Voiceover (00:06):
Welcome to The La Jolla Cosmetic Podcast, with Monique Ramsey.

Monique Ramsey (00:16):
Hello, everyone, and welcome. I'm Monique, your hostess of The La Jolla Cosmetic Podcast. And today, let's talk about, are you hot? Are you hot? Then you're in the right place. We're going to talk about a procedure that everyone can benefit from, men, women, and really at any age. And the words most people use to describe the results from this procedure are life changing. My guest today is our PA from the medical spa, Julia Jowett. Welcome, Julia.

Julia Jowett (00:48):
Hi.

Monique Ramsey (00:49):
Hello. Thanks for being here.

Julia Jowett (00:51):
Thank you for having me.

Monique Ramsey (00:53):
So can you start out by describing a few of the people who you've treated with miraDry, and what was their motivation for seeking it? And maybe we should back up, maybe we should really say, what is miraDry. miraDry is a treatment that we do to help excessive sweating in the armpits.

Julia Jowett (01:12):
Specifically in the armpits. And so people that seek this treatment out, they are generally people that come in that have excessive sweating in their underarm area. It is FDA cleared to treat only the underarm, but we have really good results for patients that have typically a condition called hyperhidrosis. And, you know, for those patients, they have excessive sweat production, it's like a leaky faucet. The fluid that comes out of their underarms is overly produced and they're just constantly sweating through their clothing. If they go on a job interview, if they are, you know, trying to go on a first date, any of these scenarios that we think of in life, where this affects them, and it can cause severe anxiety about how they might be leaking through their clothing or how that might look, it can cause depression.

Julia Jowett (01:58):
You know, it can really actually affect a lot of things in life. And our typical patient is somebody who is young, but it can be treated at any age. This condition is usually presenting in puberty, so it's something even people in high school are calling us about because it's affecting them that early. It's not only for that condition, so it's, typically, that's the person who is doing this procedure, but we have several patients who come in who just don't want to wear deodorant anymore. They don't want to worry about putting that on, using chemicals, they want to just be, you know, be natural, and so that's a great option for them as well.

Monique Ramsey (02:29):
I think that's a really good point that you bring up because, you know, there's millions of people out there who have hyperhidrosis, but there's hundreds of millions of us or billions of us who don't, and just being extra sweaty or having the white marks on your clothing, and I think the biggest thing really that you brought up is a chemical free lifestyle. There's a lot of people who don't want to put on antiperspirant and then they go to just deodorant, some natural lavender thing, but does that really work? No. You know, and even if the lavender deodorant helps, you're still sweating. So I think that this is something that a lot of people don't know about. And would you say, as a percentage of the cases that we see, are half of the people doing it for lifestyle reasons or what percent are doing it for lifestyle?

Julia Jowett (03:20):
And by lifestyle, do you mean-

Monique Ramsey (03:21):
Just where they don't have hyperhidrosis?

Julia Jowett (03:24):
So I think about 80 to 90% that we treat do it for hyperhidrosis. When we really talk to them and investigate why they want to have the treatment, a lot of them, majority of them do. However, we still have a good amount of patients that maybe, maybe they just, you know, they're not really at the clinical diagnosis of hyperhidrosis, but they are in the hot times of the year worrying about sweating. And so those are the patients. When we talk about like protocol for the procedure, you know, we have a range of how many treatments we do, and so some of those patients we'll say, "Maybe just do one treatment, see how it goes for that." And for patients that have a lot more of that sweat production, they might need more than one of those treatments.

Monique Ramsey (04:04):
Okay. So, we all sweat, that's a given, let's be real, but what causes someone to sweat too much?

Julia Jowett (04:13):
That's a great question. And so really getting down to the science of why somebody might have hyperhidrosis. There's two types of hyperhidrosis, so primary and secondary. Primary is, you know, it's just, that's what your body does. There's the faulty feedback system in your nervous system, basically. We don't know why it happens. It can be contributed to family, so if you know your mom or your dad had it, there's a risk for you to have it. Secondary is, it might have happened from a change in your body, so maybe medications, a new medical condition that you hadn't previously had, a metabolic condition, a neurologic condition.

Julia Jowett (04:50):
You would know the difference mainly in like when it started happening. So typically, primary hyperhidrosis happens in puberty. You're young, you're under 25 years old, and it just starts happening. Secondary and a reason to potentially investigate with your doctor before seeking out a treatment for this is if you're like, "Okay, I'm 40 and I just started sweating all the time and it's happening all day and all night. And it's not because I'm hot, it's not because I'm exercising, then maybe we investigate first why that's happening.

Monique Ramsey (05:18):
Okay. I think the biggest question that... I've talked about it, because I've had miraDry. So when I tell people about it, they're like, "What, there's a treatment for this?" And I didn't have hyperhidrosis, I did it just because I was on the edge of uncomfortable. But the first question they always say is, "Well, don't you need your sweat glands? Isn't sweating a natural process?" So tell us about why this is safe in the underarms.

