Webinar 13: “Get to Gold” Ultherapy + Xeomin

During this webinar, Louisa Agate, LMA, and Dr. David Kashan, MD, are discussing Ultherapy (the gold standard of non-surgical skin tightening and lifting) and Xeomin, a uniquely purified neurotoxin. Dr. Kashan also demonstrates how Xeomin injection is performed.





Transcript



(00:00): Hi, my name is Louisa from Aristocrat plastic surgery. So I’m going to be talking about all therapy and whether I end up the Xeomin and specifically we’re going to be really focusing on the non-surgical route. So this is Dr. Pasha. He is part of the practice and he’s going to be doing it today. So well therapy has been around for quite a number of years now. It’s an say ultrasound that helps to tighten the skin and it uses energy can specific depths. And we want to talk about it to help lift and tighten the skin. And Xeomin is a neurotoxin or a Botox that’s helps to also gets the actual lift, which we’ll be talking about in a few minutes. So well therapy helps to build collagen in in the skin, by using folks focused energy to help, to help usually these microscopic little pieces of energy into the skin.

(01:23): So actually forced did you buy to build some collagen? So collagen is actually what gives us our usefulness helps tone. Our skin helps from our skin and as we age collagen breaks down over time. So we lose the strength and the Alaska, the Alaska city to our skin, which leads to the visible signs of aging. And you can see on the bottom of the structure as the structure, the much tighter, which gives us a much smoother. Look, I, as we get older is that time is kind of seems to loosen and we get looser skin and we get Jolene and more wrinkles. So here’s the signs of aging skin. Dr. Pershant can tell us how our skin ages over time.

(02:20): Sure. So this is actually a great schematic. If you take a look from left to right left being that younger appearance, you can see her brows are in a great position that they’re a little bit higher up above the bone over here. You can see this very little wrinkling, even around the mouth as well. You don’t really see as many folds. And as, as you move kind of over to the image on the right, you can really see the difference. You can start developing those wrinkles on your forehead, in between your eyes, even the eyelids themselves, they look like they have excess skin on them. They’re a little bit lower on the face. You start getting a little bit of what we call that tear trough deformity as, and just overall, what you can notice is that the fat that was up here in the cheap region or what we call the mailer region has slowly descended over time. And you can really see the same thing in the neck as well. Where before on the left, it’s very smooth. You can see the perfect contour, and now you can see what we call those loose skin and a little bit of partism banding going on.

(03:24): So a therapy helps lift the skin by building collagen. It’s the first FDA cleared test off of lift the skin around the neck, the chin and the brows. And it helps to improve the appearance of fine lines and the DECA title that the day is a big area. It’s a whole lot of people, a lot of people assigned to the fields when they sleep on their side, they pick up their shots and they get a lot of little fine lines on there. That area, well therapy is one of the few treatments that helps soften those lines.

(03:58): So therapy has been around for quite a number of years. It uses some ultrasound technology and it’s the treatment is customized, so we can actually scan the face and we can see what depth we’ll have going to. And we’ll more treats you don’t want to go. We don’t want to treat to far. We don’t want to get the bone, but want to kind of go above it. And I’m going to show you in the scan later what we are looking at under the skin and what we are treating and why are we treating it? So the, the treatment is a customizable treatment. We have, if done correctly, we have a 95% patient satisfaction rate. You have to following one year after the treatment.

(04:49): So this is one way to help tie in skin without surgery when you combine certain lasers and also then you go, you’ll see what is, what we can see under the skin. So we kind of, we do the scan and the ultrasound was very, very safe, was done doing in Sydney. And just to see, to visualize where, how everything is under the skin, where we’re targeting. So we’re looking at the areas that we want to map, and there’s different transducers that we put onto the handpiece that go deeper or more superficial, depending on what we want to target. So we want to pinpoint the collagen in which layers, and once you hit those layers, it actually helps to build more collagen by treating the collagen.

(05:49): So now I’m going to show you once we get to the all therapy machine, you’ll see that you can actually see where smashes of the subcutaneous tissue have all the lights and little, little areas. The little white dots is the collagen, which fibers, and that’s what we want to treat. How does all therapy work? So there’s many different modalities down and classic shows in the office. The first being that there’s a facelift, a face liftthat is, is really great for people who are older, they have extra skin that they want to tighten, don’t you agree?

