The revolutionary Spectra FX Laser with Dr. James Wang

Trina Renea  0:07  
Hey everyone, welcome back to facially conscious with myself Trina Renea esthetician, Dr. Vicki Rapaport, dermatologist, Rebecca Gadberry, the cosmetic ingredient guru and our fabulous overly educated consumer, Julie Falls. We are gathered here together with you to talk about this crazy world of aesthetics. It's confusing out there in this big wide world. That's why we're here to help explain it to you all subject by subject. We will be your go to girls and from our perspective without giving medical advice, we will keep things Facially Conscious. Let's get started.

Hello, and welcome back to facially conscious I am Trina your dedicated esthetician, and I'm here with the extraordinary co hosts and our amazing laser specialist Dr. James Wang from Metropolis Dermatology Trifecta now. So hello, everybody. We're going to talk about a laser today. It's called Total Skin Laser. And we're also going to talk about one other little tiny laser thing. But I'll get to that in just a minute. How's everybody doing today? Hi Dr. Wang,

Dr. James Wang  1:42  
Good to be back. Hi. Good to be back.

Trina Renea  1:45  
Thank you. And you are you every time we see you, you know more and more and more and more about lasers. You travel around the world. You talk to many dermatologists about lasers, you learn new things. It's pretty fascinating. And so I'm excited to hear about the total skin laser today. But first I wanted to say, on an episode a while back for all you listeners, you can go listen to the Hollywood Spectra episode, they came out with a new handpiece called the MDF. And it's it's to treat what Dr. Wang what is the new handpiece for

Dr. James Wang  2:25  
 it's used to treat a couple different things but it is predominantly we use it to treat difficult to treat acne scars indented scars as well as pores.

Trina Renea  2:38  
Okay, so indented scars. So. So the divots in the skin

Dr. James Wang  2:44  
divots, the rolling scars, the difficult ones where it's not really responsive to many other treatment types. Certainly the ones that don't respond to resurfacing, that's when we use it the most, and

Trina Renea  2:56  
does it leave a scab in the area

Dr. James Wang  2:59  
 it can it can it depends on how we treated. So just as a background. So this is a this is a handpiece that was FDA approved this year to go with the Hollywood spectra laser, which we use for pigmentation. But this is actually a completely different use of the device. So the the wave of the 1064 you can use on 532 as well. And but we use 1064 as the wavelength. And what it does is it takes the beam and it makes it even tinier but in a grid pattern. And so each beam is much more powerful as the it's concentrated in these microbeams and focuses at a very specific level on the skin so that the cool thing is we can actually control where it will treat the skin. So we wanted to treat the skin two millimeters below the surface. That's what we do. IF we want to treat it at the surface, we can do that as well. So there's a way for us to control the depth of the damage that we want to do to treat the actually have it grow lots of collagen, and we find that this is a unique way to lift up those stubborn scars because it forms a little mesh work of micro injured skin. And so we've been using a lot to build into our acne scar treatment routine. But just want to say like this, this hand piece was actually developed to treat pores, and we actually we know how difficult it is to treat pores I used to think there's nothing to do for a pore and it sounds like sacrilege because everyone wants to treat their pores right? But most of the things that we do are very temporary and they just cause swelling to make the pores look smaller, or people just fill them in with cosmetics or skincare right so even though you may think your pores are smaller, they just look smaller, which is why now when you go buy a product, they'll say reduces the appearance of pores and and never says reduces pores. Right, right. And so this laser actually can reduce the size of pores.

it shrinks the skin?

it, it causes so much collagen to grow around the hair follicles that it squeezes the hair follicle opening. And that is actually the only way to decrease the size of the pore. or the hair follicle. 

Trina Renea  5:26  
 Because yeah, there's a lot of people who want to shrink their, their pore size. So, so you've been seeing good success with that shrinking the pore size

Dr. James Wang  5:35  
The initial study that they did for the FDA, the white paper was indeed on objectively measured pore size, they did see shrinking of the pores.

Rebecca Gadberry  5:47  
could I say something here is the resident cosmetic scientists and regulatory expert. If a cosmetic made a claim of shrinking pores, it would be a drug. So we say shrinks the appearance of pores, because anything that changes the skin visually is a cosmetic, anything that changes the skin below the surface or below the epidermis is a drug. So like you're saying, we have to change below the surface. And there's a lot of products that do that. But if we told the consumer, that's what we were doing, we would be a drug that selling without being in the parameters of a drug product with FDA. That's why we say it. And that is a common area of confusion with doctors, they think that we go, we couch our claims because the product isn't really working. It actually is working. But FDA doesn't let us tell you that it is working in the 

Trina Renea  6:45  
that damn FDA. 

