All posts by Charles Runels, MD

JCPM2023.06.20. Vampire Facial® | Hair | Scar Treatment | Radio frequency | BoNT

July 2, 2023 Charles Runels, MD Leave a comment

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Transcript

JCPM2023.06.20

Charles Runels:

Welcome to The Journal Club. Tonight we have a special guest, Sylvia Silvestri. She's been teaching for us for over a decade. When I met her, she already had worldwide renown as the Beverly Hills RN, having worked in the plastic surgery arena in Beverly Hills for years and understanding many of the technologies and lots of observation working in the OR there.

So extremely experienced, and she's been both teaching and performing Vampire Facials now for a decade as part of her practice, often with celebrities, people you would recognize coming to her, recognizing her as one of the best.

So you're in for a treat. She's going to give some of her best tips. We also have some research to talk about in regard to other uses for microneedling, like scarring and hair and acne and such. But let's just go ahead and open up the mic here for Sylvia. And let's see. Here we go. You should be able to talk now. Sylvia, are you there?

Sylvia Silvestri:

Yes, I'm here.

Charles Runels:

Thank you for making time for us. I know you're now... You're teaching in routinely now in California and Tennessee, correct?

Sylvia Silvestri:

Correct.

Marketing Tips for the Vampire Facial® Procedure from the Beverly Hills RN

Charles Runels:

Beautiful. So can you just start off by... I'm looking, we have a lot of people on the call tonight. And often, we have, as we do tonight, a mixture of people who have been in the group for years and those who are new to our group. Can you just start off by talking about what's your top two or three tips for someone? They just bought their microneedling device. They don't have a following like you do. As far as marketing the procedure, what do you tell your people when you teach your classes?

Sylvia Silvestri:

I think that microneedling is something that people who are just starting out, whether it be the vampire procedures or injectables, microneedling is something that everyone can do when they're first starting out, and they can make money doing it.

They can use it obviously with PRP for the Vampire Facial®.

You can do it on any skin type, male or female. You don't have to worry about burning anyone. There are a lot of different indications that you can use it for. And you can just use it basically on anyone because it will help anyone's skin look better.

And the theory is the needles go into the skin. It originally was called collagen induction therapy, meaning that when the little needles make channels in the skin, your body says, oh my gosh, let me make new collagen. So it was started out with the rollers.

As we know now, the rollers will cause micro tears as they're rolling back out of the skin. So now we have different pens on the market, and there's a myriad of pens that one can buy.

They all do the same thing, in my experience.

But back to your patients. So you could do it on any skin type. It doesn't matter what age they are, obviously over 18, up to however old.

This will help for acne scars, milia, fine lines, the little tiny, tiny little crepey lines that you really can't do anything with filler because they're too superficial, large pores. Let me see what else. Large pores, acne scars, milia, fine lines, crepey skin, when people have really dry skin. Say they don't exfoliate a lot; microneedling will help them just produce new collagen and give new vibrancy and give a new glow to their skin. And it really doesn't have a lot of downtime.

If you use the Altar Cream™ that we have and put it on their face right after the procedure and send them home with it and tell them, "Just use this cream for the next week. Don't use anything else," it really, really helps them. The redness will be cut dramatically, and they will get a faster healing response.

Charles Runels:

So back to the... I know you could go on, and you do go on all day long when you do your hands-on classes about pearls. And I want to get to your best pearls for actually doing microneedling in relation to both effectiveness, pain, and efficiency, but a little more about marketing.

I know you use social media, you have a website. Can you maybe give your best tips for how you think about your website and how you think about your social media as far as marketing microneedling and the Vampire Facial® in particular?

Sylvia Silvestri:

Yeah. So you have to do social media. It's just the way it is these days. If you don't want to do it or don't know how to do it, find someone in your office that can do it for you because it is really critical that you do that and post about what you're offering and microneedling.

I love to really push microneedling right after summer because everyone's been out in the sun, and they want to reverse things. And it's a good thing to do in September to start really pushing forward, but you can do it any time of the year.

But yeah, social media, Facebook. People still go to their Facebook. Instagram. TikTok is now gaining a lot of traction as far as social media advertising. I

'm seeing a lot of plastic surgeons on there. It's really important. Then you can also do an email to your patients, write a little blog about microneedling, and then attach the Vampire Facial® website. So if they have any questions, they can also go there and read about it before they decide they want to do it.

And I think you can also offer it to somebody that knows a lot of people, like a real estate agent or something like that. So there are a lot of different avenues that you can do as far as marketing and getting the word out about Vampire Facial®.

Charles Runels:

Just to add to what you've said, and a couple of things.

First of all, let me flip over. Want to not get too far behind on what you're talking about. You mentioned different skin types. There is... Here we go. This one is regarding acne and skin of color and the different options.

And of course, microneedling comes out on top as one of the options. I don't think I told you this. I don't know if he would want me to say who he is, but there's someone in our group that's extremely expert at lasers and quite a number of people that are experts in lasers. And when I spoke with him recently, he said he hardly ever even uses his laser anymore, even though he's very well known nationally for his expertise, because the microneedling works so much better in many cases, or at least as well without the downtime or the problems.

Here's the paper. And let me put this in... Actually, I put this one in the handouts, which will go away after we do the call. So if you open them now, they’ll be there after we end the call.

But these are all recent articles. This one came out this year where they compared laser with microneedling for scarring and hypertrophic scars, and they were equally effective. And so let me give you that link. Anyway, back to what you...

I'm just catching up with the other thing about Facebook and social media because, as you know, I'm not as much into social media. But with the microneedling, it often attracts a younger crowd. And in that case, I think it has more pull and effectiveness, say than social media for O-Shot®, for dyspareunia after breast cancer. That's more of an email or a Facebook communication.

And to me, Facebook is almost as old school as email these days. Any tips about... I know you mentioned just filming someone who's well-known in the community and who's willing to do that.

Any other tips about producing?

Because you've done a lot of it, obviously, you've done a lot of it for a decade and very successfully done it, enough to have a nationwide...

Actually, I know you teach in other countries. So what are your top two or three tips about actually producing the material? But for people like myself who are not really extroverts, we don't want to sing songs or something, but how do you tell your people to make those social media posts as far as content?

Sylvia Silvestri:

Yeah. If they're unfamiliar with it, I highly recommend having someone help you, someone in your office, or a friend or family member. Everyone has a younger family member or somebody that can help them do a quick video or a reel. And it's really important to do that these days.

Charles Runels:

Yes.

Sylvia Silvestri:

So, for example, my medical director in Beverly Hills, Dr. Minniti, did not want to do social media, and his practice was slow.

And I said to him, "You need to get on Instagram." And he said, "I don't want to." And I said, "Well, then hire someone to do it, come into your OR three days a week, pay them whatever you want to pay them, but have them film content three days a week."

And now, he is so busy. I think he has a hundred thousand followers, if not... I don't remember. But he is really, really busy because of Instagram. And he doesn't do it at all. He has a girl in his office do it.

Charles Runels:

Yes. I think that's probably... You had to say it three times before I actually realized what you were saying, that that is the best tip you guide, and I think it's probably the best tip. Because when I think about people like... Dr. Miami's in our group, and he's up there with the Kardashians, millions of followers. I was lucky enough to be in his office watching. And he's a hardworking, brilliant physician, but he doesn't really carry the camera around. He does what you're saying. He has someone who's following around and filming when it's appropriate. And so he'll stop or they'll film the patient if the patient's consented to it. And it takes almost no time and is tremendously more content because someone is thinking about it while he gets to think about being a doctor.

Sylvia Silvestri:

Right.

Charles Runels:

And when I think about people who are super successful with social media, you're right, they have that person. And it could be part-time once a day thing for someone who's there already, as in a receptionist or whatever, but young enough to understand the medium.

But I think most physicians, whatever they're doing, greatly underestimate the amount of content. They're afraid they're going to pester people when really, your patients want to be voyeurs. That's really what made the Kardashians billionaires was allowing others to watch them.

And so allowing... For most people, what we do is so exotic. Much of what we consider mundane is exotic to them, so allowing people to be voyeurs in appropriate ways is extremely compelling.

And then I think I'm still... I have to say I'm still old school for long-form emails. You pull them into your website, and you get them to subscribe to your email. And I think a minimum of once per week with an email and once a day if you're going to really go all out on social media. Probably should be a once-a-day thing at least. Don't you think?

Sylvia Silvestri:

Yes, or even three times a week is fine to get started.

Charles Runels:

Okay.

Sylvia Silvestri:

You don't need to do something every day because sometimes it's hard to think of content every day. But if you can have someone help you three times a week. That's the biggest tip on how to get that done, just have someone help you and have someone do it for you in your office that's savvy with social media.

Charles Runels:

So the biggest difference I saw between Dr. Miami's, he's a marketing superstar, so you have to take note, is that there's no big warmup. Most of the physicians I see, whether it's their writing email, they have to feel inspired like it's a Walt Whitman literature exercise. And if they're making a video, it's all about they have to pause and think about makeup and what their hair's doing and what the light and what they're going to say, and then practice it three times, where the people that are very good at it's just, "Oh, this is interesting. So film me doing this."

And it's not always something earth-shattering. They were... I don't know if he still does it, but at that time, at the end of the day, he would just do shout out birthdays to...

And not in a goofy way, just in a kind, thoughtful way. Almost like, oh, it used to have be a kid’s show we had when I was a kid centuries ago, Captain Kangaroo and they'd do birthday stuff. And it was almost like a little kid thing, but lighthearted, just so lighthearted shout out to patients.