(06:39): Yeah, exactly. I think, I think it’s for someone that may, even if you tried to use something else, they really just ultimately to remove that excess skin, and it’s not going to snap back just with conservative types of treatment. But I mean, to go into what Louisa was talking about, if you have some laxity, but not a ton of excess skin, all therapy really is an amazing option. I mean, I’ve even had it done on myself as well. And I really wanted some more contour around my jaw line. Cause I noticed over the years, it just got a little bit lax there and it really almost, I like to think of it as it, it almost like shrink, wraps your skin around it and really give you more depth And route your neck line face, and even upper forehead Broward region.

(07:22): We also have to discuss that, that a surgical facelift doesn’t, although it does pull back the skin, it doesn’t treat the actual skin that’s left. So if you have paper thin skin, you have to plastic surgery after a space, we still have, we still have paper. This paper.

(07:38): Exactly. It doesn’t, it doesn’t change the quality of this.

(07:41): So we want to think about changing the quality. We want to make sure that we have always have thicker skin, more collagen, which skin more or less diversity in our skin. So, so many other modalities like lasers would, you can see they go through different depths and each of those modalities work to target something different. But when you look at on the screen, you look at how deep the ultrasound is actually goes just as deep as a surgical facelift without the surgery. It just helps to target those areas. And it helps to like just lift everything up.

(08:22): So as we said earlier, we have different hand pieces or pieces that go into the hand piece to target the different depths of the skin. So we scan the face and everyone’s different. So it’s not just a stamp for everybody. We scan the whole face. Then when we see where we need more collagen, what transducers we would need for your specific skin and for errors. So the neck would be different than in the safety. The Brown would be different than, than the Debra really scared. So this gives us an ability to scan the priority areas that we want to treat and put customized to your plan together for each individual.

(09:12): So now you, you are actually seeing a difference in takes about three months to see the complete difference three to six months. But it takes some time. So it’s not like a one and done. It’s not like you come in and you get filled and you see immediate results. This is completely different. Yes, you do the treatment. You’ll have a little bit of swelling at the end, but not really noticeable, but you’ll see an immediate improvement, but then over time it’ll just gets tighter and tighter. So if you learned that the woman on the top you’ll see some early lapsing. So that’s a young person to have very little bit of looseness, but you’ll see the difference in how much improvement that you get with each type of patient. As you get older, you’re going to need a little bit more tightening. So when you’re older and you have more not going to get as tight as somebody who is in their thirties when they do the treatment.

(10:18): Yeah, exactly. I think that that bottom picture really kind of shows it best. You can see, she did definitely got much better contour specifically at her neck line over here, as well as your jaw line. But she probably would benefit from maybe a couple of treatments often and a combination of tailor-made treatments to her skin quality.

(10:37): Yeah. Which has what he started is tailor-made. So everything that we do here is tailored to the person. So it’s the person pull on the lower half of the screen would come in and it will probably suggest a combination of treatments, not just the whole therapy.

(10:55): Yeah. I agree. I think, I think that’s exactly the, you know, like, like Lisa said, it’s not just one stamp fits every type of patient you have to do what we’ll, we’ll always offer you what we think will get you the absolute best result and over however many treatments to get you there.

(11:15): Okay. So we treat different face different parts of the, the face. So we could do a Brown list submental area we do the deck latte. And so I was saying, it just customize the treatment for the person.

(11:36): And here you can actually see, this is the before and after Brown, they really gives you a, a more youthful appearance in the sense that you can see even you could see it a lot more, let’s say in that top left picture, but the before and after you can see, she has much more upper eyelid show. So you don’t look as tired. It gives you an overall younger look. It brings your brow essentially back to where it wanted to be 10 years prior, which really, really does affect the dynamic of the face overall.

