January 8, 2025 • 41 mins
In this episode, Dr. Arash Akhavan and Ashley Greenstein dive deep into three fascinating topics shaping the cosmetic dermatology world. First, they demystify cellulite, a common condition affecting most women. The discussion covers its causes, types (dimpling and rippling), and the innovative treatments available, like Avéli for dimples and a combination of hyperdilute Radiesse and RF technology for ripples. Dr. Akhavan emphasizes the transformative emotional impact these treatments can have on patients, boosting confidence and self-esteem.
Next, they explore the “labial puff” procedure, a trending topic gaining traction on social media. Dr. Akhavan explains how this minimally invasive filler treatment restores lost volume to the labia majora, addressing aesthetic concerns tied to aging. While highlighting the safety of this procedure when performed by an expert, they discuss its cultural buzz and normalization as part of cosmetic enhancements.
Finally, they tackle the ever-popular debate on eye creams. Are they worth the investment, or can a good moisturizer suffice? The pair break down key ingredients like caffeine and peptides while noting the lack of definitive scientific proof for many claims. They stress the importance of a personalized skincare routine and offer practical tips for incorporating an eye cream—or not—depending on individual needs.
Don’t miss this insightful conversation blending science, trends, and patient-centered care!
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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.
Announcement (00:15):
Let's get started, but first a quick disclaimer
Medical disclaimer theinformation provided on this
podcast is for generalinformation and educational
purposes only.
It is not intended as medicaladvice, diagnosis or treatment
and should not be relied upon assuch.
Listening to this podcast doesnot establish a
(00:36):
physician-patient relationshipbetween you and the host or any
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.
(00:58):
Always seek the advice of yourphysician or other qualified
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.
Ashley (01:22):
We're back, episode three.
I don't think we realized howpopular this was going to be.
Arash Akhavan (01:29):
Yeah, our patients like it and lots of
people we don't know, so it'sbeen nice.
Yeah, positive reception.
Ashley (01:36):
So episode three I really want to talk about
cellulite.
I think that it is somethingthat patients reach out about a
ton and it's something that 95%of women have.
I might be off on that stat.
You know better than I, butit's something that you know
almost everybody has and we geta ton of questions about it.
(01:59):
We do have some really greatprocedures that help to improve
it, and I kind of like the waythat you sort of break it down.
So let's talk about cellulitetoday.
Arash Akhavan (02:10):
Yeah, so it's.
Yeah, the stats probably alittle less than 95%.
But that is the main thing toknow about cellulite is that it
is very, very, very common.
So you know, some studies say70%, some say 90, I've seen as
high as 90%, 95%, certainly withpossible.
But yeah, so it's the norm.
(02:32):
That's the most important thingto know about cellulite.
It's not like it's a diseasestate, has nothing to do with
health, has nothing to do witheven skin health.
It's just a normal thing formost adult women and it can
actually start even beforeyou're an adult.
It can start in adolescence.
Ashley (02:48):
Right, there's a genetic component to it, isn't there?
Arash Akhavan (02:51):
Yep, genetics definitely plays a role, much,
much more common in women thanmen.
We have seen it in men veryrarely.
It's much more common in women.
And that kind of gets to yourquestion.
What is cellulite?
So it's a, it's a conditionprimarily occurs on the buttock
and the back of the thighs.
Those are the most commonplaces.
(03:15):
You'll see it on the side ofthe thighs, sometimes on the
front of the thighs, butprimarily on the buttock, back
of the thighs, and it can kindof present in two different ways
either dimples so picture likethe little puckered dimples on a
golf ball, so little circlesthat are pulled in.
Or it can look kind of likerippled skin, so just skin that
isn't smooth.
And they're both conditionsthat are caused by collagen
(03:39):
issues and they're verydifferent causes.
So with the difference betweenmen and women, as far as we
understand, is for theattachment of the skin to the
underlying muscle.
So you have the skin, then youhave fat, then you have muscle.
You have these collagen bandsthat are running from the muscle
(03:59):
layers to the skin layer,holding everything intact
together.
In men these collagen bundlesgo in every direction, haphazard
, left, right, diagonal,straight, parallel.
In women they're organized muchmore neatly in parallel bands.
I don't know why.
And if those collagen bundlesas you age get shortened and
(04:24):
condensed and hardened, it'llpull down on the skin, causing
dimples.
And then also, if we lose alittle bit of collagen which we
all do and you lose thatattachment between the muscle
layer and the skin layer, theskin will get rippled.
So you'll see it's not smooth.
So one other way you can kindof tell them apart is that
(04:46):
rippled cellulite.
If you pull the skin reallytight upwards, like towards your
head, it gets smooth.
The dimple ones, they don't goaway, they're there.
And the treatments aredifferent.
Which one do you feel like weget asked about the most?
I mean, I know we have patientsthat have both.
(05:08):
I definitely have both, I wouldsay for a patient it's hard to
just discern between ripplingand um so they just, when they
call you, they just say I havecellulite, I have cellulite.
Ashley (05:20):
Um, I would say I would say, more often than not it is
more of that laxity,horizontally running cellulite,
that is bothersome to the pointwhere someone wants to do
something about it.
But most of the younger patientsI feel like who reach out about
cellulite are dealing withthose dimples and are generally
(05:42):
great candidates for um, avalley which we'll get into a
little bit later but wedefinitely get a ton of reach
outs about both, and laxityseems to be kind of what you
diagnose a lot of the time yeah,that sort of um rippling one, I
think gets more common theolder you get.
Arash Akhavan (06:00):
That dimpling you can get you know when you're 16
, yeah, yeah, and you again juststressing that it's a um, not
something that needs to betreated in any way.
But it does seem, and studieshave also shown this, that the
majority of women who havecellulite, um, if there's an
(06:21):
effective treatment for it,would want it.
Um, so it does bother people,um, for whatever reason and the
you know it's.
It's nice that we're now ableto provide really effective
treatment for it.
It's not like the old dayswhere nothing would work.
Now we have amazing things thatwork it.
(06:42):
It's interesting the cellulitetreatment ones and we've
discussed this before togetheris the patients will literally
cry tears of joy in the room,and that's not that common in
the cosmetic dermatology world,but with cellulite treatment it
is, and you can tell how muchit's been bothering the person
for a decade, two decades, andto just see the final results.
(07:04):
It's really satisfying from ourviewpoint also, just to get to
experience that with thepatients.
Ashley (07:10):
I would say that our cellulite treatments are my one
of my favorite things that we doin the office, just because of
the, the response, the responseand the result that patients get
and how happy that they are and, you know, almost unexpectedly
better than what they thoughtthat it would be.
And the fact that these thingslast for a while is also amazing
(07:34):
and some of the treatments andwe can discuss them.
Arash Akhavan (07:36):
You know, the results seem, when you look at
the pictures, too good to betrue, but they're true and
that's why I think the patientsyou know know with every
cosmetic procedure, I thinkevery patient comes into any
office being like those resultsare probably too good to be true
and then when they see that,nope, that's what I got, I'm
perfectly smooth now in the areathat was bothering me and they
(07:58):
just get so happy yeah, it's areally happy yeah thing, um,
what are your favoritetreatments for cellulite?
Ashley (08:06):
And if we could break down the treatments that are
great for the dimpling and thetreatments that are great for
more of the horizontal laxityand stuff like that?
We'll start with dimples.
Arash Akhavan (08:16):
But yeah, they're very different again because
the cause is different.
So for the dimples, again,that's because the collagen band
is constricting, it's pullingfrom below, it's gotten
shortened and hardened and it'spulling on the skin.
So our treatments, the mosteffective treatment, would
eliminate that collagen bandthat's pulling down and release
(08:38):
it, and then the skin would popback to the surface.
Those are really satisfyingtreatments because our sort of
results thus far have been whenyou treat it, it's permanent.
Um, our current favoritetreatment for that is a belly,
um, the one you mentioned it's.
I love that device, it's.
It's really simple procedure.
You, um, you can visualize thecollagen band that's causing the
(09:05):
problem.
You can double check is thisthe collagen band that's causing
the dimple?
You eliminate that band and yousee the results right there, um
, and you know they have someminor bruising for a couple of
weeks and they can.
They can be on the beach acouple weeks, weeks later, um,
in a bathing suit and they'refine.
(09:26):
So it's pretty cool and theresults are amazing and nobody's
dimples have come back, sothat's good too.
Uh, before a belly was out, weused to do a lot of this
procedure called self FINA,which was also amazing, um, not
as sophisticated.
Obviously it's an older deviceas a valley so we don't do it
anymore, even though we have thedevice just kind of sitting
(09:48):
there collecting dust.