Sylvia Silvestri:

Right.

Charles Runels:

Okay, so let me get away from the marketing just a little bit, and I want to just throw up a couple of... Don't go away. I want to mention a couple of papers and then come back for your pearls about the anti-aging part. I also have done a few celebrities that I don't feel right to mention, and they are seeking this out. If you go to... It's a really expensive and continuous battle that we're doing every day to maintain the integrity of our brand. But for example, I'll show you one that was just out in Allure Magazine.

So this is typical sort of stuff. This one is just out, you can see May 31st, so a couple, of three weeks ago. And they talk about the Vampire Facial, and then they throw in a lot of PRP and they blur the lines. This article actually was astute enough to at least make some difference between the two, but failed to recognize the great distinction that keeps people from getting hurt. Just to remind you guys... Let's see, Rolling Stone. Here we go. This article was about how people got hurt. Actually, Rolling Stone interviewed me, and this was me trying to protect our reputation when someone got hurt pretending to do the Vampire Facial who didn't know what the heck they were doing, gave people HIV. So when people do stories like this and they don't make the distinction, in my opinion, it's dangerous.

So I'm trying to... Every time one of these articles comes out, I reach out to the people. Sometimes I get my attorney involved, and I try to get things corrected.

But the way the group can help... Because eventually, it could go generic, and then I just can't protect it. As of now, it is not generic. And our new company BrandShield, they're just so deadly effective. And if someone is advertising using Vampire Facial® and they're not in our group, their website or their social media account will just go away. It might take a few days to a few weeks, but eventually, they will have it taken down through the ISP provider.

But we don't want that to happen. We'd rather people just understand. And the way the people in the group could help, the way you guys could help is by always writing the name with that R symbol, which you do by hitting, if you're a Mac, it's an option and then the letter R, and it puts the ® symbol behind it.

And this recently happened when we were tangled up with the AMA.

We have a lot of David and Goliath stories.

And part of what happens with the examiner, with the attorneys, is they go look to see, well, is this really a mark?

And they look to see that we have a protocol and that people are following the protocol, and it helps if people using the mark make a note of that by putting the R symbol on their website.

Anyway, I didn't mean to get rambling too much, but it's still hot. It's still in the news. Just people love vampires. And this was, what, three weeks ago in Allure Magazine? A

nd if you go look at what's come out in the press, a lot just within the past month or two. Anyway, jump back in Sylvia and give some... I'll wait for more of this research, but I got off track.

Pain Control with the Vampire Facial® Procedure

But give us some of your pearls about; let’s start with pain. How do you think about pain control? What are your best pearls for making it comfortable?

Sylvia Silvestri:

Well, you definitely have to use numbing cream, for sure. Because if you don't, it can be uncomfortable unless they want a really, really light treatment. But I will always put numbing cream on them. And just make sure you get a good cream compounded at your pharmacy, like a BLT, Benzocaine, Lidocaine, and Tetracaine.

I like it when it's kind of like a, almost like an ointment because it seems to be absorbed into the skin better. I've had all different consistencies of numbing cream, and the ointments tend... Even for the O-Shot too, to me, the ointment compound absorbs better.

And again, make sure they have obviously no makeup on. But as far as pain control, as long as you have a good amount of numbing cream on their face, they should not feel anything.

And when you're finished, they should not have any pain either. It may feel tight and it may be red, but they should not have any pain by the time they leave your office.

Patterns of Microneedling

Charles Runels:

Okay. So talk to me about... I see a lot of discussion about... It's almost like tomato versus tomato, but a lot of discussion about patterns. When you're doing the Vampire Facial, are you doing circles? Are you doing... How many times are you going over the same spot? And how are you judging depth? So patterns and depth.

Sylvia Silvestri:

So I always start at the top of the face and work my way down. So I'll test it out on the forehead because that's thinner skin and more sensitive. And I'll usually start at 0.5 millimeters and just see and let them see what they think about it, what it feels like, if they're comfortable. Then I look at the skin. Okay, is it getting red? Am I getting some pinpoint bleeding, petechiae? Do I have erythema? And if I have all of those things and they're comfortable, then I'm good. So what I do is I do four passes, vertical, horizontal, diagonal, and diagonal in one section, which would be the forehead. And then on the cheeks, I would do the same, and on the chin. Now, under the eyes, on the nose, upper lip, it's smaller areas, so you can't do that. The under eye, I'll also kind of do a lower setting because that's also the really thin skin.

But around the cheeks and the chin, you can turn it up until you get your pinpoint bleeding or petechiae. And then once I do the whole face... And if they have some acne scarring or something else, like mild sunspot or something, I'll go back over there and do some circles in a one particular spot. But make sure you don't go over any moles or any active acting because then you can spread it around. If you go over a mole, you can actually cut the mole off and have a lot of bleeding. So try to avoid that too. But yeah, I started the forehead and I work my way down to the chin.

Charles Runels:

So you divide the face into the sections of forehead, cheek, chin, and then under eyes and upper lip? That's how...

Sylvia Silvestri:

Nose and... Yes.

Charles Runels:

Yes. Okay, under eyes, nose, and upper lip. And mention more about what you mean... I was listening for that. That's what I look for, those petechiae. How do you... What's deep enough? Tell me more about what you're looking for.

Sylvia Silvestri:

So some people do it until the patient is literally a bloody mess covered in blood, and you really don't need to go that extreme.

As soon as you get petechia and the redness and a little bit of bleeding, you can move on to your next section.

There's a guy that, I think he still works for Dermapen in Europe, Andrew Christie, and he trained me years ago. And he says he does a whole face in about five minutes. And he doesn't like to use numbing cream because he said it causes vasoconstriction, and then you can't see how red the person is getting, which I understand that, but it's really painful, so I personally don't think I could do the procedure without numbing cream.

But yeah, they don't have to be extremely dripping blood on their face like you see some of these Instagram people doing, just redness, pinpoint bleeding. Okay, cool. I can move on to the next area.

Charles Runels:

Okay. Let me mention a couple of other papers, and then I'd like to talk more about what and when you're applying your PRP and any other things.

You mentioned the Altar cream, but I want to get more detail about that. For those of you who joined late, Sylvia Silvestri has not only been doing, and the person who's taught the longest in our group and doing microneedling now for a decade, but...

So doing it and teaching it in multiple states and in other countries, and so much experience. If you guys have questions, type them in and I'll... Or maybe I'll unmute you if you want, but definitely, you've got an expert on the call, so this is a great time to get your questions answered. A couple of more things came out recently in the literature, this one recently out this month.

Radiofrequency and BoNT

Someone looked... I thought about this a lot and someone finally answered the question about using your radio frequency microneedling, what's an effect on Botox?

And it does seem to attenuate, but best I can tell, things were still working and not that big a deal, but that's the question that comes up. Probably better to delay them, not do the same day.

This is something, I'm just bringing it up because I don't know what to do with it and it's a question for the group.

Hopefully, someone in the call can educate me, but I'm seeing more and more in the research about these detachable microneedling devices. So you... That. It has the material, whatever it is. In this case, they use triamcinolone. And then it just delivered. It goes in, and then it stays in the tissue and delivers the product.

So I'm thinking of all sorts of ways this could be used, like with lichen sclerosis and scars, and you're seeing lots of research come out. This could be the next thing. I've reached out to one of the manufacturers and see if I can get some kind of deal, and I see Jeff's on the call and other people that might want to be involved. But our group is big enough. We should be able to get some sort of deal on something like this. Of course, the worry for me is what's that thing made out of? And I'm still educating myself on the possible downsides to it. Someone on the call, have you seen this use Sylvia, or any comments?

Sylvia Silvestri:

I have not.

Charles Runels:

Yeah. To me, it seems like something that I would not want to be... It complicates it. So if something's working, and it is. With our microneedling, with PRP alone, with nothing detaching, just opening the skin is working, so why complicate it with a possible foreign body type reaction.

But if you had something that was more resistant, like the sclerotic tissue of lichen sclerosis or maybe a keloid or something, I'm imagining things like that where it's harder to penetrate into the tissue, and maybe there's more of a pathological disease process that warrants a more powerful delivery maybe. I don't know.

So I don't see anybody commenting, so... Excuse me. Apparently no one, at least no one on the call has experienced they want to share. But I'm bringing it up. And I'll put a link to this paper in the chat box, but I'm bringing it up because I think it could have some usefulness down the line for some of the difficult problems we treat.

Cleft Palate and Other Scars Treated with Microneedling

This one, I just wanted to... I think this was a Dermapen they used, and it was so dramatic. We've looked at studies like this before, but it's always so heart wrenching to see what's... Think of a child dealing with a cleft palate. And then to see what can be done with microneedling, that's a life-changing thing for a child. That almost brings me to tears. So that's what we can do.

And some of you are treating acne scars, some of you are facial plastic surgeons on the call, and I think it's worth educating our people that this sort of possibility exists. I'll put a link to this. So realize every one of these papers is a potential marketing opportunity too.

Because if this is something you're interested in doing, any one of these papers, you could take the link, shoot it out, whether you're social media or email and let people know that, "Hey. Yeah, I know how to treat scars.

This is something I do in the office. Have this very same device." Yeah, that's a derma pen. "So I have this very same device in my office and let me know if there's someone you can help."

I think it's useful to never forget, ever, ever forget, especially if you're hesitant with your marketing, if you're the mother of a child that has cleft palette, and you happen to have a surgeon that's not into microneedling, it's not her job to figure out that there's a doctor down the street that knows how to do this.

