):
um considerations.
Um, you know you have to do whatyou've got to do If you want to
get your Botox fix.
You gotta, you gotta get it.
You know you have to do whatyou've got to do If you want to
get your Botox fix.
You got to, you got to get it,you know.
So I understand it.
You know, but you know I thinkthere is something to be said
for expertise, you know I, youknow, as a physician trained in
everything, I can deliver a baby.
(20:36):
I have been part of heartsurgeries and colonoscopies.
You don't want me deliveringyour baby, you don't want me to
your ex colonoscopy.
Could I do it?
Will you probably be fine?
Yes, could you go to a med spaand get great Botox?
Yes, um, but it's not your bestchoice.
(20:56):
So you know, if you've got thealternative, you have the means
choice.
So you know, if you've got thealternative, you have the means.
Then then yes, you can't gowrong with going to a board
certified dermatologist, boardcertified plastic surgeon.
Ashley (21:08):
Obviously I'm biased yeah, me too, but I would say in
new york the real truth of itis you're really not saving much
when you're going to a men'sbarbers.
The prices, have gotten.
Arash Akhavan (21:19):
actually, over time they're more in line with
each other.
You know it's it's not like, uh, we don't charge that much more
for Botox, we didn't chargethat much more for laser hair
removal.
In some cases we're right inline with the other, with the
other people.
So you know, to each their own.
You know, I honestly don't wantto knock anybody, and there are
horrible.
(21:39):
There's dermatologists that arehorrible at Botox and horrible
at what they do.
And there's med spa people thatare amazing.
Um, I mean, I, I go out thereand train at the med spa.
I've I've seen it all.
I've seen people I'm like, ooh,you know, that's not the best.
You know, I hope my friends seethis person.
Ashley (22:00):
And then I've seen people I'm like, okay, yeah,
they're fine, yeah it makessense, um, in terms of getting
Botox and being worried thatyou're going to look so
different or women don't wanttheir husbands to know things
like that is Botox going toreally change the way that you
look?
(22:20):
Is it going to change the shapeof your face?
What's the truth there?
Arash Akhavan (22:24):
It shouldn't.
If it's done correctly itshouldn't.
That's more of a concern.
Obviously, with fillers,sometimes you're trying to
change the shape of a person'sface.
You're trying to make theirlips bigger, trying to give them
more of a cheekbone or more ofa chin.
Make their lips bigger, tryingto give them more of a cheekbone
or more of a chin, um.
So you know, with fillers itcan be a lot more obvious.
(22:46):
Plus, there's a swelling period.
Um, so we we do get that quitea bit, with people saying I
don't want my significant otherto know.
And with filler we say goodluck, yeah, um, but with Botox
you know you wait 15 minutes.
But with Botox you wait 15minutes.
The little bumps from the Botoxgo down.
(23:06):
You should be good to go.
The two sort of exceptions thatone is master Botox, which is a
lot of people get it in thismuscle over here that's involved
in chewing.
People will get it because theyclench in that area and it
causes tension, headaches, teethgrinding, tmj.
Some people do it because theywant to slim their masseter.
(23:26):
It's a big muscle.
If we weaken that muscle youare going to get a little bit of
slimming in that area.
I think that's one of thethings that, even if it's done
perfectly, it is going to causean element of not anti-aging but
pro-aging.
So it, uh, it does age you alittle bit.
By just softening that jaw linea little bit, of that, um sort
(23:51):
of the volume is holding up yourjawline and the skin in this
area.
It's one of the reasons we canget into it in a later episode.
I hate that buckle, fat removal, um, but yeah, you just do need
to realize that it is aging inthat area and does change the
shape of your face.
So it'll soften your jawline alittle bit Softens it, so the
skin isn't going to be held upby as much.
(24:12):
And there's ethnic preferencespreferences, um, so we'll have
patients that, um, maybe Koreanor Chinese, and they actually,
in their culture, typically, um,prefer a slimmed jawline.
Um, so those are the peoplethat you know.
That's an acceptable trade off.
(24:33):
The fact that maybe it is alittle aging in the skin in the
jowl area, um, they'd like thatsort of slimmed jawline.
Ashley (24:41):
Look, yeah speaking of the jowls here, botox just got
fda approved for the neck.
That's not to say that peoplewere not treating the neck for
many years prior, but it is nowofficially fda cleared.
We're big rule followers, sowe're happy about this.
What does?
Does it mean?
What kind of patients are goingto get Botox injected into
(25:05):
their neck?
Arash Akhavan (25:07):
I mean, we've been doing it for the last
decade.
So the primary reason is thereare these vertical bands they're
called platysmal bands, anddoing injections along the
platysmal band so it's basicallyyou'll see people where the
skin kind of sticks out overhere, and injecting that relaxes
this muscle, that's like asheet across the neck and it
(25:27):
just kind of has it settled downso you don't see those bands
and just doing it along thejawline also can define the
jawline a little bit and giveyou a little upturn in that area
.
