73. Aesthetics and Peptides 101 Part 1 with Alexis Yoo

Alexis Yoo 0:02

There's no downtime you walk out of here like you've had nothing done to you. And it's not price wise. It's not horrible. It's not the cost of a facelift. I mean, it's like win win.

Dr. Stephanie Gray 0:12

Welcome to the your longevity blueprint podcast. I'm your host, Dr. Stephanie gray. My number one goal with the show is to help you discover your personalized plan to build your dream health and live a longer, happier, truly healthier life. You're about to hear from Alexis Yoo hoo, to be honest, is quite similar to myself in private practice as a female nurse practitioner offering anti aging and functional medicine. She offers more aesthetics than I do at this point and is certified in providing peptides. So today I get to pick her brain on those therapies. This is part one of a two part episode. Be sure to check in next week to hear the conclusion of our conversation. Let's get started.

Thanks for joining me for another episode of The your longevity blueprint podcast. today. My guest is Alexis you who goes by Lexie. She's a double board certified nurse practitioner in areas of family and pediatric medicine. She has been a nurse practitioner since 2011. She has a bachelor's degree in nursing from Purdue University and a master's from IUPUI as a pediatric nurse practitioner, Lexie decided to expand her knowledge and obtain her post master's degree in family medicine. She has a special interest in functional and anti aging medicine. She's certified through bio T medical specializing in bioidentical hormone replacement therapy for both men and women. She is also working to be a certified provider through the Institute for Functional Medicine to better treat her patients while fixing the root cause of their conditions. Lexi also provides a set of services such as Botox fillers, micro needling PVL threads and PRP treatments. And she certified in peptide therapy and that's what we're going to get to today. She's a member of Institute for Functional Medicine and the American Academy of anti aging medicine. Sounds like me, we

Alexis Yoo 1:50

have a lot in common. Yeah, it's like we're like the exact replica of each other except in different states, which is which is good. It's good. That's why this podcast will be awesome.

Dr. Stephanie Gray 1:59

So encouraging to me sometimes I feel like the Lone Ranger. I don't know about you, but

Alexis Yoo 2:03

it's not fair that we're in the Midwest, like if we were in Florida, California. Yeah, we'd be you know, like fish to water. It's just we're kind of these odd people out in that people don't really understand what we do. We're pioneers, right? Absolutely. Absolutely. Being females, nurse practitioners mom dependent practice. Yeah, absolutely.

Dr. Stephanie Gray 2:21

Well, tell me your story. So how did you get interested in anti aging and even aesthetic medicine.

Alexis Yoo 2:27

So I started out in weight loss. I actually used to work for a bariatric doctor, he specialized in something called a lap band procedure. And so when I worked for him, I learned a lot about metabolism, metabolic function, nutrition, I worked really closely with a dietitian. And what I learned is, is that if I could fix thyroid, if I could balance hormones, they may not need surgery. And so obviously, working with a surgeon that probably didn't jive so well, so I fortunately for me, there was a physician a do who was looking to bring on a female provider, and I was like, perfect. I started with him. And really what was nice as I had a lot of autonomy to kind of educate and kind of look to see what all I wanted to do. So I really got a special interest. And I call this last women's population, I don't know if you have you have this too. And it's kind of like, you know, women in their, their 20s and their 30s. They're pregnant, they're having babies and they're followed by their OBGYN and then it's kind of you got this postmenopausal women who are like, okay, they're done having periods well then there's this like lost population of women who are put on antidepressants who are put on phentermine who are put on all kinds of pain pills, different things.

When it's not a Prozac deficiency. It's a thyroid deficiency, or it's a testosterone deficiency. That's really where I found my niche, in that you get one lady feeling good, and she tells her friends, and then she tells her friends in them, where you know it, you've got a waitlist of 120 patients and your books out till May. So I started out through the Institute of Integrative Medicine, in hormone replacement therapy. So I learned about creams and trophies and injectables, you know, that's kind of where I started. And then one of my patients, in fact, her mom is a Viotti provider, and she's like, Plexi, you need to do this. This is like, you know, you got to do this. And so, you know, kind of like you're like, Okay, well let me look into this. And so I did some research and I was like, you know, hemming and hawing hesitant. So finally, you know, I went to Texas, and I got my bio T certification there and really, it like, just skyrocketed. So what happens so how this translates into esthetics is you know, I had a lot of women who would come see me and they're like, you know, Lexi, when are you going to learn how to do an injectable so this way I don't have to go anywhere like you're going to be a one stop shop. That's what consumers are looking for.