I think ethically, it's our job to make sure we get the word out about what we're able to do.

Once you adopt that idea, that ethical duty to let people know what you're capable of and it gets in your bone marrow, then I think... If you're visualizing this scar or acne scars in a teenager who's worried she's not going to be, or he's not going to make it to the prom, like happened with me with my acne as a senior, then I would love to have had something like Facebook to pop up and some concerned doctor say, "Hey, I've got something that might help you."

Everybody knows that thing. But I think not marketing when you have this capability is, in some ways, not doing your best duty as a physician in your community. Anyway, I love this article. We've seen these before, but I love that.

Let me stop. We have a couple more papers I want to show you, but let me stop.

And can you jump back in, Sylvia, and talk more about, whether it's you're treating scars or for cosmetic purposes, what's your method and process for applying the PRP and/or whatever else you're using?

Sylvia Silvestri:

So when I do the procedure, I usually will put my PRP into a 10 CC syringe, and I am right-handed. So I have the syringe in my left hand, and I'll drop some PRP on the skin and then immediately microneedle it with my right hand. So I just kind of follow my left hand around, drop some drops. And PRP can be really drippy so I usually put some gauze around their neck and in their ears and protect their eyes. And I'll put it on topically. And then, as soon as it hits their skin, I want to be using my pen to get it in those micro channels.

Charles Runels:

Okay. And I know some of the devices include an HA lubricant sort of glide that can be used as a standalone instead of the PRP with their disposable needles.

Sylvia Silvestri:

Yes.

Charles Runels:

Do you use that as part of your process?

Sylvia Silvestri:

I do. Sometimes I will mix the two together because the HA is usually a pretty thicker gel and it kind of helps the PRP stay together. So sometimes, I'll mix PRP with HA. Or if I have leftover HA, I will send that home with them. I do not send PRP home. You're not supposed to. You don't know what's going to happen to it when it gets to their house. It is a blood product. And I know people that have done that, and I still hear people that do that, and it's a really dangerous thing to do. But the HA, I will send home with them. And then at the end of it, I'll put the altar cream on top of that, and then they can go home with their HA and the Altar Cream™.

Charles Runels:

Like it. And then they use both of those that evening. What do you tell them about cleansing their face? When do you tell them they can and with what?

Sylvia Silvestri:

So if they come in the morning and have the procedure done, they're probably going to want to wash their face that evening. So I just tell them, use a very gentle cleanser, like a Neutrogena type products. No scrubs, no facials, no kind of acid product, just a very, very gentle cleanser for the first week, and continue using their Altar cream. Or if they don't have Altar cream for some reason, just a very gentle moisturizer because the skin does tend to get kind of dry for the first five days.

Also, sunscreen, the following day, they can start. They can put moisturizer on the following day. If I do the procedure in the evening or later in the afternoon, I just tell them, "Go home, leave all this on your face and just sleep in it. And then in the morning, you can just gently use a gentle cleanser and wash your face."

Charles Runels:

Okay. Good. By the way guys, as you probably can tell, Sylvia knows her business, and she teaches an amazing class. I just put a link in the chat box to her website, which offers training, not just in our procedures, but also Botox or whatever newer modulator you're using.

And she will also go to your clinic and train your people if you want. So that's in the chat box.

Let me pull up a couple of other papers here. This one is just sort of a one-off about wound care, but it refers to what I was talking about earlier, the idea that sometimes you have this eschar or whatever scarring or tissue that has to be worked around in order to help the wound heal. And I don't know if you guys know it, but one of the kits, Regen, actually just got... This is crazy big news. They just got FDA approval. They have FDA on label use for their kit for the treatment of pressure ulcers and diabetic wounds. So that's big.

Sylvia Silvestri:

That's awesome.

Charles Runels:

Yeah. And of course, there are many more indications that they know about, but they spent the money and went to the trouble to get that indication.

But back to this paper, when you're dealing with wounds, sometimes you can't just paint it on. You need to have some penetration that the microneedling helps with. So some of you guys are still doing primary care, and I know I snuck around to the nursing homes without telling anybody, and including...

Didn't bill the insurance because it was so insulting, what they were paying me. But I was medical director for a few nursing homes after I went cash, and this is a big problem. So there you go. Let's see. Well, there's a couple of questions that popped up. Let me throw them out at you...

Sylvia Silvestri:

Okay.

Charles Runels:

... Sylvia, and let's work on them together. So Eric says, "Any thoughts about the results of microneedling versus PRP versus Sculptra?"

By the way, before you answer that, this was an interesting paper where they looked at scars microneedling alone versus microneedling with PRP.

And of course, the two combined work better than just the microneedling, as you would expect.

But so back to the question. Really, there's some different indications, but compare those modalities, microneedling versus PRP injecting it versus Sculptra.

Sylvia Silvestri:

So the microneedling is going to treat the skin topically. So if you think of Vampire Facial® like a facial, you're going to be treating the skin from the outside in.

The other two, you're treating the face or the skin from the inside out. And Sculptra is a completely different PLLA. That's more of a full global... It's going to give you a lot more global volume in the face. It'll give you more volumization than a Vampire Facial. Vampire Facials aren't going to give you more volume, but the Sculptra will.

Charles Runels:

Good. I think that's exactly what I would say. I like the inside out versus outside in way of putting it. I think of it as Vampire Facial is more color texture, like tightening the sheet, and Sculptra, HA fillers, and even pure PRP injected subdermally in the adipocyte area and such is more like rejuvenating the mattress and creating more structure and volume, where the microneedling is more texture. Let's see. So another question is, "What do you use for pain when you're injecting the scalp with PRP?"

Sylvia Silvestri:

Some people do it without anything. And then some people need a nerve block, so I will do a nerve block on them if they desire that.

Charles Runels:

Yeah. I see everything from vibrating devices versus blocks versus nothing versus ice.

But it is one of the more... For some people it seems to be very painful. So I think that we have two ways to do a block that are on our website. And one's a ring block and one is doing near the inaudible 00:39:46

Sylvia Silvestri:

Through orbital nerve block?

Charles Runels:

Yeah. It's two in the front, two in the back, and near the insertion of the splenius capitus there in the back. But what kind of block do you prefer and why, when you do the block?

Sylvia Silvestri:

For the front, I do a super orbital nerve block, which is easy for people to learn in class. And then for the back, I'll do a posterior occipital nerve block.

Charles Runels:

Okay. So you're not doing a ring block. Those can be painful.

Sylvia Silvestri:

No.

Charles Runels:

I think those are probably more...

Sylvia Silvestri:

Too many needle sticks.

Charles Runels:

Yeah. They work well, but maybe more appropriate for when you're doing hair transplant. And you're using plain lidocaine or using with epi?

Sylvia Silvestri:

No, I'm using 1% plain lidocaine.

Charles Runels:

Okay. So another follow-up question from Eric, "Would Sculptra be better than PRP combined with Juvederm for the vampire wing lift?”

My thought is that I feel like I have more control with the Juvederm/PRP mixture, although could be that it's just I'm more familiar with it. I was trained in Juvederm before it was approved in the US, so I've burned up trainloads of Juvederm and not as much Sculptra.

And my feeling also is that even though it happens that we sometimes get a little nodularity after doing that combo in the labia majora, I feel like it might be more likely to happen and more of a nuisance, more long lasting nuisance with Sculptra. So that's my reasoning behind it, but I'm eager to be educated if that's erroneous. What's your thinking on that, Sylvia?

Sylvia Silvestri:

I think the Juvederm gives you more stability, especially in that area. I'm like you. I do more dermal fillers and HA than I do Sculptra. I haven't really spoken with anyone that's used S Sculptra in that area, so I can't really say, but I can say that your HA will give you more volume immediately. And I think it's a little easier to use, because your Sculptra, you need to prepare beforehand. And if your patient decides they want to do it there and then in the office, you'll have to use an HA.

Charles Runels:

I think to elaborate on what you just said, as far as satisfaction goes, when you use sculpture, you inject it, then you have to wait for it to work. And when the right place and when you look at the science behind it, it's a truly rejuvenating process where someone would argue more so than an HA and that it's stimulating new tissue growth. So I see the idea behind it. On the other hand, for example, you would never use it in the mouth because you don't have good control of the shape you're making, or at least not as exactly as you do with an hyaluronic acid filler. And you risk granulomas or nodularity that would be unacceptable. So when that same idea, I would not want it in the area of the labia, which to me has a similarity to the mouth as far as your... It's unacceptable to have longstanding nodularity there.

But then the other part, just from a marketing patient satisfaction standpoint, as you just said, Sylvia, which is what reminded me, that when you put a filler there, it's there. You get to go home with it. Where you put Sculptra, it goes away and comes back. When you put PRP, it goes away and comes back. So the beauty of the wing lift, or one of, I think, the big selling points of the wing lift and the facelift combining PRP with an HA is that they go home with the benefits of the HA and they have something to smile about that day, and then it just gets better when the PRP kicks in. But it is common to have, even with the HA, and I don't know why, but for some reason there's a common complaint of a small nodule in the labia majora after doing a wing lift.

I've had it happen to me. I think it probably happens to everyone who does it.

And I think it may be from just not being super diligent about homogenizing the HA with the PRP by repeatedly transferring it back and forth through that luer-lock connector. But I could be wrong about it. It could be something else going on because I know it's happened to me. But the good thing is with the HA, we have yet to have someone complain of that being long-lasting, where with Sculptra, it could be long lasting.

