Speaker 4 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:15):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey, and today we're talking about protecting your laser investment. So I have here two guests with us, Julia and Cameron. Will you briefly introduce yourselves and your expertise? So we'll start with Julia.

Julia (00:33):
Hi everyone. It's good to be back. I'm Julia. I'm one of the PAs and one of the laser specialists. I've been working with lasers for almost a decade. It's one of my passions and I do a ton of it here at La Jolla Cosmetic, and I work really closely with Cameron. You can introduce yourself, Cameron.

Cameron (00:50):
Thank you so much, Julia. Hi, my name is Cameron. I'm the aesthetician here at LJC. Have been working here for about eight years and have been in this industry since 2006, so for a long time, and I've always been on the medical side, working with post laser patients. So it's great working with Julia, because she takes great care of her patients.

Monique Ramsey (01:11):
Wonderful. So today, we're thinking about laser treatments. It's an investment in yourself and an investment in your skin. Why do we think about it that way? And investment's a financial term, obviously, so how much money are we talking about when we spend money on laser treatments approximately?

Julia (01:30):
Well, it can really range based on the type of laser and based on your consistency with the process. So the way I think of lasers, for a lot of people, that's like when you go to the dentist and you haven't been to the dentist in five years, and you go in and you have a mouthful of cavities, and they're like, "You know what? You've got to get all your cavities filled."

Julia (01:49):
It's that same concept. Your first time coming in, it might be a more aggressive laser that's recommended to really get you to that state of then being able to go on maintenance. That's one of the things that's so important to understand about any of these things that we're doing. You're investing in your skin, you're starting a process. It's not a one and done type of a thing for really anything in aesthetics. You're not going to come in one time. If you do, you're not going to get as much out of that one visit that you had.

Julia (02:18):
So when you come in, it can range from a mild skin laser like something like BBL or Vbeam, and the pricing is usually around $450 a session or so, and then we get a glam fam discount included with that, but it can range into the $2000 to $3000 range if you're doing multiple lasers, and most often, I'm recommending a couple different lasers your first session, and then that starts to dwindle down to how many you need to do in the subsequent sessions.

Monique Ramsey (02:48):
The reason that there are different lasers, just briefly, is they target different things?

Julia (02:53):
Yeah. So there's different lasers that target different types of issues with the skin. So lasers that target pigmentation only. Some are really good at targeting redness, like little broken capillaries, brown spots. Sometimes people even come in with a little sebaceous hyperplasia, little raised spots on the skin and we need to kind of plane those down and then we move into if needed some textural improvement. So whether it's resurfacing with something like halo or a really, really aggressive resurfacing, they all kind of work in different ways, but they work best together.

Monique Ramsey (03:27):
Well, and that makes sense if you're going to be laying on the table, do it all. That's my theory. And I guess your cost does go up a little bit if you decide to do your neck. If you're doing your face or just around your eyes or your face and neck and chest or arms or hands.

Julia (03:44):
Exactly. Honestly, it gets more affordable I think the more you do per area, because when you're starting say with a face and then you're adding areas you're already there and for the appointment. So the cost is a smaller amount to add different areas. And that's one thing, Cameron, I see her recommend a lot to her patients to talk about if you're treating only face up and then you're ignoring everything else, it really still shows your age. It's like, why even bother?

Monique Ramsey (04:12):
Cameron's nodding.

Cameron (04:13):
Yes, yes. You oftentimes will see women with their face and their neck and décolletage, their chest, looks like two different decades. So it's all one and we want it to all look the same. So I think it's best that way.

Monique Ramsey (04:28):
I think that it makes total sense because it's like if you paint the house and not the front door or you paint the front door and not the house. It's got to go all together. And I think also Julia, your point about the investment to me, the first thing that came to my mind is if you go to the hairdresser and you get your hair highlighted and you never ever go back. Well that was nice for that three month period, but then it grows out. And then so it's like those kind of things that we think about doing kind of on a continual basis, and this is just not quite as frequent. Right. So if you had laser this year, then do you usually recommend next year is it, or every couple years or how does it go?

Julia (05:10):
I would say a typical plan is to do maybe a corrective series. So starting with three treatments of something. It's based every six to eight weeks. And then once to twice a year is pretty standard. The patients that I've seen, and Cameron can probably attest to this as well, when you're doing this, as long as we have been doing this, you see patients over time and you see the ones that follow the plan and are consistent. And that every time they come in, their skin is glowing more and more, and they're kind of aging backwards. And I see that with patients, all they've done say over the past five years is V beam, which is a redness laser, but their pores are invisible and they don't really have wrinkles and their skin has this radiant glow.

