Inside Aesthetics

Episode 272 hosts Dani Gardner & Hayley Phillips, Registered Nurses & the founders of Luum Aesthetics (Perth, Australia) Dani and Hayley join us in the 16th Chapter of our series called 'The Business of Injecting'. In these episodes we host injectors and clinic owners to discuss all aspects of the business side of their clinic. We analyse their financial struggles and challenges, difficult decisions, friction points, staffing, hiring, firing and other topics relevant for achieving aesthetic business success. 00:00 Introduction 01:21 Thailand Trip and Alma 01:59 Patreon Offers and Legal Partner 04:07 Special Guests: Dani Gardner & Hayley Phillips 04:58 Dani and Hayley Backgrounds 06:47 Why Start Luum Together 08:38 Experience Before Owning 13:16 Planning Roles and Support 15:21 Admin Team and Systems 16:26 Funding Fitout and Launch 20:25 Pricing Budgets and Positioning 23:00 Boutique Skin First Model 24:18 Hiring a Great Therapist 25:58 Skin Revenue and Education 31:20 Imaging Tools and IA Offer 32:29 Business Mentoring Rejig 33:47 Choosing Devices Strategically 35:47 Avoiding Dusty Devices 36:20 Device Targets and Break Even 37:19 Secondhand Laser Pitfalls 38:18 Recertification Fee Explained 40:05 Insurance and Negotiation 41:37 Body Contouring Reality Check 44:18 Regenerative Womens Health Plans 46:08 Scaling Up Space and Team 47:04 Onboarding New Injectors 49:47 Products Stock and Inventory 52:53 Marketing SEO and Partnerships 58:08 Mistakes Complaints and Fixes 01:01:39 Contingency Planning for Lulls 01:04:11 Coaching Burnout and Exit 01:08:25 COGS Pricing and Margins 01:12:39 Final Wrap and Clinic Name ALL IA LINKS & CONTACT INFORMATION

Episode 271 hosts Dr Felix Li (Cosmetic Doctor based in Singapore) and Dr Stefania Roberts (Phlebologist & Cosmetic Doctor based in Melbourne, Australia) In 'The Tox Talks' episodes we feature expert injectors who have significant experience in using botulinum toxins. These episodes explore our guests experiences using particular brands, the evolution of their injecting techniques and we get special insights into the subtle nuances of getting the best out of toxins. In chapter 9 we discuss a new on label indication for Botox (by Allergan Aesthetics, an Abbvie Company) - Masseter Muscle Prominence (MMP). This was recently approved in China at an event in Shanghai and it's the first and only toxin brand to be approved for this particular indication. We discuss: What MMP is The difference between on VS off label indications Why having a standardised technique is so important What patients want when it comes to MMP Asian vs caucasian beauty ideals and beauty standards The on label dose for MMP The technique to treat MMP Masseter anatomy The role of ultrasound in assessing the masseter Risks and precautions when it comes to treating MMP 00:00 Introduction 00:42 Podcast Updates and Patreon 02:05 Topic MMP Botox Label 02:37 Meet the Guests: Dr Felix Li & Dr Stefania Roberts 04:57 China Launch and Ultrasound 07:25 Why Seek Approval 09:10 Masseter Basics and Aesthetics 13:15 On Label vs Off Label 16:42 Culture and Face Ideals 18:56 How Botox Changes Function 24:07 Consulting and Patient Requests 27:54 Alternatives and Surgery Risks 31:18 Study Dosing and Duration 32:54 Real World Dosing Strategy 36:40 Dose by Age and Ethnicity 39:41 Finding the Right Units 40:35 Training and On Label Protocol 42:30 Needle Depth and Anatomy Errors 47:56 Paradoxical Bulging Explained 54:06 Counseling Risks and Avoiding Risu 01:03:30 Three Point Injection Mapping 01:05:30 Preventing Jowls and Parotid Mixups 01:09:29 Pricing and Maintenance Strategy 01:13:23 Resistance and Closing Thoughts ALL IA LINKS & CONTACT INFORMATION