And so I was like, hey, you know, I don't know and I my background as a nurse's I actually used to be a general surgery nurse practitioner, so procedures like I knew how to suture I knew how to do all kinds of procedures, hands procedural stuff, so that was it all. And so I was like, okay, so fortunately, I had a really good friend who was a nurse practitioner injector and she worked for a plastic surgeon. So I kind of really she did a great job mentoring me kind of pick my brain Like, okay, this is you know, this is where you want to go for training. So I highly encourage people to go get trained get a good certification, and it doesn't stop there. Like I counted this year alone, I think I have attended so far already for trainings and advanced injectables. And I think I got another like four or five the rest of this year. So what's so cool about sex, it's like peptides, it's ever evolving. And you always want to kind of stay ahead of the curve. And so I think, honestly, that's kind of why women like coming is because they're like, oh, you know, Lexi will fix it, like, just tell her what bothers you, she'll fix it.

And so, so that's kind of how I got started. I mean, I didn't set out, you know, I know, some nurses like, I can tell you my office nurse, Carmen, she's like, I just want to be injector. Like my whole life. I'm like, Really, I kind of just landed in esthetics. And it just made sense, you know, made sense. And then as I got to do I really enjoy anatomy, I like looking at the face, I like how the aging process takes place. And you know how structures, if you fix this, it'll actually fix what's below it, kind of like in functional medicine we look at downstream of it's kind of translate. So that's kind of how I got into aesthetics. My practice is, it's a pretty busy practice, I have another nurse practitioner, who helps me she's bio T certified. She helps me with functional medicine, gut health. And then I will actually sit for my board this year for IFM. So the Institute for Functional Medicine, and then I'm bringing another nurse practitioner, she'll start in June, she was actually a student here. And she will probably go through a forum. So my goal was to have us all kind of trained in different schools just because it's like good because we can kind of compare notes and, and stay advanced. And then I have a nurse injector who I've sent her two different courses. And then I actually train with like, I train her in some of the advanced stuff, annual technique and things like that. So

Dr. Stephanie Gray 6:38

sounds like a very progressive and you have a successful practice, which is exciting, you're growing, but you have to stay progressive, right to stay on the cutting edge. And if you want to, obviously, we want to keep our patients and we want them to know that we're are trying to stay ahead of the game. But it takes such a commitment with providers like ourselves to go to additional trainings it right. It's a financial investment, a time investment, like but what we're very committed to that. So today I want to talk about a sec, we've had several episodes where we've talked about hormone pellets. And that's something that is near and dear to my heart, something that we certainly offer here at the clinic. And if you're listening and you want to know more about biotech hormone pellets, I interviewed CEO and founder of biotech, Dr. Gary Donovan, a few episodes ago, actually the episode launch because I don't know when this one will launch that episode launch in March of 2021.

So please check out that episode. But before we get to aesthetics, I want to leave a bit of foundation I use that foundation word a lot here on the podcast, I feel like I need to say a disclaimer. So I wrote this book, your longevity blueprint back in 2017. And if you read it, you know it's very long book. It's like 350 pages, and I wanted to add a chapter on aesthetics. And I didn't I wanted to add a chapter on the curb appeal of the home right aka settings. But I was already fighting with the publisher as far as the length. They wanted to book about half as long as it wasn't I didn't want to take anything out. So the aesthetics chapter got tabled for the time being but I hope with a second edition I can add more in about aesthetics. Quite frankly, I need more experience to even write about it. So that's why I bring on guests like guests like Flexi but how did I did that chapter would have been the last chapter, right? Because I do feel strongly that to improve the curb appeal of the homeless, aka to improve your appearance don't have that skin, we still have to work on the inside of the body, right?

So we have to have a strong gastrointestinal Foundation, right? We don't have a lot of bad inflammation because that will show up on the skin. So acne psoriasis, I mean even lines and wrinkles. I think a lot of that has to do with our inner health. And so although today's podcast is about what we can do externally, with injectables, and some fun things, Lexi's gonna share, I don't want to minimize how important it is to still eat clean right and still follow all the other steps in the blueprint for longevity. But what's happening to a disclaimer later, let's get to the topic of today which is aesthetic. So I went back say if you can to share the aging process in relation to the appearance of our face. So what happens as we age, right? No, we get wrinkles and like can you tell us more specifically what happens?