So that's maybe more answer than what was warranted, but that's my thinking about. It sounds like we're in sync with it. Let's see what else I got here for research, and then I think we call it... Oh, this was a nice little just review article that about... And it covers PRP, someone just mentioned here. So it covers PRP, but it also covers the minoxidil and the laser and all of it.

So I'll put a link to this one in the chat box. And I think it's open source. Sometimes I forget if I... I usually spend hundreds of dollars getting ready for journal club because some of them are open source and some are not, but I'm pretty sure this one's open source. And I want to remind people that minoxidil is not particularly benign. I never did the EKG because I don't want to know. But some people get atrial fib from minoxidil.

Sylvia Silvestri:

Oh my gosh.

Charles Runels:

... not the drug for me. But if you go online and look at it and just go to PubMed, I'll just do it. You should never do a blind demonstration when you don't know what's going to happen. But just watch. I just want to show you this. I don't think most people realize how much has been written about... Just watch. I'm going to go to PubMed and put in monoxide and heart prob, just put heart. And watch what pops up, unexpected refractory hypotension investigation, all these cardiac events. It is not a benign drug. Systematic.

So obviously, it's not freaking doing crack cocaine, but it's not without its problem.

There are 272 articles about problems with the heart related to minoxidil. So it's worth reminding ourselves when people throw errors at us, which I like because it keeps us smart. But we have one of the most safest, benign things that exist in the field of medicine.

And we may not get everybody well, but we seldom hurt people. Anyway, so that's a really nice review article and it frames... It's basically a nice meta-analysis and review that frames how PRP fits into an algorithm.

Anything you want to add to that when you're treating hair? And then I think we'll call it a night, Sylvia. Because I know you've treated some people's hair that others would, people on the call have seen them on television. And you know your business. You get great results. So when you're treating hair, talk to me more about what's your favorite adjunctive therapies that you use along with the PRP.

Sylvia Silvestri:

So some people will put ACell and add that into the PRP. Some people... ACell is expensive, so you don't have to do that, but you can, and that's supposed to help the hair grow in even quicker. But just remember it takes about two treatments for you to really start seeing a result. And remember that you need to take photos of every visit because your patient is used to looking at their hair all the time and they won't really realize, when it starts to grow in, that there's a difference. So make sure you show them their pictures each time they come in. I'm trying to think what else.

Charles Runels:

All good tips. Are you using any of the laser caps or not?

Sylvia Silvestri:

No.

Charles Runels:

Okay. Well, most of the people are not, even though... And I don't have them in my office, but the research is good on it and it's probably something to think about. I have a baby sister that's still battling breast cancer and that's one of the biggest things that is disheartening for those who do. We covered a study here recently about where they looked at the possibility of PRP helping during chemotherapy, and the prospect was not so good. But there was some sort of cooling device that's been approved for that purpose and that indication and...

Sylvia Silvestri:

The cold cap.

Charles Runels:

Yes, exactly. Have you used that at all or recommended it to people? Sounds like a good way to get a headache.

Sylvia Silvestri:

No. I've had such a good result with just PRP. And I teach more than I see patients these days. I'm kind of retired from seeing patients, so I just see the people that come in that are my models that I stay in touch with and follow up on.

Charles Runels:

Yeah. I've treated a number of people after they finished their chemotherapy with good results. And I think in that case, you just tell the patient, "Quite honestly, you'll probably get your hair back without us doing anything. But if you want me to help speed the regrowth along, this is something that might help."

And that's a good day's work. Anything else you want to throw out there? Again, I appreciate you being on the call. You have a really, one of our most experienced people. So if you have questions, this is the time. Oh, so Dr. English says, "Are you microneedling or injecting when you do the scalp?"

Sylvia Silvestri:

I inject. I don't personally think that microneedling goes deep enough into the hair follicle as injecting it.

Charles Runels:

Okay. I usually do some of both. There are some places where you just can't get the, or they have enough hair where it seems to hinder the microneedling device. We did one study here a few weeks ago where it indicated that maybe you get a better result with the microneedling. But to me, it's a nice study, but it doesn't take into account that sometimes you just can't get the device in there. And so usually, I'm probably 50-50 when I do to do that. Let's see.

Oh, here's a couple more questions. Yeah, I saw that study, Jeff, about adding something else in. By the way, and don't added time to think about it, but I saw an amazing lecture by someone who claims that their lab just passed FDA inspection. This is huge. And this just happened last month. They just passed FDA inspection for the production of amniotic fluid and cord blood, which is, as you guys know, when we were able to use it, it does... To me, there's a spectrum. You have people that... You don't need anything.

Think about it. When you're young, you scrape your knee, it grows back. Or even when you're not young, you get a surgical procedure and the wound closes. So there's a spectrum of things you don't need anything at all. And I think there are probably some problems that would be made much better if you just injected whole blood. Many people get great results with our PRP, but not everybody. And so I think it was encouraging to me to hear this PhD talk about his lab. They spent millions, and they were able to pass inspection. So I'm hoping I can cut some kind of deal and figure out a way to bring that to the group as an adjunctive therapy. And I just haven't had a chance yet, Jeff, to look at that. But I do agree that the idea of just sticking to PRP and not looking for something that's safe and approved to add when needed is just not the way to go.

haven't heard of Fotona, so I can't say anything about that. inaudible 00:53:42. Tell me the deepest... When you're micro kneeling the face, tell me the best and deepest, while still safe, and the needles to buy. Yeah, I think we hit on that earlier as far as just looking for, and we recorded if you came in late, but just looking for punctate hemorrhages without turning things to a bloody mess. Just in other words, when I see the punctate hemorrhages start to look like confluent red blood, I'm overdoing it. But if I see...

Sylvia Silvestri:

It's usually 0.5 To 1.5, is usually the average.

Charles Runels:

Good. That's a good guideline. So 0.5 in the thinner tissues, up to 1.5 in the cheek and around the chin. Good, thank you. That gives some... That's a real number. Anything else you want to add. To remind you guys, I put a link to Sylvia's class. Highly recommend it if you want to do some hands-on training with Botox or PRP. Anything else you want to add, Sylvia? And if not, we'll shut it down.

Sylvia Silvestri:

I think even in the other class I teach, people get really overwhelmed. And I tell them always start out with PRP, because number one, it has a great ROI. Number two, it's safe. And people get freaked out when they hear that you can cause occlusions with fillers and you can have more issues. If it's not done, you have to dissolve it. And so people get really...

And there's a trend now to not look as filled as the past few years. And so people are wanting a more natural look. And I tell my students all the time, just start with PRP, start with... Or start with Botox and hair, or Botox and under eyes, or start with two things. You don't have to start with everything because you're going to get yourself overwhelmed. And that's what my students do, and then they add things until they're fully capable of doing everything. But don't feel like you have to do everything when you're first starting out because it is overwhelming.

Charles Runels:

Great advice. And I really am... I don't know if you guys picked up on it, but Sylvia's been... She's just an amazing person.

She's been dear to me...

... and hardworking and kind and ethical and ferocious. Whatever she needs to be, she could be all those things. So thank you for being on the call, Sylvia..

hopefully we'll talk again soon.

Okay, you guys have a good night.

Sylvia Silvestri:

All right, thank you very much.

Charles Runels:

Okay. Good-bye.

References

Ismail SA, Khella NAH, Abou‐Taleb DAE. Which is more effective in atrophic acne scars treatment microneedling alone or platelet rich plasma alone or combined both therapeutic modalities? Dermatologic Therapy. 2022;35(12). doi:10.1111/dth.15925

Kaiser M, Abdin R, Gaumond SI, Issa NT, Jimenez JJ. Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. CCID. 2023;Volume 16:1387-1406. doi:10.2147/CCID.S385861

Ghiyasi Y, Prewett PD, Davies GJ, Faraji Rad Z. The role of microneedles in the healing of chronic wounds. International Journal of Pharmaceutics. 2023;641:123087. doi:10.1016/j.ijpharm.2023.123087

Our Technology - Mineed. Published June 7, 2022. Accessed June 19, 2023. https://mineed.tech/our-technology/

Solanki B, Relhan V, Sahoo B, Sarkar R, Choudhary P. Microneedling in Combination With 15% Trichloroacetic Acid Peel Versus 25% Pyruvic Acid Peel in the Treatment of Acne Scars. Dermatol Surg. 2023;49(2):155-160. doi:10.1097/DSS.0000000000003670

Luo X, Yang L, Cui Y. Microneedles: materials, fabrication, and biomedical applications. Biomed Microdevices. 2023;25(3):20. doi:10.1007/s10544-023-00658-y

Alghazawy M, Almodalal Y. Evaluation of Flexibility and Thickness of Cleft Lip Scars After Treatment with Microneedling Technique: a Cohort Trial. Dermatol Pract Concept. Published online April 29, 2023:e2023083. doi:10.5826/dpc.1302a83

Thantaviriya S, Kamanamool N, Sansureerungsikul T, Udompataikul M, Wanichwecharungruang S, Rojhirunsakool S. Efficacy and Safety of Detachable Microneedle Patch Containing Triamcinolone Acetonide in the Treatment of Inflammatory Acne. CCID. 2023;Volume 16:1431-1441. doi:10.2147/CCID.S411378

Jiang L, Liang G, Li Y, et al. Does microneedle fractional radiofrequency system inactivate botulinum toxin type A? J of Cosmetic Dermatology. Published online May 17, 2023:jocd.15826. doi:10.1111/jocd.15826

10.