Episode 270 hosts Professor Daniel Ezra (Oculoplastic Surgeon based in London, UK) Daniel is a leading eye surgeon at the world famous Moorfields Hospital. He's also part of an incredibly busy private clinic where consultants of various specialities work in a multidisciplinary team. There he leads a dedicated filler dissolving service and his team see up to 10 elective referrals a day to help patients with filler complications. In our 'What's trending in Aesthetics?' episodes we cover topics that have got injectors talking on social media or been in the news. We'll cover controversies, big stories and themes that affect our speciality. In Chapter 6 Part 1 (free for listeners on any podcast app) we discuss: Podcast news Daniel's background The basic science of hyaluronic acid fillers The behavoir of hyaluronic acid fillers in the tissues How long fillers last 00:00 Introduction 00:31 Meet Dr Daniel Ezra 01:33 Podcast News and Patreon 02:02 Travel and Patreon Updates 03:59 Episode Roadmap Part One Two 04:50 Daniel's Background 08:04 Learning to Inject 10:27 Hyaluronic Acid Basics 12:34 Cross Linking and Properties 14:32 Preferred Fillers and Volume 16:07 Dissolving and Cross Linking 17:30 Partner Masterclass Ad 18:48 Injector Training Gaps 19:34 Regulation And Accreditation 20:31 Filler Myths And Cumulative Dosing 21:34 Conference Bias And Pharma Influence 23:16 Why Aesthetics Lacks Research 23:40 Key Opinion Leader Constraints 26:27 Evidence Hierarchy And Bias 29:10 Social Media And Industry Maturity 30:38 Filler Downturn And Dissolving Clinics 32:24 Patient Anxiety And Misinformation 34:18 Dissolving Reluctance And Transparency 36:09 Study Summary And PHS Findings 39:16 Wrap Up And Part Two Tease 40:19 Follow And Support The Show In Chapter 6 Part 2 (Now available inside our new app, IA Community, ahead of our official launch this May. Click here to join our waitlist), we discuss: What the purpose of an MRI scan for an aesthetic patient is What the options are once a scan is done Filler integration - does it actually occur? Fller migration Filler 'growth' over time - what exactly is happening? Patient psychology when it comes to filler complications & filler dissolving Post-hyaluronidase syndrome Filler dissolving techniques 00:00 Introduction 00:31 Part Two Setup 01:05 Common Eye Filler Issues 04:27 Late Swelling Triggers 07:05 Inflammation Cancer Concerns 13:18 Lymphatic Block Debate 15:31 Safer Tear Trough Technique 21:44 When MRI Helps 29:16 Filler Volume On Scans 31:19 Filler Expansion Ratios 32:36 Clinic Intake Workflow 34:49 Consent and Legal Risk 36:45 Psych Screening and BDD 40:38 Community and Peer Support 41:28 Hyaluronidase Dosing Methods 44:45 Fibrosis and Encapsulated Lumps 47:32 Follow Up and Identity Shift 50:00 Post Hyaluronidase Syndrome 56:26 Media Hype and Safety 58:40 Future of Fillers 01:00:11 Wrap Up and Sign Off ALL IA LINKS & CONTACT INFORMATION

Episode 269 Part 1 hosts Dr Kate Goldie (Cosmetic Physician based in London, UK) Kate is a globally-renowned speaker and KOL for Merz Aesthetics. She has lectured in over 75 countries and is a thought leader in aesthetics. She has a particular interest in regenerative medicine and is leading research into how to best use Radiesse (by Merz Aesthetics). In our 'Masterclass Series' we host global experts with significant experience to teach us about fillers, bio-stimulators, bio-remodellers, polynucleotides, exosomes and other products. (For toxin insights, check out our other mini-series, 'The Tox Talks') In Chapter 2 Part 1 (free and available on any podcast app) we discuss: What regenerative aesthetics means to injectors How and why