Alexis Yoo 8:48

Yeah, absolutely. So typically as we all age, we lose collagen in our face, right? So collagen is what keeps your face nice and tight. It keeps what you know it keeps it in its place. It keeps the skin plump, it just does a lot going back to I call it functional dermatology, in that if I have a patient with rosacea, I often say we got to do a gut test on you before I can get my fancy laser, maybe put you on some hydroquinone, we got to do a test on you because there could be some Candida in there and we got to fix that in addition to we can do all these other fun things. So So I 100% agree with you on that. So so as we age we lose collagen and then postmenopausal Lee we lose estrogen and estrogen is another hormone that is so so important for improving the texture of the skin. We often see more creepiness when that happens. So kind of going from the top down the first thing that we start to see when aging is is the frontalis muscle so this is your forehead muscles.

So this is you know that call it like the stairsteps on the on the forehead. As everyone ages this is going to appear people who are more expressive are going to notice it a lot more. And so with that one I typically say there's maybe Botox so you can start before it becomes a huge problem. And then when I get women in their 50s and maybe they're for you know this This is their first time within a neurotoxin, they have static lines. And so static lines are etched in lines, if their faces at rest, they're still there. So those are a little bit harder to kind of treat Now I will tell patients, you know, you may notice a significant improvement after the first treatment. But truly after the second third treatment, it's pretty much gone. So I think definitely setting realistic expectations with the patient is is key in this in the aesthetic industry. So the forehead tends to start, you know, getting those static lines, typically, and especially if you know, in our situation, we see a lot of thyroid patients, they're going to start to lose some of the, the hair on the outer brow. And so then we start to notice more of the the temporal suture.

So that is kind of where your temples are starting to look more hollow, just because again, everything's kind of losing collagen. In the mid face, you're going to start to see we call this the maxillary fat pads. So if we think about our cheekbone kind of like upset like upside down triangle, right? So and it really kind of the whole face, when we think a youthful face, we think you know, the tip of the triangle is at the chin, and it is straight, and it's down, right? When we think an aged face, the triangle is where the tip is at the forehead, and it comes down. So you start to see things like jowling, or the pre gel circus, which is kind of where the marionette lines start to fall.

Dr. Stephanie Gray 11:13

So those are like coming out of your mouth if you're listening. Right, right, right. Yeah, like that,

Alexis Yoo 11:17

literally the corner of the mouth. Yeah, it looks like a marionette, right. All of that is typically caused by a loss or deterioration or shrinkage of the maxillary fat pad. So in the mid face, unfortunately, again, when that shrinks, it's also going to start pulling down your the orbital area, which is where your tear trough is. And so sometimes you're going to see more hollowing in that. And then kind of in the lower face, you know, we call them smoker lines or perioral lines. And so you get that from whistling, again, from drinking from a straw you can get from a lot of different things. But that's another really prominent sign of aging is when you get the little vertical lip lines or barcode lines. Also, there is another muscle in the lower face called the do which which is the depressor Angular oris muscle. And a lot of times over time, this is very prominent. And what it does is it pulls the corners of your mouth down.

So you always look like you're frowning, that you know that can be something we can also fix with neurotoxins. And then lastly, you know, looking at the chin, unfortunately, as women get older, we lose bone mineralization, right? So the bone starts to shrink, and then it starts to recede. So then you kind of go from this nice beautiful snatch chiseled jawline in your youth to now like this like little round, sad, saggy face. And so when I do a console with a patient, I sit up in the chair and I have my iPad out which I have a really neat like anatomy face and I turn it and I kind of go over the muscles. It's almost like a it's like an anatomy lesson when they do it. And I asked, you know, they're like, Okay, sitting in the chair, and I and they're like, Well, what do you think now? And I say what bothers you? Because what I see may not be what you see. So I think it's definitely what see what is bothering the patient, because it may just be like their crow's feet, and you're just like, Okay, well then forget what I said about your mouth. You know, when we talk about the aging process, the two biggest things is loss of collagen, and the loss of the fat patch, we lose the plumpness in our face. So from a treatment perspective, I guess I'll start with neurotoxins, right? Yeah.

Dr. Stephanie Gray 13:07

Which could be controversial for the listeners. So I want to know, if you're comfortable with neurotoxins in all patients or in certain patients with like, autoimmune conditions, are you more cautious with them?