In between those two aninjection came out called quo,
which we did a couple ofpatients with and had great
results, and then just sawphysicians in in use were just
reporting such horrible bruisingwith it and then we decided to
(10:09):
just not do anymore, not pressour luck.
We had a couple of amazingresults and I'm glad we stopped,
because one thing that thenhappened was a lot of patients
the bruising was just so badthey got skin staining from the
bruises.
And then there's really olddevices like cellulase and stuff
like that that weren't thateffective.
I don't think anybody's reallydoing them anymore.
(10:29):
So that's for dimples, for forripples it's not as satisfying.
So we have some results whereit's just spectacular, but we
have to do a lot to get there.
So probably the most populardevice right now is one called
Emtone.
It's a device that uses heat,radiofrequency, to thicken the
(10:50):
collagen layer, build up thecollagen layer in the skin, and
it uses another technologycalled acoustic sound waves,
which are basically shockwavesound waves going in.
They say it improvescirculation in the area and
things like that.
I think it's just basicallyjust pounding down on the fat.
Um, it's really the radiofrequency that's working on it.
(11:10):
The cool thing about the shockwaves is they make you feel the
radio frequency less, becauseit's a pretty intense device
sounds like a distraction yeah,almost like that, but I mean
that's not what it was made for.
The two together were shown towork better than either one of
them separate.
I just don't completely knowwhy.
Yeah, the problem with Emtoneis the results are great,
(11:33):
there's no downtime, all that,but they're just very short
lived.
So some patients need to justkeep doing it, like once a month
.
Some patients can get away withdoing it once every few months,
but it's not a.
You do it and you're cured.
Your cellulite's gone.
You just have to keep doing it.
A longer lasting thing that'snot FDA cleared that we do is
(11:55):
there's a filler called radiusand we mix it with saline so we
dilute it.
It's called hyper dilute radius.
We really dilute it with salineand then we inject it under the
skin and it doesn't add volumethat way, because it's mostly
just saline that's beinginjected.
So they look puffy right afterthe procedure, but that goes
away in a few hours.
It's just saline.
What's left behind is thiscoating, really finely dispersed
(12:18):
everywhere of this radius, andthe radius causes itself causes
new collagen generation in thepatient.
It's cool because it lasts alot longer than the M-tone.
Downside is bruising and it'svery expensive, depending on how
much area you're doing, butresults may last a year or even
(12:41):
18 months in some patients andthe best results we've had which
you know, these are sort ofreally exciting.
Where we've seen really amazingresults for this ripple type of
cellulite is where we combinethe two, actually, and there are
studies showing thathyperdilute radius followed by
radio frequency it's almost likethe radio frequency activates
that collagen production pathwayand just kind of augments your
(13:03):
results, and that's what wefound as well.
So we'll do the radius togetherwith that and the combination's
been great as well.
Just gets so pricey and it'sit's not permanent.
You know.
Best case we're talking 18months, maybe just a year yeah,
so a bit of upkeep needed what'sthat?
Ashley (13:21):
so a bit of upkeep needed.
Arash Akhavan (13:23):
Yes, upkeep needed, yep.
Ashley (13:25):
And just quickly to go back to the abeli selfina.
When we're talking about thatfirst quo, I think it's a really
, really cool procedure.
So just to kind of break itdown a little bit further, the
abeli and the selfina work verysimilarly in that it is almost
like a tiny it's minimallyinvasive, which is something
(13:47):
that we should definitelymention, right?
Arash Akhavan (13:49):
Neither one's non invasive, you're right.
Ashley (13:51):
That it does have a little bit of um downtime with
it.
Um, the aveli and the selfinaum are usually kind of inserted
right underneath the skin, atiny little needle-like um
device, and it actually cutsthat band that you've been
(14:11):
talking about that's pulling theskin through the fat into the
muscle, and it's really, reallygreat.
That is not the same as quo,and quo, being an injectable
device, was actually meant todissolve those bands.
Arash Akhavan (14:27):
Is is how I kind of understand it correct so just
to kind of um further explainlet me see for those of our
listeners watching on youtube.
So this is actually the Avelidevice.
It's a really fine little, tinyprobe that's inserted under the
(14:48):
skin.
This they probably won't beable to see on camera, but then
we push out a little hook andthen that hook catches the
cellulite band.
We tug on it to see if it'sactually causing the dimple.
We eliminate the band withanother button, we check to make
sure that we can no longer tugand cause the cellulite band and
(15:11):
then we pull it up.
And that's as simple as that.
Ashley (15:14):
That's amazing.
Yeah yeah, I just wanted to geta little bit deeper into that
because it is the coolest deviceand procedure.
Arash Akhavan (15:22):
Cool, but so simple yeah.
Ashley (15:25):
And it's like such a huge difference for such a tiny
little quick in-office procedurethat you're awake and
chit-chatting through.
It's not something you need tobe put out for, it's not
something you need your friendto come pick you up from the
office with.
It is really easy and reallycomfortable.
Arash Akhavan (15:45):
Yeah, I mean, it's simply like you just come
in, we mark the cellulitedimples, we're going after, we
numb it with local injections oflidocaine, just like any skin
procedure we do.
Or like when you go to thedentist's office and you have a
cavity same Novocaine, um, sothat's injected right where
we're treating.
That's the only part.
(16:05):
You feel a little needle fromthat.
Then we do the procedure.
You don't feel any of that.
Patients are talking, they'rewatching shows on their phone,
um, they're doing work on theirlaptop, um.
And then you, we do have youwear like exercise type, um,
compression, so not specialsurgical garments or anything,
(16:27):
just like regular, uh, yogapants and leggings and you wear
that for the first few days tohelp with the bruising and you
can exercise as soon as you feelcomfortable.
We've had patients exercise thenext day.
Ashley (16:41):
We've had patients wait like two, three days, um, nobody
takes off work or anything likethat and actually exercising I
I feel like I've heard you saycan help improve the bruising
and the discomfort, becauseyou're kind of getting blood
flow to the area, kind of movingit around.
Is there any truth in that?
Arash Akhavan (17:03):
Yeah, I mean, you may be mixing that up with
another thing.
Um, I do like that with, um,blood vessel, uh, veins, leg
veins, um no, this is justreally.
It doesn't help or hurt, it'sjust, whenever you feel
comfortable you can go get to it.
Yeah.
Ashley (17:18):
And it hasn't.
Arash Akhavan (17:19):
it hasn't been long and according to our
patients no, no, yeah, Mostpatients like a day or two, um,
you know, and, and it's like Isaid, the coolest thing about it
is how happy patients are afterthe treatment.
It's such a pleasure, the likethe day they come in for their
after photos.
I love it.
I look forward to the Aveliafter photo day and the.
(17:42):
You know, there there's thiswhole thing.
With every good thing, I feellike sometimes people ruin it.
So, all about body positivityand you know, having people just
feel comfortable with in theirown skin and not feeling like
they need to do somethingagainst cellulite is completely
normal.
(18:02):
But you'll have like aperversion of the body
positivity sort of movement andyou'll have people just confused
and saying it's wrong to treatcellulite.
You'll hear the same thingabout stretch marks, like, why
would you treat cellulite?
Why would you treat stretchmarks?
You can say that about anything.
(18:22):
I mean, people are doing it fortwo reasons.
They're doing it for themselves, or maybe they're doing it for
society, um, just because thereare societal norms.
And it just like brushing yourhair.
You know, nobody needs to brushtheir hair.
You can all just walk aroundwith messy hair.
Certainly nobody needs to colortheir hair.
We could all have white, grayhair, we could.
(18:43):
Nobody needs to do their.
You know, get a manicure, youdon't need to paint your nails.
It's just things people decideto do and there's some societal
norms.
People mostly do it forthemselves, I think, and it's
kind of crazy for people to pickon people who want to do these
things and it even gets thepoint of like confusion on
(19:06):
things like social mediaplatforms and things like that,
where they'll censor cellulitetreatment because it goes
against body positivity values.
That's just such confusion andsuch garbage.
Um, from you know these socialmedia companies and just their
algorithms and not you knowpicking and choosing what you
(19:28):
know is okay and what's not okay.
So you know Botox okay.
Treating cellulite not okay.
Uh, lip filler Okay.
Treat treating stretch marksfrom pregnancy not okay.
Who decided that?
Some algorithmic thing at youknow meta, yeah, um, so that's
(19:50):
unfortunate and that's that'skind of going against the whole.
Ashley (19:54):
You know the idea behind the by positivity movement like
you should support people anddoing things that make them
happy yeah and I I loveproviding things that make
people confident and happy yeah,I think, like a lot of the
stuff that we do and the way theoffice runs in general too, is,
um, that a lot of the time itfeels like we're helping people.