Julia Jowett (05:45):
One of the most common questions we get, of course people want to know, "Am I doing this? And it's eventually going to harm me? Am I not able to eliminate toxins that I have, that I need to be sweating out? Am I not going to be able to sweat at all?" Our bodies have between two and four million sweat glands, only 2% of them are in the underarm area. So it was really a small percentage of the actual sweat glands that we have in the body. Another consideration is that this production of sweat, the main function, the reason that we sweat is to regulate our body temperature. So when somebody is exercising or hot, we sweat and that keeps us safe.

Julia Jowett (06:21):
People that have hyperhidrosis or that sweat too much, it's more like your body's signaling to sweat when it shouldn't be. And so it's producing fluid and sweat but it doesn't need to be. It's not doing anything for us, it's not clearing these toxins or regulating our temperature, it's just like a leaky faucet, it's just running water. And so when we turn those sweat glands off, it's not harmful, it's not taking away something that we need to do as humans.

Monique Ramsey (06:46):
And so, what's the actual medical term for the condition that miraDry treats?

Julia Jowett (06:51):
Yeah. So the medical term is called axillary hyperhidrosis, which basically means underarm, hyperhidrosis or excessive sweating in the underarm.

Monique Ramsey (06:59):
Okay. And you mentioned earlier it's not cleared to be used anywhere else, because there's a lot of people who have sweaty hands or sweaty feet or maybe in the groin or their back.

Julia Jowett (07:10):
Exactly. So a lot of these same types of sweat glands exist primarily on the palms, the soles of the feet, the face. And we have options we can talk about for those areas. But right now we don't have any sort of clearance to do the miraDry treatment on those areas, it just wouldn't be safe, but we do have other options.

Monique Ramsey (07:26):
I heard they are testing other areas and body parts, and so that-

Julia Jowett (07:30):
Hoping that. I know, it's soon. This technology exists, it's just a matter of developing the safety protocol.

Monique Ramsey (07:36):
Yeah, the safety part. Because certainly, you know, if you're doing your hands, you want whatever's going to be treating your hands not to-

Julia Jowett (07:42):
You want to make sure you can use your hands.

Monique Ramsey (07:43):
Yeah, because they're important. Sort of important. So let's talk about, who's a good candidate for miraDry treatment, and what are, kind of, the health screening questions you ask them?

Julia Jowett (07:53):
Yeah, absolutely. So for any new procedure that we do in our clinic, we do a preliminary health exam called a good faith exam. And we are assessing for your overall wellness and health. You know, the criteria for if you can have the treatment is really either, do you have hyperhidrosis or do you want to do this just so you don't sweat that much anymore. People usually fall in one of those two categories. So the desire to have the treatment doesn't really matter what your motivation is. Some people also want to have it for odor. It is also FDA cleared to treat hair, so we can do it for any type of pigmented hair, whether it's dark, whether it's light, which is really unique because with laser hair removal, we're restricted by the color of the hair.

Julia Jowett (08:32):
So any of those three indications, you can have the treatment. We assess for, you know, medical conditions, such as a sensitivity to Lidocaine, any sort of heart conditions that you might have, your overall health and wellness, your ability to heal from a wound or heal from, you know, a procedure. If you have a pacemaker or a defibrillator, if you have pregnancy or currently breastfeeding. So those are things that we typically ask in the procedure.

Monique Ramsey (08:58):
Now, tell for the people in the audience who might not know, Lidocaine, what is Lidocaine? I've heard it, but what does that mean? And when do we often see it? Is that the same thing may give you at the dentist when you get like a cavity fixed?

Julia Jowett (09:11):
So, it's similar, and it's a numbing medication. So we can either use it topically, we can inject it and it actually just blocks your sensation. We use it for a lot of procedures in all types of medicine. So in emergency medicine and definitely in cosmetic and aesthetic medicine, we, you know, do either topical or injection numbing for our laser procedures, for our injectables to make you really comfortable. With miraDry, the nice thing about the procedure is that we actually do such a good job with our numbing protocol that they created, that you don't feel the procedure at all.

Julia Jowett (09:42):
When we inject that numbing solution, the procedure is completely painless, but that's something we want to make sure is safe for you. So, Lidocaine can have effects on your heart rhythm, it can be toxic if too much is given, and we want to make sure that we know your medical history and that this is something that's safe for you to do.

Monique Ramsey (10:01):
Yeah. And so bringing that up, yesterday, I saw there's a story out of Mexico, something about a miraDry patient. Did you happen to see that?

