Comprehensive Guide to Facial Rejuvenation with Dr. Robert Whitfield

Good afternoon and welcome to our webinar New Trends in Skin Care and facial rejuvenation. I'm Dr. Robert Whitfield. I'm a board certified plastic surgeon in private practice in Austin, Texas. I'm also the current president of the research foundation of the Aesthetic Society as do many other providers Wellness Skin Care and Plastic surgery. We have multiple skincare lines in our office and our spas. In my specific location in Austin, Texas I have Alastin. Alastin is part of my Club W membership program. So it drop ships like an Amazon model. We have Osmosis MD and other medical grade skincare line. We have Skinmedica going live in the next 24 hours in a drop ship model. There'll be a link to that on my website. We'll discuss at the end of the presentation. We also have Eminence and Revitalash specific to lashes and brows. I get often remarks about why we have certain lines or questions regarding why we use certain lines of different types of products. Basically, each of these lines offers the basic skin care and so any of them will fit a wide variety of needs of daily maintenance skin care. Each of them will have specific products that offer solutions to your specific problems. Some will prefer one product over another for how it affects their skin. For daily care, these are all good lines. For preparation for a procedure, I prefer to use Elastin skin care. Elastin has a particular product called Rejuvenating Skin Nectar. We'll discuss that more specifically because that's what I like to use prior to procedure. Once again, Elastin has all the basic products, but then the product that's unique to procedures that I like to use is Elastin Rejuvenating Skin Nectar. It's referred to as RSN or just Nectar. So why do we use it? Why did I choose this to be used? I spent about a year trying to figure out which lines I would carry which would be the primary line. How would I use them in conjunction with daily care and procedures. I settled on Elastin as our go to prior to procedure. I spoke at length to the chief medical officer at Elastin who is a plastic surgeon, discussed the studies they had done and these are skin biopsies taken before and after treatment with Elastin. And it shows that in as little as two to three weeks preparation with Elastin you get an increase the new collagen formation as well as Elastin production. So why is that important? Well, as we age our collagen becomes damaged. This may be to sun the effects of aging, our personal genetics. And we lose elasticity because we lose elastin and we don't produce enough elastin. So elastin Skin Care, specifically Rejuvenating Skin Nectar, is a product that with two to three weeks of use, will help improve this. Why is this important? Well, if we're going to get anyone prepared for a facial treatment where we're going to either perform a treatment with microneedling, face tights, surgery, anything invasive, we want the skin in the best condition possible. And this is a way to prepare the skin. We'll discuss how this works. Here's a nice cartoon. This essentially works by the. You can see in this image these little pac men. The pac men in this cartoon are the ones that eat up the bad collagen. The bad collagen is digested and removed from the skin, improving the texture and contour. How does this all work? Well, the rejuvenating skin nectar triggers the mmps, which in this image are the little pac man. These mmps, which are multiple types. There's type 1, type 8, type 13. These all break down the old bad collagen and help remove it. So once this is performed, then the macrophages, which are like the little garbage bin, they take everything out of the skin and get you ready for improvement in your. In your skin tone texture from the procedure. So this is a number of products plus a preparatory product. This is all, you know, potentially gets very expensive very quickly. So we've developed ways to make this more affordable for our clients. The specific way we do this is through our aesthetic membership offering. It's called Club W. And it works. Essentially, it's an aesthetic subscription service. So what does that mean? There's no fee to become a member. Once again, it's a subscription service. It includes our last in skin care. It includes neuromodulators like Botox, Dysport. It includes Restylane family of fillers and Juvederm family of fillers. It includes ipl, which you know, is synonyms with photo facials for removing red and brown spots from sun damage. There are other services like microneedling involved. Instead of essentially paying for the entire amount at checkout, there are discounts applied to members. The members typically get a 20 to 40% discount based on the product or treatment service being provided. So we'll run through a couple of examples. Don't hold me to all my math. My staff, my team will take care of this for you at checkout. So typically, cleanser, moisturizer, retinol, and sunscreen would be about $200 in a Elastin skincare package for a non member. For Club W member It'd be essentially 160 at checkout. If you didn't want to pay at all at checkout it's just three installments of $53.33 for skincare. If you wanted to add a neurotoxin like Botox, similarly it would still be three payments of 5333 for your skincare. But you'd have to add four months of payments 45 to cover the cost of the Botox. Of course, once again the Club W member gets 20% off the skincare. And then for for Club W members, Botox is essentially $9 instead of $11 per unit. We can run through another example. In this example we're adding lip filler. So that all told would be $8.80 at checkout. For the Club W member that would be 704 