The Beauty Balance podcast is hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with influential, talented women who truly encompass grace, beauty, and brains –
plus, you get an inside scoop on what it’s really like to be a plastic surgeon.
Ep. 09 - Non-Surgical Nose Job Risks: What Patients Need to Know
Ep. 09 - Non Surgical Nose Job Risks: What Patients Need to Know
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
Today I’m going to talk about a very important topic and a popular procedure that I offer here in my clinic.
What I am going to be talking about is the non-surgical rhinoplasty. I’ve seen some Instagram reports and read some articles of things that could go devastatingly wrong with fillers and non surgical rhinoplasty in particular, and also fillers in any part of the face. Several things to remember is: the face has a ton of blood vessels (arteries, veins, etc) that could not be visualized through the skin. You have to know your anatomy for a lot of the arteries. Sometimes you could have a detour and not even know.
It’s very important to know how to inject, the technique of the injection and know what to do if something goes wrong. Having said that, not only am I a very experienced injector I’m also a board-certified plastic surgeon.
Now, let’s talk about non-surgical rhinoplasty. I do a TON of these procedures, several a week, I do them all day everyday. I never had a complication and that is not hubris on my part. That’s just a fact. I am very careful when I’m doing the injections, understanding that it could happen to an experienced injector. Because I know the nose both inside and out -- I do surgical rhinoplasties. I open up the nose, straighten up the nose, fix the nose, and I could also fix the nose aesthetically non-surgically.
It is extremely important if you are seeking to go have a non-surgical rhinoplasty. You would want to go to a board-certified surgeon and realistically a plastic surgeon or a dermatologist who is experienced in doing non-surgical rhinoplasties. The technique is important and how you inject is very important. If you have a complication, how you take care of it is very important. We have an emergency protocol for surgery in case things happen. We have a list of people to call, where to go to get the fastest best help so the emergency will be resolved. We have a protocol for non-surgical enhancements with the emergency protocol: who to call, where to go, what doctors to get involved in this. I do stress that you go to someone who knows what they’re doing and knows how to handle complications. If you go to a spa, is the spa ready to handle a non-surgical emergency? Is the doctor on site? What ER are they going to? Which ophthalmologist are you going to call? Do they need to have a radiologist involved for an angiogram? These are important concerns. And most importantly, do they have hyaluronidase?
The procedure may seem simple, may take just 10 minutes, but it’s 20 years of my experience behind it and 18 years after high school that I’ve studied to get to this point. I really stress that you go to a board certified plastic surgeon or dermatologist who is an expert in injection of the face.
Ep. 08 - #NewTox (Jeuveau) Conversation with Evolus CMO, Mike Jafar
You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.
UR: I’m very excited today to have Michael Jafar, the Chief Marketing Officer from Evolus join me today on our podcast. We are very excited about Evolus and we just started using Jeuveau in our practice. So tell me a little more about Evolus. How did you decide to bring it to the United States, what’s your marketing plan and strategy?
MJ: That’s a great question and thanks for having us on this podcast. And congratulations, I noticed that you have 17,000 followers on Instagram. That’s very impressive to see.
UR: Thank you, we are very proud!
MJ: I think we share something alike and that is we tend to communicate differently in today’s world. If you look at the heart of most companies that have been successful, they have a different communication strategy. Whether it’s their language, their choice of words, or even the channels in which they operate. Here you are, a prominent surgeon in the Bay Area and we’re doing a podcast. Five or ten years ago we would never have sat here in this type of forum. And the reason why you’re doing it is because you understand people consume content differently.
For us at Evolus, we looked at a twenty-year market and we moved it closer to more of a beauty language and category than a medical category. Our company as Evolus is known as a performance beauty company, meaning FDA-approved effective product in a beauty lens. We brought in a design principle that walks through every content, every word, every model selection and thinks of our end-user –– meaning what she’s coming in here to get, which is not a medical treatment but more of a beauty treatment. We have a purpose at Evolus and that purpose is to make the beauty experience delightful and achievable. Everybody within our company abides by that purpose.
UR: Perfect. That certainly aligns with a practice like mine. We are a small but busy practice here in San Francisco. We want patients to choose us because our service is great, the products we offer are great, and the treatments that they get are wonderful and they feel good and done in a nice, elegant manner.
MJ: What I appreciate about the way you approach this market is you’re taking one of the stigmas out which is this fear. People fear looking unnatural. People fear this entire “medical treatment” because they think of it as more medical. You’re breaking these barriers down so that people listen to a podcast, or they see your content, and you’re making it much more comfortable. From this beautiful office that I have the privilege of being in, to the approach you have with the patient. We share that commonality and that barrier should not exist.
UR: Great, that’s exactly how I feel also. So, tell me a little about Evolus. I know Jeuveau but at this point is that the only product that you have available in the United States?
MJ: That’s right. Jeuveau is a 900 Kilo Dalton product and that product is the only other Kilo Dalton in the marketplace relative to the market leader. It is our flagship product. We chose to start with a toxin because most people would require the need of a toxin such as Jeuveau before anything else. So you could build a practice, you could build a company around this particular asset. We have aspiration, we are publicly traded so we have to be mindful of what we state there, but we have aspiration to invest in this market, build out a portfolio and continue to build what we look at as an under-penetrated market.