Julia Jowett (10:10):
I did. And I looked into it to see exactly what happened. And, it's still pretty recent, so the details are not fully disclosed, but what it sounds like is that the miraDry procedure was not even performed on the patient, they never got to that point. The patient had a reaction to the Lidocaine. And they are speculating that the patient had taken some supplements and medications that she did not disclose to the clinic and that might have been something that was putting her heart under some stress. And then combination with the Lidocaine, she had a reaction.

Julia Jowett (10:41):
Whether that's true or not, it was definitely something with the numbing process. What really went on, I'm not sure yet.

Monique Ramsey (10:46):
So she didn't even have miraDry?

Julia Jowett (10:48):
MiraDry never touched her skin.

Monique Ramsey (10:50):
Okay. Yeah. And this is why you want to go to somebody... And I don't know whether she lived in Mexico and was having the treatment in Mexico, but, you know, we do have... Being on the border here, we do have patients who will try to save some money, and they think that traveling out of town might do that for them. But at the end of the day, you want to make sure that you're safe, you're in a safe environment, and that the people who are working on you are going to ask all these questions upfront. And, you have to, you know, as a patient, it's incumbent upon you to, if they say, "Have you taken any drugs? Are you doing this? Are you doing that?" You've got to tell them, it's for your safety.

Julia Jowett (11:26):
So important. Absolutely. And I 100% agree with that point. You know, the patient that I treated yesterday, she...her and I were talking about this because she had just read about it, and she's Mexican. She says, "I'm from Mexico, my family's there. I was thinking about going there for the treatment. And then I thought again and thought, 'You know what? I better go to who's the most experienced and a very credible clinic.'" And it's just so important with any procedure that you do.

Monique Ramsey (11:49):
Yeah. And we're actually just right now about, we've been doing miraDry for four years. We were one of the first places in San Diego to get it. And so we've done hundreds and hundreds, maybe thousands of armpits.

Julia Jowett (12:01):
Closer to thousands.

Monique Ramsey (12:06):
Lots of them. So we were one of the top miraDry offices in the country. And so I think, you know, that experience and knowing exactly how many treatments the person might need or to pre-assess them. Would you say if you know you have a sweating problem, you're going to need more than one treatment, is that pretty much the case?

Julia Jowett (12:26):
Typically, with our patients that have that excessive sweating, we like to do at least two treatments. We can treat up to three times for miraDry, that's the most amount that they have evaluated for their recommended protocol. So typically, it's not even needed to do a third treatment, but in general, I would say the majority of patients get the best result out of doing two. And if you think about why, so say we're covering the underarm, you know, as we treat down the underarm and we're killing the majority of those sweat glands in that area, but there are still some glands that are over-producing sweat.

Julia Jowett (12:57):
Just by covering some of those glands, the ones that are still there are still going to do what they're doing that bothers you. So if there's still some overproduction of fluid, it's still going to be annoying. So if you go through the process and say, "You're getting maybe a 70% reduction with that first treatment, but you get closer to 80 to 90% with that second one, that's really where that happy place is.

Monique Ramsey (13:15):
And speaking of happy, these are patients who really, like I said at the beginning, the procedure's life changing. And would you say the satisfaction rate is super high?

Julia Jowett (13:25):
It's one of my favorite procedures to do. And it is definitely, you know, all the providers, we always talk about our satisfaction rates with procedures, what is everyone loving? And miraDry is always at the top of the list. People, you know, I had a patient yesterday who emailed me, her treatment was not even two weeks ago, and she said, "It's already changed my life." It is something where if you're constantly having to think about this, everything you do during the day, maybe you've been doing that for so long, you don't even realize you're doing it. And when you suddenly don't have to do that anymore, you don't have to worry about, what color is my shirt I'm going to wear today? Or, how am I going to hide this on my date tonight?

Julia Jowett (13:59):
It is life-changing. It is really, a really great procedure. And it doesn't matter how old you are, you know, any sort of like behind the scenes medical things going on, your underarm glands, sweat glands are going to respond to this. So it's not, there's not a lot of variability in how it works. You know, some of these treatments we do for skin tightening or for fat reduction, you know, it can vary on how much fat you have or how old you are, or these factors and for the sweat glands, that isn't the case.

Monique Ramsey (14:26):
It's pretty cut and dry. Oh, cut and dry, there you go. Hopefully. RIght? So how does miraDry technology work? I saw on their websites that miraWave. Well, what's a miraWave?

Julia Jowett (14:40):
They patented that technology and called it miraWave, but it is essentially using microwave energy to cause thermal damage to the tissue. So we're essentially, you know, suctioning up tissue into the applicator handpiece. And that releases the microwave energy that, kind of, hangs out right at the depth of the sweat glands. So it's not going deeper, but it's at that perfect depth. And that's really the only technology that has been able to achieve that depth in damage that area. It also cools the dermis while it's doing that. So that's why it doesn't, you know, this amount of heat into the skin, like through the skin to get to that layer, it would normally burn the skin, but because of their technology, the miraWave technology, they are able to keep that skin cool so that there's no damage to the skin.