We're not we're not, you know,trying to make a perfect human.
(20:17):
It is things that really botherpeople, that they really want
to improve, and how we can helpthem do that.
And the reason why I love thisprocedure so much is because of
the confidence that we givepatients when they see their
overall result, and it'ssomething that maybe they've
never worn a bathing suit on thebeach because they don't feel
(20:38):
comfortable with their butt ortheir legs out.
And then, to you know, havethem, show us pictures on
vacation and their bikini on thebeach and how happy they are
with it.
Um, it is.
It's interesting that theinternet kind of decides that
improving specific things onyour body is vain and abnormal
(21:00):
when other things are totallynormal and perfect.
Um, so I think it's it's goodto kind of talk about um in
terms.
I think we we've gotten kind ofthe, the dimpling and the
procedures for the dimplingunder under wraps here.
But in terms of the rippled, Iknow we kind of touched on it
(21:21):
and it's a little bit harder tomanage and a little bit tougher
to keep results in place.
Arash Akhavan (21:27):
Um, for that rippling, do you feel like m
tone or the radius is the bettermove, or ideally the
combination is better, and thenif the combination, because of
monetary reasons, is notsomething that's feasible, it
(21:48):
comes down to do you wantsomething that has absolutely no
downtime, no bruising, noswelling, actually leaves you
looking better right after thevisit.
Yep.
Ashley (22:00):
It's all.
Arash Akhavan (22:00):
No, yeah, no swelling actually leaves you
looking better right after thevisit.
Um, then natural, yep, it's all.
No, yeah, no external productsbeing injected.
Then you pick Emptone, um,understanding that you'll have
to come frequently for visits,but people are really happy with
it and people do comefrequently to our office for it.
Um, people have loved it andhave been doing it for years.
Ashley (22:18):
Like a hot stone massage meets a lymphatic drainage
massage.
Arash Akhavan (22:25):
Like it is it's not I mean, I've never had a hot
stone massage.
I would say an intense hotstone massage.
Yeah, really hot.
Yeah, I mean again, patientslove it and keep coming back for
it.
But the couple of times I'velike tested it out on my own,
like abdomen or something, I'mlike whoa that is hot, yeah,
(22:45):
yeah.
But then, for some reason, alot of our patients are like
it's fine.
Ashley (22:49):
Well, they do say men have a lower pain tolerance.
Yeah, yeah.
Arash Akhavan (22:53):
And I've never had a hot stone massage.
I don't know, but that soundsmiserable.
Report back when it does.
Yeah, and then the radius wouldbe for somebody who doesn't
want to keep coming back in isokay with the downtime Maybe
it's the winter or somethinglike that.
If they had to pick one or theother and it does cost more, so
they'd be willing to put up withthat as well.
(23:14):
Even if you split the cost ofM-Tone over all that time, it's
still less expensive than radius.
Just because radius is anexpensive material, you know,
it's a filler.
Ashley (23:23):
Yeah, absolutely.
And it's, it's, you know, a lotbigger than a cheek.
Arash Akhavan (23:26):
Yeah, yeah, you're not like filling a chin
or a cheek here.
It's, you know, maybe theentire back of somebody's thighs
or back and sides, but you knowit's, it's.
It's a lot of injections, it'sa lot of bruising, it's a lot of
swelling.
Ashley (23:39):
And do you feel like diet and exercise can help to
eliminate cellulite?
Arash Akhavan (23:48):
No, I mean so that second type, the rippling
type of cellulite.
When you have more body fat,the fat you'll see pushing out a
little bit more.
So people will say, you know,if their body fat percentage
goes down, some people willactually improve that type of
(24:09):
cellulite.
Um, it doesn't go away, though,or anything cause.
That's not really the rootcause of it and, yeah, it's not
really anything you're eating ordoing and you can't exercise
cellulite away really.
Except for that, except formaybe a little bit of
improvement by decreasing yourbody fat percentage.
Ashley (24:28):
Right Interesting.
And then I see all over creams,Cellulite reducing creams
they're kind of all over theplace and they pop up every now
and then and then they kind ofgo away and then a new one comes
out and people swear by it.
Arash Akhavan (24:46):
Um, I bet, uh, you know, with all the good
targeting they do now on socialmedia, you probably see a lot
more of those and I see all thebaldness things.
Ashley (24:54):
Yeah, I'm like, yeah, I'm on cellulite, talk I guess,
talk I guess.
Um.
Well, like, what are in thesecreams?
Arash Akhavan (25:03):
are.
I mean they're.
They vary, but a lot of themcontain like caffeine.
Some of them contain likepepper extracts, so they're
temporarily irritating your skin, which makes your skin swollen.
So you don't see imperfectionsunder it.
Um, that's basically all it is,you know I know like long-term
effects no, zero, yeah, zerochance of improving your
(25:27):
cellulite with the cream.
Um, and if it is really goingto be effective, it it needs to
be pretty damn irritating, yeah,yeah, um, cause a lot of
swelling so you don't see thecellulite temporarily.
Ashley (25:40):
Yeah, maybe just a few hours, honestly I've definitely
tried them and uh, no, they donot work, yeah, not even in the
short term.
Um, I don't know.
I don't know why they, whythey're so buzzy and why it
won't just go away, because itseems like they keep popping up.
Arash Akhavan (25:55):
But I had a friend try one.
Um, she kind of got fooled bythe ad and it was like these
neon attractive bottles and theylooked very harmless and her
skin was, like she said, it feltlike she's been burned alive.
Um, but her skin was smooth fora few hours, all right.
Ashley (26:18):
Okay.
Arash Akhavan (26:18):
So not no, but not yes for sure.
Ashley (26:24):
Anything else you want to talk about regarding
cellulite?
Arash Akhavan (26:28):
No, I think.
I mean, I think we covered itand I've got patients in, so
let's wrap it up, okay.
Ashley (26:36):
So switching gears, our trending Tik TOK or social media
, yeah, procedure of the weekwould be something we saw as an
an alert article actually, andit was called the labial puff
procedure.
Have you heard about it?
What does it do?
Arash Akhavan (26:57):
Yeah, I mean we've actually used that term,
even in our office, I think, formore than a decade probably.
The first time I heard about itwas when I did it with one of
my professors at when I was aresident at Mount Sinai in the
cosmetic clinic, and that wasthe first I heard about it.
So I mean, that was probablylike 17 years ago or something,
so it's nothing new.
Ashley (27:18):
It has the title of, it is new.
Arash Akhavan (27:21):
Yeah, maybe a late veal puff.
Yeah, I don't think we like callit that to patients.
When we we do it, it's notsomething we do like every day.
We're talking about you know,handful here and there per year,
but definitely increasing.
We've done a lot more this year.
The procedure is basicallyfiller in the labia majora.
(27:46):
T-dure is basically filler inthe labia majora.
So as we age we lose volumeeverywhere and it causes some of
the signs of aging.
So on your cheeks you'll lose alittle bit of the fat there and
the muscle and the bone andthings start to sag down.
That's one of the big causes ofaging.
And combine that with collagenloss and elastin loss, which
(28:08):
ruins the structural integrityof your skin, so you start to
get aging on the face.
The labia, the vulva is reallyno different, obviously for the
great, great, great greatmajority of people, less sun
exposure there, um.
So collagen, elastin loss notas severe.
Some of that just happens withage and stress and unhealthy
(28:30):
lifestyle and things like that,and some of it just happens
naturally.
But that's not the major issue.
The major issue is the labiamajora, which is the part that's
on the outside, versus thelabia minora, which is on the
inside.
The labia majora loses a littlebit of the fat under it and we
see the little bit of crinklingon the skin there.
It looks deflated a little bitand the only solution when you
(28:55):
lose volume is to fill thevolume one way or another, same
thing as we do for the lips andthe face and the butt and all
the other areas.
In this area we're injectingfillers um to smooth it out
again, so to add the volume backthat's been lost with time.
That's it's one of the areasthat actually shows I think you
(29:18):
know age relatively early, um,and that's in the labia majora,
the inner part.
You don't really see that.
What you actually see is fromloss of collagen, elast in the
labia majora, the inner part.
You don't really see that.
What you actually see is fromloss of collagen and elastin.
The labia minora can actuallyhang a little bit lower so it
becomes elongated, but in thelabia majora it's really that
loss of volume.
And you can use any filler.
I think the majority of thetime we use either Sculptra,
(29:42):
which is polylactic acid.
That's a powder we inject andslowly you build volume over
time.
I like that one because itlasts a long time.
The patients sometimes haveresults that last two, two and a
half years.
We also do juvederm, voluma, ahyaluronic acid one.
You can use really any of thefillers.