Rebecca Gadberry  6:46  
I know. I just want to make that clear. products have come a long way. Yeah. And I've seen products, I've developed products that do have do physically shrink the pore are not, I'm not gonna tell you which products they are. So I'm not related to products. So I am still within the FDA requirements. But I just wanted to let you know that. Okay. Yes.

Dr. James Wang  7:10  
And I think I think I think that is the point that's well taken, I thank you for that that's actually really helpful. I think I think the what I'm saying kind of wood products is that, if not that product, over time can help increase collagen around pores and make them smaller, I think people use tons of different types of retinols. And things to do that. This is the first device that can actually do it effectively. And you know, in the products, skincare has so many different categories, as you know, a lot of times the over the counter categories that things aren't doing too much for the pores is like, oh, three days my pore looks a lot better. Those types of changes are the ones that really aren't really altering the biology of the pores. Those are truly just the ones that cover them.

Trina Renea  7:54  
So if people are out there, and they're looking for this treatment, what do they call it? Or how do they look it up in their area to see if somebody has it?

Dr. James Wang  8:01  
It's relatively new. So I'm actually not 100% sure how many providers around the country have this device although I've spoken to many maybe like five or six people at this meeting that have it and so they are really excited and using it to treat scars. But we are one of the first clinics in the country to have it. So we've been we've been using it now for a little bit less than a year and it's been kind of a workhorse for a lot of these things. So I think the best way to do it is actually to reach out to your skincare provider whoever that may be and just mentioned like oh do you have a Hollywood Spectra and if they do, ask them if they have the MDF handpiece i for short. I say fractional handpiece because that's what it's doing. But MDF is the official name of the handpiece and that's stands for multi depth focal handpiece 

Trina Renea  9:01  
Okay, great.

Rebecca Gadberry  9:02  
I hope you have your your pen and paper out there to write that down. 

Trina Renea  9:09  
 they can read listen to the episode.

Rebecca Gadberry  9:12  
Or just go back a second.

Trina Renea  9:15  
Yeah. Okay. So then let's get on to this Total Skincare Laser. What is that? So total skin. I mean, yeah,

Dr. James Wang  9:25  
total skin. It's actually called Total Skin Solutions. It's actually a combination of two lasers. Right. So we've actually talked about these lasers in the past, which is the Lutronic Ultra, and then the Genius RF microneedling. With new data that allows us to combine those two treatments on the same day, which is a big benefit to patients not only in terms of convenience, but also with enhanced efficacy and decrease downtime. And the biggest questions I get the most are and just move on to production first. So Genius is a radio frequency micro needling device, which they're insulated needles, they go into the skin, and it releases radiofrequency energy in the dermis. Okay. And the insulated needle tips protect the epidermis from heat. And that decreases the risk of hyperpigmentation. So you're able to generate these cones or zones of coagulation in the dermis, and that helps you volumize the dermis. Ultra is a 1927 nanometer mild resurfacing, that can really shake the epidermis kind of just allow that epidermis to be opened up a little bit with some mild collagen regeneration in the papillary dermis at first, you know, between 100 to 200 micron area of the skin right underneath the epidermis that it's trying to treat. So the reason you can safely combine them as because they are treating different parts of the skin,

Trina Renea  10:57  
ones down in the dermis and the other ones in the epidermis.

Correct. So it's called Total skin, it's really total thickness skin treatment. Right. So that's really wonderful because people are scared about one laser think, oh my gosh, are you doing to laser on the same day. But there is a scientific reason behind why that can be done safely. And because the Ultra is actually very 1927 is a very, very good wavelength for pigmentation. That combination is safe. In fact, the combinations are safer than doing them alone. It's not that they're dangerous anyway. But our microneedling has a lot of heat under the skin. And people who've done RF microneedling by itself versus this total Skin Solutions find that the downtime is actually less when they add the ultra on which is counterintuitive. And we think that's because there is usually a little bit additional energy that stays around that pocket of coagulation in the dermis. And so the little breaks of epidermis allow the excess heat to escape faster, and decreases the inflammation that ensues. At least the inflammation you don't want to have at that particular moment. Ultimately, it's the inflammation that generates the collagen. So you actually do want to be red, for some amount of time, you do want to have a little bit of downtime to the procedures that you do regularly.