Julia (05:49):
And it's because they're doing something that's causing a subtle small amount of inflammation, which is in turn kick starting, collagen remodeling, and just making their skin healthier. And so that's something that is not advertised on the billboards to do this and you're going to age backwards. But for people that do this for a living, we see that all the time that if you're consistent with something it's going to speak for itself.

Monique Ramsey (06:09):
And I would think, Cameron, being consistent when you're not in that pre, post laser time, let's say within a few weeks or a month of having a laser treatment, but in between having either facials or the importance of their skincare products.

Cameron (06:27):
Skincare is so important. You know, I always tell people it's, you know, so much of how your body looks is what you eat, not necessarily the amount of exercise, but skincare is very important. When you don't do good skincare and you do all these treatments, it's like going to the dentist and not brushing your teeth in between. It really does help to enhance and maintain your laser results. So very important to be on the correct skincare, something that's going to work for you, but it's a really important part of the equation.

Monique Ramsey (07:04):
Can laser treatments also prevent maybe scarier things down the road, like skin cancers, Julia.

Julia (07:11):
So that's a great question. It's a little bit of a tricky question. Lasers are not a replacement for skin checks by your dermatologists, skin cancer treatments that are designed to be skin cancer treatment. With that said, there is a theory that if you're, just like with anything in your health, if you're healthier, if you have better skin health, if you're using the right skincare products, if you are staying out of the sun, if you're having lasers that are in turn making your skin healthier, taking away precancerous lesions, taking away brown spots that could down the line morph into something more, there is a school of thought of that, but that's not something that I would say laser is cancer treatment. Or if you think you're high risk have laser, but it can definitely make your skin healthier, which in theory could reduce that.

Monique Ramsey (08:02):
So let's talk about how we might protect this investment into before the treatment, immediately after, and long term. So Cameron, what do you and Julia... I'm assuming you guys work together to suggest what the patient ideally is doing prior to treatment.

Cameron (08:22):
One of the things that we want the patient to be using is something that's going to clear out the extracellular matrix. Basically, it's going to take all that debris out of that area, so you get a better laser treatment. So using something like the elastin skin nectar two weeks prior, or the TNS advanced plus serum, it's going to prep your skin for it to get the best treatment. Also, using a retinol prior to, we stop five days prior to the laser, but it's going to again, prep your skin. And oftentimes, and I know Julia is really great about doing this, if we're a skin type four or higher, we may recommend doing a hydroquinone so that you don't have any kind of post-inflammatory hyperpigmentation. So that's protecting your skin because anytime that you traumatize the skin, if it's a skin type four through six, you're going to get that post-inflammatory response and we don't want that to happen. So we're really good about being on the same page with pre-treatments just to make sure that you get the best treatment out there.

Monique Ramsey (09:26):
And Julia, can you talk a little bit about if people haven't heard of their skin type one through six, what does that mean? Skin type four through six might be who?

Julia (09:38):
Yeah, so there's a scale that we use and it starts with one ends with six, the Fitzpatrick skin typing scale. And basically a good way to think of it. As one is like the lightest, most fair skin type you've ever seen. Six is the darkest. And we, as providers, can assess based on your complexion, your ethnicity, how you respond to the sun, your eye color, your hair color, your skin tone, where you fall in that category. So somebody that's considered a four will be somebody that may be Hispanic, olive, a little darker complexion, tans when they go in the sun, doesn't usually burn. A five would be someone with even more melanin in the skin. It's basically how much melanin your skin produces.

Julia (10:18):
And the reason that's important with any sort of aesthetic treatment like peels, lasers, anything that's energy based is, as Cameron mentioned, when you have that inflammation in the skin, that's part of what we're doing, we're causing a controlled inflammation. But as that inflammation calms down, you can get a little congregation of that melanin in the skin surface and that can create a darkened pigment so it can create a hyperpigmentation or what's called post-inflammatory hyperpigmentation.

Julia (10:43):
So it's really important when we do your initial skincare consultation where we're talking about what your plan is, I will recommend a timeline of using certain things before and after. And hydroquinone is one of them that most patients end up needing. Most patients, especially in Southern California have a little bit of a tan or Americans always have a little something with olive skin, something with light skin. We're kind of blends. So when we have that prep for the skin, then it makes it much lower risk to have that hyperpigmentation after the laser.

Monique Ramsey (11:11):
Now does the prep, I guess if we talk about hydroquinone, does that bleach the skin or does it... What does it do? How does it work on the pigment?