And the one thing to kind of beaware of in that area it's it's
(30:07):
not like the lips, um, on onyour face, on your mouth, where
one syringe does a lot.
So you are going to need a fewsyringes so it can get a little
bit more pricey.
That's one of the other reasonsI like sculpture in that area,
because it lasts a long time, so, um, you're getting your
money's worth.
It's another one of thosethings that I feel like.
(30:29):
Again, just getting back to thatsort of body positivity
arguments, again you'll hear itis weird.
It's always like the femalespecific conditions.
I feel like people get sort ofhyper sensitive about them and
we'll say nobody needs to treatthat, it's a normal part of
(30:49):
aging.
One thousand percent, it's anormal part of aging and nobody
needs to treat it.
It would be hard to make amedical argument for why that
should be done.
For medical reasons.
It's a cosmetic thing.
People are doing it forthemselves, maybe they're doing
it for their partner.
Why it's getting a little bitmore um buzz to it is the labia
(31:10):
majora.
A lot of people have donethings like laser hair removal
and things like that, orregularly get wax there more
than they used to, so it's morevisible than it used to be.
That's probably one of the mainreasons and sort of you know,
the adult movie industry andstuff like that and exposure to
(31:30):
that creates societal normsaround that as well.
So, whatever the cause is, ifsomeone wants to do that, there
is an available treatment forthat.
It's safe.
It's a vascular area.
So we always do it with acannula as opposed to needles
and I suggest if anybody ishaving it done, they don't have
(31:50):
it injected with a needle, justbecause it decreases the risk of
accidentally injecting thefiller into a blood vessel.
Do it with someone who'sexperienced and does a lot of
injections of fillers.
Yeah, it's a safe and easything.
It's.
It's uh, you know, I, I think I.
(32:12):
I saw the allure um article andthen all of a sudden everybody
started posting about it again,cause it's interesting.
Anything that I feel like hasto do with the genitals or this
or that, everybody's like Ooh,that's, that's going to be a hot
topic, let me, let me postabout that, so you'll hear
people talking about that.
So like, oh, that's, that'sgonna be a hot topic, let me.
Let me post about that, soyou'll hear people talking about
that.
Ashley (32:29):
So I think that's why we saw it trending yeah, plus the
nice little buzzy name, yeahit's got a name, maybe a little
puff, yeah it's really anythingthat they want to kind of
rebrand an old, an old treatmentor procedure on and give it a
new name.
Arash Akhavan (32:44):
Kind of tends to pop off and it isn't I I feel
like two years ago with theBotox and the scrotal skin.
Everybody was talking aboutscrotox, scrotox.
I mean, yeah, I mean it's nownobody talks about that anymore.
Yeah, yeah, it's, it's, it'syeah social media for you,
things just um yep, um Yep.
Ashley (33:05):
All right, do you know, like how many is it patient to
patient?
Or like how many syringes?
Arash Akhavan (33:14):
What's the average?
I mean I think we averageanywhere.
So if we're doing like eitherof those two fillers I mentioned
, like the Sculptra or theJuvenile Voluma, it's probably
somewhere around like two tofour, something in that range.
Yeah, I think one would be kindof pointless almost.
Ashley (33:31):
Yeah, um, all right, and I think that leads us to our
last topic of the week, which isthis week's product of the week
.
Um, I'm ready for you to toroast me on it, oh, no but I
(33:54):
enjoy.
I've fallen into a deep, dark,dark hole on eye creams.
Um, I have tried caffeine eyecreams.
I've tried growth factor andpeptide eye creams.
I've tried.
I've tried everything um onethat I have tried and really,
(34:15):
really liked is the chaos byisden our patients like that too
.
Yeah, I have no idea why I likeit.
Um, I obviously don't sufferfrom much under eye issue, but
that one I like the way that itgoes on and the way that it
drives and how concealer lays ontop of it.
But what do you think about eyecreams?
(34:36):
Is there one type that worksbest?
Is it the one with the caffeinein it?
Is it the one with growthfactors in it?
Or are they all kind of madethe same?
And how do they differ,honestly, from just your regular
face facial moisturizer that'salso being put on your under
eyes?
Arash Akhavan (34:53):
probably not much .
And if you love your facialmoisturizer and it's doing what
you want in the under eye areaand you try an under eye area
and it's not really looking likeit's any better than your
moisturizer, then you probablycould skip the um under eye
cream and just stick with yourfacial moisturizer.
Everywhere you know they'll,they'll always be filled with
(35:14):
things like, like you said, thecaffeine or peptides a big
buzzword where peptidessupposedly can penetrate into
your skin and do things likegetting you to generate collagen
and elastin your skin and dothings like getting you to
generate collagen and elastin.
All of that without any sort ofenough definitive proof
scientifically to actually likeprove that they do that.
(35:36):
Um, you know we're not seeingmajor double blind, placebo,
controlled studies.
We're not seeing any fdaapproval for any of these things
, um, so some of it's a trialand error.
Maybe your under eye cream isjust suited better for the thin
skin there and you like it andyou think it is doing something
compared to your moisturizer.
Put it on.
I don't think it's probablymaking any sort of long-term
(35:57):
changes.
Um, but if you're using itevery day, on the days that
you're using it, it may beimproving the fine lines and
wrinkles.
Some of them have like titanium, which masks.
It's like a block, so itdoesn't allow the darkness to
show through, kind of likemakeup.
So that's another benefit itcan help with, like the darkness
(36:20):
and the hollows under the eyes,you know.
But then they all have otheringredients.
You know, the one ingredientthat does have FDA clearance for
treating fine lines andwrinkles and improving
discoloration and things likethat is retinoids.
So retinol over the counter,tretinoin as a prescription.
It's tough to use it.
(36:41):
There are some retinoids,retinol products, that are under
eye creams, like there's one.
Let me just look it up, hold on, there's one.
So the La Roche-Posay RedermicR Eyes Retinol Eye Cream.
(37:03):
That's a mouthful.
Yeah, it's a lot.
That's one that I had tried andcould tolerate.
I don't use one.
I don't use it regularly.
I think I tried it like a whileago and gave up after a few
days.
Um, but using a retinoid underyour eyes could build collagen
and be anti-aging.
(37:24):
I use um, a prescription oneand just put it over my
moisturizer.
Um for anti-aging.
I use a prescription one andjust put it over my moisturizer
for anti-aging and nothing'sgoing to be better than that in
terms of a cream.
But a lot of people you knowthe problem with retinoids is
they're irritating for a lot ofpeople and eventually you'll get
used to it.
Most people on, especially onlike the thicker, like forehead,
(37:45):
nose areas like that but in theunder eye people, some people
just never get used to it.
So I'm not suggesting everybodyjumps to using retinoids there.
Just test it out and see ifyour skin can handle it.
Ashley (37:55):
Yeah, I would say like the meatier parts of the face in
terms of retinol first, andthen, as your skin gets used to
it, you can kind of kind of kindof scooch it up to the under
eye area and your face should beokay with that.
But always, um, if you, if youhave an under eye cream, you may
want to put it on top just sothat you don't have, um, any
(38:15):
like discomfort in in terms ofredness and dryness in the under
eye area.
Um, but I mean, I guess overallit works for some things.
Um, I mean, sometimes there arethere are things in people that
just need intervention if theyreally want to improve that area
(38:35):
.
No wonder I was going to fixsome things, but it could.
Arash Akhavan (38:41):
Yeah, what I'm hearing is it could help yeah,
no, I mean, and patients reallylike some of them and everybody
has their favorites, and I Ithink that, yeah, our skin on
different parts of our face isdifferent, like your under eyes
very different than the skin onyour nose which is right there
next to it.
You know just, different oilgland, different makeup, um, and
(39:05):
you know if you find aparticular cream that's best
suited for that area and it'snot too much of a hassle, then
go for it.
Yeah, use an eye cream and thenuse a moisturizer on the rest
of it, and you know, you can,you, you can figure it out,
maybe like a particular neckcream or this.
You know everybody's got theirthings, um, and you just a lot
(39:26):
of it's trial and error, so it'dbe ridiculous for me to be like
these are the four steps thateveryone must do.
There's, that's just.
You know that's not true.
Everybody has to kind of dotrial and error and work with
your dermatologist oresthetician or figure it out on
your own, and you know trialyeah, figure it out, yeah, uh,
(39:47):
yeah, I agree I think, um, it'sjust like makeup, it's just like
anything else, it's like yourface wash and your moisturizer.
Ashley (39:56):
No one is going to be great for everyone.
And if it is something you wantto try and it's really not an
integral part of your, yournighttime routine, right Like at
the basis of what you should bedoing every morning and every
night, and eye cream is an addon.