UR: When we’re talking about toxin, we’re talking about neurotoxin. We do have a few neurotoxins here in the United States. How do you hope to gain more market share? How are you going to differentiate yourself or be superior to the neurotoxins we have here now?
MJ: That’s a great question. A lot of people see this as an equivalent product. These are not bioidenticals they are biosimilars in a sense. They’re not identical products. Our differentiation is less about the product and more about the language. Our intellectual property and our differentiation is going to be and will always be our design principle. Our design principle allows us to communicate differently. We are sitting here and there’s a “Hello Jeuveau” pamphlet with pink gloves and a heart. You wouldn’t look at this and say, “this must be a neurotoxin” you look at this content and say “this looks more like a beauty experience or treatment and I should read more into it.” That principle is what we have been fairly successful with in a short period of time. We hear from patients, and as you do some social listening, that this company understands how to talk to me. This company is putting things out that I want to learn a little more about. You will hear less features and benefits and you will see and feel a true beauty product in this space.
UR: I have seen that you have great social media presence and, in the non-medical terminology, you are considered the “Newtox” in the market. A lot of patients come in asking about Newtox or have questions regarding Newtox so I think you’ve done a really good job of getting that name out.
MJ: I appreciate you acknowledging that because we are the first company to launch with a hashtag. If you think about it, most companies would launch with their brand name first and then you learn more about it. We launched with a hashtag because in today’s world that’s how consumers find things. They will find you through a hashtag and we modernized the search experience right off the bat.
UR: With your marketing strategy are you hoping to attract younger patients? What is your demographic? Is it going to be changing or extending?
MJ: That’s a great question. The beauty of this space that we are in is that we have as many 20-year-olds interested in this category as 70-year-olds. The bell curve in this market has always been that late 30s to late 50s. Our goal is to look at a demographic and age range that is between 25-39, understand how to speak to her, and understand how to unlock that market for two reasons.
One, they influence your 40-, 50-, and 60-year-olds quite drastically. They have a tremendous amount of influencing as they do with their parents. The second reason is, millennials have purchasing power more so than any other generation that has come through healthcare or retail. The reason being is they’re putting off purchasing homes to a later time, they’re buying their second car at a later time due to ride-sharing, they’re having kids later, and they’re really interested in their self-care. They have access to great products at their fingertips.
That gig economy that is making its way through the system is going to be one of the most powerful generations that we’ve seen. We have been marketing to them as an industry by accident. It’s been the flavor of the month. One day it’s about mail, one day it’s about millennials, it’s all about whatever the hot topic is everyone will jump onto it. Our goal is to market to them and understand them by design.
UR: One of the things I notice with my practice is that millennials are very smart, they have a very different ideal of the way they look at life. They look at it as an experience, so small experiences make up this large experience. Each time they come into our practice, to see me or one of my nurses, it is an experience. And what we are offering them is a fantastic experience so that they can come back again.
MJ: I love that you’re staying close to that. These micro touches, to your point, add up to them walking away and simply saying “That was a good experience.” That makes a world of difference to that demographic.
UR: What other products are coming down the pipeline?
MJ: We are a publicly-traded company. We are on the NASDAQ and our ticker symbol is EOLS. We do have aspirations of building out a portfolio. We’re heavily and singularly focused on aesthetics and we will start with the face and then hopefully go beyond that.
UR: Do you plan on getting FDA approval for the lower half of the face? I’ve been using Botox for decades and we started with the glabella and slowly moved to the upper half and, now with my slightly older patients, we are moving toward the lower half of the face and it has been remarkable how great that’s been. Do you see that as a trend where we encompass the whole face instead of certain areas?
MJ: Over time, we will look at all options, whether it’s training, supporting medical education, or supporting medical indication. All the options are there. As you recall, when Botox launched in 2002, you had one indication. It took about 10 years or so for the second indication.
Currently, there are four toxins in the market and only one of them has three indications, but you’re using it across probably nine or ten different areas. The industry will always be behind you because you will move faster, you’re more innovative, and you see things clinically much faster than any company will. But we will access it over time and see where the right path is.
UR: So, tell me a little about yourself. When did you join Evolus?
MJ: I joined about a year and a half ago around last June. This is probably the best thing I ever did personally. There are two kinds of people in the world. There are those that build things and there are those that fix things and -- I guess I should say three, those who ride a ship and just stay on autopilot. I like building. I’ve always had an entrepreneurial, innovative side of me that likes to explore the upper boundaries of things. I mainly joined for that ability to build something and watch it come to fruition.
UR: What do you want practices to see or do to enhance what we offer to patients?
MJ: The easy thing to do in life is not to do anything at all and to stay the course. Change, rethinking something, instituting a new product, is never easy. For accounts and practices that have given us the opportunity to be part of their practice, they will immensely to see how we will work with them to keep them up to date and modernize them. Our entire goal as a company is to always evolve, whether it’s the content, education, or go-to-market strategy. We will always be on the cutting edge of the next wave of deployment. Accounts and customers that bring us on will get that benefit -- but Rome wasn’t built in a day, and to prove that we have to earn a little bit of trust and support within the community, and from there we will build the next best thing. We are excited about that.