Pathmarajah P, Peterknecht E, Cheung K, Elyoussfi S, Muralidharan V, Bewley A. Acne Vulgaris in Skin of Color: A Systematic Review of the E ectiveness and Tolerability of Current Treatments. Quality of Life. 2022;15(11).

11.

Nobari NN, Tabavar A, Sadeghi S, et al. A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers Med Sci. 2023;38(1):67. doi:10.1007/s10103-022-03694-x

Relevant Links

Apply for Online Training for the Vampire Facial® procedure<--

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Dr. Runels Botulinum Blastoff Course: Using Neuromodulators (Xeomin, Dysport, Jueveu, & Botox) to Change Lives and Increase Profits

Uncategorized

JCPM2023.05.16.ED-Algorithm.PenisPumpScience.NewsInterviews.

May 27, 2023 Charles Runels, MD Leave a comment

Topics Discussed Include the Following...

Treating alopecia in women undergoing chemotherapy for breast cancer
Treatment algorithm for erectile dysfunction
Vacuum Pump for Penis--science
What etiologies for ED are best treated with the P-Shot® procedure?
*Tips for interviews on the news, podcasts, and magazines

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Relevant Transcript, Relevant Research, Relevant Links

Transcript

Welcome to the Journal Club. We have four main topics for the night, hope you guys will jump in. In the end, I'll cover a question. For two days in a row, it usually happens about once or twice in a month, but now two days in a row have had text messages with questions from people who are being interviewed about our P-Shot® procedure on the news or a podcast somewhere, and still seems like our popularity of the procedure's growing. So I thought I would cover some of those commonly asked questions and some tips about how to deal with the news if you're on the news or in someone's podcast or webinar. How to direct the questions so that you are in control and yet honestly deal with both concerns and benefits of what we do. That will come last. Also wanted to cover some research regarding vacuum devices. There was a nice review article that came out about treating erectile dysfunction in those who suffer from diabetes, and the pump came up in that article. So I thought I'd review that.

And then there was a nice paper looking at the treatment of alopecia and those who are undergoing chemotherapy specifically for breast cancer. And I thought that would be interesting. So those are the topics for the night. Why don't we start with the chemotherapy article?

Treating alopecia in women undergoing chemotherapy for breast cancer

Okay, hold on a second. There we go. Specifically, the question I get repeatedly is what about PRP and those who are undergoing chemotherapy?

This article has to do more with while people are in the process of receiving their chemotherapy, this is a huge problem. Research shows us one of the major disturbing things about undergoing chemotherapy, especially for women, is the loss of their hair. And so, is there something we can do to help prevent it?

The main thing I wanted to show you here is yes, there are scalp-cooling devices that have been approved by the FDA for this purpose. Actually, let me go ahead before I go further and give you a link to this article, and I'll put this in the chat box.

But the main gist of what I wanted to show you is that when they looked at preventing it during therapy, PRP was not so hot. And that has been my observation as a matter of fact, you can read it right there. Whereas host dermal collagen, endogenous thrombin are able to activate PRP calcium gluconate. Oh that's just talking about the activation. And many of the studies leave that off. So I wanted to make sure you see that in my opinion, if they're studying are especially or sexual dysfunction procedures, they should be activating. This is what I was getting at in the rat model, it didn't help. And my recommendation is you wait until people are through with their therapy. Because the general rule of thumb that I go by and when I use platelet-rich plasma is if your body is in a catabolic state, then it's going to attenuate possibly completely block the benefits of platelet-rich plasma. All on the other hand have had great results in helping people regrow their hair after they finish the chemotherapy.

Whether it's making it come back faster or not. I think it is, they think it is. I tell them that without the PRP, it would eventually come back, but we can help it along if they want. All the rest of it, you can read it. But the bottom line is, in my opinion, you're left with pretty much the cooling devices, and then afterward, then you do everything you know to do. Otherwise, I think you'll be frustrated.

A treatment algorithm for those with ED and diabetes

Okay, that's the first thing I wanted to cover. Let me see if anyone has questions or comments about that. Because I am not an oncologist, I've just seen and heard from our providers that they are usually not helpful. Don't see any comments. So let's jump to the next topic, which is this review article that came out. Let's see this one. This one. I love this article because although I think it isn't absolutely complete, it's still helpful, especially for the primary care people in the group or if you're doing primary care as part of your gynecology or urology practice for women and men.

To back up a step, I honestly think that I could take a reasonably attentive 14-year-old and teach them to Botox the glabella and they would get pretty much 100% results, and they wouldn't have to know much of anything else. I don't think that's the case with treating sexual dysfunction. I don't think you have to be Tinsley Harrison or William Osler, but I do think to do it successfully requires an understanding of general medicine. And even if you're not going to do some of what's required, at least understand that certain things need to be done.

ED Treatment Algorithm. ©2023 Charles Runels, MD

If you're going to do the procedure, at least have some idea of everything else that should be done, not just doing P-Shot®s. Otherwise, unlike treating the glabella, I think you'll have frustrated patients.

So this is really nice, this is an open-source article, so I'll give you the link to it, and you can download it. Hold on a second. Let me do that before I go further. Remember, if you click these buttons before I shut down the webinar, they'll be there. If you wait until the webinar's over, the link goes away. So basically, the idea was, how to manage ED and people with diabetes that are not responding to PD5Is. I would, and if you go down, they talk about comorbidities, complications from the comorbidities, you've got the metabolic syndrome, obesity, dyslipidemia, hypertension, hypogonadism, depression, polypharmacy or go along with those, that metabolic syndrome. And then there's a nifty little chart algorithm for the treatment.

And I would like to propose some mild modifications of this in that, maybe not everybody wants to go straight to PD five inhibitor. For example, it's hard to do, but when someone has type two diabetes or hypertension, unless something's changed, I don't know about, I think in the early stages, lifestyle modification is supposed to be the first thing to do.

And so this basically assumes that you start off with the PD five inhibitors and then if that's not helpful, you do the lifestyle thing. So I've included everything on this chart, but just made some modifications, and I'll show you the rest of it, and then I'll show you the modifications. And you guys correct me to add to whatever as we go along.

So it's to ensure they're using the medicine properly and then optimize the comorbidities. And then take a tailored approach, patient-centered care. In other words, you're going to do what good doctors do and listen to your patient. Maybe some of them aren't interested in taking supplements and the pump makes them feel like they're on a comedy show and they want to go straight to regenerative therapies and try your P-Shot®. Or maybe they have a friend and that's getting great results with injectable trimix and you go there.

Maybe you, there's a lot of expertise within physicians too. Maybe you have lots of experience with the intra urethral prostaglandin and that's your first choice. But the idea is you pick the best thing here and then combine them based on the results you get. And of course that would be the third step. Some synergistic combination of therapies. And fourth step would be penile prosthesis insertion.

So of course in this novel therapies, they put stem cells in shock wave, but they left out Botox and PRP, which as stem cells are not even available in the US. But if you look at a lot of these studies come out of like, this is Greece and London and maybe they don't have to worry about the FDA as much.

But here's the modification I made and not much was modified. I respect what they did. But trying to take more of a lifestyle change approach, at least incorporating it from the very start along with, and instead of just slamming with them with the Viagra to start with, there's a growing body of research about, they're not benign, these PDE5 inhibitors, you have blindness, you have strokes, and although there's some evidence that might help with prevent dementia and help with your knee retention and from prostate enlargement, but whatever, I just redesigned this and said diabetes associated with ED and of course this could be ED because the same changes happen in those who are just suffering general erectile dysfunction associated with aging. So the lifestyle, I expanded his list of lifestyle changes.

Exercise alone has been shown to increase erections seven points on the erectile dysfunction score, of course, cigarettes. And one thing that's not talked about but recreational marijuana can change some of the endocrine function. And I've seen that associated with higher estrogen levels, low testosterone, of course, alcohol and diet.

I think although alcohol is great to cause a loss of inhibition, I think it's responsible for also loss of erection. Just people get sleepier and not as erect. Anyway, the comorbidities also expanded that you have, of course, obesity, depression, I added in pain meds because I've seen that a lot. Maybe I'm somewhat biased because I've worked at pain clinics in the past and helped detox quite a number of people. But almost always, if they're on chronic pain medicines, they're LH and FSH drop and they're essentially castrated at the pituitary level and are going to almost always need some testosterone or something thrown in. I hesitate to treat chronic pain patients often cause their hormones are goofed up and oftentimes they're not as compliant. But that may be biased, but for sure, think about LH and FSH and testosterone levels. Of course offending polypharmacy, beta blockers classically.

And when it comes to depression medicines, I think most of you guys know I like swapping over to Wellbutrin and off of the SSRIs, oftentimes you come off of the antidepressant completely if they implement the exercise. On the endocrine level, the chart just listed testosterone. If you check for it, you'll find one or two per year who have hyperprolactinemia from a micro adenoma and you block them back with Destinex and they love you. And oftentimes that's all you have to do.

I had a UPS man that called on our office that was young and strong and impotent and I did... He asked me to take care of him and as he was dropping off his boxes one day drew his lab work and he came back in and all he needed was, he had a micro adenoma, nothing on MRI, just hyperprolactinemia. And you'll oftentimes see in the book, no reason to check that unless they have other pituitary hormone abnormalities.

But I just have found that to be wrong. I just make it part of my routine check in those with impotence.