Alexis Yoo 13:16

Or Exactly, I mean, give me so I get I don't say get flack, but I've gotten some really some really nasty DMS from people like how can you say, you know, you focus on root cause? And then you know, what I, I don't try to peg myself as anything, I would say I am more like an anti aging like longevity provider. And who am I to say don't get toxins because it's bad. So I just leave it up to the patient. And if they want to do it, I'm here to provide them with all the information in the comfort now there is an actual neurotoxin on the market that is supposed to be preservative free. And so I've actually I just talked to the rep this week and I was like semi what studies you have as far as this product in autoimmune patients. Now I'll be 100% honest with you. I have patients who have autoimmunity who do fine with Botox Dysport, you know, especially with Hashimotos. I feel like so many patients have it, so, yeah, so it's kind of like the first toxin that I'll talk is is Botox. And so this is made by a company called Allergan So Botox is kind of a term like when we say Kleenex, you really mean tissue, but you say Kleenex, because it's just the most well known, right? So Botox, it's a neurotoxin modulator.

So what it does is, you inject it and it goes in in it and it paralyzes the muscle, it starts to act in about seven days. And it will take about a full 14 days to have its full appearance. And so it's not uncommon, where we first inject you and you might have like a wonky brow at like day five so you kind of look like you know a sprinter or he's got like those weird brows, and I always tell patients, it's okay, we're not going to touch anything up until day 14 duration it should actually last somewhere between three to four months. Some people get longer duration at minimum though. Hopefully about three months now, we have a lot of patients in our practice who were right next door to a CrossFit gym. So we have tons of very, very fit metabolically Hi patients. And so man, they just like their pellets, they just burn through them so quick. So some of those patients, I have to kind of give them a little bit more than where I would, you know, and then the question we always get is, well, how many units am I going to need? So Botox is dosed by units, a good kind of rule of thumb is I'll say for every year of age of life is how many units you may need. So for me, I'm 36. So 36 is a pretty solid dose for me.

Again, the range can kind of just depend on you know, what is the achieved? Look, do you want it completely smooth, some women come in and they'll say, I want it, I want it like, I like my margaritas frozen. I'm like, Okay, some women will say I want it more natural, and that's fine, too. So that's one product. Another product that I really, really I probably use this product the most is called Dysport, Dysport. I like it because the molecule is a little bit smaller. So the onset is much quicker. So if you have an event in like a week, this would be a great product to get because the onset is about day three, day five, there's different ways that you can mix it up. And the reason I actually liked this product is because the spread is a little bit bigger. And what I mean by that is, is that you can make one poke, and in the circumference, imagine the area around it will actually capture more wrinkles. Versus Botox, it's kind of more of a precise injection. So you know, it takes out obviously some practice and training and familiarity with the product. But I really, really liked this port for that reason as the onset is much quicker, I also find that women notice that they don't get an overly stiff or an overly frozen look. And so you know, women in their 30s, they kind of want to just look for fresh, they don't want to look like they've had a lot of stuff done.

They just kind of want to look like them, but just rested. And so I really liked this port for that reason. So that one onset is three days, three to five days, compared to Botox is seven to 10 duration is exactly the same. I like you love to kind of do my own experiments. And so I actually did a split face study on a patient, she was like in her 60s, because most of my patients when they would come to me, they were Botox all day, every day. And I'm like, I feel like you're missing out here on this really awesome product. So I had a patient she was in her 60s and I took a ruler and I literally just drew it on her face and I landmarked her face like on a diagram and I said, Okay, these are where the injections go. So I injected the exact same dose and the exact same location as I did on the left and the right side. And what's so crazy is that the Dysport side, the onset was obviously much quicker. The spread was much nicer what I mean by that she didn't have we call it Spock brow. So it's like where the tail of the brow starts. Because you didn't you didn't hit that area, you didn't hit that frontalis muscle over there. So it actually showed on this experiment to be far superior than Botox, which is crazy, because all we know is Botox. Right? Well, then

Dr. Stephanie Gray 17:50

she had to wait three months for the

Alexis Yoo 17:54

lopsided broad second, but she I mean, she was so most of my patients were like, you could try whatever you want on me just like let's go. My patients are very willing to let me do some cool stuff to them. So I thought that was so interesting. And those are the two products I mainly carry in my office mainly because I feel like sometimes when you offer too many options, patients have no idea what you're talking about. But those are the two main ones I use, there is another product called Xeomin Xeomin. What's neat about this product is it's it's preservative free, this is the product that I have some research out for to see if this would be a preference for patients with auto immunity. The other thing is is because it is preservative free, they say that you are less likely to build an antibody to this toxin. So what I mean by that is, you know, if you get Botox every three months for five years, it may start requiring more product to get the same effect. So I actually like to kind of change it up for my patients. So sometimes I go every other sometimes say, Okay, you're due for Botox, we're gonna do Dysport the next time. So this way it kind of creates this, you know, this neurotoxin confusion.