(12:12): And then this is, this is kind of what we had mentioned before too. You can see the angle from the chin to the neck line before and after it’s much deeper, which is a good thing. You want to see that the skin has shrink, wrapped around that. And that gives you a much better contour of the doll line. Definitely. If you look in that bottom left picture, you can see it was really that skin was her main skin laxity was remained issue, even though it looked like she may have had some fat on her there just with the old therapy treatment, she looks much thinner and much more improved proving that sometimes it’s, it looks like it’s fat, although it really, sometimes it’s just some skin that needs to be created.

(12:51): You also have to keep in mind that when you have a lot of Texas fat, this may not be the best option for you, but this helps tighten this around. And if you’re looking for something non-surgical, this is a perfect adjunct to the treatment. We can also do the depth of Marriott lines, Marriott lines. So the marionette lines can you see me? Yes, yes. So the marionette line, when you lift the face, the marionette lines, I think are the most difficult areas to get to. So it does lift a little bit, but sometimes you need a little bit of volume there, but you need it. You may need something, something else.

(13:51): Yeah. I agree. I think this is, this is where you know, combination treatments really work well. You know, sometimes you can use a filler at the same time, whether it be a hyaluronic acid, whether it’s fat injections and the combination is what you really is the most important part. So it’s, it’s a skin tightening that might be needed, plus an almost like, think of it like a skin plumping type procedure to, to fill in that deficit that’s developed over time.

(14:22): Okay. so, so the achievement, so we give you a little bit of a title for the treatment. Some people, we need somebody a little stronger for the treatment. We generally like to give our patients a combination of to cocktail. And we like, it’s like a purpose and a value, or sometimes we give them like an M kale that’s in the dazzling, Kevin, and then what, okay. So it helps to, so something to help you relax in something to the pain and something for the anxiety so that you don’t feel it as much. So most of the area is not painful. I think that the Jawbone closer to the bone is where you have a little more heat, you’ll feel more heat than anything. But the rest of it is not as bad. It’s really not as bad. And we try and go to it as quickly as possible and try and kind of move it around. So, so you’re not doing that, that constant heat in that one spot.

(15:30): Yeah. so what do you expect to the treated? We we do a medical concern one and we clean the areas and do some before and after pictures. And then we discussed the areas that really, really bother you. So then we can customize it for you. Hi area. And and then I, for my, in my own hair, I kind of calculate the lines for you, even though there’s already a, a basic there, I can kind of tailor it for you. So we would them to deliver the energy in the areas that we need.

(16:11): So after the tree, what do you expect? So, Y after the treatment, you’re going to throw a little bit of soreness, I would say day two, but it’s really, it almost feels like you have a bruise, but when you look at your face, you don’t see anything. You may have a little bit of redness for an hour or so. But otherwise you can go back to normal activity without having any, any side effects or we will tell you though, if somebody is on a lot of blood thinners, you may get a little bit of you may get a bruise because of that heat, that’s going in the dermis area. So you may get a little goose, but for the most part, there is no, you won’t see anything. You can go right back to your regular activity. Okay. And would you follow up back 90 days later to see the problems?

(17:10): So potential side effects. And, and just to go over again, like I had this and honestly I had nothing afterwards, no one knew I even had it done in terms of immediately after the procedure. You couldn’t tell, looking at me that there was anything done for my face, and I absolutely loved the results. But we have had people and everyone’s very different. People have said that they noticed a little, almost like rawness of the skin. So they’ll see, it appears a little red, a little flushed that usually goes away on the same day. You know, I, if I had it, I don’t remember having it because it was gone by the time I had left the office. And then the swelling that you actually experienced, I did have a little bit of swelling, but not in the sense that you could tell I was swollen.

(17:57): It actually just looked like my skin was much tighter afterwards and it actually looked good. I actually kinda liked the way I looked. Immediately after the procedure. It’s not like another procedure where you would actually see this large amount of the spine. We’re talking about minimum amount. It just makes you look a little fuller and then it goes away within one to two days. In terms of one thing that we haven’t really mentioned is really what is great about it is there are no scars associated with this. There’s no cuts made on the skin. This is all done. Transcutaneous, there’s nothing that, that will happen from the machine itself, which really is the most beneficial part of it in my mind is that it’s really, if you don’t want any type of scar, this is a way to get a scarless lift and really the best way to do that. And then, like Louisa said, once in a while, you can get a little bruising here and there and you can, you can feel pain for a day or so, but it really, really is very, very minimal. I would say a one out of 10 and then, you know, by day two, day three, you don’t even feel anything anymore. And you wouldn’t even remember that you had it done. So it really is amazing.