Julia (11:21):
Yeah. So it's actually inhibiting an enzyme that contributes to producing pigment. So I like to think of it, you know, you have different pathways that your body produces melanin and hydroquinone is putting the break on that pathway and stopping your body from being able to overproduce that pigment. So it's not something that's going to be bleaching or whitening or causing pigment loss in the skin, but it's going to stop your body from overproducing that melanin if it feels like it needs to from the inflammation. Oh, got it.

Monique Ramsey (11:49):
Okay. That makes total sense. It's one of those questions I've always wanted to know, so now I know. Here, if I've been around and I don't know. We don't know unless you're using it. So I think that's a really interesting thing. So prior to treatment, we're going to pretreat the skin, but then right after going home that night, and I'm sure maybe it changes depending on which laser you're having, but Julia, what does that look like for your patients?

Julia (12:16):
It does depend based on what laser you're having. So for the non-ablative... There's kind of two classes of lasers, ablative and non-ablative. For non-ablative, it's a much more simple regimen. You're avoiding irritants, you're wearing your sunscreen. Typically, people can still wear makeup. They can just be gentle on their skin for the first three to five days. If it's ablative, then that's a different ballgame because there's certain things that we want you to use and certain things that we want you to avoid. And that list is a little bit more extensive. Usually with our patients we'll give you a kit of all the products we want you to be using. So a really gentle cleanser, a really gentle moisturizer. Cameron mentioned the product elastin skin nectar, which has been in the market now for maybe five years or so. What'd you say, Cameron?

Cameron (12:59):
Yes.

Julia (13:00):
And that's been a really nice option for pre and post laser. So I'll touch on that a little bit more with how it helps your healing. She mentioned the clearing out the extracellular matrix that basically helps your cells communicate better with each other. It's taking away some of that cleaved collagen debris and helping that clear out of your body and out of your skin so that when you're healing and you have all this inflammation and trauma in the skin, you're able to heal faster and better. So we'll use that as a pre-treatment for two weeks before a laser. And then we have patients usually put that on as they're healing and that is going to help with their healing process.

Julia (13:37):
Also we'll use a topical moisturizer and in some cases, a laser balm, that's just like a little thicker ointment if they're having a deep laser. So the deepest laser that we do is called Contour TRL. That is usually involving laser balm, vinegar soaks, which help promote wound healing and keep that wound bed clean. And then you can transition on to more lightweight products once your skin is considered re-epithelialized. So once that surface layers come back and it's more intact, then you can move back to more regular products.

Monique Ramsey (14:06):
So you were talking about a non-ablative laser. So what would be an example of non-ablative laser, where the post care, like the one where you're saying you could wear makeup or where-

Julia (14:17):
I think, yeah, our two most common that I do and all the laser specialists at the clinic do are called the Vbeam Perfecta and Broadband Light or BBL. So most people have a mixture of either red or brown pigment in their skin. So non-ablative devices like the Vbeam and BBL help pull that out. They work on detecting the hemoglobin in your blood, those little capillaries that are kind of pooling and kind of tone that down. Or they look for the melanin and the sun damage and pull that out. So those are the two most common.

Monique Ramsey (14:47):
So then the patients come back, let's say a couple weeks after their laser and then what happens next, Julia?

Julia (14:58):
Well, when they come back for their follow up, we do a follow up with the provider. And then we also, if they have not yet met with our aesthetician, typically Cameron is the person that sees all the post laser patients and they will meet with her for a post laser hydration treatment. And so that is an opportunity for her to kind of assess their skin as well, and kind of build that relationship that's going to be the long term relationship with maintaining the result that they get from the laser.

Monique Ramsey (15:24):
So Cameron, tell us what that post hydration facial is. What does that do?

Cameron (15:29):
So we call it a post laser hydration treatment. And so people come in and we take photos because we want to see how they've healed and just make sure that everything's going well. They come in. This is a great time for them to kind of reassess what they're using. So it's a great opportunity for them to bring in their skincare that they were using prior to the laser. So we can fill in the gap so to speak. So when we do the post laser hydration treatment, we're not really touching the skin too much because it's usually been maybe a week and a half to two weeks post laser. So you don't want to overwork the skin. So we simply would be using a hydrating serum. And then we use a calming mask to calm that redness and just to kind of heal that skin a bit. And we use the steam to just really help it to penetrate into the skin. At that point, I go over what their skincare protocol would be from that point on and how to best maximize their results.

Cameron (16:30):
And so by using the correct skincare, that's going to get them the results that they want. We may introduce things slowly. And then typically what will happen is that patients will come back at the two month mark post laser. Oftentimes they'll come in to see me for a medical grade treatment facial and be able to take those photos and really kind of reassess with the provider. Where do we want to go from here? Have we achieved the goal that we want? Are we wanting to move forward, or what have you, because I think what people don't realize is that the skin is the long game. It's not the short game. So we're here to walk you through that and make a plan that's going to work for you, for your budget. One, that's going to work for your time and that's going to get you the best results and what you need.