So Xeomin is another really good product. And then there's another one that I don't use just because again, I try not to confuse my patients, but it's called jeuveau. And jeuveau is the newest neurotoxin on the market. From my understanding and talking to some of the other injectors. I just, I hear it, you know, the onset is good. I just don't hear that you get the longevity that you get out of Botox and Dysport. So, again, just to try to make it easy for my patients to just pick one, Botox and Dysport is typically what I would I use?

Dr. Stephanie Gray 19:24

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Alexis Yoo 20:30

Oh, absolutely. So the areas that you could get Botox and you know, there's I want to talk off label just because you know, I'm not affiliated with anybody. So I'll kind of start from top down. So frontalis muscle is a very common area, a lot of times I like to get the tail of the Brown, it'll give you a really nice arch in your brow kind of give you a low brow lift, which tends to help a lot with think about patients who've lost that collagen, they got toeses or lid lag. So like two or three little units in the tail, the brow can really go a long way. So that's the frontalis muscle, then we treat the glabella. So the gobo is the elevens or the frown lines, you know, and that is in the glove Bella is the procerus muscle, which is the muscle right between the eyebrows. And then you've got two muscles called Cora gators. And the way I describe it, it's kind of like a tug of war, like one's going this way and the other one's going this way.

And so when you're treating the 11th, it's really important that it's a very strong muscle that you really do a good job of assessing where does the muscle start, and where does it end and making sure that you're hitting the belly of the muscle. So the corrugator is just to make sure you've got evenness, that that's probably the most common areas. Another area that you're going to see is the orbicularis occupy. So that's like your crow's feet, right. So those are your smile lines. Some people I call it like the Tyra Banks, the smizing, you smile with your eyes kind of thing. So some people have deeper crow's feet than others, that's a really good area to kind of open up your eyes and to to kind of give you a little bit of a brow lift, it works really you just look really rested. And you'll notice it a lot when you take pictures like oh, you know, I don't see those lines anymore. It's easy to go a little overboard on the crow's feet sometimes.

So it's one of those things you have to look to see are you hollow in the under eye because if you're really hollow, I would not overly relax that area because it'll actually make kind of that top mid face fall. And you don't want to do that and now unless you're planning on chasing it with some filler, so so so that's a common area bunny line. So when you go into your nose, you'll get little bunny lines kind of right in between there. So so that's a common area I like to get mine done. So the nice Alice muscle there's something called a gummy smile. I don't have one but when you smile, let's say your your top lip disappears. And you see mostly your gums we call it a gummy smile jacked like four little units in the labia less muscle and you kind of do like right in the like, right in the middle not in the vermilion border but right in the middle. And what's so cool is it'll actually relax the labia muscles.

So you're when you smile, it doesn't crawl up in there, it actually stays put. So that's an option, we do something called the lip flip. So lip flip is where we inject about four, four or five minutes just depending on the patient into right into the vermilion border. And so what that does is it creates a little bit of an easy version, or like a little bit of a more protrusion up of to give you a like a nice little pout, it does not replace volume, it just changes kind of the positioning of the vermilion border area, we do something called da o injection. So if you make kind of like a little weird sour face, you're gonna see two little muscles right there. And what this will do is it will it will relax depressor Angular or muscle which will help your mouth not look so frowny it kind of relaxes it so you can have a you know symmetrical smile and said downward and then the mentalis muscle so the mentalis is we call it orange peels, like Botox has all kinds of slang words Orangefield chin is what we call it. So people again, as we age, that bone D mineralizes. And it start that chin starts to recede in and I usually prefer to do some filler with it but it's a great way to kind of smooth out that chin to give you a nice little peek because again, if we think about what does anti aging or what does youthful look, it's the upside down triangle. So we really want that chin to be nice and pronounced and pointed. It will soften up the jawline so you don't look like jelly.