So if you do do the Total Skin, what types of skin can do it? every fitzpatrick from one to six,

Dr. James Wang  12:30  
we've done every skin type on this. Now not at the same energy level, right? Certainly skin type five and six, we have to dial it way down and also requires more counseling and understanding that results may be slower because we cannot go as high per session

Trina Renea  12:50  
and this is for resurfacing and pigmentation at the same time? I'm sorry, I mean resurfacing collagen building under the skin and it works on pigmentation?

Dr. James Wang  13:03  
Correct, the Ultra is a laser that does a little bit of everything the chroma forum, 1927, Just like co2 is water. So it basically physically destroys the tissue that it hits. And so it doesn't matter if theres pigment in the tissue are not yet resurfacing because that'll hit all your skin. But if there happens to be pigment there and also destroys it as almost like collateral damage but it's actually a positive thing that you're doing.

Trina Renea  13:28  
And so what is the downtime on this one, the real down. 

Dr. James Wang  13:34  
So the downtime is is mild so you get this two days on average of pink on the skin and then within two days usually it's completely the color is normal. The issue is that that ultra step causes there to be a sandpapery texture on the skin for up to two weeks. Which is usually not visible once you're looking really close about the skin but you kind of feel it so tell people if you like feel gritty for up to two weeks but then once that grit comes off the skin is really nice and smooth

Trina Renea  14:06  
and does it hurt so anything that causes grit must hurt it

Dr. James Wang  14:11  
actually the the ultra actually is very it's very gentle and it does not hurt very much. The the part that hurts the most is actually the first component which is the Genius RF microneedling and RF microneedling by itself as a technology it needs to be uncomfortable. Anything that bulk heats the skin right, the things that do that ultherapy, thermage, like all these things hurt us we heat the dermis, the nerves sit there and nerves do not like to be heated in any way. So if you're heating the dermis, it's got to hurt. I owned RF microneedling devices before that did not hurt but they also did not work. Right and so there are things that we can do to mitigate the discomfort. We have a Zimmer chiller that people hold on to we have a little Squeezy ball we have an hour topical numbing We have laughing gas.

Trina Renea  15:01  
Dr. Vicki you have all of that too right? You have the Morpheus. 

Dr. Vicki Rapaport  15:06  
 I don't have the Zimmer, but the cooling. But yes, of course we numb them and we squeeze that squeeze ball them. Pro-Nox laughing gas. 

Trina Renea  15:16  
do they get little shoulder massages.

Dr. Vicki Rapaport  15:18  
Can you come and do that?

Rebecca Gadberry  15:19  
do you have somebody stand there and wipe their tears. 

Dr. Vicki Rapaport  15:24  
Yes.

Rebecca Gadberry  15:25  
Oh, good. I like that part

Dr. James Wang  15:29  
Yeah. So, so So yes, it is it is a, it's not something that we don't tell our patients beforehand, right? You don't want to surprise someone like, by the way this hurts like as they're on the table like this is something that goes into the initial counts, like you've understand that it's uncomfortable. But we can usually bring the pain down to about a four, a three to four out of 10 with the various factors that we do introduce for them during and prior to prior and during the procedure itself.

Trina Renea  15:56  
So So you first start with the RF microneedling and then you do the other Ultra. How long does that take? How long are they there for for that.

Dr. James Wang  16:06  
So our when we do Genius RF microneedling it takes, it takes me on average about 10 to 15 minutes. And then the Ultra itself is another 10 minutes or so. So the total procedure time is about 30 minutes. And the the numbing part takes about an hour. So I tell patients, they're in the in the clinic for about two hours total.

Dr. Vicki Rapaport  16:27  
But I thought you said once doctor when you wouldn't ever do a laser that took you more than 15 minutes to perform.

Dr. James Wang  16:33  
Its actually two lasers so i can do that

Trina Renea  16:42  
double laser in one day thing sounds like it might cost a lot of money. How much does it cost? Dr. Wang

Dr. James Wang  16:51  
it's it's as much as it would cost if you did them on different days.

Rebecca Gadberry  16:58  
It's not a cost. It's an investment.

Dr. James Wang  17:04  
look, people. And I believe this wholeheartedly. There are many things we spend money on that don't work. If something works, I think it's worthwhile, right? Because it sounds like it's safe and works. I do think it is investment. I mean, you can try to save money, but I always think you get what you pay for. And so it's like so cheap and a miracle was promised, you have to wonder why it's that cheap, because good things have to be made properly. And to be made and manufactured properly takes money and management and all this overhead. And so I'm a big believer in like the value of things. And in the end, I think if you can get a nice result on these things, it's worth it, it really is.

