Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect. Hello, Valerie.

Valerie (00:10):
Hi Dr. Houssock. How are you?

Dr. Houssock (00:12):
I'm so good. Thank you for coming here on your lunch break.

Valerie (00:16):
Thanks for having me. I'm happy to be here.

Dr. Houssock (00:18):
Welcome to the Perfectly Imperfect podcast again. This is going to be fun. So Val is a jack of all trades when we recruited Val to join our practice some years ago. What year are we coming up on?

Valerie (00:34):
We're coming up on four

Dr. Houssock (00:37):
Holy smokers.

Valerie (00:38):
I know.

Dr. Houssock (00:39):
And I knew Val before that. Just as an aside, Val and I have known each other since I was in training. I was in residency actually. I rotated where she was working and we got to know each other. And then your girl gave me some skin treatments and even some lippy, right?

Valerie (00:54):
I did.

Dr. Houssock (00:55):
You gave me some lips. We did filler, which is what we're going to talk about today. And so Val and I know each other longer than our professional relationship here at JEV, but we started talking about having Val join our practice. One of the things that was really important to her, and she really stressed it very heavily, is that while she absolutely loves doing injections and seeing patients for nonsurgical treatments like lasers and whatnot, she also loved the operating room and she wasn't willing to give up either. And I will tell you, that has worked so great in our benefit too, because she gets to meet the patients in so many different environments and it's been a lot of fun. And so our last podcast, we talked more surgical, and today we're going to talk about your non-surgical side, Val?

Valerie (01:41):
Yeah.

Dr. Houssock (01:41):
You are like a ying and yang.

Valerie (01:44):
I love it. I'm very lucky to get the best of both worlds.

Dr. Houssock (01:48):
And so are we. So we're going to really focus today on specifically fillers. There's so much the nonsurgical world that there's no way we can do it all in one podcast. So today we're really focusing on the filler injections and we're going to try to cover them as much as we can. But I will say that in itself over the last five years or so has ballooned so largely at this point that it's impossible for us to do even all that in one, but we're going to try.

Valerie (02:14):
Definitely.

Dr. Houssock (02:15):
So tell us how you got into injecting and what got you intrigued and how you started the whole process of being so good at it.

Valerie (02:21):
So I started in the OR about seven years ago, and back at my last practice that I was at, there was injections being done there as well too. And I would go in and observe, and I really enjoyed the artistic part of it, because that's what we do in the OR what we do is art. And I felt like it was the right time in my career to learn a new trade, learn a new skill, and enhance my skills in the OR too. So I was sent to different trainings at my last practice, and I really enjoyed the part of just being on a journey with this patient as far as them feeling themselves more like themselves in their own skin and just enhancing their natural beauty. So I do that twice a week here and I get to see a lot of my surgical patients too. So I'm with them in the operating room and then I get to see them for non-surgical stuff, and it really ties everything in together nicely. So I always stress about how injections are great, but they're not the only thing that's going to correct everything.

Dr. Houssock (03:31):
So let's dive into that a little bit. So first and foremost, you've had a lot of training, so let's start there. People always ask, especially our nurses, because in Maryland as a nurse you can inject, not every state allows that, but in the state of Maryland, you can as an RN, be a professional injector. And we get asked all the time because it's a very popular and a lot of fun to do. So we have a lot of people who would love to inject. And one of the things that I think you said from the beginning is you started out doing something else in a plastic surgery realm.

Valerie (04:06):
Correct.

Dr. Houssock (04:07):
And then you were trained over time. So you've had a lot of training under your belt to get where you are today. It's not just like you woke up this right much. A lot of our patients, we don't just wake up like this, so you don't wake up knowing how to do this. So you took the time to really learn how to do this safely, effectively, and beautifully I would say.

Valerie (04:28):
Absolutely. I couldn't stress enough that education is everything when it comes to this. And I am a big nerd when it comes to this stuff, and I really love going on these different trainings. And my goal is at least to take one to two a year. I sat down with Dr. Houssock when I first started working with her, and I was like, every year I want to learn something different.

Dr. Houssock (04:49):
Yes.

Valerie (04:49):
Because I want to be able to give that to my patient. They deserve that. This industry is always changing, always enhancing. There's new products coming out, there's new techniques coming out. So education is everything.

Dr. Houssock (05:02):
Absolutely. And that goes for any part of medicine. So no matter what we do here, we're always willing and able to be better.

Valerie (05:11):
Absolutely.

Dr. Houssock (05:11):
That's for sure. It's a lifelong learning concept. So I think one of the things that you were starting with, Val, you were going to talk a little bit about how you integrate the idea of fillers into someone's kind of non-surgical plan. So when someone comes in, I'm assuming that not everyone comes in knowing they need fillers, but they probably come in for their consult and they have an idea. So talk us through just a basic non-surgical consult that you might see that ends up in the realm of fillers.

Valerie (05:42):
I start off my consults by asking the patient what are their goals, what are the things that they want to focus on and correct or enhance? Because filler overall is an amazing product. It can correct asymmetry, it can enhance volume loss, it could also improve texture. So fine lines and wrinkles. That's the beauty about filler is there's so many different levels of cohesiveness. So if we need to target softer fine lines or anything like that, we have that capability.

Dr. Houssock (06:12):
We don't expect a patient to come in and know what cohesivity they need, but it is good for you to know that we have a range. Fillers are not just one. We have a range. We probably have 15 different fillers here at this point.

Valerie (06:23):
Oh, so many. Which we're so lucky to have that because it's not like a one product for everything. You what I mean?