Michael Mazen Jafar, Chief Marketing Officer
Michael Mazen Jafar joined Evolus as Chief Marketing Officer in June 2018. Mr. Jafar formerly served as Vice President of Marketing, U.S. Medical Aesthetics at Allergan™. Prior to that, Michael led the assessment and integration of Zeltiq along with the upstream development plan for Allergan’s aesthetic portfolio of brands including Botox® Cosmetic, JUVEDERM® Collection, KYBELLA® & Natrelle®. Mr. Jafar has nearly 15 years of commercial and executive experience building multiple market leading pharmaceutical, device and topical brands in eyecare and medical aesthetics.Michael is a board member of the Irvine Public School Foundation, an Orange County based philanthropic organization, he holds an MBA from University of Southern California and a B.A. in International finance and Supply Chain from the University of San Diego.
Ep. 07 - Breast Augmentation Patient Testimonial
The Beauty Balance Podcast - Episode 07 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
Ep. 06 - Mommy Makeover 101
The Beauty Balance Podcast - Episode 06 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
Today we will be covering some questions from the readers of Haute Living regarding mommy makeover.
What procedures are most popular in a mommy makeover?
A mommy makeover consists of procedures that a mother would need after having babies or just a combination of procedures that a woman is interested in. The most common areas of the mommy makeover are the breasts, abdominal area, and vaginal rejuvenation. For the breast, it could be a breast augmentation, breast lift, or a combination procedure with lift and augmentation. With the abdominal area, a woman can have liposuction or, if they have loose skin, they can have liposuction along with a tummy tuck. The mommy makeover also includes some sort of vaginal rejuvenation procedure. Non-surgical procedures include the Femilift or Emsella. A surgical option would be vaginal tightening or a labiaplasty.
When should women seek out this makeover?
Generally I would recommend for women to finish having their family. That means the patient is pretty much done with having kids, done with nursing, and not anticipating any other large changes in weight. I also recommend that women get closer to their pre-pregnancy weight. I understand that it may not be quite possible but the women should be at a stable weight prior to having a mommy makeover done.
What benefits can be expected?
In the breast area you’re going to have beautiful breasts and that will give you great options for clothing. This is a nice enhancement for a woman who has lost a lot of volume and shape in her breasts from having done her duties to nurse and bring to life beautiful babies.
In the abdominal area, it will give you back that shape of having a nicer abdomen. A lot of times when women get pregnant, their six pack or rectus muscles do separate, and when that happens it gives you a little bit of a pooch. This really decreases your overall core strength which means you may be more prone to having back issues. Also with the pelvic floor area or “vaginal area”, the baby’s head is pressed down in the pelvic floor and the weight of the baby causes the muscles of the area to overstretch and weaken. So having a type of procedure to strengthen that muscle and rejuvenate that area, like the Emsella and the Femilift, can improve overall strength of the vaginal area and help with urinary stress incontinence, or even improve your sexual satisfaction.
What does recovery look like?
If it’s non surgical, there is usually no downtime and you can resume back to regular activities. If it is a surgical procedure, then there is a minimum of 2 ½ weeks off of work so you’re resting at home. Full return to gym activities would be at 6 weeks.
How do you know if a surgeon is qualified to take on this package procedure?
The most important thing a surgeon should be evaluating is if the patient is a good candidate for the surgery and take into consideration of her health, making sure there’s no major medical issues, and the patient should be at a good weight. Generally when you do a combination procedure, I want to keep the procedures time limit of 5 hours or less. I don’t want to do extended procedures because a lot of these are out-patient surgeries. I want to make sure these procedures don’t take a long time and we’re not anticipating any blood loss issues. You really want to make sure that you’re going to a board certified plastic surgeon who is well versed and experienced doing all these procedures. The more your surgeon has done of these procedures the better your outcome will be. Look for a board certified plastic surgeon and make sure that they’re using a certified surgical facility.
*Bonus Questions*
What is a day like at the office of Dr. Rajagopal?
It depends on whether it’s a surgical day or non-surgical day. On a surgical day, I’m usually in the operating room from morning to end of day doing procedures. Today I had two surgeries. One was a breast augmentation where we used slightly different sized implants on this young woman because her breast size were pre-operatively different in volume. The second was an abdominoplasty (tummy tuck) procedure on a patient who had a really great figure but lost some of that tightness of the abdomen from having had children. After the two surgeries, I will do finish up some paperwork in the office.
If it is a day where I’m mostly in the office doing non-surgical procedures, I will see patients every 15 minutes or so. We are doing lots of fillers, botox, and laser procedures.
Do you have any plans for the end of summer?
I usually like to take at least a week off in the summer. The summertime is usually the busiest time for us so it’s hard to take time off, but I can’t see myself not having a vacation. This year, I have a trip planned with my youngest daughter Nina to go to Portugal. I’ve never been there so we are going to visit Lisbon and then go down to the south of Portugal to a region called the Algarve. I heard it’s quite beautiful so I’m looking forward to that.
Ep. 05 - Ultimate Beauty Guide for Women Over 40
The Beauty Balance Podcast - Episode 05 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
If we were to create the ultimate beauty gift guide for women over 40 what would your top treatments and beauty products?
Sunblock: I usually recommend sunblock SPF 30-50 on a daily basis if you’re out in the sun. If you’re in the water, I recommend SPF 100 and reapplying every 1-2 hours. That goes for both men and women.