(19:03): I also want to talk about how long, how long the treatments last. So when you’re doing it, you need younger when you’re doing it. We, you have more collagen when you break up collagen and it actually makes more collagen. Whereas if you’re older you need to break more collagen to divide and make more. So when you’re older, not that it doesn’t last as long, you may need to do an additional treatment, but generally lasts about two years. I want to say two years, but if you’re like I did my mom and at the time she was in her late seventies or late sixties, I’m sorry. And she, I felt like we needed to do a booster like in six months, but I did it three times already over the course of 10 years. The first time I did it I think I did it one, it lasted probably about three years. And then I didn’t, I, the second time I did it just in my, my brows. So I think it lasts a lot longer when you’re doing it. When you don’t have as much laxity, I feel like the more waxy somebody has you may need to do them a little closer apart or closer together, or just to a booster in about six months.

(20:31): So there’s no, we don’t have to. There’s nothing that you have to prepare for when you come in for therapy there’s no pre or post treatment required. Well, I do recommend always to put sunscreen on and to use a retinol on a regular basis to help maintain the results. And you left, you noticed a difference in about 90 to 180 days.

(20:58): I was gonna say before we move on to, and I just want to circle back to something Lewis has said, which I think is really important. You know, the thing when it comes to skincare and skin tightening and lotions and all of those kinds of things, I’m not talking about all types of skincare is you want to stay ahead of aging. You don’t want to have to play catch up. And that’s to her point where when you have that skin, that’s rich with collagen and can react the best to whatever you’re doing to it. That’s the best way to prevent wrinkling and aging and everything like that. Don’t wait until you start noticing major changes to try and now combated, I think that’s the best way to stay out of it.

(21:38): Absolutely. We also got several questions about therapy, so maybe you can show them now questions. Absolutely. So if you use this treatment, how is it a fact that when you have that work done? So the question is when you’re getting this treatment, how, how effective no, like how is it going to affect that when you get some dental work done? Is it, I mean, if you getting some dental work where you have an actual active infection, obviously I wouldn’t do the treatment. I’d like, I’d like to get by it to heal because any of the treatments that we do in this office, we were causing a micro womb. So forcing your body to use its immune system to help build up and to help heal. So if your body is really in pain, or if you have some issues going out in your mouth or anywhere else in the body, I wait for that to really, I think also you won’t be able to, I think you’ll feel pain more also if, if you’ve gone through some, some dental work outside, wait until after it’s done personally.

(22:49): Yeah. And if the question is also, you know, can you get it done? If you’ve had dental work, you 100% can, that’s not a problem. It’s just, we don’t want you to have that active dental work happening. If it’s something that happened six months before, let’s say you got a cavity filled or something, that’s perfectly fine. It’s safe with the author.

(23:09): Can I use old therapy to have a more defined jawline? Absolutely. You can. And that’s exactly what it’s for it’s to help it’s, to help define the Jorn and helps to tighten that skin around it. And we actually, when we do the, the scan we ask, you see where the bone is, so we try and we try and treat around it so that we do get that tiny. How much does it cause lots of people ask about the pricing. So each area is broken down into a separate category. So I would say the browse, if you will, we just want to do the Brown. We charge 1100 and we treat the browse. Then on the walls with that, the mixtape is really just the cheeks and the some mental area. And they see, Oh, the cheeks in the submental area. And that is 3000. And then the full face is 4,500. We can also do the lips. The lips itself is 450. If we’re doing the Debra Tate is 2,500. And at the, just doing the some mental area, which I wouldn’t recommend just doing the supplemental heavier along because the, the muscles from the submental area and the cheeks are kind of attached. So you want to do that together. So if I do do a submittal area, it would just be full touch

(24:44): Is it at one time treatment could usually is a one-time treatment. As I said in my mother, when I did have I think I should have done a booster shot on her and do it six months later. So yes it is. Okay. Does it help with things?

(25:10): Sorry, we’re going to check that. We just got another question. Just give us one second.