So that's kind of you know, when we go there, so to your question the neck so there are two things so if you make like a pulling face, those are called political bands. So we can inject a little bit of neurotoxin in the political bands and that will definitely relax it. We also have something called and I don't even know what these lines are called. We call them technic. So technic, if you think about when you're texting on your phone, and you're looking down we call those techniques. I have a lot of them just because I'm on my phone a lot. And so we can do a couple things with that we can do some there's a product called radius which is a bio stimulator Carmen and I will do something called hyper dilution radius. And so we dilute it a little bit down with bacteria, normal saline, and we come subcutaneous such as beer or like almost like intradermal even. And what that does is it stimulates your own collagen and your own growth factor which She's great. So that one will build over time. You can do a little bit of Botox in there, I typically over diluted a little bit cuz I don't want it to overly relax. It's just kind enough to improve the skin texture. The biggest one that I do a lot with is threads, PDO threads and we'll talk a little bit about what that is, but that's another option.

So it kind of one depends on like, what's our acquired? Look, how much movement Do you have? What's your budget? You know, how quick do you need to be looking good? Like, do we got it? Do we have like a thing next week or is this like just in long term processes, so So those kind of cover neurotoxins, other areas, we we can do it in the master muscles and that'll actually slim down the face and it also helps with migraines like jaw clenching migraines, we can also do it in the axilla for hyperhidrosis. So excessive sweating.

Dr. Stephanie Gray 25:42

Right. I have like 10 questions based on everything you just said for hyperhidrosis. So Botox is also still going to just last three to four months, right. So those patients would have to return every three to four months.

Alexis Yoo 25:52

Because the dose is actually a lot bigger, I actually find that six months is what they can get out. Awesome. I mean, six months,

Dr. Stephanie Gray 25:58

if a patient has excessive sweating, then they're probably pretty toxic. Potentially, there's some other functional medicine things we can work on wedding as well. So I want to make sure the listeners are hearing what you're saying. So when you said you know based on your age, you may need the equivalency in units. That's for a full face yet for full face. Yeah. So if you're 37 years old, and you need Yeah, so that would be to get the whole whole face out. Okay. I want to go back to the comment you said because I had a patient told me this once that her mother told her to never drink out of a straw and she was going to get lines on her face. Are you saying which lines Did you say okay,

Alexis Yoo 26:29

oh, there's there's like the vertical lip lines. So those are like your smokers line. So they're the lines above the vermillion. So like if you whistle and you'll see those little HTN lines. Those are vertical lip lines.

Dr. Stephanie Gray 26:40

Okay, interesting. Now, let's go on to PDO threads, which I do not know a lot about, although maybe by the time this podcast launches, I'll be doing them.

Alexis Yoo 26:47

Yeah, yeah, for sure.

Dr. Stephanie Gray 26:48

They sound pretty excited. Oh, they're off dummy. So in these an alternative to fillers as it's just the difference. So

Alexis Yoo 26:53

let me explain the difference. So filler replaces. So we you know, like I said with aging, we have loss of volume in the mid face. So typically, the company who makes this sport is called Galderma. And they have a huge portfolio of different fillers. So every place in your face has a filler for that exact reason, for example, and I'll make it quick because I know you want to get into threads. So in the midface, there's a product called wrestle and lift l yFT. It is it has a high G prime, meaning it holds heavy stuff up. So when I do some cheeks, I love to do wrestle and lift, I say it's literally like a push up bra to your face. Now it doesn't necessarily lift it gives you the illusion of lifting. But what it does is it replaces the volume loss in that maxillary fat pad. You want to fill in the tear troughs if you've noticed some hollowing because if you just feel fill in cheeks, and you've got these hollow eyes, you're going to look sunken in even more.

So there's a product called wrestling classic or even wrestling, silk is a good product in there, the perioral lines, lip lines, you can do some wrestling silk in there, the lips off, there's a beautiful product called wrestling kiss. And it's the only product on the market that has a one year duration with no touch ups required. And these are all reversible fillers. These are what we call ha or hyaluronic acid fillers. So if some event should happen, and perhaps you got a vascular occlusion, these are all reversible. So we have a protocol such should that happen. And basically what that means is that filler has occluded in some sort of artery and so we have to reverse it. So we have to inject something called hyaluronidase or Heiland. X into that. And that's, and that is why when I talk about training and fillers and because I don't want new NPS or nurses to think I'm just gonna go this class, and I'm an injector, absolutely not, no, no, no, that's not how it works. You have to know what are the risks and like, you know how, as a nurse, I don't know if you ever were on the unit, you do like mock code blue, we actually do like mock vascular occlusion because I want all my staff to know, what is your role in this situation? Because time is of the essence, where's everything located? You know, where's this at?