at checkout. If you looked at essentially the neuromodularity would be $76 a month for four months. The skincare is before 53, 33 and then the filler is just 12 months $41.66. Once again, you're just spreading out over the lifetime of the product. So these are ways that we make things more affordable for our clients on a day to day basis for their skincare needs. If they want neuromodulator or lip filler, ipl, a host of other services, including our microneedling services. So let's transition now to what is new in facial rejuvenation. And we're going to use a case example and then discuss what's new and what's available and what I decided to use to help this particular client. So the case is going to be 69 year old woman. She came, she had concerns about aging. She wanted non surgical options. Her number one concern was her neck. On her medical history, she had no medical problems. She was taking no medications. She had had no other neck treatments or surgery of the face or neck. Here's her frontal image. And essentially what you need to be acutely aware of in any kind of facial rejuvenation or neck rejuvenation procedure is what's going on beneath the skin. Our tissues lax beneath the skin. Are there other abnormalities? And a particular band is sitting here in the front. This essentially is causing the skin to tend to weigh. So what's causing strictly. So the platysma is this large flat muscle. It runs from the border of our Jaw down across our neck, over our collarbone, and then rests on the upper chest. The division is right down the midline. And that edge, what you see protruding in her neck, now that is something I cannot correct with pure skin tightening. So I instruct every client that I cannot correct that. The options to help relax that are using Botox or Dysport as a neuromodulator to weaken the muscle across that area and get it to relax. And that does prove effective. It just has to be repeated similar to what we discussed with lines and wrinkles of the face that you want relaxed. So more importantly, this is a major issue for her is her profile picture. She's very uncomfortable with her neck and jowl area. So she asked me like, you know, what options do we have to, you know, really take care of the lower portion of my face, my jawline, my neck. And once again I said, you know, and I point out clearly I could not take care of these bands and on your profile, that's really affecting your image. And so I point out that, yes, you want the neck tissue tucked up, there's this band in the way. We want the jowl to move up, away, back where it came from, towards the, you know, the ear and the upper cheek area. And then we would just want all this tissue to globally move. And so, you know, if someone came 10 years ago and said, Hey, I have this problem, Dr. Mitchell, what can you do about it? I would have said, well, we have a facelift and that's about it. We don't have anything that I'm confident in. And then I would lose those clients because many of them were concerned about having facial surgery, couldn't afford the downtime, didn't want the scarring. Fast forward now 2020. We have all these new options. We have incredible skin care options like we discussed earlier with Elastin, osmosis, Skin Medica, eminence. We have non invasive options we haven't discussed, which are forma, which are not appropriate for this client. Her level of skin laxity. We have minimally invasive options. These range from microneedling with RF. There's different types. There's Fractura, there's Morpheus 8, we'll discuss in just a minute. And there's more options that include treatment both above and below the skin. These are acutype, base type, body type, and then obviously there's always surgery for facial rejuvenation with brow lift, eyelid lift, facelift, neck lift, cheek lifts, all these things can still be performed. So she wants a non surgical options. So that that kind of leaves us to skin care. I've already said that her non invasive options aren't going to affect change the way she needs it. So it leaves us with skin care and something minimally invasive. So the best way these days is to combine those modalities using skin care microneedling with radio frequency. And in this instance we're going to add face tight. Once I said, you know, I chose elastin because preparation for one of these procedures. This is the product I chose because it has this flexibility to increase collagen and elastin production prior to procedure. So we use the rejuvenating skin nectar two weeks prior to procedure. One pump twice a day. And then obviously at the time of procedure when we're doing our microneedling, we'll apply it afterwards to get it directly down into the dermis. And then the patient is supposed to go ahead and apply this over the next few weeks while the supply lasts and then transition to different products. We'll discuss that as well. Other products are not supposed to be used after the procedure because the skin will be open and really susceptible to some of the harmful preservatives and other products. That's why we stick to the elastin regenerating skin nectar. So we're going to combine techniques. So we're going to use Morpheus 8, which is a specific microneedling system I was the first one in Austin to have. It's a very interesting microneedling system because its range of small needles goes from 1 to 4 millimeters. So out of the tip of the device, the needles will project. You just set the depth and then the energy on the machine itself. We'll watch a quick video. Actually, my friend Dr. Dibenard did this video. So it just gives you a little sense of how it works and what it's used for. So we'll just listen to this really quickly. Sa. I'll play this.