It's a nice add on if you wantto.
But, um, you know I, I knowwhat you kind of tell our
(40:20):
patients in terms of, like youknow bare minimum what you want
to do for your skincare routineand eye cream is something you
can work into when you kind ofget bored, yeah.
Arash Akhavan (40:30):
They do get pricey.
Some of them, you know some ofthe like $50.
Ashley (40:34):
Yeah, yeah, and that sucks If you try yeah.
Arash Akhavan (40:38):
And if it's doing nothing for you, then skip it
and just use whatever you'reusing on the rest of your face.
Ashley (40:41):
Yeah, case closed.
Cool, we did it.
Arash Akhavan (40:45):
Let's go see patients.
Let's do it All right.
Ashley (40:47):
See you next week.
Bye.
Announcement (40:51):
Bye.
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(41:13):
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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.
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(00:36):
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Ashley (01:22):
We're back, episode three.
I don't think we realized howpopular this was going to be.
Arash Akhavan (01:29):
Yeah, our patients like it and lots of
people we don't know, so it'sbeen nice.
Yeah, positive reception.
Ashley (01:36):
So episode three I really want to talk about
cellulite.
I think that it is somethingthat patients reach out about a
ton and it's something that 95%of women have.
I might be off on that stat.
You know better than I, butit's something that you know
almost everybody has and we geta ton of questions about it.
(01:59):
We do have some really greatprocedures that help to improve
it, and I kind of like the waythat you sort of break it down.
So let's talk about cellulitetoday.
Arash Akhavan (02:10):
Yeah, so it's.
Yeah, the stats probably alittle less than 95%.
But that is the main thing toknow about cellulite is that it
is very, very, very common.
So you know, some studies say70%, some say 90, I've seen as
high as 90%, 95%, certainly withpossible.
But yeah, so it's the norm.
(02:32):
That's the most important thingto know about cellulite.
It's not like it's a diseasestate, has nothing to do with
health, has nothing to do witheven skin health.
It's just a normal thing formost adult women and it can
actually start even beforeyou're an adult.
It can start in adolescence.
Ashley (02:48):
Right, there's a genetic component to it, isn't there?
Arash Akhavan (02:51):
Yep, genetics definitely plays a role, much,
much more common in women thanmen.
We have seen it in men veryrarely.
It's much more common in women.
And that kind of gets to yourquestion.
What is cellulite?
So it's a, it's a conditionprimarily occurs on the buttock
and the back of the thighs.
Those are the most commonplaces.
(03:15):
You'll see it on the side ofthe thighs, sometimes on the
front of the thighs, butprimarily on the buttock, back
of the thighs, and it can kindof present in two different ways
either dimples so picture likethe little puckered dimples on a
golf ball, so little circlesthat are pulled in.
Or it can look kind of likerippled skin, so just skin that
isn't smooth.
And they're both conditionsthat are caused by collagen
(03:39):
issues and they're verydifferent causes.
So with the difference betweenmen and women, as far as we
understand, is for theattachment of the skin to the
underlying muscle.
So you have the skin, then youhave fat, then you have muscle.
You have these collagen bandsthat are running from the muscle
(03:59):
layers to the skin layer,holding everything intact
together.
In men these collagen bundlesgo in every direction, haphazard
, left, right, diagonal,straight, parallel.
In women they're organized muchmore neatly in parallel bands.
I don't know why.
And if those collagen bundlesas you age get shortened and
(04:24):
condensed and hardened, it'llpull down on the skin, causing
dimples.
And then also, if we lose alittle bit of collagen which we
all do and you lose thatattachment between the muscle
layer and the skin layer, theskin will get rippled.
So you'll see it's not smooth.
So one other way you can kindof tell them apart is that
(04:46):
rippled cellulite.
If you pull the skin reallytight upwards, like towards your
head, it gets smooth.
The dimple ones, they don't goaway, they're there.
And the treatments aredifferent.
Which one do you feel like weget asked about the most?
I mean, I know we have patientsthat have both.
(05:08):
I definitely have both, I wouldsay for a patient it's hard to
just discern between ripplingand um so they just, when they
call you, they just say I havecellulite, I have cellulite.
Ashley (05:20):
Um, I would say I would say, more often than not it is
more of that laxity,horizontally running cellulite,
that is bothersome to the pointwhere someone wants to do
something about it.
But most of the younger patientsI feel like who reach out about
cellulite are dealing withthose dimples and are generally
(05:42):
great candidates for um, avalley which we'll get into a
little bit later but wedefinitely get a ton of reach
outs about both, and laxityseems to be kind of what you
diagnose a lot of the time yeah,that sort of um rippling one, I
think gets more common theolder you get.
Arash Akhavan (06:00):
That dimpling you can get you know when you're 16
, yeah, yeah, and you again juststressing that it's a um, not
something that needs to betreated in any way.
But it does seem, and studieshave also shown this, that the
majority of women who havecellulite, um, if there's an
(06:21):
effective treatment for it,would want it.
Um, so it does bother people,um, for whatever reason and the
you know it's.
It's nice that we're now ableto provide really effective
treatment for it.
It's not like the old dayswhere nothing would work.
Now we have amazing things thatwork it.
(06:42):
It's interesting the cellulitetreatment ones and we've
discussed this before togetheris the patients will literally
cry tears of joy in the room,and that's not that common in
the cosmetic dermatology world,but with cellulite treatment it
is, and you can tell how muchit's been bothering the person
for a decade, two decades, andto just see the final results.
(07:04):
It's really satisfying from ourviewpoint also, just to get to
experience that with thepatients.
Ashley (07:10):
I would say that our cellulite treatments are my one
of my favorite things that we doin the office, just because of
the, the response, the responseand the result that patients get
and how happy that they are and, you know, almost unexpectedly
better than what they thoughtthat it would be.
And the fact that these thingslast for a while is also amazing
(07:34):
and some of the treatments andwe can discuss them.
Arash Akhavan (07:36):
You know, the results seem, when you look at
the pictures, too good to betrue, but they're true and
that's why I think the patientsyou know know with every
cosmetic procedure, I thinkevery patient comes into any
office being like those resultsare probably too good to be true
and then when they see that,nope, that's what I got, I'm
perfectly smooth now in the areathat was bothering me and they
(07:58):
just get so happy yeah, it's areally happy yeah thing, um,
what are your favoritetreatments for cellulite?
Ashley (08:06):
And if we could break down the treatments that are
great for the dimpling and thetreatments that are great for
more of the horizontal laxityand stuff like that?
We'll start with dimples.
Arash Akhavan (08:16):
But yeah, they're very different again because
the cause is different.
So for the dimples, again,that's because the collagen band
is constricting, it's pullingfrom below, it's gotten
shortened and hardened and it'spulling on the skin.
So our treatments, the mosteffective treatment, would
eliminate that collagen bandthat's pulling down and release
(08:38):
it, and then the skin would popback to the surface.
Those are really satisfyingtreatments because our sort of
results thus far have been whenyou treat it, it's permanent.
Um, our current favoritetreatment for that is a belly,
um, the one you mentioned it's.
I love that device, it's.
It's really simple procedure.
You, um, you can visualize thecollagen band that's causing the
(09:05):
problem.
You can double check is thisthe collagen band that's causing
the dimple?
You eliminate that band and yousee the results right there, um
, and you know they have someminor bruising for a couple of
weeks and they can.
They can be on the beach acouple weeks, weeks later, um,
in a bathing suit and they'refine.
(09:26):
So it's pretty cool and theresults are amazing and nobody's
dimples have come back, sothat's good too.
Uh, before a belly was out, weused to do a lot of this
procedure called self FINA,which was also amazing, um, not
as sophisticated.
Obviously it's an older deviceas a valley so we don't do it
anymore, even though we have thedevice just kind of sitting
(09:48):
there collecting dust.
In between those two aninjection came out called quo,
which we did a couple ofpatients with and had great
results, and then just sawphysicians in in use were just
reporting such horrible bruisingwith it and then we decided to
(10:09):
just not do anymore, not pressour luck.
We had a couple of amazingresults and I'm glad we stopped,
because one thing that thenhappened was a lot of patients
the bruising was just so badthey got skin staining from the
bruises.
And then there's really olddevices like cellulase and stuff
like that that weren't thateffective.
I don't think anybody's reallydoing them anymore.
(10:29):
So that's for dimples, for forripples it's not as satisfying.
So we have some results whereit's just spectacular, but we
have to do a lot to get there.
So probably the most populardevice right now is one called
Emtone.
It's a device that uses heat,radiofrequency, to thicken the
(10:50):
collagen layer, build up thecollagen layer in the skin, and
it uses another technologycalled acoustic sound waves,
which are basically shockwavesound waves going in.