How do I mix it because it's important, it's a safety issue, we want to keep our patients safe. So PDO threads help with stimulating collagen and they help with traction or lifting. Filler replaces volume. So it's a little different. So in a lot of our patients, again, thinking about going back to what kind of practices we have, we have a lot of hormone patients, right. So again, you know, they've lost a lot of estrogen and a lot of collagen in their face. So the cool thing is, is that I find that if I work on maybe a little bit of PDO threads, it will actually help do most of the work. So PDO PDO stands for poly dioxin on what it is. It's a dissolvable stitch. They there's different kinds, there's smooth threads, which are more of your collagen producing threads. And these are all dissolvable. There are twists, threads, which are kind of like filler in that they tend to replace a little bit of volume with it. And then you have barbed threads.

Barbed threads are kind of like imagine like the stem of a rose and how you got the stick but then you got these little thorns on the side of it. And so as you remove the the little straw or the cannula that comes in as you pull it out those thorns activate and it lifts as it pulls up. So it holds structures up. So those actually lift versus saying wrestler lift lifts, it really doesn't it replaces volume, but it gives you the illusion of a lift. So with that those threads typically last somewhere between 18 months to two years, I would say probably 18 months. The onset is pretty quick, as far as you're going to notice an improvement like that day. The best part about it is is it's also a bio stimulator. So it does stimulate collagen. Over time. The threads that are in there should dissolve by about four or five months. But what's left is you've built up all this really beautiful collagen around it. And so as you've lifted it, it should stay in place. So it works extremely well. It is a completely awake procedure, we don't give any sedation for it. It is an in office procedure, we call it a non surgical facelift is basically what we're doing. We do a fair amount with like lidocaine, I do like like a local block and always have different tracks of threads.

So as far as you know, what product and where do I pick, it just depends, you know, if patients have strong nasal labial folds, which are like the parenthese lines or the smile lines around the mouth, I will use my BB threads or my lifting threads, and I will start them kind of by the zygoma is the insertion point. So I numb that area, I put a little I like make a little insertion hole. So I use about an 18 gauge, you know, they should be numb, they if I've done my job, they should feel nothing. And then I make the little hole, I slide these little threads so the threads are not activated. When you slide them in, you're sliding kind of somewhere between the the intradermal layer and a layer called the sum as, as it's going in there. You put it in, you activate it, you twist it and you pull it out. And as you pull it out, all these little thorns come out and it holds it up. So it works extremely, extremely well. What I personally like about it, as I say kind of like threads are like the goGreen of esthetics because they're like there's no toxin involved. There's no risk of vascular occlusion, you know, there's no real, I don't say risk, because there's there's risk with everything, but there's no real adverse event that like really can't be fixable.

You know, the worst thing you can have is you bruise or if you're not in the right plane, and that's the hardest thing is finding the right depth to which you need to be at. You might have some dimpling if you're not in the right place, but honestly, those are the two worst things that can happen compared to some of the other stuff that we do. And like we'll take that all day every day. So I do like the threads and that it gives us the collagen that we're looking for. It's not a toxin. The risk of vascular occlusion is not their patients love them. We've come in and I we trained in like December, and since that time, we've done probably 70 or 80 cases of threads in that time. And my practice, we're not a med spa. We're not an esthetics only practice. No, I have to actually block time in my schedule to do esthetics only because if I didn't, I'd be doing pellets all day every day, you know, kind of thing.

So I do strictly esthetics every other Friday, and there's some sprinkled throughout the week, but it's allocated to that day, because I'm in like thread mode, or I'm in filler mode. You know, it's like a brain thing. But yeah, we do a ton we do. And the coolest thing is, is that one of my patients put it best. She's like you're probably a surgeon's worst nightmare. And I was like, why is it and she's like, there's no downtime. You walk out of here, like you've had nothing done to you. And it's not price wise. It's not horrible. It's not the cost of a facelift. I mean, it's like when when so it's cool. I love doing threads.