Retin-A/Retinol: The second great product we can start using when we’re quite young is Retin-A or Retinol based products. Retinol is a non prescription slightly milder form of Retin-A but both of them work well to help prevent fine wrinkles to improve overall skin quality and texture. However, Retin-A can be harsh for some people so it can create more dryness to the skin. It’s important that you start out slow and always use sunblock with it. I recommend Retin-A to be used at night time and sunblock during the daytime.
Vitamin C: The other really good ingredient is Vitamin C because it’s an antioxidant. Not only does it help improve the skin’s defense, it also is a sun protectant.
DefenAge: There’s a really simple skincare regimen that I really love and highly recommend for women over 40 is the Defenage. It helps with wrinkles and improve the quality and clarity of my skin. I use it twice a day and works quite well.
Hydroquinone: For women of color, the skin tends to get more hyperpigmented in patches as they get older. So you don’t have the clear and even skin tone you had during youth and it does tend to get a little patchy due to hormonal changes. Sunblock is huge and short burst of a prescription strength hydroquinone is also amazing. I do use hydroquinone once or twice a year and my favorite brands are from the ZO or Obagi line. The hydroquinone is not for prolonged use but for short term use.
Latisse: As you get older you start experiencing loss of hair. For example, with my eyelashes and eyebrows losing hair, I started using Latisse more regularly and I noticed that it does promote hair growth and thicken my eyelashes.
Non-Invasive Beauty Treatments:
Intense Pulse Light (IPL) or Broadband Light (BBL): These treatments work best on lighter skin tone. They even out skin tone and are great for brown pigmentation or sun damage so you can get more clear skin. If you want something stronger then you will need to go for the fractionated laser treatments. This is primarily for lighter skin tone and with the IPL it’s a simple out-patient procedure. You don’t have to take any time off but your skin will look a bit irritated for the first week.
SkinPen Microneedling + PRP: Another treatment with little to no downtime. Microneedling can be combined with PRP (Vampire Facial) and other growth factors and serums to improve the quality and boost collagen production of the skin. These are nice treatments to do on a regular basis.
Botox + Fillers: My two favorite aesthetic treatments are Botox and fillers. I get Botox done regularly in my upper face (between glabella, forehead, and eye area) and lower face (corners of my mouth, depressor anguli oris, and platysma bands). These are great treatments to do when you get older. I use all hyaluronic fillers that are available now both in the cheek and nasolabial fold areas. Fillers is great non-invasive option for women beginning to age. These are my go-to regimens and I believe have helped me tremendously over the years.
Ep. 04 - Style + Travel Blogger Jyo Shankar, Preventative Botox and Skin Care
The Beauty Balance Podcast - Episode 04 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
Hello, this is Dr. Usha Rajagopal! Today, we’re excited to have our very first guest on our podcast – Jyo Shankar! We will be chatting about her work, beauty, and the preventative measures we can take for younger looking skin. She’s a travel and style blogger based in the San Francisco Bay Area. She describes her blog as her creative outlet to share her love for fashion, travel, and lifestyle. She’s a sucker for cute outfits, warm beaches and all things tropical. She lives her life one outfit at a time and aspire to travel the world one beach at a time, while hoping to inspire others to do so as well.
UR: Welcome, Jyo! Let’s start things off by giving our audience a little background about yourself. How did you become a full time blogger? What was your journey like? What inspired you to become one?
JS: I started my blog back in the day, about 5 years ago, and primarily started as a style blogger. I was in Boston back then and used to post outfits on Instagram and that’s when I started my blog. Within a year I was voted Top 10 blogs in Boston and after I moved to California is when it took off to be my full time gig because I got a lot more opportunities that seemed more aligned with my brand, including travel because travel and style go hand-in-hand.
UR: How would you describe your style of travel and how do you decide on what places to go and what shots to take?
JS: I am a total tropical girl at heart. I love warm places. I love beaches and tropical destinations. But that doesn’t mean I won’t travel to a fun city or a beautiful mountainscape. I have a list of countries I want to visit and I always try to go that way. The way I like to take shots is to invoke that sense of wanderlust in my audience to make them want to book that trip there to aspire to go there.
UR: Who accompanies you on these trips?
JS: My husband. He also has a full-time job but this is like his second job. He is my full-time manager, photographer, web developer, etc. He’s pretty flexible to travel with me and he is my travel partner.
UR: How many countries have you travelled to?
JS: 34 countries so far.
UR: Have you traveled to all the continents?
JS: Yes, except Antarctica.
UR: Do you have any favorite countries?
JS: Every destination has something special about it. So far, some of my favorite countries are Maldives, Greece, and the Cook Islands.
UR: What are your favorite beaches?
JS: My favorite beaches are South Ari Atoll in the Maldives and One Foot Island in Cook islands.
UR: Since I’m into beauty I’m wondering if you wear good sunblock when you go to these places?
JS: Yes, that’s my number one thing. My husband was not that good at it before but now he reminds me. We’re always carrying extra sunscreen in our bag because we’re always out during the day.
UR: You were recently on a travel panel for TripAdvisor! How that experience like?
JS: I was excited to do my first travel conference this year and I was really grateful to be given the opportunity to be on a panel with TripAdvisor. The panel was basically about how to build an authentic brand and TripAdvisor came up with these traveler insights. They were asking me and some of the content creators how we can use those insights to create content for our audience. It was very interesting and I had the opportunity to meet and network with so many cool different people in the industry. I’m super grateful for the opportunity.