Monique Ramsey (17:15):
Yeah. And really talk about that investment working. It's like, you're going to pay a certain amount for that laser treatment, but then like you say, what happens afterwards? And I think that people don't really realize that sometimes the cost of the product, and if you go to Sephora, you go to a store like that, some of those things are really expensive and they're not really going to help you. And so all the products that we have, have been tested and studied and we know, and that's where Cameron really can come in to help you, let's say, okay, what's your biggest goal? What's your biggest concern about your skin? And let's prioritize which products are going to help you get there. What would you say, Cameron, is the biggest concern that people have either at that post hydration appointment or after?

Cameron (18:06):
Post hydration, they're feeling red, they have a lot of erythema or they're feeling very dry.

Monique Ramsey (18:13):
Wait, what's erythema?

Cameron (18:14):
Erythema is just redness. Again, it's post laser. So that's very normal. I think that what happens too, is that your skin flushes a lot more easily and that's something that happens post laser and takes time. And that will get better. But again, these are all very normal things. And I think that with them coming in to see us post laser, it just really helps them to know that you're exactly where you need to be. We're going to get you on the right skincare that's going to help you heal and go from there.

Monique Ramsey (18:48):
So what do people need to avoid before a laser treatment, Julia?

Julia (18:55):
Well, a rule of thumb is just anything that might irritate your skin. So things that normally if you put on, you might feel a little bit of a burn or might be kind of sensitizing, such as retinols, glycolic acid, salicylic acid. Even the hydroquinone, I typically have patients stop it for a few days before, depending on the type of laser. The range of that can vary, but you want your skin to be calm. You want it to be tolerant to the energy that we're about to put into it and not already at a limit with irritation and inflammation, and then putting that energy into it. Similarly to, if you were going to be going in the sun, you'd want your skin to feel calm. You wouldn't want it to already be red or peely or irritated.

Julia (19:35):
So those are the main things to avoid right before. Sun exposure is important in the weeks prior to any type of laser. So that's something that when we do your consultation, we talk about avoiding spray tans, sun exposure, anything like that, at least two weeks prior. And then the few days prior kind of scaling down your skincare regimen to simplify it and make sure that it's very gentle.

Monique Ramsey (19:55):
Spray tans. I forgot about spray tans. Is that a big thing?

Julia (19:59):
A lot of people forget about spray tans.

Monique Ramsey (20:00):
Yeah.

Julia (20:02):
It's staining the skin basically. And so when you come in a lot of the way these lasers work is they have a target they're looking for. And so if your target is pigment and then you have an artificial layer of pigment in your skin, guess what? Energy's going to go right there. It's going to burn your skin. It's going to cause a bad reaction. So it's a big no-no.

Monique Ramsey (20:20):
Oh, interesting. I never would've thought of that, but that's because I don't go spray tanning, but that's true though, here in Southern California. I mean certainly a spray tan is better than sunbathing with SPF four like we all used to or nothing, baby oil. Now, are there any medications that people have to stop or worry about taking around treatment like this?

Julia (20:42):
Yes. So usually we'll do a full screening of that as well. In general, things that might suppress your immune system. So if there's any sort of systemic medications that people are taking long term, that discussion will happen of why you're on it if it's a good idea for you to even have laser, if it's something that you're taking long term, because if you're impairing your wound healing ability, then you're not going to heal as predictably from a laser procedure. Other things to consider are oral photosensitization medications like certain antibiotics can make you more susceptible to reacting or burning from a laser. Those are the main things. I usually advise to avoid things like blood thinners, similar to injections, just because that can affect your healing, your bleeding during the laser, your bruising, from the laser. Usually those aren't hard and fast rules. It just means you might bleed more. You might bruise more, but certain medications like antibiotics that increase your photosensitivity, that would be something we would want to avoid treating while you're using those.

Monique Ramsey (21:38):
All of a sudden, I just thought about birth control. Is birth control something that you guys have to worry about or not really?

Julia (21:45):
No birth control is okay. The main consideration I would say for hormones is postpartum. So pregnant women and maybe the first three months postpartum, or if you're continuing to breastfeed, you're in a little bit more of a hyperpigmented state. So anyone that is pregnant, you probably notice that you get pigmentation in areas. You never had it before you can get melasma or hormonal pigment on your face. So it just kind of throws a variable into that. I'll usually have patients wait until at least two to three months after they stop breastfeeding if they're going to be doing an aggressive laser or they're more olive toned, just because it can take that long for that pigment to regulate.