Monique Ramsey (15:26):
It is, I have to say, having it done, it does, you feel you're like, it sucks it up in there, and then you hear the little beeping and then you're like, "Okay." And then they move to the next little spot.

Julia Jowett (15:37):
I always joke, it sounds like you're at a casino, they make these fun little noises as it's going on.

Monique Ramsey (15:43):
Yeah, it is pretty funny. So we're just like, "Okay, I guess it's working." So how painful do people say that they have pain?

Julia Jowett (15:51):
If you have pain during miraDry, it just means that there's a spot that isn't numb enough. So really when we do the procedure, we do such a good job with that Lidocaine injection that you don't feel it. And with our protocol at our clinic, we use a tiny little device that has needles that are basically the diameter of a hair. You know, they're a little 32 gauge or less needles, seven on them at a time, but they actually just go right underneath the skin so that you're feeling one poke, but it's treating a large surface area. And then we move on to the next and we inject a ton of that fluid.

Julia Jowett (16:23):
And so when we actually start the procedure, most patients, they put on a movie they haven't seen in a while, they zone out on their headphones, you just relax and you don't feel anything. You feel a little bit of that tug, a little bit of that pressure. If a patient ever says at one point they do feel some pain, I just inject a little bit more of that numbing medication and that goes away.

Monique Ramsey (16:41):
Okay. That's good. Now, what can you do to make the treatment more comfortable for someone, or are they pretty much comfortable once they get the numbing cream, I mean the numbing injection?

Julia Jowett (16:51):
Injection, yeah. Yeah, once they get the numbing injection, they're comfortable. I would say, you know, the part that people will feel more is once that Lidocaine wears off. So, you know, later in the day or the next morning, that's when you might feel a little bit more of the discomfort. And this really ranges in my experience per patient. I call the patients the next morning to follow up. If some of them say, "I don't really feel that much at all," it's fine. And other patients, they might rate it a four or five out of 10. And that's important to know because, you know, when you're planning, and you're, you know, what to know to expect with your healing, we know that that's probably the point in time that you will feel that discomfort, but quickly it gets better.

Julia Jowett (17:26):
So usually, if I talk to a patient a little later in the day, for example, a patient I called today, she had discomfort before she went to bed last night, she woke up this morning and it was gone. We have you take anti-inflammatory pain medication, so ibuprofen is our typical protocol, doing cool compresses, 20 minutes on 20 minutes off as you're healing, and using your arms, moving around, stretching. That all helps with that inflammation. So it's good to kind of refrain from just holding your arms in and feeling afraid to move.

Monique Ramsey (17:56):
Yeah. Yeah. Now, I remember there being some swelling afterwards.

Julia Jowett (18:00):
Yes.

Monique Ramsey (18:00):
But again, I had this right when we first got the machine, and I think some of the things have changed slightly. But, is that typically, like..If you've got a big event next week, we shouldn't be doing miraDry today?

Julia Jowett (18:12):
Yeah. Anything that you need to wear a tank top or anything sleeveless, I would give yourself at least, I mean, a week cushion for that. And if there's an event, give yourself at least two weeks cushion, you know, because you can have that swelling. And again, that ranges by the person. I have some patients who are like, "I was expecting the swelling, you told me that might happen and it never happened." Other patients, two weeks later, they still have swelling. And it depends on your body and how it heals. A lot of the swelling is just from the fluid that we inject in the procedure. And so for the majority of people, that usually clears out within a few days, that more dramatic golf-ball-looking swelling.

Julia Jowett (18:47):
Then you might have a little bit of inflammation from the actual destruction of the sweat glands, and that's happening at the same time. And so that can be more confined to directly in the treatment zone, kind of, raised a little bit puffy or swollen, and that can take a little longer to go away. But that's a good sign. That means that this inflammation is killing the glands, your body's reacting to it and it's working

Monique Ramsey (19:09):
Now, do people need to take any time off usually?

Julia Jowett (19:12):
It depends.

Monique Ramsey (19:13):
Like if you had it during the day, you just go home or could you go back to work in theory?

Julia Jowett (19:19):
I had one patient who I will always remember. She did the miraDry treatment, and then she left the office and went to take the final exam like an hour later, and I was so impressed. You can do things right away. There's no activity restrictions as long as you're not going to be heavily exerting yourself. I had another patient who was an airline pilot and he took a week off because that, you need your arms, you need your hands, you need to be healed. He didn't want to have to worry or wonder how he was going to feel. And so I always at the consultation, talk with patients about what their profession is, what their activity level typically is.

Julia Jowett (19:50):
You know, things that you want to avoid that week are really strenuous exercise, any really heavy lifting, things over 15 pounds, like on a constant basis. You know, if it's like you have to pick your kid up, you can't avoid that. But say at work you're doing that, definitely take an extra day or two off just to be comfortable, but you don't have to, it's not a requirement.