UR: With all this traveling, especially with the time change in your daily routine, how do you stay so fit and what is your regimen for that?
JS: Fitness is a big part of my regimen, whether or not I’m traveling, I’m always trying to workout and keep my fitness routine to the T, eat clean (for the most part), and even when I travel. I try to take exercise bands where I can even get in 20 minutes inside my hotel room or go on a hike. I’m addicted to fitness so I can’t take a break. Even with beauty and body routines before a trip really takes a whole village to prepare. I love to make sure my hair is done, get a spray tan, and love to come here to your clinic to get the Emsculpt done. I’m so hooked on it! It really helps me look toned for photoshoots. I definitely have a lot of steps I take before going on a trip.
UR: That’s really great to hear all your routines and you’re doing a really wonderful job. I love seeing your pictures on Instagram. Just seeing all the vivid colors, you being beautiful with your great outfits, and that amazing sun and sea. You got the whole package going.
Questions for Dr. Usha:
JS: What is the difference between Botox and fillers?
UR: They’re actually very different. The only category where they’re similar is that they’re both non-surgical treatments to improve your face and rejuvenate you. Botox is a muscle relaxer primarily used in the upper half of the face. Between the eyebrows, the “11s”, the wrinkles that go across your forehead, and the crows feet wrinkles around the eyes and underneath the eyes. Botox is less commonly used in the lower face but we can also use it on someone who has a very wide jaw. Botox can slim down the face or help with teeth grinding. In middle age to older women it can be used in the neck but it is primarily used in the upper half of the face.
Fillers are very different. They are plumper uppers. We inject fillers in areas where the skin takes a dip or there’s less volume. We have fillers for the cheek area to plump up and lift up the cheek. I tell women that we aren’t going to give them fat cheeks but rather more lift and structure. Everyone wants that high cheekbone look. If the filler is placed strategically in the under eye cheek bone area, it can make your eyes appear more almond shape and make the under eye bags disappear or look much less visible.
JS: What are some common misconceptions about Botox and why does it get a bad rep?
There are some amazing qualities of Botox. It is a very powerful medication that a medical person has to dispense, so it has to be used very carefully and with an artist’s eye. If you just go ahead and do a bunch of Botox on someone’s forehead they can actually drop the forehead and make themselves look very angry or look frozen. If you really want to rejuvenate a person’s face it has to be used strategically and less is more. I often tell first time patients, “Let’s do this first and we will see you back in 2-4 weeks. We can always adjust and add more.” When you look at someone and their face looks frozen that means they had a bad Botox job. It’s not the fault of the Botox, it’s the fault of the provider for injecting too much. It really depends on who you go to.
JS: Who is a good candidate for preventative Botox?
My philosophy for Botox has evolved over the years. 10-15 years ago, when Botox just came into the practice, I would have patients wait until I saw solid deep creases in their face. Overtime, and now with new studies on board, we use Botox as a preventative treatment called “pre-rejuvenation”. When we start seeing very faint lines at rest where the patient is not smiling or animating, we can start treating with Botox and that will help reduce the lines and help prevent it from getting any deeper. Studies have actually been done in a microscopic level. If you look at someone’s skin who has had Botox for years such as myself (who’s in her 50s) compared to someone who hasn’t had Botox, you will notice that my skin will look younger.
JS: What do you recommend is a good age to start either?
It depends from person to person. I have patients in their late twenties who start to come in and we do “Baby Botox” where we place small amounts of Botox in strategic areas. They come in less frequently and about twice a year for a small dose. When they get older, toward their late 30s and 40s, they will need a little more done and may need to come in three times a year. Having a good skincare regimen with sun protection, vitamin c, peels, and at-home regimens can help keep the skin looking very nice.
JS: Being brown/ethnic skinned what do you recommend are good treatments? A follower also asked if Botox is for brown skin people?
Botox is color blind. It helps everyone if you need it. There are no side effects at all in women and men of color. It’s perfectly safe and is an amazing treatment if you’re brown or dark brown skin and for white skin. Generally with brown skin, we are more protected against finer wrinkles. So for us we would actually need Botox about a decade later. If you have very fair skin with light eyes and blonde hair, you’re going to notice more signs of sun damage and wrinkles in your 20s. Whereas if you’re more Indian skin or brown tone/darker stone, you may need Botox later in your 40s.
My favorite regimen is sunblock/sun avoidance, especially on the face. In brown skin, instead of us wrinkling a lot, we will tend to have unevenness of the skin tone such as discoloration that gets more prominent in certain parts of a face. I recommend getting on a skin program that has some hydroquinone, a bleaching agent, to even out skin tone. We carry one in our office called ZO Pigment Control Creme that I’ve been using approximately once a year for three months. A great time to use it is in the fall or winter. Office treatments such as microdermabrasion or very mild chemical peels are very important. As your skin gets darker it becomes more sensitive to treatments so you have to be careful when doing laser or deep chemical treatments. Your skin can hyperpigment as a response so it’s important to go to a provider who is used to skin of color and ethnic skin.
JS: With my travel schedule I’m always concerned with sun protection and always staying SPF protected. What are your recommendations for skincare tips while being on the go?