Monique Ramsey (22:23):
Now, Cameron, can you think of any patients' stories? You're seeing people all day, every day, who've had all kinds of treatments where this kind of collaborative approach with the provider helped help the patient.

Cameron (22:40):
Well, Julia said it right there. You do see patients that have seen all of us, who get laser on a regular basis. They have been using skincare on a regular basis. They get all the injectables. They may do PDO threads or what have you. And those patients, when they come in, literally everyone says, "Oh my goodness, their skin is beautiful." But it's, they do everything, and it shows. So there are things that I, as an aesthetician cannot do, and I need to have my other providers like Julia and we all just work so well together to get our patients the best result and just to have a patient turn around and say, "No one has ever given me compliments on my skin and I'm getting compliments on my skin now." It's just wonderful.

Monique Ramsey (23:28):
Well, and that's the largest organ in our body. We're showing it off all the time, good or bad. So it really makes sense that you look at it as a lifetime commitment and with people who you can trust to say, "Okay, yeah, you know what? You can skip this session. You're looking good. Or let's double up something because you've got a wedding coming up or you've got a life event." I think that's something that not everybody always thinks about until it's too late. If you have a big life event, a reunion, a wedding, something that you know you want to get ready for. And if it's six months away, it's okay. You can start now and start looking good. You're not going to wait till the very last minute to really be able to get the best result.

Cameron (24:15):
You'd be very surprised though, the people who are consistent about it, anything can come up and they're going to look fabulous.

Monique Ramsey (24:21):
Yeah. Well, I'm sold. I can never get in with Cameron. She's so busy. She doesn't have time for-

Cameron (24:30):
Oh my gosh.

Monique Ramsey (24:31):
For the rest of us. It's very sad.

Julia (24:37):
No, it's so fun. Every time I see one of my laser patients in the lobby and I know that they were just there to see Cameron and I'm looking at them. I'm like, "You're glowing. You just saw Cameron didn't you?"

Monique Ramsey (24:45):
We're all jealous.

Cameron (24:49):
But I mean, it's just when you're consistent with anything. And I think that people understand this with exercise, right? If you get to your goal and if you stop, you're going to lose it all. It's the same thing with skin, but we live in an instant gratification kind of society. And that is not the way that it works. So I think that places... I love working at LJC with providers like Julia, because we're all about the truth. And I think it's really important to know that.

Monique Ramsey (25:20):
Yeah, that's a great point because the instant gratification part, some things take six or eight weeks to start working, but then boom, all of a sudden, so you can't give up because you're just not going to see the result and whether that's Latisse or whether that's Nutrafol for your hair or whether that's the TNS Advanced+ Serum, things take some time, but then there's a big payoff.

Monique Ramsey (25:46):
So thanks everybody, Julia and Cameron for your expertise today. And I love the fact that you guys work together to give the patient the best possible result in maintaining that result over time. And that's the key, not just looking great next week, but looking great in six months and beyond. So for anybody who has questions about the different lasers, there's a lot of good information on our website about lasers. And we also have done a podcast or two about lasers. And so you can learn all kinds of fabulous tidbits.

Monique Ramsey (26:20):
And then also we have payment plans for non-surgical services, which a lot of people don't know that if you're doing something a little bit, either more aggressive or more body parts that you're adding and you want to have it now, but not have to pay for all of it today, then there's ways. There's some different interest free plans and it really makes it affordable. And so you can get what you want and spread out the payments. So there's some information about that on the website. And then now do you guys do virtual consultations?

Julia (26:53):
Yes. We both do virtual consultations and it's a really great way to develop a treatment plan. We can see the skin really well, usually with the photos that are sent in and then we do a video consult over Zoom and it's been working really well for the past couple of years.

Monique Ramsey (27:10):
Oh good. So if you're listening today and you want to schedule a consultation, head to ljcsc.com or give us a call or send us a text and we've got all that information in the show notes. And then if you love our podcast, we would love for you to write a review of our show on Apple podcasts or Good Pods or Spotify or wherever you're listening. We love having reviews. So we want to get better and we want to know the types of content that you want to hear about. So thank you both for such a fascinating little afternoon and I will let you get back to your patients, but thanks for joining us.

Cameron (27:50):
Thank you.

Julia (27:51):
Thank you.

Cameron (27:51):
Have a wonderful afternoon.

Monique Ramsey (27:52):
Thank you.

Cameron (27:53):
Bye.

Julia (27:54):
Bye.

Speaker 4 (28:00):
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 I5 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 at LJ CSC. The La Jolla Cosmetic Podcast is a production of The Axis. the axis.io