Monique Ramsey (20:08):
I went back to work the same day, because I had it in the, during-

Julia Jowett (20:11):
In training?

Monique Ramsey (20:12):
... in the office. I was really fine. And then about, I don't remember what time we did it, like late morning or around noon, and then by like 3:30 or 4:00, I noticed the Lidocaine was wearing off. I'm like, "Okay, it's getting a little hot under my armpits." And so I went and found those little ice packs. And that night I was like, "Whew, it's hot." And I was busy switching out my ice packs at home and thinking, "God, I hope it's not, in the morning, like, worse." By the morning, it was gone, I was fine. So it was like, "Oh, okay. That was the rest of it? That's it?"

Monique Ramsey (20:46):
But my big advice for everybody was, I came to work the next day, but I didn't think about how swollen I was. And I wore an underwire bra as you do, when you, you know, and I was like, "What is digging into me?" And so I thought, "Okay." So here's my advice, you know, wear something soft.

Julia Jowett (21:06):
Yeah. That's a great point. Be comfortable.

Monique Ramsey (21:09):
Yes. Something soft with a little tank top, or a sport's bra, just something that's not going to be binding you. So just think about that. But other than that, that was kind of like the biggest amount of fuss. And now tell me about what happens that week, let's say after, and what are the post-op instructions for somebody? What do you want them to do? Or what do you not want them to do?

Julia Jowett (21:33):
Yeah. So the typical rule with miraDry is to keep your areas that are treated clean, cool, and dry. So really for that full week after, you want to avoid anything that might be contaminating them. So things like you know swimming in the ocean, rolling around in a muddy field, really don't let your animals lick your under arms. If you just keep it clean, cool. So avoiding really hot shower. So don't, you know, go take a steamy shower that night or really for the rest of the week.

Monique Ramsey (22:02):
It's going to your pores up.

Julia Jowett (22:03):
Yeah. And you have all this inflammation, and the worst thing for inflammation is more heat. So you want that heat to get better not stick around longer or be worse. So in that token, no hot tubs, no saunas, no steam rooms, no hot yoga, Jacuzzi, anything like that. I mean, you know, some patients, they love to go in the hot tub every night, I say, just dip your feet in, but don't go in underneath the area that we treat. Even at the pool, I really caution anything that might cause any sort of like sensitivity or reaction on your skin.

Julia Jowett (22:33):
Because if you think about the inflammation you have, and you go in a pool that 100 other people have swam in that week, full of chemicals, full of who knows what, just don't go in beyond your waist. And that's important.

Monique Ramsey (22:44):
That makes sense. Are they allowed to wear deodorant or antiperspirant after the treatment?

Julia Jowett (22:50):
Yes. There's no restriction on wearing deodorant or antiperspirant, we just want you to make sure it's clean. So think about, you're putting something on your under arms every day, it's not the cleanest thing. So usually, I advise people to either wear the spray deodorant or purchase a new one, and just have that ready to go. You don't have to wear it though. Some people are fine without it. You know for most people, it's like a security blanket before you start your day, you just like to put that on and have it on.

Julia Jowett (23:14):
A lot of people will see results as soon as the first week after the treatment. So you might hit a point where you're like, "I don't really need to wear this because I'm just not sweating." And then sometimes some of the sweat will come back a little bit as you go through that healing process and your sweat glands are dying and purging a little bit, but you can wear deodorant the entire time after, and there's no special kind you have to wear.

Monique Ramsey (23:34):
And so that purging, somebody, I don't know if I read it, somebody was saying, "Oh, there's the purge." I'm like, "What does that mean? What do they mean? I don't remember anything about a purge." What is that?

Julia Jowett (23:44):
It only happens to some people, and so some people will get like this mal odor is like your sweat glands are just, you know, kind of starting to break down. And as they break down, they release what is left in them and it kind of creates a purge effect. Sometimes we can feel the lumpiness, which I always tell, especially female patients, because if you feel lumps in that area, your concern is okay, is there something going on? But it's part of that gland breakdown process and it's part of your healing.

Monique Ramsey (24:11):
Just normal. Now, can you combine miraDry with any other treatments in the same appointment? Is that something that you guys normally do or?

Julia Jowett (24:19):
Yeah. All the time. When you're in the office having miraDry, there's a certain amount of time that you are just having the treatment. And so if you want to have other procedures like fillers, Botox, other types of lasers, we can do that either before or after the miraDry treatment. So a lot of our patients will end up doing filler right after, they will do say, laser hair removal or really anything. There's no contraindication as long as you're not treating over that same area.

Monique Ramsey (24:46):
Oh, that's good to know. Why not?

Julia Jowett (24:51):
One-stop shop.