They say it improvescirculation in the area and
things like that.
I think it's just basicallyjust pounding down on the fat.
Um, it's really the radiofrequency that's working on it.
(11:10):
The cool thing about the shockwaves is they make you feel the
radio frequency less, becauseit's a pretty intense device
sounds like a distraction yeah,almost like that, but I mean
that's not what it was made for.
The two together were shown towork better than either one of
them separate.
I just don't completely knowwhy.
Yeah, the problem with Emtoneis the results are great,
(11:33):
there's no downtime, all that,but they're just very short
lived.
So some patients need to justkeep doing it, like once a month
.
Some patients can get away withdoing it once every few months,
but it's not a.
You do it and you're cured.
Your cellulite's gone.
You just have to keep doing it.
A longer lasting thing that'snot FDA cleared that we do is
(11:55):
there's a filler called radiusand we mix it with saline so we
dilute it.
It's called hyper dilute radius.
We really dilute it with salineand then we inject it under the
skin and it doesn't add volumethat way, because it's mostly
just saline that's beinginjected.
So they look puffy right afterthe procedure, but that goes
away in a few hours.
It's just saline.
What's left behind is thiscoating, really finely dispersed
(12:18):
everywhere of this radius, andthe radius causes itself causes
new collagen generation in thepatient.
It's cool because it lasts alot longer than the M-tone.
Downside is bruising and it'svery expensive, depending on how
much area you're doing, butresults may last a year or even
(12:41):
18 months in some patients andthe best results we've had which
you know, these are sort ofreally exciting.
Where we've seen really amazingresults for this ripple type of
cellulite is where we combinethe two, actually, and there are
studies showing thathyperdilute radius followed by
radio frequency it's almost likethe radio frequency activates
that collagen production pathwayand just kind of augments your
(13:03):
results, and that's what wefound as well.
So we'll do the radius togetherwith that and the combination's
been great as well.
Just gets so pricey and it'sit's not permanent.
You know.
Best case we're talking 18months, maybe just a year yeah,
so a bit of upkeep needed what'sthat?
Ashley (13:21):
so a bit of upkeep needed.
Arash Akhavan (13:23):
Yes, upkeep needed, yep.
Ashley (13:25):
And just quickly to go back to the abeli selfina.
When we're talking about thatfirst quo, I think it's a really
, really cool procedure.
So just to kind of break itdown a little bit further, the
abeli and the selfina work verysimilarly in that it is almost
like a tiny it's minimallyinvasive, which is something
(13:47):
that we should definitelymention, right?
Arash Akhavan (13:49):
Neither one's non invasive, you're right.
Ashley (13:51):
That it does have a little bit of um downtime with
it.
Um, the aveli and the selfinaum are usually kind of inserted
right underneath the skin, atiny little needle-like um
device, and it actually cutsthat band that you've been
(14:11):
talking about that's pulling theskin through the fat into the
muscle, and it's really, reallygreat.
That is not the same as quo,and quo, being an injectable
device, was actually meant todissolve those bands.
Arash Akhavan (14:27):
Is is how I kind of understand it correct so just
to kind of um further explainlet me see for those of our
listeners watching on youtube.
So this is actually the Avelidevice.
It's a really fine little, tinyprobe that's inserted under the
(14:48):
skin.
This they probably won't beable to see on camera, but then
we push out a little hook andthen that hook catches the
cellulite band.
We tug on it to see if it'sactually causing the dimple.
We eliminate the band withanother button, we check to make
sure that we can no longer tugand cause the cellulite band and
(15:11):
then we pull it up.
And that's as simple as that.
Ashley (15:14):
That's amazing.
Yeah yeah, I just wanted to geta little bit deeper into that
because it is the coolest deviceand procedure.
Arash Akhavan (15:22):
Cool, but so simple yeah.
Ashley (15:25):
And it's like such a huge difference for such a tiny
little quick in-office procedurethat you're awake and
chit-chatting through.
It's not something you need tobe put out for, it's not
something you need your friendto come pick you up from the
office with.
It is really easy and reallycomfortable.
Arash Akhavan (15:45):
Yeah, I mean, it's simply like you just come
in, we mark the cellulitedimples, we're going after, we
numb it with local injections oflidocaine, just like any skin
procedure we do.
Or like when you go to thedentist's office and you have a
cavity same Novocaine, um, sothat's injected right where
we're treating.
That's the only part.
(16:05):
You feel a little needle fromthat.
Then we do the procedure.
You don't feel any of that.
Patients are talking, they'rewatching shows on their phone,
um, they're doing work on theirlaptop, um.
And then you, we do have youwear like exercise type, um,
compression, so not specialsurgical garments or anything,
(16:27):
just like regular, uh, yogapants and leggings and you wear
that for the first few days tohelp with the bruising and you
can exercise as soon as you feelcomfortable.
We've had patients exercise thenext day.
Ashley (16:41):
We've had patients wait like two, three days, um, nobody
takes off work or anything likethat and actually exercising I
I feel like I've heard you saycan help improve the bruising
and the discomfort, becauseyou're kind of getting blood
flow to the area, kind of movingit around.
Is there any truth in that?
Arash Akhavan (17:03):
Yeah, I mean, you may be mixing that up with
another thing.
Um, I do like that with, um,blood vessel, uh, veins, leg
veins, um no, this is justreally.
It doesn't help or hurt, it'sjust, whenever you feel
comfortable you can go get to it.
Yeah.
Ashley (17:18):
And it hasn't.
Arash Akhavan (17:19):
it hasn't been long and according to our
patients no, no, yeah, Mostpatients like a day or two, um,
you know, and, and it's like Isaid, the coolest thing about it
is how happy patients are afterthe treatment.
It's such a pleasure, the likethe day they come in for their
after photos.
I love it.
I look forward to the Aveliafter photo day and the.
(17:42):
You know, there there's thiswhole thing.
With every good thing, I feellike sometimes people ruin it.
So, all about body positivityand you know, having people just
feel comfortable with in theirown skin and not feeling like
they need to do somethingagainst cellulite is completely
normal.
(18:02):
But you'll have like aperversion of the body
positivity sort of movement andyou'll have people just confused
and saying it's wrong to treatcellulite.
You'll hear the same thingabout stretch marks, like, why
would you treat cellulite?
Why would you treat stretchmarks?
You can say that about anything.
(18:22):
I mean, people are doing it fortwo reasons.
They're doing it for themselves, or maybe they're doing it for
society, um, just because thereare societal norms.
And it just like brushing yourhair.
You know, nobody needs to brushtheir hair.
You can all just walk aroundwith messy hair.
Certainly nobody needs to colortheir hair.
We could all have white, grayhair, we could.
(18:43):
Nobody needs to do their.
You know, get a manicure, youdon't need to paint your nails.
It's just things people decideto do and there's some societal
norms.
People mostly do it forthemselves, I think, and it's
kind of crazy for people to pickon people who want to do these
things and it even gets thepoint of like confusion on
(19:06):
things like social mediaplatforms and things like that,
where they'll censor cellulitetreatment because it goes
against body positivity values.
That's just such confusion andsuch garbage.
Um, from you know these socialmedia companies and just their
algorithms and not you knowpicking and choosing what you
(19:28):
know is okay and what's not okay.
So you know Botox okay.
Treating cellulite not okay.
Uh, lip filler Okay.
Treat treating stretch marksfrom pregnancy not okay.
Who decided that?
Some algorithmic thing at youknow meta, yeah, um, so that's
(19:50):
unfortunate and that's that'skind of going against the whole.
Ashley (19:54):
You know the idea behind the by positivity movement like
you should support people anddoing things that make them
happy yeah and I I loveproviding things that make
people confident and happy yeah,I think, like a lot of the
stuff that we do and the way theoffice runs in general too, is,
um, that a lot of the time itfeels like we're helping people.
We're not we're not, you know,trying to make a perfect human.
(20:17):
It is things that really botherpeople, that they really want
to improve, and how we can helpthem do that.
And the reason why I love thisprocedure so much is because of
the confidence that we givepatients when they see their
overall result, and it'ssomething that maybe they've
never worn a bathing suit on thebeach because they don't feel
(20:38):
comfortable with their butt ortheir legs out.
And then, to you know, havethem, show us pictures on
vacation and their bikini on thebeach and how happy they are
with it.
Um, it is.
It's interesting that theinternet kind of decides that
improving specific things onyour body is vain and abnormal
(21:00):
when other things are totallynormal and perfect.
Um, so I think it's it's goodto kind of talk about um in
terms.
I think we we've gotten kind ofthe, the dimpling and the
procedures for the dimplingunder under wraps here.