our skin ages The role of fibroblasts How structure defines function in skin aging The role of collagen and elastin Pre-juvenation An introduction to calcium hydroxyapatite 00:00 Introduction 02:24 Two Part Episodes Patreon 03:04 Meet Dr Kate Goldie 05:07 Regenerative Aesthetics Mission 07:38 Masterclass Focus CaHA Radiesse 09:00 Behind the Scenes Exosome Research 15:17 Future of Regenerative Medicine AI 19:07 Sponsor Break Vida Soul 20:49 Reality Check Biostimulators 21:53 Three Pillars of Regenerative Aesthetics 23:37 Back to Basics Skin Aging 26:19 Why Skin Ages 27:42 Bowl of Soup Model 30:11 Homeostasis Breakdown 31:40 Lifestyle Stress Effects 34:22 Sponsor Offer Break 35:17 Fibroblasts and Mechanotransduction 37:30 Collagen Balance Windows 40:18 When Collagen Declines 44:01 Radiesse Explained 50:11 Off Label Innovation 52:28 Wrap Up and Subscribe In Chaper 2 Part 2 (Now available inside our new app, IA Community, ahead of our official launch this May. Click here to join our waitlist), we discuss: Calcium hydroxyapatite as a material What Radiesse is How Sculptra differs to Radiesse The concept of hyperdiluted Radiesse and how to do it The difference between different hyperdilution ratios Protocols to treat the face, the neck and body Combination treatments with Radiesse and other injectables 00:00 Introduction 00:30 Radiesse Basics and Goals 01:06 Bone Lining Microdroplets 03:23 Dilution Effects and Planes 07:20 How to Mix Radiesse 09:05 Butterfly Technique and Four Ds 13:06 Comparing Radiesse vs Sculptra 15:42 Choosing the Right Tool 19:44 Treatment Rhythm and Scheduling 21:17 Younger Patients and Prevention 23:01 Consults and Setting Expectations 25:23 Youthful Skin Not Weird 26:03 Younger Versus Beautiful 27:56 Art Science Tissue Remodeling 30:05 Neck Treatment Deep Dive 32:11 Neck Dosing Zones Technique 35:20 Avoid Over Dilution Lumps 38:43 Who Needs Surgery Instead 39:29 Profilo Versus Radiesse 40:48 Body Areas Dilution Strategy 42:50 Nodules Safety Management 46:00 Future Regenerative Aesthetics 48:25 Wrap Up Resources Plug ALL IA LINKS & CONTACT INFORMATION

Episode 268 hosts Dr Steven Weiner (Facial Plastic Surgeon based in Florida, USA) Back on July 11th, Steve and another previous IA guest April Harrison did an Instagram Live together where they discussed their thoughts and aproach to botulinum toxin resistance in their own patients - including a very novel (and controversial!) approach to using hyaluronidase to 'cure' it. In our 'What's trending in Aesthetics?' episodes we cover topics that have got injectors talking on social media or been in the news. We'll cover controversies, big stories and themes that affect our speciality. In Chapter 5 Part 1 (free for listeners on any podcast app), we explore: Botulinum toxin resistance Theories around what happens with the immune system to cause toxin resistance The issue of 'pseudo-resistance' How to approach suspected toxin resistance in patients 00:00 Introduction 00:31 Catching Up and Weekly Updates 01:22 Clinic Busyness and Market Trends 02:16 Biostimulators and Sculptra Talk 03:56 Patreon Split Episodes Update 05:21 Meet Dr Steven Weiner 09:24 Origins of Toxin Resistance Live 10:03 What Is Toxin Resistance 13:43 Antibodies and Protein Load Debate 15:45 Vaccines Illness and Injecting 18:27 Does Xeomin Reduce Resistance 20:39 Brand Hopping Myth 21:22 Pseudo Resistance Explained 22:12 Testing Limits and Hype 24:16 Toxin B Option 25:20 Injector Error Deep Dive 27:15 Frontalis Depth Nuances 30:31 Frequency Drives Resistance 31:31 Dilution and Longevity Debate 36:24 Ultrasound Guided Toxin 41:56 Saline Reconstitution Myths 43:42 How Rare Is Resistance 44:53 COVID