Monique Ramsey (24:52):
One-stop shopping. Yeah, exactly. Now, let's say somebody's got hyperhidrosis, they want to know all their options, is miraDry the only option or what other things can be done to treat that?

Julia Jowett (25:07):
Yeah. So, there are a variety of options to treat it, and in different areas on the body where it is affected, you know, since we can't do miraDry, we also have treatment options for those areas. In general, like the typical, you know, most conservative to most aggressive way to treat hyperhidrosis is with, say, starting aluminum chloride prescription deodorants, oral anticholinergics. So something that's going to decrease that overproduction of that neurotransmitter that's causing that excessive fluid production. One treatment option that we do at our clinic that is also an option in the other areas is actually using Botox to inject.

Julia Jowett (25:42):
Botox, we all hear about it to relax muscle movement and quiet wrinkles and lines. The way it works is it blocks the neurotransmitter acetylcholine, which is also what is overly produced and causing the excessive sweating. So when you inject it in the depth of the sweat glands, it actually inhibits that process and causes the sweat glands to temporarily stop responding or stop producing that acetylcholine. So we can do that in the hands, we can do that in the feet.

Julia Jowett (26:09):
One thing that we've been doing recently is actually putting Botox in our procedure, Aquagold for facial sweating, because that's something that people have and you can't inject Botox all over the face without freezing the muscles. But when we put it in the Aquagold, that penetrates really superficial in the skin and we saw some great results with that for people with excessive facial sweating.

Monique Ramsey (26:28):
Very Interesting. And how would you compare... I think the one thing about Botox, let's say you were saying, "Oh, well, look at miraDry or what if I had used Botox for my armpits?" But isn't that a lot of Botox? And then a lot of units it's temporary. So, whereas miraDry, it's permanent.

Julia Jowett (26:48):
Exactly. Any patient that comes in, you know, asking about their options, when I tell them what their options are, they usually pick miraDry. I would say 9.9 times out of 10, they pick miraDry because, you know, it's not available in other areas of the body. So we just don't have that yet, hopefully soon. But the Botox result typically lasts about three to four months. So it's something you have to continuously do.

Monique Ramsey (27:12):
And if you had what, 50 units per armpit. Then, so it's a whole vial, that's a lot, that's a lot. So, and it's going to wear off. So that makes sense.

Monique Ramsey (27:21):
And it's nice that there's this new, and you're not taking a medicine. I think that's the other thing is you take a drug, you have to keep taking the drug.

Julia Jowett (27:30):
And it has side effects. Anytime you're taking something systemic, you're going to notice that decrease fluid production, but some of the side effects are dry eyes, dry mouth. So that's something that is not desirable if you can avoid that.

Monique Ramsey (27:43):
Yeah, exactly. So how much does the miraDry procedure cost? Is it right around $1,850 to $2,100 or somewhere in there $2,200?

Julia Jowett (27:55):
Yeah. So, our typical pricing is based off of how many treatments you have. So typically the first treatment is around that I believe $2,000 or so. And then the second treatment is at a reduced price when you come back for your second one.

Monique Ramsey (28:09):
So they sorts of do a bundle? Yeah. And that's something that, again, with our GLAMfam, the GLAMfam membership gets you the better price. And so if you're wondering why there's a range, that's why. And then consultation is complimentary. So walk us through sort of a typical consultation. Is it something you can do on Zoom where they don't have to come in or do they need to come in and actually show you their armpit?

Julia Jowett (28:36):
You know, because this is such an easy way to verbally assess and get a history of a patient, and that's the main clinical diagnosis, that's the main screening that we do is verbal, we do these consultations over Zoom. We can even do them over the phone. So some people just don't have the time. They don't want to come in or make a whole appointment for Zoom, we can still go through all of the information verbally. And that's the initial clearance for the procedure. We go through your medical history, you know, go through your symptoms, why you're interested in having the procedure.

Julia Jowett (29:04):
We'll talk about procedure day. And a lot of the things we just discussed about what to expect during that procedure. You know, one thing we always talk about is like how long you're going to be in the office. So coming in and having the numbing medication on topically for a little bit, and then having the injection, and then miraDry actually provides us with a temporary tattoo that we put on. And that makes sure that we cover the area completely. So it's not even a provider dependent to make sure we don't miss a spot, miraDry make sure of that, they give us that temporary tattoo, and we cover everything.

Julia Jowett (29:35):
And we use full power that's one thing that has been adjusted in the miraDry protocols over the recent time, they used to have providers start at a lower strength and then increase it to a higher strength the second time. Now, it's full strength each time. And that gives really great result.

Monique Ramsey (29:50):
Oh, that's really good. That's nice to know. And I think that the other thing you mentioned earlier, that the way that we inject the lidocaine now, with that little, it almost looks like a little block or a stamp with a bunch of little needles when I had it, that wasn't part of the protocol and it was bigger needles. And I had a few hotspots during the treatment. And I think now that new way to deliver the lidocaine, it makes it just a much easier procedure for the patient all the way around.