(25:24): Oh, three normal veins. No, it doesn’t. It doesn’t help with the preapproval things, but it does help with the, the fine lines around the highs. How long the pregnancy can you do it? I would get a clearance from the doctor. But I would, I would imagine if you’re breastfeeding, can you do it?

(25:50): Well, we try to say for anything like that, it’s probably safe, but we always like to make sure that you don’t have anything else is okay. Probably going on in breastfeeding is pretty taxing on the body and itself. So in general, we want to just make sure to hold off on stuff like that.

(26:09): So if you had a, more of the escape treatment, how long should I wait until receiving all therapy? So the Morpheus eight treatment is a radio frequency microneedling device and actually dissolve. So I would wait about three months to see if that she needed the treatment because you’re going to get some, you’re going to get some sort of tablet dissolve. And you’re also going to get some tiny with, with the Morpheus. The only thing with the Morpheus eight, you really don’t do the cheek area. So you need some tightening in that area more than the some mental area in three months, probably about three months.

(26:51): Then there’s the question about nano fat injections. And you know, what I would say is very similar to how soon can you use all therapy after nano fat injections and that’s any fat grafting to the face. And I think you want to weight the same thing that Louisa was saying, wait, wait, three, four months. You want to see what part of the fat survives and how it takes and how everything looks before you tried doing anything else. You want to let things settle in. You’re going to be swollen. And then once everything kind of settles in, she’ll be able to tailor the all therapy treatment to you, as opposed to kind of guessing what it’s gonna look like after the swelling.

(27:29): Yeah. I wasn’t like to see I’d like to do the therapy before, cause you’re going to get some tightening already. And you want to see how much timing you get and help the surgeon to see how much family needs for that is a jewel. I consider its own area or part of the law it’s considered a part of the, the mid-face. Yes.

(28:01): And then I think there was one question about Xiamen. Let’s see where that lens is. Xeomin included in the now the show, I, if the question is, is it part of the treatment for all therapy, if we do them as separate? Exactly. But we do have a special currently that’s combining the two and I’m going to kind of dive into the whole Xiamen and talk in a second. If there aren’t any other question

(28:29): The under our area too. Yes, we do the underline area. So for the brows, we do the upper brow, the pros feet underneath. So you get the whole, the full cover of this for that treatment does a full face create, does a full face, creates more phase contract after all? Yes it does. But like you said, it really is customized. So when you come in, we’ll see where you need a little bit more contouring and more timing. So let’s just keep in mind that all therapy does not give you volume. So it’s not going to give you volume where you have lost a volume. This just helps tighten the skin. And it helps with craziness. Some people need more volume. So I can you talk about,

(29:28): Yeah, exactly. And I think this applies to any facial rejuvenation procedures that we do, whether it be all therapy, whether it be a basis, regardless of the skin tightening and the deeper tightening, like Louisa said, some people just require fats or fillers or whatever junk do you want to use to try and help fill those areas. It’ll look much smoother, which is great. And it’ll make the filling part look much better for example. So if the skin looks better and then we feel it will give you a better result overall, as opposed to trying to fill something that’s not as taught, we would have to use a lot more filler or fat to get that similar type of response. I think that’s it. I think that’s it. So zoom. And so this is a bottom line toxin that we use. And whenever we’re talking about botulinum toxins specifically to the forehead eyebrows in between the eyebrows, the main thing to keep in mind is that this is meant for paralysis of muscles. So this is meant for deeper wrinkles that you notice when you’re making different facial expressions. For example, when you’re frowning, when you’re raising your brow and things along those or smiling, for example that’s forward.

(31:03): You know, and, and this is really where ZMA is so versatile for one, it’s an excellent thing to use with all therapy because they work synergistically, right? You want to tighten that skin and you also want to address the muscle. And this is, has to do with that whole filler phenomenon too, where don’t just look at it as one or the other, look about, look at it. How can I get the best result with a combination of things to really get you to the look you’re looking for? And if you look at this picture, we really could use it for so many different things, whether it be poor headlines, those angry lines, or Eleven’s between your eyebrows, use it as a brow with is absolutely amazing. When you smile. So you’ve got those crow’s feet around your eyes is an excellent source of it. And then kind of a little bit more, less commonly because you don’t see it as often, but for people that tend to have what we call a gummy smile, when they smile and you see a lot of their upper gums you can actually inject Botox in the right area that will bring that lip down and really give you an aesthetically pleasing smile. And then once in a while, we’ll use it also in the chin area. If you have a hyperdynamic tell muscle over there as well.

