Speaker 1 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today we're going to welcome back to the show Dr. Luke Swistun. And if you listened to our last podcast, you heard him talk about getting ready for his laser procedure and his laser date with his wife. Welcome back, Dr. Swistun.

Dr. Luke Swistun (00:35):
Thank you very much. Thanks for having me.

Monique Ramsey (00:38):
To catch the audience up, in case you missed our part one, I just want to hear about how things turned out. Dr. Swistun had a combination of the BBL and the HALO laser treatment with Julia Jowett, our PA in the medical spa.

Monique Ramsey (00:54):
And BBL stands for BroadBand Light, and the HALO is a fractional laser that's made by Sciton. And it's great for sunspots texture, hyperpigmentation, wrinkles, and even some scars. This was your first laser treatment ever. And when we talked to you on the day of your treatment, you said you thought it would either be a relaxing experience or that it might feel like pins and needles or burning. Which of your predictions was right?

Dr. Luke Swistun (01:23):
I think it was a little bit of everything. In this case, I think it was both just because the relaxing part of it was the fact that I could let somebody else take the helm on a patient care and become the patient. That was the fun part.

Dr. Luke Swistun (01:38):
The experience itself was very tolerable. I know, I think we'll talk about the different modes of anesthesia that we used for this. I think the nitrous oxide is very effective and I'll comment on that a little bit later. But overall, yes, it was pins and needles, but it was very tolerable pins and needles. And that modality lets you distance yourself as far away from the procedure as you want. That's a very, very effective way of doing it.

Monique Ramsey (02:02):
And what do you mean by that?

Dr. Luke Swistun (02:03):
The nitrous oxide basically is probably the most effective part of the anesthesia that we used. I know we used a couple different things like numbing cream. One other option that I didn't use was a little bit of a sedation medication. And then the nitrous oxide, which is basically a gas, it's essentially laughing gas, which we breathe in, in order to stun the pain receptors a little bit.

Dr. Luke Swistun (02:27):
And I think the value of that modality is that the patient controls how much they inhale and therefore, how much of an anesthesia they get. And they still remain conscious throughout the procedure, but they can really control how much gas they inhale and therefore the effect.

Dr. Luke Swistun (02:41):
And it's just an interesting experience. I've never actually had this before. And knowing what I know about physiology and learning in medical school about different things, I can sort of picture that it affects specifically very specific receptors, but not others so that again, you can remain conscious and make conscious decisions during this process. But at the same time, you're very removed from the experience.

Dr. Luke Swistun (03:01):
It's a little bit of a surreal feeling, but you know, again, not scary, very relaxed and stuff. And I felt like I was in control the whole time and it was up to me to titrate that gas.

Monique Ramsey (03:12):
You had the topical numbing cream put on about, what, an hour before?

Dr. Luke Swistun (03:16):
I think it was about an hour before. Yes.

Monique Ramsey (03:18):
That helps numb the skin.

Dr. Luke Swistun (03:20):
Correct.

Monique Ramsey (03:20):
And you had that on your face now. I think somebody told me you ended up having laser on your arms too, or your hands?

Dr. Luke Swistun (03:26):
No, no, it was a neck.

Monique Ramsey (03:27):
No?

Dr. Luke Swistun (03:27):
As well.

Monique Ramsey (03:28):
Oh, your neck. Okay. Does the numbing cream go on your neck as well?

Dr. Luke Swistun (03:31):
Yes, it did go on my neck and that was actually the least painful part.

Monique Ramsey (03:35):
I saw it in the video. You got some in your mouth. And I've done that before and it's the weirdest, yucky feeling to have that.

Dr. Luke Swistun (03:41):
Oh yeah.

Monique Ramsey (03:42):
On your tongue, that weird

Dr. Luke Swistun (03:43):
The numbing cream?

Monique Ramsey (03:44):
The numbing cream. Yeah. Then, during the treatment between those two things. And the reason you chose not to have any kind of sedation, is you wanted to drive yourself home, is that correct?

Dr. Luke Swistun (03:56):
Correct.

Monique Ramsey (03:57):
Yeah. I think that's a really nice thing for people to know, because not everybody can get a ride home from a treatment like this. And you don't necessarily need one if you aren't taking any narcotics. Tell us about what it felt like afterward and then later in the day. Because you were talking about going out to dinner that night, you had some friends coming into town. Tell me about that experience right after the procedure.