Julia Jowett (30:18):
Absolutely. It's faster it's less painful, it's safer, quite frankly. There's no variance in how deep you're injecting and you're putting it right where your body needs it for the procedure.

Monique Ramsey (30:29):
Yeah. I went online yesterday and I was looking at miraDry and I noticed one thing that it has, and we talked a little bit about this earlier, a really high satisfaction rate. And I actually did the calculations as of yesterday, and of our patients, it's 4.9 out of five stars. I mean, that's crazy. It's really high. So I thought we would talk about a couple of the reviews. So here's one that I found. It said, "It worked. I have dealt with sweat issues since I hit puberty and now I can wear t-shirts and tops I would never have worn prior to this. It has been only two weeks, but it's been truly life changing for me."

Monique Ramsey (31:07):
And that's funny because that was basically what your patient just said, and this is a different patient, but very, very similar. And I found another one of your patients who said, "I did the miraDry procedure with Julia. She was very sweet and gentle and knowledgeable. Any questions I had she'd answer and made me feel the most comfortable throughout the process. It's only been two weeks and I've seen such a dramatic difference. Only did one treatment. And I'm very content. I've struggled with excessive sweating ever since I was younger, and I would definitely recommend to anyone out there going through that same problem."

Monique Ramsey (31:41):
So the words comfortable, informative, knowledgeable seem to show up in your reviews a lot, Julia, does that surprise you?

Julia Jowett (31:47):
Oh thank you. I love hearing that. Well, and that's what I think, you know, at our clinic, yes, we have the technology, not many people have the technology, but we also have the experience and the background to kind of give a great treatment because there's more components than just being able to administer this device. It's really knowing all the different scenarios that can present with a medical procedure like this. You know, knowing how to manage a complication if it happens, or knowing how to make somebody feel comfortable that's really nervous. You know, I have some patients who are terrified of doing a medical procedure.

Julia Jowett (32:19):
The only reason that you're doing this is because it's so disruptive in their day-to-day life, but they don't want to, they're scared. And when they come in, they realize the process is nothing to be afraid of, and it is as comfortable as can be. You know, we put on the Netflix for them, we make them so comfortable, and you know they're falling asleep by the end of it just like, I'm so happy, this was a break in my day.

Monique Ramsey (32:40):
Yeah. Sometimes we need a forced break just to relax.

Julia Jowett (32:43):
My kids are at home, I don't have to watch them right now.

Monique Ramsey (32:47):
Now, you kind of touched on this, I think it's worth bringing up. You know, what are the biggest risks of this procedure? What could go wrong and how do we fix it if it happens?

Julia Jowett (32:55):
So, you know, the things that we know might happen or things that are standard with any type of procedure, like inflammation, bruising, swelling, there's potential for infection if we don't keep the area clean after. As part of our protocol, we give a medical strength skin cleanser that we put in your post-care kit. We give you topical antibiotic ointment that you wear every day throughout that week. And, you know, really those descriptive instructions on what to do and what not to do can minimize that risk. Other things that can potentially happen, so, you know, either during the treatment or after the procedure, you might notice, kind of like a numbness or tingling, even going down to your arms or hands.

Julia Jowett (33:31):
And that's typically just from the lidocaine, sometimes if it's around a nerve or aggravating it, it can because that sensation. Sometimes you can feel nerve pain. So as we're injecting, you might feel a little twinge in a nerve or as you're healing from the procedure and all that inflammation and certain motions, you can feel a little bit of nerve pain. That is something that is temporary. So as you go through the healing process, it resolves. One of the things that makes the procedure so safe is there are protocol for the numbing solution, all that fluid that we're injecting in the area, we're actually also compressing away any of the lymphatics, the nerves, the blood vessels, things that we want to avoid with that energy. And that makes the treatment very safe.

Julia Jowett (34:10):
So, you know, if there's a provider that does not follow that protocol and does not inject all that fluid, there's actually a higher risk of having something like that happen.

Monique Ramsey (34:18):
Oh, that's interesting. And I remember Yvette, and she's on our blog. We have a blog post too, and we'll put it in the show notes about those of us at the center, not everybody, we interviewed a few people, who've had miraDry and what their experience was. And she had something with her muscles , sort of, tightening a little bit, like a Band-Aid or something. So what is that? Is that still something that can happen to people?

Julia Jowett (34:43):
It's still something that can happen, but it is less risky. I would say it depends on the person. So it typically can happen in somebody that's a little like thinner, not a lot of body fat in that area. And what happens is basically as your body's healing from the inflammation, you can get some tightening and banding and the fascia underneath the skin. And it can cause, almost it looks like little ropes, kind of pulling when you move your arms. And sometimes that can just happen for a week or two. And for some people it can last a little bit longer or can show up later.