And of course testosterone, I listed estradiol because in my experience you need about a 10 to 12 fold ratio of testosterone to estrogen. I like estrogen levels to be around more than 50 in men to help prevent dementia. But less than 80, somewhere around 50 to 70 to me is ideal and of course thyroid. So I expanded his chart some in regards to the endocrine function. And then this is pretty much the same as what he had or the authors had. All I added was I moved the PDE5 inhibitors down to after thinking about all of this because you don't need the Viagra if they have hyperprolactinemia or maybe if you pull them off the SSRI and put them on Wellbutrin. Anyway, but it's here.

I put here things that have been shown to help with Peyronie's disease and secondary with erectile function and good studies.

And then the rest of this is the same except I added our P-Shot® and Botox on the regenerative side. If you look at of everything on here, the only thing down here in the other than lifestyle and comorbidity treatment that actually makes the tissue of the penis healthier is in this box. And so I want to expand upon this vacuum device part of the idea because most people don't think about that as being regenerative. And then of course after you pick one or two of these, and then the next thing on his chart was the level three was using intelligently combined therapies.

And many of us already combining Botox with the shot, with the shockwave, with the VED. That's your Rolls-Royce trip to one of our offices. You get a shockwave therapy, followed by a P-Shot® with Botox, and they go home with a penis pump. And to me, that's the Rolls Royce of improving the tissue health of the penis in the United States, where we can't use exosomes. And yes, we cannot use exosomes. If you missed last week, that's still current. Can't do exosomes or stem cells or birth products in the United States. I mean you can, but you can't do it without risking your license—still.

So combination therapies would then be, obviously a lot of people are doing on everything on this list pretty much. And the Botox studies were done, when they were done it was done with people continuing their Viagra. Many of us do everything in this box and the win is that they get to go down on their Viagra or they get to go down on the dose of their trimix until half the dose, or if they're on a low dose, they might be able to discontinue it.

So all of these work in combination with each other. And I put a link in the chat box of this little chart. I'll print it up and make it available on the website. But before I move on, let me see if anybody wants to correct it or add to that. To me, treating sexual dysfunction is, the whole thing used to be, if you understand syphilis internal medicine. Then I always said if you understand testosterone replacement, you really understand medicine.

I think even more than those two, if to really be good at sexual medicine because it's the cherry on top of good health, you have to understand medicine. But if you don't want to do this part of it, the lifestyle part, the hormonal part, at least have some idea of what's been done for your patient. If you're just going to do shockwave and P-Shot®s, make sure that the person's primary care doctor or gynecologist someone is thought about in an excellent way, everything on the top of this page.

Okay, let's see if there's any other comments and then we have an interesting question to answer, but I want to jump back over to the vacuum pump research because I think it gets overlooked and maybe to the loss of some of the benefits to our patients.

First of all, I admitted I had a blind spot. I did not realize that Xiaflex or collagenase had been made not available in Canada and Europe. I never was proud of the fact that they seemed to... Am I reading? I never could get a really good answer about the true incidents of penile fracture went on collagenase, but the best I could tell it was around 2%, which doesn't sound like much, but 2% is one in 50. If our P-Shot® was causing one in 50 people to have a fractured penis, we would already been run out of town. So I think that's what happened basically is, but I haven't figured out why I was blind that it was even happening. But I'm showing you this article where someone in the Netherlands is trying to prove that it should be reinstituted in Europe by doing more research with collagenase.

But then if you look, let's find the, yeah, yeah. So this is my favorite paper showing that our P-Shot® helps Peyronie's disease with a side effect of improving erection by a legend. This was really the pioneer of doing intracavernosal injections. Ronald Virag is a legend, received rewards for just changing urology forever and this is his paper. You guys have seen me wave it around a lot showing that PRP helped Peyronie's disease. The thing that can be confusing for people is this hyaluronic acid part. This was not in the context of a filler, it was in the context of an activator. Regen has a tube that comes with a non cross-linked hyaluronic acid to activate the PRP. So that's the purpose and again, I think emphasizing the fact that PRP needs to be activated. Cell field comes with calcium chloride.

Most of us buy calcium chloride or calcium gluconate separately to activate our PRP. So that's the PRP part of it. But back to the pump part of it, this is one of my favorite papers about the pump and in this paper, those who used the pump twice a day you can see it was 31 patients with Peyronie's disease and they 51 was the average age, 24 to 57 for 12 weeks, which 12 weeks if you notice is a common endpoint for soft tissue. This seems to be where most people grade the conclusion. And so 51% canceled their surgery. These were all people bound to have surgery as you can know, which the side effect is your penis gets shorter and the Peyronie's may come back in a different place because it's autoimmune. So you take away one place, and it comes back in another, not something most people want to sign up for. So 51% satisfied.

The reason I wanted to bring this back up, this is just a straight up pump. If you go back to this guy who was smart man, but he's campaigning to have Xiaflex or Collagenase reinstituted in Canada and Europe. And if you look at the actual percentage, it went from 41% able to have sex before treatment up to 74%. In other words, and part of the study that was with pump part was out. The bottom line was, it was about using a pump. As far as going from curvature too much to be satisfied to curvature to where you're satisfied enough to have sex.

The pump wasn't mentioned here, but the numbers were similar to using the pump in this British Journal of Urology paper. Again, I know lots of people are using the Xiaflex in the states and love it. All I'm saying is that, in my opinion, if we can use Xiaflex, we should be able to talk about the other part of the chart I showed you and be just as excited about everything here and use our shockwave and our P-Shot® and our pump rather than going straight to surgical therapies.

In other words, we're still first class when you look at the numbers. Now back to, we didn't cover... Oh, that I wanted to bring this up again. This was just because I got more questions about it. I'll put a link to this in the chat box. This guy as a sideline to his paper just mentions that in the US we still cannot use, he says be aware of the evolving guidelines. And he just says right here in the paper that, "Exosomes are an air of research, but currently, no FDA approved exosome. None. None. If someone tells you they have a product that's okay with the FDA," this paper came out in this month. So he's backing up what I'm saying here. It scares me when I have people arguing with me. I'm not going to argue, but they say I'm just wrong that their drug rep said it's okay to use our exosome products and not say, oh, okay, well. I guess we just are going to agree to disagree. But that's what this review article said as well.

Vacuum Pump for the Penis—science

Okay, so we covered the chemotherapy, the diabetes, there was another pump article. I think I'll skip over that one though. The bottom line is that I think what the other thing that might... Oh, I know what it was. Let me pull it up. Hold on. There's another one I want to show you about pumps. That's huge. This one. You guys have heard me talk about this I think, but I've never actually shown you the paper where they measured oxygen saturation before an after vacuum therapy with erectile dysfunction after prostatectomy. And not only was the penis more oxygenated post-pump, but it stayed more oxygenated. I'll put a link to this one in the chat box, throughout the day. In other words, it's taking the place of the nocturnal tumescence by feeding blood.

And David Harfield was on here, I don't know if he's on tonight, but he was on, I couldn't find the paper, but there's a paper talking about intermittent hypoxia causing triggering reaction that causes tissue repair and neovascularization after hypoxia.

So not only is it more oxygenated afterwards, both immediately and throughout the day, it could be triggering a regenerative process. And then my theory is that since we know vacuum, this one have nothing, this is me making up something, but it makes sense. Since we're putting vacuum on a tube full of blood, we know that vacuum activates platelets and so we're actually making, in my opinion, small aliquots of activated platelet-rich plasma or activated platelets every time the person uses the pump.

But I wanted you to see this study because that's part of the reasoning behind using the pump. That's part of a penile rehabilitation protocol and many of us are combining the pump along with a low dose daily Cialis and our P-Shot® plus find a shockwave. So there you go. The last thing I think to talk about, let's see if any questions yet.

Yeah, that's a good point. Thank you January. The other thing that people are saying that you should, in my opinion should be, they're adding propaganda to lies. The same reps who will tell you, you should use their exosome product, even though exosomes are not approved, there is no exosome-approved product for IV or intra or injection use in the US, they will make the case that if you're over 40 years old, you're a PRP doesn't work. Which if you're 20 years old and your inaudible 00:28:45 and on high dose corticosteroids, your PRP doesn't work. But the rule of thumb I think makes the most sense as a clinician, is if you can heal from surgery, your PRP is going to do something beneficial because it's the same process. If you can't heal from surgery no matter what the age, then maybe your PRP isn't going to work so much. But whatever the idea about the PRP in the states, exosomes are a risk to your license, currently. Okay, let's see, what else? Any other questions? Thanks January for that reminder. All right.

Press Interviews

All right, let me jump over to the question and some tips about how to deal with interviews. A lot of you guys are interviewing each other or being interviewed by others regarding our procedures. So I can run through. If you guys know me, anybody who knows me knows that at heart I'm the most introverted introvert that I know. I mean, there have been times in my life when I avoided going to public places, almost agoraphobic. But on one-on-one I always cared for people and that came naturally to me and just for some reason was intrigued and enchanted maybe by almost everybody. But I wasn't too hip on talking in public. I just make myself do it because it needs to be done and I've enjoyed the people I've met and I've been on the news way more than I would've ever anticipated in multiple countries and in states all over.

And so these are the tips from the introvert who did it and had to figure out a way to do it and make it work. So I'm not a media coach, but this is what has worked for me. So we'll get to that. The general tips are at the bottom of here and I'll expand on those. But these are common questions that people are asked that were sent to me by this person who'll be interviewed tomorrow.