I tend to like sunblock that has some zinc oxide or titanium dioxide because they are actual physical blockers. If you apply it, that sunblock will be working for you until it’s rubbed off and it’s water resistant. If you wear mainly chemical sunblock, in about two hours, they will lose effectiveness. I would also bring a large hat and sunglasses, get lots of hydration, avoid smoking, and minimize your alcohol intake.
Ep. 03 - Emsella for Urinary Incontinence in Men and Women
The Beauty Balance Podcast - Episode 03 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with industry experts and influential, talented women who truly encompass grace, beauty, and brains – plus, you get the inside scoop on what it’s really like to be a plastic surgeon.”
We’re kicking off our podcast with the first part of our V-Suite Series, where we discuss all things vaginal rejuvenation. Today we will be discussing the Emsella for urinary incontinence.
What is the Emsella Treatment?
Emsella is a treatment that has high intensity electromagnetic energy. It works on energy that’s similar to the MRI and it really stimulates and strengthens the entire pelvic floor. When a woman does kegels, that's the muscle she’s engaging. That muscle gets stretched out when you have kids and can get weaker when you age. When you have an orgasm those are the muscles that tighten and go into spasm. The Emsella targets the pelvic floor and makes those muscles stronger, thicker, and have more nerve endings.
How does the Emsella feel?
The Emsella treatment is not painful at all and in some women it’s actually enjoyable. It gives little stimulations to the pelvic floor area. We have the woman to sit on the Emsella and target the region between the vagina and the anus (the perineal muscle). That’s the central point where all the muscles attach. It gives a little vibration and stimulation. You don’t have to do anything but just sit on the Emsella and relax for 30 minutes.
How long is the treatment? How many sessions do I need?
I usually recommend a 6 treatment regimen for the Emsella. We recommend that they come twice a week and each treatment is about 30 minutes long.
Who are ideal candidates for the Emsella treatments?
The Emsella treatment is for women and men who want their pelvic floor strengthened. Both men and women can have weakness of the pelvic floor especially when they age. For women, it’s usually related to childbirth. Men and women can experience leakage of urine, especially with stressful situations, such as stress of the urinary bladder. This can be urinary stress incontinence with exercise. Young women would come in and say that they have some urine leakage when they laugh, cough, or doing jumping jacks. Sometimes when they go for a run and their bladder is full they notice that they could have issues with urinary stress incontinence.
In men, what they notice when they get older is that they’re unable to empty their bladder completely. This is quite a problem for older men who have hypertrophy of the prostate or when the prostate gland gets larger. When the prostate gland gets larger it’s harder to empty the bladder and you need to have more strength of the pelvic floor muscle to empty the bladder. Men who have prostate hypertrophy can have symptoms of waking up several times at night to go pee. The Emsella will help with this because when your pelvic floor is strengthened they can empty the bladder completely despite having a hypertrophied prostate so they can have a more peaceful night.
How long do the results last? How often do you have to maintain?
The pelvic floor has an active, dynamic set of muscles so these muscles need to be stimulated and that’s what the Emsella does first. It kind of wakes up sleeping giant of the pelvis. Think of it that way. Once the muscles are stimulated and strengthened you need to continue with pelvic floor exercises. For example, doing kegels for both men and women to keep the strength up. Otherwise, if you don’t do any of that, I would say every 4-6 months or so patients need to come in to keep strengthening the pelvic floor.
What are some success stories you have heard from your patients?
Yes, we have some amazing success stories with the Emsella. We often combine it with the Femilift laser and I call it the “dynamic duo” because both of these improve urinary stress incontinence and vaginal health for women. The Emsella strengthens the pelvic floor muscles and the Femilift laser treats the internal vaginal canal and thickens the vaginal mucosa which also supports the bladder. I would say we have had great success with both of them and a lot of patients would say that after the first treatment with this combo they would notice improvements. In fact, I just saw a patient who’s in her late 30s, a mother, a professional, and she loves the super long marathon runs. She said that even after a single treatment of the Femilift and Emsella, she has noticed a huge improvement and stopped having any leakage.
Why is it important to take care of your vaginal health?
Vaginal health is really important because sexual health and sexual well being is important for both men and women. The vaginal area, pelvic floor, and bladder are all in close proximity to the rest of the organs, so having the vaginal health happy can improve your entire well being. Imagine if you could go on everyday without issues of urinary stress incontinence or having a good night sleep without waking up in the middle of the night and have more energy during the day. The Emsella is also known as the “Orgasm Throne” so imagine having better, stronger orgasms. I think everyone would be happier.
What do you recommend for feminine grooming?
We’ve been using the Lady Suite which is a botanical oil for your post lady-scaping. We take 2-3 drops of this light, really fresh, and not overbearing product applied topically and externally to that area. It’s not too oily and I like to put it on just to soothe after lady-scaping.
What’s really great with the Lady Suite is all the organic ingredients. It’s got organic jojoba oil, meadow foam seed oil, and carrot seed oil. All these are organic and lightly scented, not too oily, and won’t clog your pores. It gives you a fresh scent and they’re good for your skin.
Photo Credit: Lady Suite
Ep. 02 - Tone Your Abs & Butt With Emsculpt
The Beauty Balance Podcast - Episode 02 Transcript:
“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with influential, talented women who truly encompass grace, beauty, and brains – plus, you get an inside scoop on what it’s really like to be a plastic surgeon.”
What is Emsculpt?