Julia Jowett (35:12):
Typically what can improve that or make it less risky to happen is stretching. So I advise all my patients to do stretches every day, three times a day for even like one to two months after the procedure, especially if they're a little bit higher risk than that. And when they massage the area, stretch it, it typically goes away on their own.

Monique Ramsey (35:31):
See, and those are the things that I think us having done thousands of treatments, now. You know, some of us who were at the very beginning we were like, "Well, we didn't know that could happen, and how do we fix it?" And so, but if you want to talk to people who've had the treatment, there's so many of us who have, and we really believe in it. We always vet the technology before we bring it in and we want to make sure that whatever we're bringing in is the best in class, and that you're going to have a great result. And, so yeah. But I think it's good to have those who've gone before you.

Monique Ramsey (36:02):
So the protocols, you know, you can give good advice or know how things resolve because then you, as the provider could say, "Yeah, well sometimes we see that, maybe 2% of the time and it resolves in about a month." You know, and then people know. So since this is your first time on our podcast, we want to ask this question. At La Jolla Cosmetic it's our mission to be the place where dreams become real. So Julia, what is a dream of yours that has become real?

Julia Jowett (36:32):
Being part of the family here, honestly. It really has been. I have always wanted to be part of a company like this. And, you know, since the moment I've set foot in the doors here, I feel at home. The patients, you know, that's one of the best parts of the job is obviously the patients that come here are just so amazing. We get to really make a difference in their lives, and they are just lifelong patients. I see patients from 30 years ago that are patients of the surgery center and they're still coming in for treatments and trusting us. And the company, you know, in general, just being a part of the family.

Julia Jowett (37:05):
There's so many people that have worked here for that same amount of time since we've opened our doors. And it's amazing, it's hard to find the place like that.

Monique Ramsey (37:15):
It's pretty unique. It's pretty special. I will agree. So one of the things that if you're thinking about is miraDry right for me? Who can I talk to? In the show notes, we'll have links how to contact us. You can text, email or call. And like we said in one of the other episodes, carrier pigeon, we're here for you. Now, one thing I wanted to ask earlier and I meant to is, could somebody have treatment in the same day or is it better to do the consultation ahead of time?

Julia Jowett (37:45):
Well, I like to do the consultation ahead of time, and that's where the ease of doing something like a phone or Zoom comes in handy, because we can catch, you know, say, we plan for this big procedure, you take time off work, you're coming into the office. And then you find out that even though there aren't many contraindications, that you can't have the procedure, or it's not a good idea, or you need a medical clearance, or something like that. So typically for this procedure, even if it's like a quick little screening phone call that we can fit in, it's better to do that first.

Monique Ramsey (38:13):
So, one of the things I was mentioning, you don't see a lot of before and after pictures for this treatment because your armpits sweat, and then they don't sweat. But if you Google images of miraDry before and afters, you see some really weird stuff. Can you explain what we might be looking at Julia?

Julia Jowett (38:31):
So, a lot of the images that come up as before and afters are actually showing something called a sweat iodine test. And we can do that before you have a miraDry procedure or any other treatment for hyperhidrosis. And it's actually involving putting a layer of iodine and then covering it with cornstarch and then letting you sweat. And you sweat for however long it takes you to start producing that fluid, and then we can analyze where it's turning a darker brown. And so if you see those images where it looks like this mottled, deep, dark brown, that's actually where the fluid is coming out.

Julia Jowett (39:05):
And that's a good way to track your progress if you say, "Okay, you know what, I want to see exactly where I'm sweating from. I've had one treatment, I think there's still a little bit of sweat." But as far as our medical protocol, we don't make any modifications based off of that because we're treating the full coverage area, the full power level all the way down, we're not patch treating or spot treating in case we miss a spot doing that, why not just get the full treatment again?

Monique Ramsey (39:25):
Right, so that's not part of your protocol?

Julia Jowett (39:29):
Not typically necessary. We save that for a case by case basis if for some reason we need to do it, but it's not typically part of our protocol.

Monique Ramsey (39:36):
So when they look it up, it is weird looking at it. So I'm glad we talked about that. Okay, so ways to contact us will be in the show notes and feel free to reach out. And it's a great procedure, you can look online. You can read lots and lots of reviews. And like we said, the satisfaction is through the roof. It just is a great procedure and really works. And we're so excited to have you, Julia, back from your maternity leave.

Julia Jowett (40:05):
Thank you.

Monique Ramsey (40:05):
She's back, she's back, and with us and performing treatments. And so we look forward to seeing you all again on the next episode of LA Jolla Cosmetic Podcast. Thanks.

Julia Jowett (40:16):
Thank you.

Voiceover (40:23):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, T-H-E-A-X-I-S.io.