Etiologies for ED best treated with the P-Shot® procedure

So what's the most common ED causes best treated with a P shot? Your rule of thumb is that what we are doing with PRP anywhere is we are having a local effect on the tissue. So any etiology that is not local, we're not as likely to help it. So if someone has low testosterone level and their hypothyroid and depressed and on beta blockers, then all we're doing with the P-Shot® is making the tissue of the penis healthier, maybe it won't work so well. If you go... I want to show you guys this real quick because a lot of this, and we'll come back to the rest of this. Let's see, hold on a moment.

So if you go to our Priapus Shot® website, if you've been in the group a while, you may not have seen this. But I put a more structured course in here that I think is probably helpful for to go through, even if you've been in the group for a while. Let me just go to the website, and I'll show you. When you land, you'll usually be on this dashboard. And this was all that was here. It was more like a filing cabinet, how to do the procedure, the marketing part, and the survey, et cetera.

This is where all the consent forms live and where to buy your stuff, you get; it’s self-explanatory. And people used to have to jump around. Usually, they started here, learned how to do the thing, and then went back to the rest as they needed it. The thing that's different is I added a formal guide that takes you through that filing cabinet in a fairly logical way. And these lessons are often just a few minutes long.

Here's the first lesson is just to recommend people sign up and come to these journal clubs, and I show them where to do it because I know that the people who come to these journal clubs are more involved, the ideas stay fresh in their minds, they get better results. They market better and see more people, make more money, and have more people crying in gratitude in their office.

So these first four things are just how preliminaries know where the research is. Teachers can't overemphasize teacher staff this phone script. And so I lead you through every... That's my son back when he was a high school kid. I lead you through the filing cabinet, but everything that's in the course is in the filing cabinet. All right? And in this filing cabinet is the answer to almost every question that might be asked.

And then, if you get really stuck, the other thing that's helpful is to just put your question over here in the search bar right there, and it'll bring up these journal clubs. If I put here Peyronie’s, then it will bring up where we've talked about Peyronie's in the past and previous journal clubs.

But then back to the question I just wanted to show you because that structured course is a good thing because a lot of things that are helpful in both the marketing and the pearls for doing the procedure sometimes get overlooked in the more haphazard way that I had things set up. So I wanted you to see that's available. Everybody that's in the group can log in and do that.

Now, back to the questions and how to deal with the press; get you back there.

So with this first one. The most common causes that would be best treated would be ED that's mild to moderate because those are the people less likely to have iliac disease. This would be someone who's erectile dysfunction score is going to be somewhere around 10 or more. And another practical way to think about it is, if they get nothing, no tumescence at all from taking Viagra, no morning erection at all, no morning tumescence or they've had diabetes for 30 years, then P-Shot® alone is not likely to help them. Now that we're adding Botox in, I don't know, I have less experience with the combination, but just for the P-Shot®, because some of those, or actually all of those who responded in the double line placebo controlled studies were not responding to maximal doses of PDE5 inhibitors. So maybe we'll do better now that we have that combination.

But in general, two things that I don't like treating, someone who has had long-standing ED with no tumescence, no matter what they do, and someone whose main goal is to change the size of their penis significantly. I've found those two people difficult. Your easy-hanging fruit is the person who's got some tumescence. They may even be on one of the injectables or the Trimix or maybe they're on a higher dose of Viagra, but things are working; they’re just not working as well as they were. They'll be able to cut their dose in half or come off of it.

Nothing else does that.

You just have to go up on the dose until you need an implant, or perhaps your shock wave might help. But as far as there's not a lot out there except of our regenerative therapies other than just going up on the dose and people can become unresponsive to the trimix sometimes pretty quickly. Then in other words, our easy stuff would be very difficult otherwise.

So you got that and then you have, so the person who's responding but do something else, but they want things to be better. Also, Peyronie's disease, like in sclerosis in men and they're trying to recover from prostate surgery, but were able to have erections before the surgery that's worth the shot. Your lowest hanging most common treatment is going to be the person who is responding to some pharmacology but wants to go down on the dose or they're not on Viagra but they want to avoid it or Peyronie's or recovering from prostate surgery. That's your best candidates as far as the maintenance go and how often, most people are coming back for the past decade that I've been doing it. T

hey usually show up about every 18 months.

If they're wanting to see if they can make things improve or perhaps the first procedure was not as helpful as they would wish, I'll let them come back as long as every time they're coming back it seems to be improving. I had a man who flew from New York City down to the Gulf Coast here to see me in Alabama five times for loss of sensation. Each time he thought he improved it until the fifth time didn't seem much better than the fourth, so we stopped and he was happy.

Most of the time people are getting their maximum benefit, unlike with a hair, they seem to see their maximum benefit after the second injection and they show up every year to 18 months. And the other question that gets asked along with that is, well it is almost an I got you kind of thing. If you have to keep doing it and then maybe I don't want to do it. Well, what you're doing of course is you're slowing the inevitable aging process with doing nothing. Research shows most men lose about 50% of the endothelium. Their biceps are shrinking, but their penis is also shrinking by and they lose about half by the time they're 65.

But that doesn't stop. We reverse it with the P-Shot® and then it progresses again from a new set point. So we just try to stave off the inevitable eventually, unless something big happens, we're all dirt on this planet and we just we're slowing the process down for that one part of the body.

Tips for Interviews with the Press

Okay, so general tips when being interviewed about any of our procedures, I'll go through this pretty quickly, and then we'll end the call. But this would also, I think, even if you're not being interviewed, these points would be helpful on the website, podcast, and your own videos.

These are points that I think allow you to be truthful, to be complete and yet, and so not lose your credulity, yet you are still able to give genuine hope. So I'll run through them things. First of all, before I talk about anything to do with sex, I like to always, even though most of us love the pleasure of sex, I like to bring it to a higher level, which is that sex also relates to creativity. It relates to Riner Maria Rilke who wrote Letters to a Young Poet, and thought it was directly related to your creativity.

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poets and philosophers have said the same thing. Thoreau said the same thing (see the last chapter of Walden). And so your creativity is related to it. If you're a salesperson, you sell more if you have a good sexual function. If you are a leader, if you're a politician, if you are an athlete, if you're a mother, if you're a grandfather, sexual function gives you more energy. It gives you more sparkle to your personality.

Walt Whitman said, "Whether you're blackening a shoe or you're writing a poem, it's all about sex."

And in when you take it in the larger sense of the word, outside the bedroom, but in relating to creativity almost on a spiritual level, that sex is involved and truly is involved in pretty much everything. So that's that part of it. The other part is that, it's about relationships and family and of course family is part of the fiber of our society and our lives.

And when that falls apart, then you're dealing with economical and psychological disaster often. So it has, as part of that fiber of family, and I like to bring it as quickly and as succinctly as I can, pull that into the conversation. Now, I'll get to more keywords in a moment but just realized that you can do that. It's worth it, even though it is somewhat angering, it's worth watching. It doesn't matter what TV news channel you like to watch, it's got nothing to do with politics because they all do it.

But watch politicians, when someone asks them a question, you can't watch them for more than a minute without seeing it happen that they don't want to answer, they will quickly talk about whatever they want to talk about and use the question more like a bell to talk than actually a signal for what topic they should dive into.

Now, obviously you take that to too far of an extreme and you're disingenuous. But if for example someone says, "Well, does this make sex better?" Then my answer would be, absolutely when this works, it can make the pleasure in the bedroom tremendously better. But before we talk more about that, just realize that sex, it has much more to do with our lives than just sexual pleasure with the lights out has to do with our, than I would clinge into all the things I just talked about.

So you can start where they are, where the question is. And that brings me to this point, number three is that when you're being interviewed or when you're just going to do your own videos, podcast, whatever, I like to have a list of keywords that I'm going to say. You can ask me the weather and if I'm going to talk about the P-Shot®, I'm going to bring it up.

Or if I'm going to talk about how it relates to family, even if you ask me about orgasms, I'm going to talk about and orgasms create an emotional bond between, you get it. So you can always bring your topic in. But I like to rake those keywords out often the night before or so oftentimes it's just a few minutes before and then right before I have to go on camera or do my video at home, wherever, I'll look at those keywords. If possible if I'm home making a video, I'll just stick them up on the screen somewhere where I can look at them to remind me.

The next thing is that, really, I said to someone you love, but when you're doing an interview podcast or the news, there's really three people you're talking to and everyone else is just listening in. At least the way I conceive of it.

The camera is someone that I love that could relate to the topic. So many of I have a baby sister who's, in my opinion, the biggest hero I know at the moment who's struggling with breast cancer. And so if the topic was breast cancer, I would imagine that the camera lens is my baby sister. But then there's also the host or hostess of the show or the podcast or whatever. And so I would be as connecting as I can to that person.

You could do an interview and you could say all your words and never connect to the person. You need to be in the present moment and connect to the person you're talking with. And I would add to that brag, I like to always brag on their courage because even now, even though you have all sorts of people doing outrageous things on Twitter or whatever, it still takes a lot of courage for most people to talk about sex in an open manner and risk their reputation doing it. Which brings up the other idea, which is that sex is still taboo similar to psychiatric problems.

And so I always brag on the host who's interviewing me for having the courage to talk about it. And if I get the chance right up front, thank you. I realize this takes a lot of courage to talk about sex.

Sex as a medical physician or as a patient is similar to say schizophrenia. If you break your arm, you have people sign your cast, you take a picture of it, put it on Facebook. But if you had schizophrenia and auditory and visual hallucinations, you may not put that on Facebook.