Good side benefit but yeah,with Botox we've been using it
off label for years.
Even what I just mentioned,that uh, tmj, not not FDA
(25:48):
approved, but something wecommonly do.
Um, I think if, if you're doingit when you've been
well-trained on it, youunderstand the risks and
consequences of all of that,that a lot of that stuff we can
use off-label safely.
Nice, all right.
Yeah, that is actually hot offthe presses.
Ashley (26:07):
I mean, I think it's like a week or a week ago.
It's just hitting TikTok.
Oh, okay, there you go, so Isee it everywhere.
Okay, I feel like we, you knowwe pretty much got to the basis,
basics of Botox.
Arash Akhavan (26:27):
Yeah, there's so much to discuss with both.
I mean, we could literally talkabout it for hours and I'm sure
we'll do other episodes.
I do.
Ashley (26:34):
I have so many questions, lip flips, these
people who are taping their faceat night instead of getting
Botox, isn't working.
He's Botox in a bottle, likewe'll get to all of that at some
point.
But pivoting here a little bit,I want to talk about something
else that I'm seeing on socialmedia.
Can you tell I'm addicted toTikTok, the salmon sperm facial.
(26:57):
Yeah, what's going on?
Arash Akhavan (27:00):
Yeah, we've been getting lots of again just
social media.
Like you said, we do get lotsof patients asking about that, I
think over the last month.
You know that I don't reallyhave mixed feelings with.
I'd say if this were a take itor leave it question, I'd say
leave it.
This, you know, it's a, it's a,it's, that's all it is.
(27:25):
It's really just a social mediatrend.
So there's claims that thesalmon sperm has nucleotides
like little RNA and DNAfragments, that when they're
injected, all sorts of things,great things happen.
You know, you, you generatescollagen and tightens pores.
There's no such thing astightening board tightens pores
(27:48):
and all these things.
You know.
There I have a couple of issueswith it.
Primarily, who got the salmonsperm?
You know, know, where's itcoming from.
There's no FDA clearance for it.
There's no U S companies, youknow, unless you're, you know,
collecting that sperm yourself,which you know I, I, you know,
(28:09):
you don't know what the sourceis.
It's not something that'sregulated, so that's, and it's
being injected into the, the,into your skin, not only your
skin, your face skin like.
No, thanks, I would rather not.
The other thing is you knowwhat are all the other
ingredients that they've mixedin with that salmon sperm.
(28:31):
You know, I saw like one of theleading brands.
One of its main ingredients ishyaluronic acid and then
patients are saying it'shydrating, giving them a glow
and plumping them up.
Are you just doing some sort ofweird hyaluronic acid,
unregulated not to be injectedinto the face and now you're
injecting into your face Justjust?
If you want to do that, justget a little filler, get a
(28:54):
little skin beaver, somethinglike that.
You know, something that's FDAcleared for that purpose and is
sterile and clean and made forthat purpose.
There's a lot of trends andhopefully we'll discuss them in
coming episodes that areharmless, you know, and if it's
fun, do it and no big deal.
(29:15):
Then there's some that arepotentially not safe.
This would be one that I wouldsay don't even do it and no big
deal.
Then there's some that arepotentially not safe.
This would this would be onethat I would say don't even do
it for fun.
There are better things thatcan generate collagen.
There are better things thatcan hydrate you.
There's better things forrejuvenation that are also FDA
cleared and made in our countryand safe.
Um, leave it, leave it.
(29:43):
Leave it.
It's a leave it.
So that is, our social mediasort of discussion of the day.
Ashley (29:45):
I think those things are good to discuss.
Yeah, for sure.
I mean a lot of stuff that youyou'll hear on tech talk is just
positives about it.
Nobody's really getting downinto the nitty gritty of what
this stuff is.
Arash Akhavan (29:55):
Yeah, I mean, I've been seeing now this
interesting thing wheresomething will come up in Tik,
tok, everybody's positive on it.
Then I'm like, just wait.
And then, like six months later, everybody's negative.
It ruined my face, it melted myfat.
Oh, I don't want to discuss thespecifics of what devices I'm
(30:15):
talking about, but there wasthis device that was all the
rage because the Kardashians didthis, that and everybody was
doing it, and my patients wouldask and I'd be like Nope, and
maybe we'll get into anotherepisode, but I don't know, I
don't know about the legality ofit, let's hold on, we'll get
into it, we just maybe won't.
Ashley (30:32):
Won't say the name.
Arash Akhavan (30:40):
But and then they ?
You know, now everybody'stalking all the posts about this
thing all.
Whenever you see this hashtagor mention of this one device,
it's always melted my face,melted my fat.
Ashley (30:46):
I was like see, ya, see , I told you yeah yeah,
especially for younger patientswho really you want to keep that
healthy facial fat as we age,and introducing something like
that to kill it, it's not great,um.
Next topic would be our at-homehero product of the week.
(31:07):
This is a new one, um.