Vaccine and Fibrosis Theories 47:33 Part Two Preview and Patreon In Chapter 5 Part 2 (Now available inside our new app, IA Community, ahead of our official launch this May. Click here to join our waitlist), we discuss: The background to why they looked at using hyaluronidase for toxin resistance April's toxin resistance case Steve's theories about how hyaluronidase might work 00:00 Introduction 01:08 Immune System Damping Ideas 04:21 Practical Limits and Ethics 07:51 Hyaluronidase Paper Insight 11:51 Hyaluronidase Products Explained 13:23 Fraxel Surprise and Efficiency 16:18 Mechanism and Diffusion Risks 19:13 April Case Breakthrough 22:55 Protocol and Dilution Strategy 27:04 Is Resistance Actually Rare 28:05 When Tox Stops Working 28:47 Washout Period Reality 29:37 Antibody Data Surprises 31:43 User Error And Referrals 32:50 Dose Variability In Vials 34:58 Stock Theft Business Risk 37:36 Touchups And Timing Rules 41:14 Dose Adjustment Language 43:38 Zinc Supplement Myth 44:59 Off Label And Insurance 50:15 Wrap Up And Outro ALL IA LINKS & CONTACT INFORMATION

Episode 267 hosts Dr John Delaney & Dr John Holbrook, the founders of Fresh Clinics. In this episode we discuss: Who Fresh Clinics are and how they successfully disrupted the Australian injecting market Their thoughts about the new Australian regulations and what it means for injectors The software that Fresh Clinics created to allow for seamless and legally-compliant remote prescribing Their future plans to launch a Fresh CRM software for complete clinic management Fresh's expansion to Texas, USA and how American injectors attitudes differ 00:00 Introduction 02:16 Meet Dr John Delaney & Dr John Holbrook, the founders of Fresh Clinics 03:59 What Fresh Clinics Does 07:20 Why Tech and Doctor Oversight 10:25 Australia Regulation Shakeup 14:31 TGA Ads and Euphemisms 18:08 Tasmania Doctor Onsite Debate 23:45 Industry Infighting and Complaints 26:31 Regulators and Influence Explained 32:19 Do Regulators Understand Injectables 36:16 Patient Education vs Ad Rules 37:05 Media Fear and Fillers 38:18 Nurse Networks and Training 39:38 Regulation Workarounds 40:42 Why Texas and Why Now 42:01 US Risk Appetite Shock 46:22 Texas Growth and Product Fit 48:11 Compliance Tech Advantage 52:20 Med Spa Scope Creep 54:00 EMR Launch and Beta 01:01:10 End to End Clinic Suite 01:03:25 Analytics and Benchmarking 01:08:19 Privacy and Cybersecurity 01:10:59 Data for Business Decisions 01:12:35 AI For Business Decisions 01:13:39 Market Maturity And Data 01:14:56 AI Notes And Efficiency 01:18:24 LLM Analytics And Marketing 01:20:48 Outcomes And Upsell Insights 01:22:23 Pricing And Business Model 01:25:13 Conference And Giveaway 01:28:06 Criticism And Market Impact 01:33:58 Training New Injectors 01:36:05 Doctor Network And Governance 01:41:16 Regulatory Nuance And Compliance 01:42:32 Wrap Up And Where To Follow ***COMPETITION NEWS*** In partnership with Fresh Clinics, anyone who purchases a ticket to their 'Fresh Life Conference' (being held in Byron Bay, Oct 29-31 2024), Fresh Clinics will randomly draw 10 winners for an annual subscription to our Patreon. (and if you're already signed up, you'll get an extra year!) Follow Fresh Clinics on Instagram for the announcement of the winners by September 6th! ALL IA LINKS & CONTACT INFORMATION