But in terms of the rippled, Iknow we kind of touched on it
(21:21):
and it's a little bit harder tomanage and a little bit tougher
to keep results in place.
Arash Akhavan (21:27):
Um, for that rippling, do you feel like m
tone or the radius is the bettermove, or ideally the
combination is better, and thenif the combination, because of
monetary reasons, is notsomething that's feasible, it
(21:48):
comes down to do you wantsomething that has absolutely no
downtime, no bruising, noswelling, actually leaves you
looking better right after thevisit.
Yep.
Ashley (22:00):
It's all.
Arash Akhavan (22:00):
No, yeah, no swelling actually leaves you
looking better right after thevisit.
Um, then natural, yep, it's all.
No, yeah, no external productsbeing injected.
Then you pick Emptone, um,understanding that you'll have
to come frequently for visits,but people are really happy with
it and people do comefrequently to our office for it.
Um, people have loved it andhave been doing it for years.
Ashley (22:18):
Like a hot stone massage meets a lymphatic drainage
massage.
Arash Akhavan (22:25):
Like it is it's not I mean, I've never had a hot
stone massage.
I would say an intense hotstone massage.
Yeah, really hot.
Yeah, I mean again, patientslove it and keep coming back for
it.
But the couple of times I'velike tested it out on my own,
like abdomen or something, I'mlike whoa that is hot, yeah,
(22:45):
yeah.
But then, for some reason, alot of our patients are like
it's fine.
Ashley (22:49):
Well, they do say men have a lower pain tolerance.
Yeah, yeah.
Arash Akhavan (22:53):
And I've never had a hot stone massage.
I don't know, but that soundsmiserable.
Report back when it does.
Yeah, and then the radius wouldbe for somebody who doesn't
want to keep coming back in isokay with the downtime Maybe
it's the winter or somethinglike that.
If they had to pick one or theother and it does cost more, so
they'd be willing to put up withthat as well.
(23:14):
Even if you split the cost ofM-Tone over all that time, it's
still less expensive than radius.
Just because radius is anexpensive material, you know,
it's a filler.
Ashley (23:23):
Yeah, absolutely.
And it's, it's, you know, a lotbigger than a cheek.
Arash Akhavan (23:26):
Yeah, yeah, you're not like filling a chin
or a cheek here.
It's, you know, maybe theentire back of somebody's thighs
or back and sides, but you knowit's, it's.
It's a lot of injections, it'sa lot of bruising, it's a lot of
swelling.
Ashley (23:39):
And do you feel like diet and exercise can help to
eliminate cellulite?
Arash Akhavan (23:48):
No, I mean so that second type, the rippling
type of cellulite.
When you have more body fat,the fat you'll see pushing out a
little bit more.
So people will say, you know,if their body fat percentage
goes down, some people willactually improve that type of
(24:09):
cellulite.
Um, it doesn't go away, though,or anything cause.
That's not really the rootcause of it and, yeah, it's not
really anything you're eating ordoing and you can't exercise
cellulite away really.
Except for that, except formaybe a little bit of
improvement by decreasing yourbody fat percentage.
Ashley (24:28):
Right Interesting.
And then I see all over creams,Cellulite reducing creams
they're kind of all over theplace and they pop up every now
and then and then they kind ofgo away and then a new one comes
out and people swear by it.
Arash Akhavan (24:46):
Um, I bet, uh, you know, with all the good
targeting they do now on socialmedia, you probably see a lot
more of those and I see all thebaldness things.
Ashley (24:54):
Yeah, I'm like, yeah, I'm on cellulite, talk I guess,
talk I guess.
Um.
Well, like, what are in thesecreams?
Arash Akhavan (25:03):
are.
I mean they're.
They vary, but a lot of themcontain like caffeine.
Some of them contain likepepper extracts, so they're
temporarily irritating your skin, which makes your skin swollen.
So you don't see imperfectionsunder it.
Um, that's basically all it is,you know I know like long-term
effects no, zero, yeah, zerochance of improving your
(25:27):
cellulite with the cream.
Um, and if it is really goingto be effective, it it needs to
be pretty damn irritating, yeah,yeah, um, cause a lot of
swelling so you don't see thecellulite temporarily.
Ashley (25:40):
Yeah, maybe just a few hours, honestly I've definitely
tried them and uh, no, they donot work, yeah, not even in the
short term.
Um, I don't know.
I don't know why they, whythey're so buzzy and why it
won't just go away, because itseems like they keep popping up.
Arash Akhavan (25:55):
But I had a friend try one.
Um, she kind of got fooled bythe ad and it was like these
neon attractive bottles and theylooked very harmless and her
skin was, like she said, it feltlike she's been burned alive.
Um, but her skin was smooth fora few hours, all right.
Ashley (26:18):
Okay.
Arash Akhavan (26:18):
So not no, but not yes for sure.
Ashley (26:24):
Anything else you want to talk about regarding
cellulite?
Arash Akhavan (26:28):
No, I think.
I mean, I think we covered itand I've got patients in, so
let's wrap it up, okay.
Ashley (26:36):
So switching gears, our trending Tik TOK or social media
, yeah, procedure of the weekwould be something we saw as an
an alert article actually, andit was called the labial puff
procedure.
Have you heard about it?
What does it do?
Arash Akhavan (26:57):
Yeah, I mean we've actually used that term,
even in our office, I think, formore than a decade probably.
The first time I heard about itwas when I did it with one of
my professors at when I was aresident at Mount Sinai in the
cosmetic clinic, and that wasthe first I heard about it.
So I mean, that was probablylike 17 years ago or something,
so it's nothing new.
Ashley (27:18):
It has the title of, it is new.
Arash Akhavan (27:21):
Yeah, maybe a late veal puff.
Yeah, I don't think we like callit that to patients.
When we we do it, it's notsomething we do like every day.
We're talking about you know,handful here and there per year,
but definitely increasing.
We've done a lot more this year.
The procedure is basicallyfiller in the labia majora.
(27:46):
T-dure is basically filler inthe labia majora.
So as we age we lose volumeeverywhere and it causes some of
the signs of aging.
So on your cheeks you'll lose alittle bit of the fat there and
the muscle and the bone andthings start to sag down.
That's one of the big causes ofaging.
And combine that with collagenloss and elastin loss, which
(28:08):
ruins the structural integrityof your skin, so you start to
get aging on the face.
The labia, the vulva is reallyno different, obviously for the
great, great, great greatmajority of people, less sun
exposure there, um.
So collagen, elastin loss notas severe.
Some of that just happens withage and stress and unhealthy
(28:30):
lifestyle and things like that,and some of it just happens
naturally.
But that's not the major issue.
The major issue is the labiamajora, which is the part that's
on the outside, versus thelabia minora, which is on the
inside.
The labia majora loses a littlebit of the fat under it and we
see the little bit of crinklingon the skin there.
It looks deflated a little bitand the only solution when you
(28:55):
lose volume is to fill thevolume one way or another, same
thing as we do for the lips andthe face and the butt and all
the other areas.
In this area we're injectingfillers um to smooth it out
again, so to add the volume backthat's been lost with time.
That's it's one of the areasthat actually shows I think you
(29:18):
know age relatively early, um,and that's in the labia majora,
the inner part.
You don't really see that.
What you actually see is fromloss of collagen, elast in the
labia majora, the inner part.
You don't really see that.
What you actually see is fromloss of collagen and elastin.
The labia minora can actuallyhang a little bit lower so it
becomes elongated, but in thelabia majora it's really that
loss of volume.
And you can use any filler.
I think the majority of thetime we use either Sculptra,
(29:42):
which is polylactic acid.
That's a powder we inject andslowly you build volume over
time.
I like that one because itlasts a long time.
The patients sometimes haveresults that last two, two and a
half years.
We also do juvederm, voluma, ahyaluronic acid one.
You can use really any of thefillers.
And the one thing to kind of beaware of in that area it's it's
(30:07):
not like the lips, um, on onyour face, on your mouth, where
one syringe does a lot.
So you are going to need a fewsyringes so it can get a little
bit more pricey.
That's one of the other reasonsI like sculpture in that area,
because it lasts a long time, so, um, you're getting your
money's worth.
It's another one of thosethings that I feel like.
(30:29):
Again, just getting back to thatsort of body positivity
arguments, again you'll hear itis weird.
It's always like the femalespecific conditions.
I feel like people get sort ofhyper sensitive about them and
we'll say nobody needs to treatthat, it's a normal part of
(30:49):
aging.
One thousand percent, it's anormal part of aging and nobody
needs to treat it.
It would be hard to make amedical argument for why that
should be done.
For medical reasons.
It's a cosmetic thing.