Dr. Luke Swistun (04:24):
It was just like Julia basically predicted. It felt like a sunburn essentially for a couple of hours maybe. And then it just calmed down and it wasn't painful at all. But I think the only residual effect after is the swelling. And it's most pronounced around my eyes, at least in my case. I had pretty aggressive treatment to the upper and the lower eyelids. That is very thin skin that does swell significantly once you have a treatment like this. As long as I wore sunglasses, I was actually perfectly okay.

Dr. Luke Swistun (04:51):
We had some guests visiting from out of town, which we warned them about that this was going to happen. And when they saw me, they're like, "Okay, yeah, you're swollen, but it's fine." We went to one restaurant after another over the weekend to take them out. And really, the only thing I changed about the experience is I wore sunglasses the entire time.

Dr. Luke Swistun (05:08):
It gave me an excuse to wear sunglasses at night. Fulfilled that dream, but it was perfectly effective. I don't think anybody noticed, I just maybe looked a little bit sunburned on the face, which is very common in San Diego anyway. And as long as you hide your eyes, nobody can really tell.

Monique Ramsey (05:23):
Now, we learned a couple things from Julia when we talked to her about your treatment. She said you were a very good patient, so kudos.

Dr. Luke Swistun (05:32):
Thank you.

Monique Ramsey (05:32):
Now, she mentioned that you had the corneal shields to protect your eyes. Tell us about what that felt like.

Dr. Luke Swistun (05:38):
Perfectly normal. I'm familiar with the experience, not on myself, but I use corneal shields when I do surgery on patients to protect their eyes. It was interesting to experience that awake. But between the numbing medication that she put on my eyes and the lubrication medication, the corneal shields were literally not a big deal. Just lifted up my eyelid and slipped right in there. And then, at the end of the procedure, she took them out and there was nothing.

Monique Ramsey (06:02):
Oh, that's good. And then she was talking about a cold air blower that during the treatment. Is that something that she used or is that something you directed yourself?

Dr. Luke Swistun (06:11):
I think she used it because I think the only thing I had in my hand was the nitrous oxide inhaling device. Afterwards, to relieve a little bit of that sunburn effect, I did have the cold air blower, but that was after she was done with the procedure. During the procedure, it wasn't me. If somebody else was holding it, that's possible. I don't know.

Monique Ramsey (06:30):
Now, your wife also had laser treatment at the same time. Well, right after you. And Julia said she was a hoot. She really enjoyed having her there. And what was it like doing this together?

Dr. Luke Swistun (06:42):
Yeah. Well, she's way funnier than I am. That's true. It was fun because it gave us the chance to disconnect from the rest of the world and just focus on this together experience that we had. Her treatment was a little bit less aggressive because one thing that Julia identified is melasma on her, which is something that you really should pretreat with medication with hydroquinone for a couple of weeks prior to the laser treatment.

Dr. Luke Swistun (07:06):
That's not something that we identified before. Had Dominica come to a regular consultation, as we normally schedule, then that would've been identified and treated prior to her actual laser date. But we just coordinated this, not so much at the last minute, but she didn't have time to come in before. She didn't get that evaluation so therefore, we decided to be a little bit less aggressive with her laser treatment just to account for that.

Monique Ramsey (07:29):
Now, did she have the same laser or a different one?

Dr. Luke Swistun (07:31):
She did not. I think she believed she just had the BBL, but not the HALO.

Monique Ramsey (07:35):
Oh, okay. Now, how many days has it been?

Dr. Luke Swistun (07:39):
13.

Monique Ramsey (07:40):
Oh, oh two weeks.

Dr. Luke Swistun (07:41):
Yeah, almost two weeks. It will be two weeks tomorrow.

Monique Ramsey (07:43):
Okay. And I saw some pictures come over today, with you right after then that next day. And then a couple days later. And so, we'll add those into the show notes because it's really amazing to me to see you the day after and you are swollen. And you look like you had something done.

Monique Ramsey (08:06):
And then by day six it was perfect. I mean just that... I don't know. I guess I expected that if you look that, I don't want to say bad, but it's obvious you had a treatment. And if you look like that on day one, that it would take maybe two weeks to look back to normal. And really, by day six, it's like you're right back to normal. And other than having a little beard that you probably weren't shaving. Right?