Episode 266 hosts Dr Rebecka Gardell (Medical Doctor based in Stockholm, Sweden) Rebecka joins us in the 22nd Chapter of our series called 'The Injector Diaries'. These episodes feature in depth conversations, stories and experiences from injectors around the globe. Each injector brings their own unique take on things and we showcase every level of type of injector, from newbies to masters. We'll explore how and why they chose to inject, why they favour using certain products, look under the hoods of their clinics and aim to inspire our injector listeners. 00:00 Introduction 04:35 Meet Dr Rebecka Gardell 05:11 From GP to Clinic Owner 09:32 Instagram Growth Strategy 13:38 Advertising Rules in Australia 17:01 Teaching Injection Ethics 22:57 Educating Patients Pre Consult 26:11 International Patients and Aftercare 31:10 Mentors Cannula and Role Models 35:20 Peripheral Filler Philosophy 36:35 Masculine Rejuvenation Strategy 37:13 Temple Filler Risks 38:53 Choosing Stiff Fillers 39:59 Ethnicity and Beauty Ideals 41:22 Adapting to Patient Goals 43:34 Educating Without Judgment 46:48 Next Skills to Master 51:39 Training and Cadaver Courses 53:57 10,000 Hours to Mastery 56:29 Building a Kind Clinic Team 01:03:27 Threads and Patient Selection 01:05:57 Risky Areas and Ultrasound 01:07:17 Sculptra Biostimulator Results 01:09:36 Ideal Sculptra Candidates 01:10:15 Injection Areas and Dilution 01:10:58 Avoiding Lumps and Risks 01:11:18 Why Choose Sculptra 01:12:14 Ultrasound in Practice 01:15:32 Toxin Brands and Mixing 01:17:11 Longer Lasting Toxins 01:18:05 Building a Scalable Clinic 01:24:43 Instagram Growth Tips 01:26:57 Biggest Complication Lessons 01:29:51 Subspecialize in Aesthetics 01:32:23 Listener Q and Wrap Up ALL IA LINKS & CONTACT INFORMATION

Episode 265 hosts Dr Ben Talei (Plastic Surgeon based in Los Angeles, USA) In Part 1 (free for listeners on any podcast app), we cover: Ben's background (previously on episode 173) both as a surgeon but also how he learnt to inject Facial aging and what happens to the different layers The impact of our teeth and orthodontic techniques on facial aesthetics What collagen and elastin are Ben's views on 'collagen stimulation' and why he feels it's disingenuously marketed His approach to face lift surgery and how this has changed over time His attitude to the role of injectables 00:00 Introduction 05:57 Meet Dr Ben Talei 06:57 Ben's Background and Practice 08:54 Modern Facelift Techniques 11:39 Hollywood Beauty Culture 15:05 Celebrity Surgery Commentary 16:51 How Faces Age 21:36 Setting Realistic Expectations 22:06 Surgeon vs Injector Biases 25:59 Orthodontics and Facial Structure 26:59 Bite And Jaw Shifts 27:35 Behavioral Face Training 28:40 Mewing Reality Check 30:15 Perioral Beauty Framework 30:52 Collagen Beyond The Hype 32:11 Macro Versus Micro Collagen 36:37 Facelift Consult Skin Strategy 40:24 Deep Plane Facelift Method 43:57 Fat Grafting By Palpation 46:05 Ligaments And Decussation Zones 48:59 Injector Origin Story 51:42 Part Two Teaser And Wrap In Part 2 (Now available inside our new app, IA Community, ahead of our official launch this May. Click here to join our waitlist), we discuss: What Ben sees in surgical cases after bio-stimulators have been used Histology results vs macro-changes that can be seen in surger 'Filler fatigue' His thoughts about how Sculptra should be used vs how injectors market it His thoughts about how calcium hydroxyapatite fillers should be used vs how injectors market these Why he firmly believes that bio-stimulatory products are problematic in facial surgery Why Ben believes that the dermis should be treated by other means instead of bio-stimulators Ben's attitude to social media and teaching patients through this channel Permanent fillers and Ben's caution about ever using these 00:00 Introduction 02:32 Legal Letters Controversy 03:42 Biostimulators Misused 05:04 Sculptra Proper Use 09:13 Collagen Quality Risks 14:24 Calcium Products Overview 16:14 Hyperdilution Critique 21:33 How to Use Calcium Safely 24:19 Neck Use and New HA 26:18 PRP For Skin Remodeling 27:48 PRP Maintenance Versus Heat 28:41 New Dermal Injectables 30:04 Sculptra Versus CaHA 31:22 Avoiding Regeneration Hype 33:21 Teaching Safe Filler Use 36:05 Social Media Misinformation 40:26 Permanent Fillers Risks 43:20 Tracking Injectables Records 46:45 Counterfeit Toxin Crackdown 48:41 Final Takeaways And Wrap ALL IA LINKS & CONTACT INFORMATION