Emsculpt is a way to contour your body and improve muscle definition without surgery. Emsculpt works on the principle of HIFEM (High-Intensity Focused Electromagnetic) technology. It’s the same technology that an MRI machine would work on. Emsculpt has more to do with magnetic energy and not radiation. This energy is focused into FDA-approved targeted areas such as the six pack muscle and the gluteus muscle.
How can Emsculpt help diastasis recti/muscle separation?
The Emsculpt helps with diastasis recti, which is a common occurrence after pregnancy. When the womb stretches and the baby grows, the abdominal muscles want to accommodate the growth of the baby so the six pack muscles separates. When that happens, it’s great for accommodating the baby, but after the baby is born the muscles may not necessarily come back together. A lot of women could have a little pooch which may not be fat at all -- it’s just muscle that’s weak and could not come back together. Muscles need to work symmetrically in concert to be most effective. Some women could have issues with back pain and not enough core strength, and Emsculpt can also help with that.
How does Emsculpt work?
A lot of our patients are young men and women who really want to improve their appearance. They are very athletic, go to the gym, and they want to take it step further and get this sculpted look. Because of this high focused supra maximal contraction of the muscles, the muscle does hypertrophy (thickens) and you also reduce the overlying fat.
It works in two ways: you get less fat sitting above the muscle and the muscle gets bigger and stronger resulting in a more defined core. When you go through the Emsculpt treatments, the contractions are so strong that you start to notice changes in both your six pack forming and your oblique muscles coming inwards. When you look at patients who had the Emsculpt treatment, not only do they have a good six pack, the entire abdominal wall (six pack and obliques) are much tighter and they have a smaller and more defined waist. In the buttock area, we have a lot of patients who want more fullness to the buttock. It will also improve and strengthen the buttock muscle but when we do the buttock treatment, we use a different protocol since we don't want a lot of fat loss because most men and women are looking for more fullness. This is much more than what you can achieve by doing squats at the gym.
How often should patients come in for their treatments?
With Emsculpt, we are treating active tissue in the body (remember our body is alive and dynamic), so like every other muscle in our body it needs constant stimulation. Once the treatments are done we usually recommend 4 treatments approximately once a week for 4 consecutive weeks. They will notice the best improvement in about 6 weeks to 2 months. Once the treatment is done, to maintain their results and defined musculature, we recommend 2-3 times a year.
Does Emsculpt hurt?
It doesn’t hurt but it does feel like a workout. I personally did the Emsculpt treatment up to maximum strength both in the abdominal and buttock area. The contractions are extremely strong and it does take a while for you to get used to the feeling. Our office staff is very friendly and have all gone through these treatments so they will be there encouraging you as your Emsculpt coaches. We want you to have the best results so our team will be there to cheer you on and get you up to 100% so you get the best results with each session.
How does the Emsculpt compare to Coolsculpting?
Coolsculpting is also a non-surgical treatment and primarily for fat reduction. If you have a little bulge that you want to reduce, or can’t get rid of small budges, Coolsculpting works the best for stubborn fat but it doesn’t work on the muscle at all. Whereas Emsculpt works in the muscle primarily and a little in the fat. We offer a dynamic duo where we recommend the Coolsculpting treatment first, then in about 3 months, when the Coolsculpt has reached its final result then we will recommend the Emsculpt. They work hand in hand to give you your best body.
Who are good candidates for the Emsculpt treatment?
The Emsculpt is a great treatment for different kinds of people. Obviously, it’s ideal for a young, athletic person who is interested in gaining muscle definition. Emsculpt is also used to improve function of the body. When someone has diastasis recti it will bring that in together and provide more core strength. I have some patients with chronic back pain who come in for their Emsculpt. These patients with back issues just want to improve their core strength. When you strengthen your core, your abdominal, rectus, and oblique muscles, you will notice that you have less back pain. Lastly, I have patients who have issues with either their lower back or hip. Strengthening your buttock muscles can help with these issues. We have patients who have very functional issues that have been treated by the Emsculpt. I have a patient who had a hip replacement last year, but felt like she wasn't her optimal self. We ended up doing the Emsculpt treating both on the abdominal and buttocks. I was so surprised at her last visit to the office. She looked like a new person. She appeared to be at least 20 years younger. The first time I saw her she came in hunched back walking with a cane. And now she walks in full of life and energy, plus she’s taking salsa dance classes! It really can change someone’s life especially with these functional issues.
Drew Barrymore’s Ultimate “Ab Secret”
Non-Surgical Body Contouring Treatments
Ep. 01 - Achieving Facial Balancing with Fillers
The Beauty Balance Podcast - Episode 01 Transcript:
You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with influential, talented women who truly encompass grace, beauty, and brains – plus, you get an inside scoop on what it’s really like to be a plastic surgeon.
DR: Hello, this is Dr. Usha and today I’ll be going over facial balancing with fillers and my co-host and patient care coordinator, Victoria, will present some of our frequently asked questions regarding these treatments.
First off, what is facial balancing and how do we achieve it?