(32:30): So moving forward what makes it unique? And this is really, Oh, sorry.

(32:40): This is really the what makes even is that it really doesn’t have any excess protein. So you can really tell the difference in the other box line. And this doesn’t mean refrigerated because it doesn’t really have those projections, the less you put into your body, the less locally your body is going to try and break down the problem, an object, as opposed to seeing it as a natural object. And the theoretical advantage is that it will last longer than the other ones as a result of that. And, and, you know, I, we definitely have had patients that have used other forms of botulinum toxin that were really just not getting responses anymore. For whatever reason, they have been using it for years. And they transitioned over to Xeomin and the same amount of units, and they had the same better results than they had with the other version. So I think this is where that tailoring also comes in handy. You have to use what works best for you. And a lot of people have transitioned over because they felt that that worked the best for them, and also lasted them

(33:50): The longest for them. And then finally,

(33:54): Which again, this applies to that whole protein thing I was mentioning is that you’re less likely to get any type of reaction as a result of it, because again, this is less for your body to address or acknowledge foreign material, next slide. Okay.

(34:13): All right. Well, you know, we wanted to thank you guys for joining us and thank you for asking questions. We’re going to show you our lovely model. I’m going to show you how we do it.

(34:24): Yep. And then Let’s see. Does anyone have any questions about zoom in specifically?

(34:34): Yeah. So is a great option for a master Botox and really for those of you that don’t, it’s right on your jawline and it really has multiple advantages. One, it will slim your face over time. So it’ll give you a more defined jawline because if you have a little bulkiness of that muscle there over time, it shrinks and it really allows you to see that jawline beautifully. The other thing it works really well for, for that same injection is if you grind your teeth at night, if you really clench, you know, a lot of people that’s historically what we’ve used it for, and it gets rid of that pain you have, when you feel, when you grind your teeth at night, and people have told us that they also don’t feel the headaches that they wake up with that art.

(35:19): Can you talk about how often you need to do the treatments?

(35:21): That’s a great question. So everyone’s different. In general, I like to tell everyone, the more often you come in or the sooner you come in, the better we’ll be able to control your results. Now that could be anywhere from three to six months, usually depending on what part of the face and how

(35:38): Quickly your body breaks it down on average, I’m going to say that it’s about that four or five month Mark. We tend to see people coming back because it’s not that they immediately have all of their muscles moving again, but they start noticing some expression and it’s better to just knock it out right there, and then to really maintain the overall result that you want.

(36:01): We had a question about the difference in price between Botox and Xeomin. So Xeomin is a little bit less expensive than the Botox. I think for Dr. Tehrani it’s $20 per unit for a Botox and for Xeomin don’t really quote me on this, but I think it’s, it’s like $15 a unit. So I put it it’s, it is less expensive. But then we get an additional 20% less, our nurse injector does it as an introductory. Dr. Keshaun would be doing it to at the 20% discount.

(36:43): And well, you got asked to get up for teeth grinding just in case you missed it. Yes. 100%. And it works amazing for that. It works the same way that Botox works, where it it’s really, really a phenomenal option for that. I really think people get amazing results out of that.

(36:59): Thank you. All right. So we’re going to show you how we’re going to show Dr. Chuck doing a Xeomin treatment.

(37:47): Yeah. At work and texting, a lot of you have probably if you’ve ever come into our office and Joe has graciously decided to pull out to be our model. So I’m going to show you guys exactly. I’m going to Mark her in her forehead. So you see exactly what we’re targeting. So Joe, before we start, can they see us now? So you always want to talk about this. I want her to make an angry face, that match. So you can see she’s got these dilemmas, Erica, you can relax. So I’m going to Mark those so I know I’m going and now raise for me as well. You can see she has these lines here too. Not too bad, actually. Especially a week. They expect even more. She seems to be very relaxed, happy. And what we’re going to do is you could see, she actually has nice contour to her.