Episode 264 showcases our hosts Dr Jake Sloane & David Segal. In our 'What's trending in Aesthetics?' mini-series we cover topics that have been popular with injectors on social media or in the news. We'll cover controversies, big stories and themes that have got our industry talking. In Chapter 4 we cover: The collapse and fall out of the large UK chain clinic called 'Sk:n' (since this story broke, there has been a major new update and we'll attempt to cover this in a future episode!) The growing problem of injectors educating patients via social media The drop in sales of hyaluronic acid filler around the globe The impact on medical professionals when they are reported to the medical regulator - including a shocking report that 16 of these have committed suicide in the last 6 years. 00:00 Introduction 00:31 Update on Skin UK 01:34 Travel and Industry Events 02:25 New Profhilo Structura 04:38 New Profhilo Protocols 06:31 Upcoming Allergan Trips 08:00 Patreon Community Updates 10:41 IA Offers and Guest Calls 12:54 Trends Episode Kickoff 13:10 Skin Group Collapse 17:22 Private Equity Explained 27:45 Prepaid Treatments Risk 34:08 Social Media Misinformation 36:31 Financial Pressure Dilemmas 36:58 Consult With Anxious Patient 37:54 Instagram Sensationalism Effects 39:31 Misinformation and Unqualified Training 40:03 Ultrasound MRI Filler Confusion 41:51 Setting Boundaries With Patients 44:56 Pre Screening and Fair Pricing 46:48 Why Filler Demand Is Falling 50:48 New Tools and Patient Expectations 53:29 Injector Ergonomics and Injuries 57:36 Packaging Treatments to Replace Filler 59:43 AHPRA Complaints Crackdown 01:03:08 Anonymous Reports and Malice 01:06:51 Stress Impact and Indemnity Advice 01:09:24 Regulating the Regulator 01:11:47 Upcoming Episodes and Farewell ALL IA LINKS & CONTACT INFORMATION

Episode 263 hosts Dr David Eccleston (Cosmetic Physician based in Birmingham, UK) David joins us for chapter 8 of our mini-series 'The Tox Talks'. In these episodes we feature expert injectors who have significant experience in using botulinum toxins. These episodes explore our guests experiences using particular brands, the evolution of their injecting techniques and we get special insights into the subtle nuances of getting the best out of toxins. In chapter 8 we learn about one of the newest toxin brands called Nuceiva (Prabotulinum Toxin Type A). Manufactured by Evolus and also known as Jeuveau in the USA, Nuceiva will formally launch in Australia this week. 00:00 Introduction 03:25 Dr David Eccleston 04:04 Early Botox Days 07:38 Couture Toxins Approach 09:34 Training and UK Regulation 14:32 KOLs and Conflicts 18:00 Longer Lasting Toxin Debate 20:20 Toxin Science and Spread 27:18 Everly Company Backstory 32:37 Freeze vs Vacuum Drying 38:51 Packaging and Reconstitution 41:17 Preserved Saline Myths 45:07 Comparing Toxins and Consent 48:11 Consent and Disclosure 50:08 Placebo and Brand Bias 50:42 Switching to New Toxin 53:58 Technique and Dosing Nuance 58:33 Dilution and Equipment 01:02:10 Marketing and Regulation 01:03:24 Commercial Pricing Reality 01:10:29 Clinical Trials and Millennials 01:15:58 Resistance and Case Studies 01:21:26 Aftercare and Pregnancy 01:25:44 Future of Toxins 01:33:12 Conference and Wrap Up ALL IA LINKS & CONTACT INFORMATION