The same thing even with major depression, people say, oh, you've got a nice life and pretty car and healthy family. You don't have... There's not a lot of empathy it seems to those problems. And people will say things they would never say if you had cancer or congestive heart failure. You'll see snide remarks.

Women seem to be the most vicious against other women when they on the chat forums and such, you'll see women saying stuff like, "Oh, you just need a man with a black Amex card o,r" stuff like that. Things that they would never say to each other about something having to do with other physical ailments.

So the keywords and the outline that you guys, if you've been to my workshops, you know my outline. And so that will be incorporated into my keywords. What's the problem? How's it affecting things other than secondary effects that are affecting their life? What's been tried? What's new? And you try to make something, even though the P-Shot® now has been around for a decade, there's new research, there's new ideas about how we're combining it. So there's new, now we're combining it with Botox. Shockwave is becoming more prevalent. So there's always something new. And part of what I hope to provide here is new things for you to talk about. So it does stay fresh.

So it's what's the problem? What's been tried? What's new? What's not possible? And what is possible? And tell me what to do. And I like to have something set up someplace to send them a website to send them to, a phone number. And now a lot of people are texting something somewhere, but something where they can engage with you afterwards and get something free.

Send me an email here and we'll shoot you our latest research. And I'm not a big fan of something off because to me it sounds too much like a used car salesman. I like giving away something educational if they'll reach out to me and then in the process of giving it to them, I collect their email address and now we have a chance to establish a relationship. I don't usually try to make the sale to get to my office on the interview, I make the sale to get to my website to get something for free in exchange for their email address.

So that's the thing that I put for the thing to do. Then I always include something about you just lose credulity if you're all roses. So always bring up something about how this doesn't help everyone. And if you've got something like if you, let's say if it was the P-Shot®, if you have prostate cancer, we can't fix that with a P-Shot® or if you're trying to double the size of your member, we can't do that, but we can do this, this, and this. And I think it balances out and gives you more credulity.

So then this is a question, it doesn't come up so much now because thankfully most people have figured out the answer to it. But it should roll off your tongue so quickly, because every now and then, when I was on the doctor's show, it was the very first question. It took a deep breath. I didn't have to try to think of what the answer was. I mostly had to take a deep breath. Because the fact it was asked by a host on our hostess, one of the celebrities on the doctor show.

Maybe she was asking it for the benefit of her viewers. So I'll go with that. Anyway, her first question was, or comment was, this is not approved by the FDA.

So the thing that should immediately come out of your mouth is that the FDA doesn't regulate procedures, they regulate drugs and devices and they don't regulate body fluids. Plasma is a body fluid. They don't regulate it anymore than they do saliva or urine, but they do regulate the device we use, which is part of the reason for the price involved because we use a device that's approved by the FDA to prepare plasma to go back into the body. That's the answer to that question, should it happen?

And then just having some knowledge of our research and all of our research lives at whatever the procedure is, .com/research. So for the P-Shot®, it would be priapusshot.com/research, oshot.com/research vampirefacelift.com/research. So you might want to zip over some of that before you do your interviews and some of it will, you might even pick one or two that you bring up, never talk down.

And many of you've heard me talk about this before, but in my opinion, you want to be understood. But if you don't, let's say use the big words. If you don't say a few things, they don't really understand, they're not going to think you're smart. So be as smart as you are. You're no longer on the bus. If you're like me and you rode the public bus and you started talking about the Shakespeare you read yesterday in the library, you might be considered a smart ass and wind up having to have a fistfight. So you possibly have learned not to be as smart as you are. And I have to remind myself sometimes, it's okay, it's actually desirable that oftentimes if I'm smart as I am, I still will not be the smartest person in the room.

And so your patients are smart and smart or not unless you say at least a few things they don't quite understand they might have trouble thinking you understand what you're talking about. They need to hear that. Okay, I think that's all I have for tonight. Let me see if there's any questions. I don't see any. Let me see. I might want to put a couple more links about the research whenever and unless more questions pop up, we'll call it a night. Let's see, oxygen saturation, yeah I'll put that one in there. And think with that, we'll call it a night. So if you click on that, it'll be there when we end it.

Always honored when you guys come out. I hope you found something helpful in tonight's call.

Goodnight.

References

Cayetano‐Alcaraz, Axel Alberto, Tharu Tharakan, Runzhi Chen, Nikolaos Sofikitis, and Suks Minhas. “The Management of Erectile Dysfunction in Men with Diabetes Mellitus Unresponsive to Phosphodiesterase Type 5 Inhibitors.” Andrology 11, no. 2 (February 2023): 257–69. https://doi.org/10.1111/andr.13257.

Geelhoed, Jeannette P., Olivier Wegelin, Ellen Tromp, Bert‐Jan De Boer, Igle‐Jan De Jong, and Jack J. H. Beck. “Improvement in the Ability to Have Sex in Patients with Peyronie’s Disease Treated with Collagenase Clostridium histolyticum .” BJUI Compass 4, no. 1 (January 2023): 66–73. https://doi.org/10.1002/bco2.185.

Raheem, Amr Abdel, Giulio Garaffa, Tarek Abdel Raheem, Michelle Dixon, Amanda Kayes, Nim Christopher, and David Ralph. “The Role of Vacuum Pump Therapy to Mechanically Straighten the Penis in Peyronie’s Disease.” BJU International 106, no. 8 (2010): 1178–80. https://doi.org/10.1111/j.1464-410X.2010.09365.x.

Wikramanayake, Tongyu C., Nicole I. Haberland, Aysun Akhundlu, Andrea Laboy Nieves, and Mariya Miteva. “Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?” Current Oncology 30, no. 4 (March 25, 2023): 3609–26. https://doi.org/10.3390/curroncol30040275.

Virag, Ronald, Hélène Sussman, Sandrine Lambion, and Valérie de Fourmestraux. “Evaluation of the Benefit of Using a Combination of Autologous Platelet Rich-Plasma and Hyaluronic Acid for the Treatment of Peyronie’s Disease.” Sexual Health Issues 1, no. 1 (2017). https://doi.org/10.15761/SHI.1000102.

Yang, Shangyang Christopher, James M. Weinberger, Robert H. Shahinyan, Gary K. Shahinyan, Jesse N. Mills, and Sriram V. Eleswarapu. “Regenerative Therapies for Erectile Dysfunction: The Influence of Direct-to-Consumer Marketing on Patient Interest.” Translational Andrology and Urology 12, no. 4 (April 2023): 586–93. https://doi.org/10.21037/tau-22-309.

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--> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

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Uncategorized

Vampire Facial® Imposter Pleads Guilty

June 26, 2022 Charles Runels, MD Leave a comment

On June 24, 2022, the attorney general for New Mexico (Hector Balderas) announced that he secured a guilty plea for 4 felonies from a spa owner who was unlicensed to do the Vampire Facial®. Because the procedure was done incorrectly, at least two people contracted HIV.

Procedures involving blood are done routinely by most medical clinics on a daily basis; but, the Vampire Facial® is sometimes not understood (even by some physicians) because the device used to do the procedure should be approved by the FDA and the procedure must be done in a specific way in order to assure safety and the best possible clinical and cosmetic outcome.

Rolling Stone reported that only those listed on the official Vampire Facial® directory are licensed by the Cellular Medicine Association to perform the procedure. All others are illegally advertising and could be following dangerous practices.

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Botox & Fillers Course Online with CME

January 18, 2020 Charles Runels, MD Leave a comment

1. I very strongly recommend Dr. Seiler's course (a true wizard with neuromodulators and fillers)...

Excellent on-line, cme course for Botox and fillers (click)<--

2. Also recommend this book..

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Vampire Facial® Trademarks & Provider Group

Video January 19, 2018 Charles Runels, MD Leave a comment

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“Jennifer Aniston has undergone a Vampire Breast Lift®” — Vampire Breastlift

August 24, 2016 Charles Runels, MD Leave a comment

Did she or didn't she? InOutStar quoted Dr. Harutynunyan (plastic surgeon) as saying, "It looks like Jennifer Aniston has undergone a Vampire Breast Lift®." Here's the article with before & after photos (click) Here's more about the Vampire Breast Lift® procedure (click)

via “Jennifer Aniston has undergone a Vampire Breast Lift®” — Vampire Breastlift

Transcript, References, Relevant Links

Transcript

Marketing Tips for the Vampire Facial® Procedure from the Beverly Hills RN

Pain Control with the Vampire Facial® Procedure

Patterns of Microneedling

Radiofrequency and BoNT

Cleft Palate and Other Scars Treated with Microneedling

References

Relevant Links

Topics Discussed Include the Following...

*Treating alopecia in women undergoing chemotherapy for breast cancer *Treatment algorithm for erectile dysfunction *Vacuum Pump for Penis--science *What etiologies for ED are best treated with the P-Shot® procedure? *Tips for interviews on the news, podcasts, and magazines

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Relevant Transcript, Relevant Research, Relevant Links

Transcript

Treating alopecia in women undergoing chemotherapy for breast cancer

A treatment algorithm for those with ED and diabetes

Vacuum Pump for the Penis—science

Press Interviews

Etiologies for ED best treated with the P-Shot® procedure

Tips for Interviews with the Press

References

Relevant Links

Physician Log In

Treating alopecia in women undergoing chemotherapy for breast cancer
Treatment algorithm for erectile dysfunction
Vacuum Pump for Penis--science
What etiologies for ED are best treated with the P-Shot® procedure?
*Tips for interviews on the news, podcasts, and magazines