This is Morpheus 8. This is a array of small little needles that apply radio frequency energy just under the sky.

So this is.

The Morpheus 8 is adding another dimension of superficial tightening to the area. It's especially good in patients who have surface irregularities. For example, in her case, she has this deep crease from just the crease between the large fat that was there. And we're going to remodel that on the side surface with this and enhance the surface contour for patients who are a little older and have wrinkled skin in the area. Also, that's more superficial than what we're treating with the Embrace, this adds a combined tightening to those areas to have the surface look good as. When I'm done with this, we're going to change the depth to four. Okay. So we can also vary the penetration of this so we can make it deeper. So in her, she has areas that has thicker skin. So I'm going to go deeper in those areas because I can control the depth. Those areas that are deeper are the area of the angle of the jawline. So I'm going to.

Here.

Okay. We have now completed the, the Morpheus 8 procedure.

And now is the treatment. So many will ask, well, if microneedling is such a great tool, why don't you use it as a standalone technique? I get asked that frequently. And the reply is, well, here's a before and after of microneedling. You can see the visible change in the depth of the lines. But in areas where you want to get a large movement or greater movement of tissue, microneedling will not be enough to accomplish most patients stated goals, especially if they are more advanced in age or have more facial aging, more skin laxity. So what do we do in this case or in cases like that? Well, we have to add additional modality, and that's when we add Facetight. Now, the combination of Morpheus AIDS and Facetight is the branded procedure, Embrace rf. Interestingly enough, I had had Face Tight for a period of time and another microneedling system prior to the launch of Embrace rf. So I was essentially the first person in Austin to be able to do embrace RF because I had Morpheus 8 prior to anyone else having it. It's been a great tool for us. Face Tight is a really advanced tool in terms of what it can offer because one portion of it goes below the skin. In this slide, the small probe is beneath the skin, and then the larger probe is above the skin. And so this works by almost like, think of like your, your tweezers. So everything is happening between the tips of the tweezers. When you activate them to pluck a brow or do something else, then you control it. So I control the face type probe by activating it and then gliding it along these tissues. And in areas where I want tightening, I can stamp or I can gently apply pressure, just like pressure along tweezers and glide along the tissue. And so in this cartoon images, there's little vines, it looks like within the fat. And that's the fibroceptal network. And once the heat's applied to this area in this network, the fat remodels. And this Tissue tightens. And that's really the crux of the video you're about to watch. It's another cartoon like video. So it just shows the gliding along the tissues of the face type. Probe. So this is the probe itself. It's actually relatively small in nature. It does have. So now we've described, you know, our patient, her stated goals. We figured out the modalities we're going to use. We're going to use Elastin skin care, we're going to use combination of face tight and Morpheus 8, which is essentially how the brand procedure embrace RF came about. We're going to do this in the office under local anesthesia. So for all office based procedures, if folks want to just come on their own, that's absolutely fine. We can do this under straight local with the adjunct of Pronox in the office, which is just nitrous oxide like you get in a dental office. Except for ours is in a 5050 mixture. There's no ill effects. After that you can drive. After that if someone's really anxious or wants or desires more, you can get oral medications like a small amount of Valium. In this instance you do need someone to drive you home. This, this whole kind of design is to make it as simple to do on your own as possible. I have a lot of people in our area who come and have the procedure done and then just drive themselves back without any limitations. So this is a nice out office based procedure. So let's go over just a few before and afters. One, we're going to use a very famous Italian surgeon, Dr. Rovatti. He's done the most, I believe in Europe and his before and afters is shown enough length. And then we'll discuss our case and go over the before and afters. Here you can see and you just gotta follow the blemishes on the skin to know the lifting. So here we have a very, very good neck and jowl lift. You can see the change in the skin at the just under the chin and then along the border of the jaw. So this is a great example of the power of lifting with this device. Now this is all done with no incisions other than a 2 millimeter poke hole which is about the size of the tip of a pencil or a pen. This is all done in the office under local as an outpatient. So we're going to go back to our lady and discuss if you remember, everything she was concerned about. So this is our patient done at our office in Westlake Hills. So essentially she was very, very concerned about her neck beneath the chin. Trying to get that to tie up, trying to get the color, I'm sorry, the, the tissue to move as well as her jawline to improve. So I would just ask you to look at the jowl and the position of the blemish as well as her neck contour