It was just dropped off to us afew weeks ago and I've been
using it ever since.
It is the CeraVe oil controlmoisturizing face gel.
Arash Akhavan (31:24):
Yes, you, you were kind enough to drop one off
for me.
I used it for a couple of weeksand what do you think?
You can go first.
Ashley (31:33):
Obsessed.
Yeah, for someone who, at theend of the day, is just like
feeling so oily.
We're running around a lot here, you know we're, we're touching
our face, we're explainingthings to people, um, and by the
end of the day, every day, I amso oily.
There's just no if and or butsaround it.
Um, um, with this moisturizer,I kid you, not no oil, like I
(32:00):
and, but I'm not dry, not drywhatsoever.
I'm moisturized, I'm smooth, Ifeel hydrated, but I'm not shiny
and I'm not slick to theforehead and it's amazing and
when I say I've now startedusing this as my makeup prep,
this is now my skin prep.
Your makeup doesn't get thatshiny, crazy hue after wearing
(32:22):
it for a few hours.
It actually stays on so nicely.
It's got like a little bit of agrip and I'm pretty much
obsessed with it.
I know it just came out.
I'm not sure if it's on shelvesyet, but it should be
relatively soon.
If it isn't yet, I didn'trealize it was that new.
Arash Akhavan (32:45):
I think it is brand new and it's amazing.
So I just full disclosure.
I mean, we want to be honestabout everything we talk about.
I.
I like it, not obsessed.
Um, I thought it was okay.
The you know.
It just kind of shows differentthings work for different
people and different skin types.
Uh, I think I'm probably justtoo oily.
I'm like an oil slick and Ifound it helped for an hour or
two and then I just want to washit off because it was my oil,
(33:06):
was mixing with the moisturizer.
So you know it's everybody'salways looking for that miracle
oil control.
I haven't found it yet there's.
I'm so bad.
There's a La Roche-Posayay likematt.
I don't know the name, um, butsomething matt.
Somebody dropped off for methat I do use um.
I'll get the name for that andmaybe we'll discuss it on
(33:27):
another episode.
But as far as the surveyproduct you mentioned, it was
good, it was, uh, it was a.
It was fine it was.
It was a moisturizer.
I could definitely see myselfusing.
Um did not give me the amountof oil control.
You'd kind of really hyped itup.
I was so excited to use itsorry, I'm gonna do better next
time.
Ashley (33:47):
No, no, this is good.
This is good we should.
We should love this product yeah, but yeah, definitely just goes
to show like what works foryour best friend is not going to
work for you.
This is a huge thing on allsocial media is you know the
perfect skincare routine andinfluencers saying you need to
use these three products andyour skin is going to be amazing
.
And guess what?
For 90% of other people, thatjust doesn't happen.
(34:09):
And so it really is.
It's so subjective and it socomes down to your skin and what
your skin likes.
My skin likes CeraVe oilcontrol.
Okay, there you go, but maybeyours won't.
You should try it.
Leave it at that.
Yeah, yeah, um, and I feel likethat's it.
Yeah, it's sort of everythingthat we wanted to talk about
today.
Yeah, um, oh.
(34:30):
I do have one last thing.
Yeah, barbie Botox.
Just to kind of bring it backreal quick, because that was
huge Barbie movie came out and,I kid you, not beginning the
next day, we had 30 reach outs aday to our office wanting to
come in for Barbie Botox.
So can you just quickly explainwhat it is?
Arash Akhavan (34:50):
Yeah, I mean that was just sort of like clever
rebranding of something we'dbeen doing for a while trapezius
Botox.
So there are these muscles overhere on top of your shoulder
towards the back, and they canget overdeveloped in some people
, especially people with, like,desk jobs and things like that,
because we're holding that areaunder tension.
Some people overuse them intheir gym, like misuse them
(35:13):
almost, and it can be a sourceof neck tension for a lot of
people.
And that's a reason why peoplerelax the muscle for the with
the trap Botox.
But the, the Barbie Botox angleof it is, if you can get this
muscle to shrink down a littlebit, it creates more of an angle
(35:34):
between your neck and yourshoulder, so it gives you the
illusion of elongating your neck.
It makes sense, it works, it'seffective both cosmetically and
for symptom relief, and a lot ofpeople love both of those
benefits.
It's just another use.
It requires more units than weuse in the facial muscles.
(35:54):
These are much bigger musclesbut it works and people like it.
Ashley (36:00):
Love it.
Yeah, it's been huge.
I think that's good, right Ithink that's it.
Arash Akhavan (36:05):
So the one thing I wanted to kind of reach out
and ask is if you have anyquestions or anything.
Our email address and ways tocontact us will be listed at the
end of the podcast.
Please reach out with thingsyou'd like us to discuss and
we'll definitely incorporatethose into future episodes as
well.
Absolutely.
Ashley (36:26):
Looking forward to next week.
Arash Akhavan (36:28):
Sounds good.
Ashley (36:29):
I'll get a better product Okay.
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