Dr. Stephanie Gray 33:17

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If you're interested in learning more about how mitochondrial complex can help support you living a longer healthier life check out my blog post on why antioxidants are important found at your longevity blueprint.com forward slash y dash antioxidants dash r dash important four in chapter four of my book Your longevity blueprint to get 10% off our mitochondrial complex just use code energy when checking out at your longevity blueprint dot com now let's get back to the show so am I hearing you right so basically you're numbing up the face you're doing some sort of nerve block whatnot you're you're essentially placing I don't know the depth of these if you guys want to watch her she she on her Instagram what's your Instagram thread Lexi

Alexis Yoo 35:18

it's at you direct health underscore esthetics. And there's there's tons of videos of me putting in threads and numbing threads and pulling threads. Yeah, there's tons for those

Dr. Stephanie Gray 35:26

of you even listening today, if you want to understand more of what she's saying, watch the video on YouTube. Because that she you know, she's been pointing to the the facial muscles and whatnot through this whole interview, which I know can be difficult to take in and absorb when you're listening. But you want to say her place PDO threads, check out her Instagram site. So essentially, you're literally just placing this thread you're saying you're activating it, and then you're actually pulling it out. And it's going to stimulate collagen production for the next like, year and a half.

Alexis Yoo 35:48

Yes. So what you're placing there is a very tiny like a metal wire. So the metal wire has the thread in it. So imagine like a cannula, that's what it is. It's kind of like a cannula, weaving the

Dr. Stephanie Gray 35:58

thread, you're taking off the wire. Exactly. It's

Alexis Yoo 36:00

kind of like yes, it's kind, like you're weaving it in there. And we call those vectors. So vectors are basically one thread. So if I say I placed four vectors on each side, that meant I placed four barbed threads for lifting on each side. So we call them vectors. But yeah, so it is a very thin metal cannula that helps me glide into the into the depth that I need to do it. Once I'm in the right spot, I feel it and it's like a pop, you twist it as you twist it, it activates the thread. And so you're unable to slide or glide the metal piece out.

Dr. Stephanie Gray 36:33

And basically, they're gonna see, I mean, they're gonna see results over time as the collagen is, you know, production stimulated, but are they going to look different, like immediately,

Alexis Yoo 36:42

it's creating a little bit of traction or a lift. So you're going to notice it fairly quick right away. But the maximal results to see it will be about eight weeks, about two months later, I bring them back and I and we take pictures and

Dr. Stephanie Gray 36:54

but like you said there's no downtime, like literally there's no no, I mean, it's just swelling or like,

Alexis Yoo 36:59

yeah, it's hard to take a week off of working out sometimes just because that's my that's my Prozac there. But aside from that, no, I mean, sleep feels a little weird. Like the best recommendation I give to patients is get like an airplane pillow. Because we're those insertions where they're a little tender, you know, they're a little tender. And so I had people try to like lay on your back or like a neck pillow is helpful. I have patients make sure that they don't do any dental work for at least two weeks after because you don't want to overextend your mouth. I actually got some threads and I forgot about and was gonna bite into an apple and I was like, Oh, it doesn't hurt. It just kind of pulls like it feels like your mouth is a little restricted to kind of open it up a little bit, but it's it's not

Dr. Stephanie Gray 37:37

bad. So can patients combine fillers with friends? Oh, absolutely. And those are

Alexis Yoo 37:41

like the best rejuvenations we're actually talking about our April specials. I think that's what we're gonna do. The coolest thing is when you when you do threads, they don't need as much filler because you're you're helping smooth out some of that red. So instead of me doing I call it a Liquid Facelift instead of me putting like four or five syringes in someone's face, they may need one or two because the threads did most of the work.

Dr. Stephanie Gray 38:07

Aesthetic so interest me and I know we just scraped the surface here today. Stay tuned next week to hear part two where Alexey talks about peptides for weight loss, specifically CJC 1295, if MRL and AOD and semaglutide. And we'll get into peptides for hair loss and libido as well. We'll see you then. Be sure to check out my book your longevity blueprint. And if you aren't much of a reader, you're in luck. You can now take my course online where I walk you through each chapter in the book. Plus for a limited time the course is 50% off, check this offer out at your longevity blueprint.com and click the Course tab. One of the biggest things you can do to support the show and help us reach more listeners is to subscribe to the show. Leave us a rating and review on Apple podcasts or wherever you listen. I do read all the reviews and would truly love to hear your suggestions for show topics guests and for how you're applying what you learn on the show to create your own longevity blueprint. The podcast is produced by the team at counterweight creative as always, thank you so much for listening and remember, wellness is waiting

the information provided in this podcast is educational. No information provided should be considered to be or used as a substitute for medical advice, diagnosis or treatment. Always consult with your personal medical authority.

Transcribed by https://otter.ai