People are doing it forthemselves, maybe they're doing
it for their partner.
Why it's getting a little bitmore um buzz to it is the labia
(31:10):
majora.
A lot of people have donethings like laser hair removal
and things like that, orregularly get wax there more
than they used to, so it's morevisible than it used to be.
That's probably one of the mainreasons and sort of you know,
the adult movie industry andstuff like that and exposure to
(31:30):
that creates societal normsaround that as well.
So, whatever the cause is, ifsomeone wants to do that, there
is an available treatment forthat.
It's safe.
It's a vascular area.
So we always do it with acannula as opposed to needles
and I suggest if anybody ishaving it done, they don't have
(31:50):
it injected with a needle, justbecause it decreases the risk of
accidentally injecting thefiller into a blood vessel.
Do it with someone who'sexperienced and does a lot of
injections of fillers.
Yeah, it's a safe and easything.
It's.
It's uh, you know, I, I think I.
(32:12):
I saw the allure um article andthen all of a sudden everybody
started posting about it again,cause it's interesting.
Anything that I feel like hasto do with the genitals or this
or that, everybody's like Ooh,that's, that's going to be a hot
topic, let me, let me postabout that, so you'll hear
people talking about that.
So like, oh, that's, that'sgonna be a hot topic, let me.
Let me post about that, soyou'll hear people talking about
that.
Ashley (32:29):
So I think that's why we saw it trending yeah, plus the
nice little buzzy name, yeahit's got a name, maybe a little
puff, yeah it's really anythingthat they want to kind of
rebrand an old, an old treatmentor procedure on and give it a
new name.
Arash Akhavan (32:44):
Kind of tends to pop off and it isn't I I feel
like two years ago with theBotox and the scrotal skin.
Everybody was talking aboutscrotox, scrotox.
I mean, yeah, I mean it's nownobody talks about that anymore.
Yeah, yeah, it's, it's, it'syeah social media for you,
things just um yep, um Yep.
Ashley (33:05):
All right, do you know, like how many is it patient to
patient?
Or like how many syringes?
Arash Akhavan (33:14):
What's the average?
I mean I think we averageanywhere.
So if we're doing like eitherof those two fillers I mentioned
, like the Sculptra or theJuvenile Voluma, it's probably
somewhere around like two tofour, something in that range.
Yeah, I think one would be kindof pointless almost.
Ashley (33:31):
Yeah, um, all right, and I think that leads us to our
last topic of the week, which isthis week's product of the week
.
Um, I'm ready for you to toroast me on it, oh, no but I
(33:54):
enjoy.
I've fallen into a deep, dark,dark hole on eye creams.
Um, I have tried caffeine eyecreams.
I've tried growth factor andpeptide eye creams.
I've tried.
I've tried everything um onethat I have tried and really,
(34:15):
really liked is the chaos byisden our patients like that too
.
Yeah, I have no idea why I likeit.
Um, I obviously don't sufferfrom much under eye issue, but
that one I like the way that itgoes on and the way that it
drives and how concealer lays ontop of it.
But what do you think about eyecreams?
(34:36):
Is there one type that worksbest?
Is it the one with the caffeinein it?
Is it the one with growthfactors in it?
Or are they all kind of madethe same?
And how do they differ,honestly, from just your regular
face facial moisturizer that'salso being put on your under
eyes?
Arash Akhavan (34:53):
probably not much .
And if you love your facialmoisturizer and it's doing what
you want in the under eye areaand you try an under eye area
and it's not really looking likeit's any better than your
moisturizer, then you probablycould skip the um under eye
cream and just stick with yourfacial moisturizer.
Everywhere you know they'll,they'll always be filled with
(35:14):
things like, like you said, thecaffeine or peptides a big
buzzword where peptidessupposedly can penetrate into
your skin and do things likegetting you to generate collagen
and elastin your skin and dothings like getting you to
generate collagen and elastin.
All of that without any sort ofenough definitive proof
scientifically to actually likeprove that they do that.
(35:36):
Um, you know we're not seeingmajor double blind, placebo,
controlled studies.
We're not seeing any fdaapproval for any of these things
, um, so some of it's a trialand error.
Maybe your under eye cream isjust suited better for the thin
skin there and you like it andyou think it is doing something
compared to your moisturizer.
Put it on.
I don't think it's probablymaking any sort of long-term
(35:57):
changes.
Um, but if you're using itevery day, on the days that
you're using it, it may beimproving the fine lines and
wrinkles.
Some of them have like titanium, which masks.
It's like a block, so itdoesn't allow the darkness to
show through, kind of likemakeup.
So that's another benefit itcan help with, like the darkness
(36:20):
and the hollows under the eyes,you know.
But then they all have otheringredients.
You know, the one ingredientthat does have FDA clearance for
treating fine lines andwrinkles and improving
discoloration and things likethat is retinoids.
So retinol over the counter,tretinoin as a prescription.
It's tough to use it.
(36:41):
There are some retinoids,retinol products, that are under
eye creams, like there's one.
Let me just look it up, hold on, there's one.
So the La Roche-Posay RedermicR Eyes Retinol Eye Cream.
(37:03):
That's a mouthful.
Yeah, it's a lot.
That's one that I had tried andcould tolerate.
I don't use one.
I don't use it regularly.
I think I tried it like a whileago and gave up after a few
days.
Um, but using a retinoid underyour eyes could build collagen
and be anti-aging.
(37:24):
I use um, a prescription oneand just put it over my
moisturizer.
Um for anti-aging.
I use a prescription one andjust put it over my moisturizer
for anti-aging and nothing'sgoing to be better than that in
terms of a cream.
But a lot of people you knowthe problem with retinoids is
they're irritating for a lot ofpeople and eventually you'll get
used to it.
Most people on, especially onlike the thicker, like forehead,
(37:45):
nose areas like that but in theunder eye people, some people
just never get used to it.
So I'm not suggesting everybodyjumps to using retinoids there.
Just test it out and see ifyour skin can handle it.
Ashley (37:55):
Yeah, I would say like the meatier parts of the face in
terms of retinol first, andthen, as your skin gets used to
it, you can kind of kind of kindof scooch it up to the under
eye area and your face should beokay with that.
But always, um, if you, if youhave an under eye cream, you may
want to put it on top just sothat you don't have, um, any
(38:15):
like discomfort in in terms ofredness and dryness in the under
eye area.
Um, but I mean, I guess overallit works for some things.
Um, I mean, sometimes there arethere are things in people that
just need intervention if theyreally want to improve that area
(38:35):
.
No wonder I was going to fixsome things, but it could.
Arash Akhavan (38:41):
Yeah, what I'm hearing is it could help yeah,
no, I mean, and patients reallylike some of them and everybody
has their favorites, and I Ithink that, yeah, our skin on
different parts of our face isdifferent, like your under eyes
very different than the skin onyour nose which is right there
next to it.
You know just, different oilgland, different makeup, um, and
(39:05):
you know if you find aparticular cream that's best
suited for that area and it'snot too much of a hassle, then
go for it.
Yeah, use an eye cream and thenuse a moisturizer on the rest
of it, and you know, you can,you, you can figure it out,
maybe like a particular neckcream or this.
You know everybody's got theirthings, um, and you just a lot
(39:26):
of it's trial and error, so it'dbe ridiculous for me to be like
these are the four steps thateveryone must do.
There's, that's just.
You know that's not true.
Everybody has to kind of dotrial and error and work with
your dermatologist oresthetician or figure it out on
your own, and you know trialyeah, figure it out, yeah, uh,
(39:47):
yeah, I agree I think, um, it'sjust like makeup, it's just like
anything else, it's like yourface wash and your moisturizer.
Ashley (39:56):
No one is going to be great for everyone.
And if it is something you wantto try and it's really not an
integral part of your, yournighttime routine, right Like at
the basis of what you should bedoing every morning and every
night, and eye cream is an addon.
It's a nice add on if you wantto.
But, um, you know I, I knowwhat you kind of tell our
(40:20):
patients in terms of, like youknow bare minimum what you want
to do for your skincare routineand eye cream is something you
can work into when you kind ofget bored, yeah.
Arash Akhavan (40:30):
They do get pricey.
Some of them, you know some ofthe like $50.
Ashley (40:34):
Yeah, yeah, and that sucks If you try yeah.
Arash Akhavan (40:38):
And if it's doing nothing for you, then skip it
and just use whatever you'reusing on the rest of your face.
Ashley (40:41):
Yeah, case closed.
Cool, we did it.
Arash Akhavan (40:45):
Let's go see patients.
Let's do it All right.
Ashley (40:47):
See you next week.
Bye.
Announcement (40:51):
Bye.
Thank you so much for tuning intoday.
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