and her neckline. So the neckline is improved, it's more acute versus obtuse. It's tucked up, her jowl has lifted. These are all obvious visual changes. So, you know, goals were to improve the neck, both beneath the chin, along the base of the neck and elevate the jowl. All those goals that were stated have been met. We've done this in a office based outpatient setting under local anesthesia. She left on her own and drove herself home. So in summary, we've discussed skin care and how I change from a daily to a prep for procedure with Elastin Rejuvenating Skin Nectar as our product of choice. We discussed she's not really a candidate for non invasive. We do have non invasives like Forma, but for her, her level of facial aging, that was not going to be enough. So the minimally invasive options we have like Fractura Morpheus 8, acutite, face tight, body tight, all of these are available to us. So I chose to combine skincare with Elastin Rejuvenating Skin Nectar with my minimally invasive options. And in this instance, we chose a combination of Phase Titan Morpheus 8 to perform Embrace RF. Although surgery is still the gold standard, I have fewer and fewer clients requesting facelifting procedures either because of downtime costs or they've taken care of someone and didn't want to have a similar recovery period. So, you know, in conclusions, what can we figure out, you know, from what we've discussed? So nutrients in skin care, we have lots of skin care options. We have options now that will just help repair the skin like have never existed before. With a product like Elastin, it's a good preparatory product for procedures. It's a good daily maintenance product. We can do, you know, skin tightening and lifting in the office. We can do it under local, we can do it with a combination of minimally invasive techniques. It's powerful, it'll give us visible change. Now both before and after this, skin care is mandatory. And once completion of the skin care with our regimen for the procedure complete, you can go back to your maintenance skin care maintenance. Skin care in our office consists of whether it's elastin, osmosis eminence Skin Medica or if you have a particular line you're comfortable with, we'll continue that for you as well. Maintenance. Everybody wants to know how long this lasts. Well, everybody's aging. None of these products or treatments are going to stop facial aging. Our goal is to create a desired effect and then maintain it. And so maintenance is specific to each client. I like to do microneedling for maintenance either on a semi annual basis or an annual basis. I think these are all incredibly powerful ways to go ahead and maintain a result. I want to thank everybody for joining us for our webinar Nutrients and Skin Care Facial Rejuvenation. Everybody who was able to register and attend the webinar gets a free virtual consult using our Simplast for patient application. It's HIPAA compliance. We're going to give treatment discounts of up to 20% of those who are qualified. After consultation, it's free to become a Club W member. If you want to PrePay and receive 20% off Elastin, we can do that for you as well. Purchase of Skin Medica Care products is going to be available. It's going to be 30% off MSRP from our website over the next 24 to 48 hours. And then we have a special offer. If you want to prepay for 1cc of Juvederm Family Filler products, you will receive 2000 Brilliant Distinction points. These are redeemable only in our practice that can't be used elsewhere, so you'd have to to come in and use those in our office. I want to thank everybody for joining the webinar. If you're interested in any of these offers, please feel free to email brettrrobertwitfield.com we will be emailing out a list of all of our offers. Thank you for joining us. Along the jawline here, it goes beneath the skin and as I mentioned, you activate it, apply pressure and you'll heat the tissues and tighten the tissues, remodeling the fat as well. There are temperature settings that have to be reached and there's a temperature sensor in each of the components at the tip. External and internal temperatures demonstration is it's heating the fat so it can remodel and it's tightening the fiber septal network so instead of being lax it becomes tighter. Once again, this is all in combination with our elastin rejuvenating skin nectar preparation. We want to clean out the bad collagen and then tighten and improve the existing collagen as well as have deposition of new collagen and elastin. Okay, video.

This is Morpheus 8. This is an array of small little needles that apply radio frequency energy just under the skin.

So this is.

The Morpheus 8 is adding another dimension of superficial tightening to the area. It's especially good in patients who have surface irregularities. For example, in her case, she has this deep crease from just the crease between the large fat that was there. And we're going to remodel that on the surface with this and enhance the surface contour. For patients who are a little older and have wrinkles in the area also, that's more superficial than what we're treating with the embrace. This adds a combined tightening to those areas to have the surface look good as. When I'm done with this, we're going to change the depth to four.

Okay.

So we can also vary the penetration of this so we can make it deeper. So in her, she has areas that has thicker skin. So I'm going to go deeper in those areas because I can control the depth. Those areas that are deeper are the area of the angle of the jawline. So I'm going to. We have now completed the Morpheus 8 procedure. It's sam.