DR: Facial balancing can really be divided into both a very technical way of facial balancing or creating a more harmonious face. For example, when you look at a face and your first impression when you look at a pretty, beautiful woman or handsome guy is “Wow! They’re so pretty!” -- that’s because the first thing our eyes notice is the triangle between the eyes, nose, and lip (an inverted triangle). The more symmetry someone has the more beautiful they are. Symmetry equates to beauty and our body subconsciously figures that out. This is something that we look at more with a scientific eye. Leonardo da Vinci talked about facial balancing and facial harmony where the face is divided into thirds. You want equal thirds of the face where from the brow to the eyebrow area is considered a third, the second third is between the eyebrow to lower part of the nose, and the lower third is from the lower part of the nose to the chin. You can try that out with your own hands to see if your face is balanced according to Leonardo.
The second part of facial balancing, especially nowadays, is the profile view (side view). A lot of patients look at themselves in profile largely due to the selfie culture. They’re taking side views. They have pictures taken by their friends and they see a side or profile view, and some people are surprised by the way they look because they’re not used to seeing themselves in a profile view. And some people are not very happy with their profile view. Things that would create a better balance or pleasing profile, is when you have balance between the forehead, nose, lips, and chin. That’s where a lot of profile balancing comes especially when someone is unhappy with either the size of their nose or sometimes it could be the unbalance area of the nose and chin. For example, when a patient thinks their nose is too long, I can assess them and let them know that they may need a little more chin projection to balance their nose or a better jawline to balance out the nose. In the end, it has to do with the aesthetics look. Facial balancing makes someone feel prettier and look more rested, and all these treatments for facial balancing is to give a person more confidence.
How do non-surgical nose jobs compare to rhinoplasty? Would this treatments work for all noses (bumps, wide tips, crooked noses, etc)? How long do results last?
DR: The attractiveness of non-surgical rhinoplasty is that it’s a great way to achieve facial balancing. Non-surgical rhinoplasty is a quick lunchtime treatment done in the office and it literally takes 10-15 minutes. There is not much downtime so the patients can go back to their normal activities in 24 hours. With non-surgical rhinoplasty, I am looking to achieve a smoother profile so the most improvement a patient is going to notice is in their profile/side view. The least amount of improvement they’re going to notice is in their front view. When we’re doing a non-surgical rhinoplasty, I am adding filler -- so I’m adding stuff to smooth out the nose, so it creates a bit of an optical illusion. Even though we add filler, it makes the nose appear a little smaller because it could be more symmetric or have a smoother profile. If someone doesn’t like their front view at all and feels that their nose is too wide, big, or nostrils are too flared, unfortunately, that could not be treated with non-surgical rhinoplasty. Non-surgical rhinoplasty is temporary and it could last anywhere from 6-9 months and slowly your body absorbs the hyaluronic acid. What I’m noticing is that I have patients who have come in for several treatments of non-surgical rhinoplasty, and after the 3rd session, the filler tends to become semi-permanent and they won’t need to come back as often for maintenance.
Surgical rhinoplasty does require some downtime and it’s usually done as outpatient surgery, and for most patients I recommend that they take 10 days off and 6 weeks to get back into intense exercise. With the rhinoplasty, you can achieve many different things. You can make then nose smaller, reshape the nose, improve symmetry, and improve breathing issues caused by a deviated septum. Compared to non-surgical rhinoplasty, this procedure has more downtime, a little more cost, but the results are permanent. The best way to determine if you’re a good candidate for surgical or non surgical rhinoplasty is to have a consultation. For patients with busy schedules or from out of town, we recommend that they send in pictures of their nose for assessment and we can do an e-consultation.
Walk us through the non-surgical cheek treatment?
DR: Generally for cheek treatments, my favorite hyaluronic filler is Voluma followed by Sculptra or Radiesse. I also like using Bellafill, which is a long-term filler. Cheek filler is for patients who need a little more lift and structure. The cheek area does drop as we age so when I do cheek fillers, patients come out with lifted cheeks that also appear slimmer but not rounded. I aesthetically don’t like the Housewives of Orange County look where they have fat cheeks with them very prominent in the center and they look like the Joker. That’s not the look I like for myself or my patients who I feel are an extension of my aesthetic goals. My goal is to give them more of a lifted and elongated look.
Who qualifies for these treatments?
DR: For young patients, it could be someone who genetically lacks a nice, high cheekbone look. It could also be someone who is middle age and now showing signs of aging where they may not notice it in their cheeks, but they notice the under eye area looks a little hollow, or their nasolabial folds or smile lines are starting to appear more deep is because the cheek has started to lose volume. When you inject some filler to the cheek area to lift up it can enhance and give you a more rested and beautiful look.
What precautions should patients be aware of?
DR: With any treatment, we are putting needles in your face. The most common side effects of these fillers are bruising and swelling. To reduce both of these, I recommend patients:
start planning for this appointment approximately 10 days prior to their appointment date
Avoid over the counter blood thinners such as aspirin, ibuprofen, motrin, aleve, supplements such as fish oil and flaxseed oil
Eat a lot of pineapple beforehand. The active ingredient in pineapple is called bromelain and that can help with swelling both before and after the procedure
How can chin fillers balance out the profile? How much would a person need?
DR: That is one of the most common areas that would produce the most harmony to the face and make the face appear more pleasing in the profile or side view. When patients are coming in for the first time for a chin filler, I like hyaluronic fillers such as Juvederm Ultra, Juvederm Ultra Plus, Restylane, or Radiesse. Most patients I recommend starting out with just one syringe first even if I think they need more, and the majority of patients will notice a significant improvement with just one syringe.