Dr. Luke Swistun (08:30):
Yeah. I was instructed not to.

Monique Ramsey (08:32):
Yeah. Other than that really, I mean, it was pretty stunning. I encourage you all in the audience to look at the show notes and see this progression of these photos so you get an idea of what you would look like after having this treatment. And like you said, you did the face and neck, but really focused on the eyes. Maybe that's why your eyes are more swollen.

Dr. Luke Swistun (08:53):
Yeah. The joke around the office was that I looked like a swollen baby. I think that's a very accurate description. Yeah. And the eyes show it the most. And you can see on that very first picture, post-op day one, Saturday morning. Especially after sleeping, after laying down, I think it's a little bit worse when you wake up. And then as you get up and walk around after a few hours, some of that swelling goes away.

Dr. Luke Swistun (09:10):
The rest of your day is good, but then you go back to sleep again. On day two, it was almost back to the same as on day one, just because I spent the night in bed in a sleeping position. But then it started getting better and better. I did have a surgery on Monday morning. And really, my concern at that point was I want to make sure I can keep my eyes open. And that was not a problem at all.

Monique Ramsey (09:33):
Oh. That would be important.

Dr. Luke Swistun (09:34):
Yeah. It was never really a problem, but it was when they're swollen, it's a little bit of an effort to make sure. But that was only a concern post-op day one and maybe to Sunday night, everything was fine. And then certainly Monday morning, not an issue at all. I still looked swollen. There was some pigment coming off. There's this coffee grounds that I believe that Julia refers to. But basically, some of that pigment is now flaking off and it's important not to rub it off. Just let it come off by itself, not to create any additional scarring. That was happening. But other than that, everything was back to normal.

Monique Ramsey (10:05):
Now, what were your post-op instructions? What did she have you do to take care of your skin in that first week?

Dr. Luke Swistun (10:12):
Moisturize, moisturize, moisturize, which I was diligent for a couple of days, and once things were back to normal, I kind of forgot. And then avoid the sun. If you do go out in the sun, then put on sunblock. And that's included in our package, which is very convenient. I really tried to avoid the sun for the first two days anyway. And that's about it.

Monique Ramsey (10:32):
And I think really the risk for the sun is because your skin has been ablated or taken off and it's more sensitive. And we don't want you to get any extra pigmentation, any brown because any amount of sun is going to-

Dr. Luke Swistun (10:49):
Essentially the pigment, which is normally protective, has been removed from the surface. Now it's the UV exposure is a little bit more dangerous, I guess, for lack of a better word. Obviously, you want to avoid that until you regrow that outer layer of skin to protect yourself from the sun again.

Monique Ramsey (11:05):
Now, can you see any difference yet?

Dr. Luke Swistun (11:07):
Yeah, for sure there's a difference. And I think the easiest way to see it is if you just walk into the room. I still have a couple of spots here and there, but they're significantly much more faded than they used to be. They're not as pronounced.

Dr. Luke Swistun (11:20):
I have vitiligo, as you noted. The laser wasn't deep enough to deep pigment me completely to basically bleach me, because that would be the next step. If I really wanted to get rid of all vitiligo, then bleaching is really the next step. They just take off the layer of skin that has any pigment in it and turn me completely white.

Dr. Luke Swistun (11:37):
That was not the goal. That's not what this laser does, but it definitely blended the lines, that transition. I think it just fades everything out and makes it smoother. It's almost like putting an Instagram filter on your face.

Monique Ramsey (11:49):
Oh.

Dr. Luke Swistun (11:51):
I think that's the best description of it.

Monique Ramsey (11:53):
Now, did you look at your VISIA photos?

Dr. Luke Swistun (11:56):
I did the one before. I did not take one today. I actually asked about that, but I wondered if there's going to be a significant difference there.

Monique Ramsey (12:03):
Yeah. We'd be interested to see that. Let's find out when she wants to do those and we can put them in the show notes at that time. For anybody who's curious, along with, to watch Dr. Swistun's progression, the girls have been filming you. Right?

Dr. Luke Swistun (12:20):
Correct.

Monique Ramsey (12:20):
We'll put together a whole start to finish video. And then, like I said, in the show notes there's before and after pictures of Dr. Swistun, but there's also then links to before and after pictures of HALO on our website. And then, so you are back to work on Monday, doing surgery. And I figure if you can go back to work right away, then all of us can. You're doing a much more important job, doing surgery on people. That's good to know that really, do it on a Friday and by Monday, you're in good shape.