(38:47): I’m going to just let this look. So these injections we’ll let the high ground here just very subtle. And this injection, you actually have a muscle that comes around the eye reaches all the way up here. I want to do is by paralyzing in that it prevents that muscle or the orbicularis from depressing, the eyebrow. And it actually that’s where you get your butt. And this is what we were talking about doing that injection is what’s going to get you that lift in conjunction with the all therapy treatment. Now, what I’m going to do is I’m going to have her lay down because I’ve already markers. She gets to relax now.

(39:30): And we absolutely use the tiniest, tiniest needle we could ever use Just a little pretreatment here just to clean the skin. Just very

(39:55): [Inaudible].

(40:05): And in general, we like to inject about, you know, anywhere from 2.5 to 7.5 per injection, to really make sure we get those muscles and paralyze them and still have that natural look, but make sure that they don’t move it.

(41:03): So I’m most upset for a couple of minutes. Tell the patients to move. I’ll make those frown lines happy just to keep those muscles moving for the first power after Botox or Xeomin injection the product to get into that muscle a little bit. Give me another angry.

(41:34): And because she has a little bit of a stronger that’s perfect. I’m going to just stick her a little bit more here. And I always save some for the end there just for that reason. That’s it? No bruising. You can go out today. No heavy lifting or exercise. We usually say until tomorrow, how would that

(41:55): Very nice and clinical, do you want to show the therapy machine? Yeah. So let me show you the Ultherapy here. So that’s the lower on. Okay. So what you’ll see here is this whites, the lashing, this light is the right there. You see that is the bone. Then you can talk where, where, where we’re targeting. So we want to avoid the bone so we can see how deep we’re going. So we have three times at different modes. If you don’t want to go any deeper, because you’re going to hit that goal. So that’s what we say. We try to customize the you’ve been for the person Ms. Scan. We scan the week, we’re scanning the, the bone and we’re looking to see how deep we want to go. So we put different transducers in it to target this area without hitting that balls.

(43:12): Okay. So I guess, does anybody have any questions you can type it in? Do you use it? No, you don’t. We don’t use a topical anesthetic. Generally the treatment focuses under the skin, so you’re not going to steal it on the surface of the skin. So I feel that using a topical numbing is useless really. So that’s why I would give you a practice, no value for the treatment to make you more comfortable. What about injectables? The injectables? We definitely do a topical therapy. I will dissolve that. So we had a few questions about this in the past. So he does dissolve sending on how deep we’re going. We minimize the amount of lines that we put into what area for somebody who is thinner for somebody who has a little bit more of a heaviness, we tend to put a few more lines in there too. Patchy generate a little bit more heat. So it actually helps the title of better to it. Doesn’t dissolve. A lot of it can make a lot of tiny bits. But it’s really not made that,

(44:33): But generally for somebody who’s that they’re going to need less lines to do that at all. That’s it. Okay. Thank you so much for joining us for those who want to participate in our raffle. Can you please send us your full name and we’ll pick you randomly right now? Yes, of course. And while you do it we want to mention them that right now we have a special going on. It’s a brow lift. It’s a 30%, less than usual. It’s 1100 was ample with therapy. So we’ll give you several minutes to submit all your we’re going to assign a number to every name that was submitted. And then we’ll use the random number generator to pick a winner and we’ll show it to you.

(46:06): Okay. okay. Anyone else? Anyone else? That’s cool. How can I submit a name? So yes, now we are going to assign a number to everybody. Hi, excuse me. Go ahead. How can I submit my name? Can you just type it in the chat? There’s a chat form, type it in. Okay. What’s your name? What’s your name? Ellen. Austin. Okay. All right, we’ll put you back. Oh, okay. So right now we have seven, eight, nine, 10, 11, 12, 14. And now I’m going to share now the camera using a random number generator. We’ll show you from one 13. You’ll have to deliver number two, number two, follow [inaudible] congratulations, please. Contact our office. Get your prize. I was speaking to you yesterday. All for Johnny. Have a wonderful day. Bye.

smiling young woman standing in the snow