Trina Renea  17:53  
So you really liked this one, this combo, you're seeing great results,

Dr. James Wang  17:57  
really, it's actually our most popular procedure at our practice. So let's make the most of so. So these lasers will kind of range depending on again, your where you're getting it done, and what part of the country you are right. But in general, for Total Skin I've seen, you know, between $1,500 total to close to $3500 total, it will range.

Rebecca Gadberry  18:26  
Wow. Okay, and how often do you need to do it

Dr. James Wang  18:31  
depends on your training. So if you're trying to treat acne scars or kind of particular issues on the skin, then you may have to do maybe two rounds or three rounds. I always think you don't have to do Total Skin every single time. Right. So you can some people finish up with Total Skin for the overall improvement. Some people do Total Skin first and what's left over that they want to treat specifically then they use one or two modalities to treat those individual areas. And that's how costs can be much lower. We're not expecting people to be doing this over and over and over again, obviously at those price points. It's difficult for any of us to be able to do that on a regular basis. But it is a really nice once over where it could really try to just do a little bit of rejuvenation year to year. You do it once a year. Right once a year, maybe twice a year. But if you're trying to treat like an area of really bad scarring than short, you may want to do a couple rounds of RF microneedling finished off with a Total Skin to help polish up the surface. And that's how we usually use the device.

Trina Renea  19:36  
All right, well, that's great. Thank you so much for sharing the information that sounds like a really good investment on your skin. If you if if you want like a really good result. That does it right. That's a good you can guarantee almost a great result. People are happy.

Dr. James Wang  19:56  
Yeah, people you will always see something and you'll get this you'll get almost like this immediate change, or people feel the texture of the health of their skin has improved. And that happens between the two and four already because it shrinks the collagen that's already there. But what you're really trying to get with good RF microneedling with the surface as you're also getting the long term Neocollagenesis . And that happens starting in week six, and goes all the way to six months. And so you are in a long term rejuvenating effect, we also get this nice shorter term, like gratifying result and change in the way your skin glows and looks and feels pretty early on.

Trina Renea  20:32  
Okay. So if are both of these, like, what if you live in a city where like if you wanted to get this result of this Total Skin, but your doctor only has an RF microneedling and but somebody else in town has an Ultra? Like you could do them on separate days and still get the same great effect? Not in the same day?

Dr. James Wang  21:00  
Yes, I think you can. I think results really won't be dependent on how much the provider understands your skin, they can assess your skin. So of course the settings matter. And so sure, Genius RF microneedling can do a nice job by itself, Ultra can do a nice job by itself for the right things. And the combination of it, you can do it. So you can really do a split Total Skin, which which can work of course as well.

Trina Renea  21:31  
Okay. All right. Well, that sounds good. I think we're gonna let you go now. We keep holding on to you. We could just keep you all day.

Dr. James Wang  21:43  
Now. It's my it's my pleasure. This is all these are always helpful, and I love being on.

Trina Renea  21:51  
Well, thank you for for joining us, and I'm going to do a takeaway for today. My takeaway is that you should listen to our show about lasers. Listen before you go and get a laser in wherever you are. And a doctor tells you about a laser I would recommend taking a listen, if you're hearing this, you're probably listening. So go listen to our laser episodes before getting one and make sure it's right for you and go to somebody good. All right.

Rebecca Gadberry  22:22  
How do you find out if they're good?

Dr. Vicki Rapaport  22:23  
Ask Friends ask your friends. Also remember as Dr. Rivkin said in the earlier episode, people call his office from all over the country. And if he knows somebody in that, that state that you're calling from that he's either trained or he has a colleague, he'll give you those names. We do the same thing. I have people that I love in Florida, New York and so you could call Dr. Wang's office, if somebody lives in Indiana and see if he knows someone near you. And if he doesn't know somebody near you, he'll know somebody closer than maybe LA.

Trina Renea  22:54  
Right? It's really good. That's such a good, do you that Dr. Wang? Do you refer out to patients who live in other cities?

Dr. James Wang  23:01  
I do. You know, if I don't, I can can ask around in my network to figure out if somebody is a good provider, in another state.

Dr. Vicki Rapaport  23:11  
I love that. Thank you.

Trina Renea  23:13  
All right. Well, thank you very much, and we hope you have a wonderful day.

Dr. Vicki Rapaport  23:17  
Thank you, Dr. Wang. Have a lovely day.

Dr. James Wang  23:20  
Thank you so much. Bye, bye.

Trina Renea  23:27  
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