Dr. Luke Swistun (12:54):
Yeah. Functionality was never really an issue. I think the appearance was a little bit of an issue. On Monday during the clinic hours, I did tell my patients, "Hey, I feel like I owe you an explanation," because I didn't wear my sunglasses to clinic. That would be rude. But I did say, "My eyes are swollen because I just had treatment." And half of the patient's like, "Oh, yeah. We saw it on Instagram. We know."

Monique Ramsey (13:14):
Oh, good. Good.

Dr. Luke Swistun (13:15):
But by Wednesday it was not even a conversation point anymore.

Monique Ramsey (13:19):
Now, what would you tell a patient who's considering doing laser resurfacing now that you've done it yourself?

Dr. Luke Swistun (13:25):
I think it's worth it if they're the right candidate, obviously I would go for an evaluation with Julia and ask what she thinks is the best treatment. It has its limitations, but definitely, for someone who has the skin that I do, I'm not really in need of any major surgery. Yet, I'm not really qualified for a facelift. I could probably use an upper blepharoplasty, but I think it's a little early.

Dr. Luke Swistun (13:48):
But there's these fine wrinkles that creep in around your eyes. There's these pigment changes because we live in San Diego, so sun is unavoidable. And that causes that in the long term. Basically, just smoothing that out. Resurfacing the skin is a great way to jump back about 10 years or so.

Dr. Luke Swistun (14:05):
Again, this is my first and we just jumped right into it. And again, the patient is very much in control of how much anesthesia they get. And I think that's the biggest take-home point is I think that's what made it the easiest.

Monique Ramsey (14:21):
And that's really good to know because I think most of us, we might have concerns about how long are we going to be off work or have downtime socially. But I think at the heart of it all, a lot of us are worried about what it'll feel like during and concerned about pain. I mean it's an obvious, natural concern for people to have. It's nice to know that that... I've never had that laughing gas before either. I wouldn't know what that kind of disconnected feeling is. But I think, did you feel like you were in La La Land, or did you feel very much part of the room?

Dr. Luke Swistun (14:50):
It was strange. I don't know what to compare to because I've never done drugs in my life. But it was as if like you're there, you're in full control, but at the same time, you're distant from the actual painful experience of it. It's difficult to describe, but it's as if you're looking at yourself from above and seeing like, "Okay, that is happening to that skin down there on the table. And I'm just a little bit above it."

Dr. Luke Swistun (15:11):
And again, how far above is up to you. If you want to be further away from the experience, you just breathe in the gas a little bit more and it takes you a little bit further away. And then as soon as you're comfortable, then you stop breathing in the gas. And then, you slowly start coming back. But again, you're in full control of it. At least I was.

Dr. Luke Swistun (15:28):
If you want to gesture with your hands or do anything, you can still do that. You're not out of it completely. It's a very specific receptor that gets affected, but not the rest of them.

Monique Ramsey (15:38):
And how long does it take till that wears off? Is it minutes?

Dr. Luke Swistun (15:42):
It's minutes. Yeah.

Monique Ramsey (15:43):
Oh.

Dr. Luke Swistun (15:43):
It's literally minutes. Even after less than a minute, you start feeling, transitioning back in. And then, if something uncomfortable is still happening, all you have to do is just make the decision to take a little bit more gas and then you're back to where you're comfortable again.

Monique Ramsey (15:57):
Interesting. Makes me want to have laser just to experience it. All right. Well, if anybody has questions, check the show notes. You've got all kinds of links there. And thank you again, Dr. Swistun. And make sure you give us your updates, as you look like you're totally healed. But when you go in, I think Julia said at two months she wants to take a look again and maybe look at the VISIA then at that point too, to see how your skin's come along.

Dr. Luke Swistun (16:26):
I think if I rub my eyes a little bit too hard, then I still turn a little bit red a little bit faster than I expect, but overall, I look pretty normal now.

Monique Ramsey (16:33):
Yeah, I would say so. All right. Well, thank you. And we'll see you again next time.

Dr. Luke Swistun (16:38):
Thank you very much. Thanks for the experience.

Speaker 1 (16:45):
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. the axis.io.