Dr. Houssock (06:30):
Right. Certainly not. Everybody's, everybody's facial needs are different. Everyone's skin texture is different. And we in particular at this practice don't cater to just a single company. So while we might love some of the Juvederm products, we also carry Restylane products. We also carry the Revanesse products. We like a little bit of everything. And I have always said, because we have really three injectors in the practice, I don't like to corner someone into having to use something that they don't like. And so I have never limited us as to what we can have in the practice. And each one of us, much like using artistic paints, prefer different things for different places. Wouldn't you agree?

Valerie (07:12):
Absolutely. I might have a patient that will come in and say, I just feel like my skin's just looking really dull right now. And to me, that says hydration all over it. So I might pick a filler that's not so thick, but it's more hydrophilic that's going to pull water to the area and really plump up the skin nicely. You know what I mean? Also anatomy wise too, that's everything. Anatomy is the most important thing when it comes to injections is just making sure that you really are comfortable with anatomy so that way you know what product is going to be appropriate for that patient.

Dr. Houssock (07:44):
Absolutely. And we've seen it, I mean, we've seen it where maybe a patient will come from another place and maybe the filler that was chosen for the area or for the need didn't match what was necessary. And so luckily these days, the vast majority of the fillers that we currently use are an HA or hyaluronic acid filler. And so we have that ability to dissolve when needed, but it's not a steadfast and an easy concept to dissolve fillers is painful. It also, so if Val has a patient who wants, there's somebody who comes in, let's say for their lips, and the one portion of the lip is something that the patient doesn't like, we have to educate that. Unfortunately, it kind of means dissolving whatever this thing dissolves and.

Valerie (08:30):
Starting over.

Dr. Houssock (08:31):
Starting over. And it may not dissolve all of it. I mean, the idea is to dissolve the filler, but nothing is steadfast. So you also want to go into fillers very seriously with the right person because it's not as simple as, oh, don't worry if you don't like it, we'll just dissolve it because it's complicated. And so you always want to be thinking about that with whoever you allow to work on face is, do they know what they're doing? Do they know what type of filler to use? Are they just selling you a product? How often Val, on a weekly basis, will you tell a patient no?

Valerie (09:05):
Once a week.

Dr. Houssock (09:07):
Yeah, I believe it. And it's for everyone's own good. I mean, we probably have something for you. People love coming in, but the reality of it is, is that in this generation, nobody wants to be overdone. Everyone wants to look beautifully natural for the most part. And getting filler consistently and constantly is not the way to get that look. And so sometimes we have to say no, right?

Valerie (09:33):
Going back to that, I might say no for a certain thing, but then I'll kind of gear them in the right direction.

Dr. Houssock (09:39):
Yes, yes.

Valerie (09:39):
Of a plan that would benefit them more. So maybe like, Hey, let's talk about skincare. If you really focus on taking care of your skin, then that's going to help you hold your fillers better. That's just going to over optimize your results, so.

Dr. Houssock (09:56):
A hundred percent.

Valerie (09:57):
Yeah. So that's when I get into my consults like, alright, skincare is everything. Honestly, if I had to pick one thing, skincare is my number one love. I am very obsessed with skincare.

Dr. Houssock (10:07):
And your fillers going to do better.

Valerie (10:08):
Absolutely.

Dr. Houssock (10:09):
If you don't have an envelope that has been treated well, your filler is just going to add volume to kind of a wrinkly balloon.

Valerie (10:16):
Exactly. And then I go into talking about like, alright, we need to simulate collagen too. So as much as filler is great for restoring the volume loss, improving your texture and hydrating, you also need something that's going to help overall improving your texture. So unfortunately, us women, we lose collagen every year we get older. Ugh, it's not fair. But thankfully we have access to all these different treatments like microneedling and CO2 lasers and IPL, that's really going to help improve our pigment and our texture. And stimulating that collagen, you're creating that cell injury that's going to help rejuvenate new healthy skin cells to be created.

Dr. Houssock (10:55):
Heck yes. Heck yes. And so you can combine that with the volume loss that is natural in aging as well.

Valerie (11:01):
For sure.

Dr. Houssock (11:02):
And you create this very natural look that has a multimodality concept to it.

Valerie (11:09):
Oh, yeah.

Dr. Houssock (11:09):
And it's probably the hardest patients, but the ones that are more willing to listen are going to be those patients that, at least in my experience, patients who have been consistent filler patients for the last decade. And we have women who are such great consistent patients because they care about their skin. But they started at a time when the focus was really, really filler based.

Valerie (11:32):
Absolutely.

Dr. Houssock (11:33):
And we are trying to now create this concept with that patient population because the younger population I think gets it, but the older population, we have to explain to them that it's not just about filler anymore. We have this multimodality concept of improving your skin texture and toning your skin, which is the envelope while we fill your volume, which of course you need in addition to you doing great skincare at home. And though it sounds overwhelming, it doesn't have to be. It just means instead of spending all that time and investment and money in filler, filler, filler, filler, filler, we spread that joy just a little bit more with multiple things. And so we are obsessed with filler, but it has to be looked at as a single item in a multimodality, anti-aging approach.

Valerie (12:19):
And it's got to be the right timing too. I have patients that come in every three to four months to see me for toxin. They're like, am I ready for filler yet? And I'll feel their lips, or I'll feel their cheeks and I feel their filler still in there. I'm like, no, you're holding onto it really well. And that's the biggest thing. If you overfill, then you're going to get into migration.

Dr. Houssock (12:38):
Talk about that a little bit, especially when it comes to lips. Talk a little bit about that.

Valerie (12:41):
That's probably the number one thing I'm seeing on social media right now that is getting a little out of control is just overfilling. And then filler's going to go to the path of less resistance and it's going to migrate. And then that happens is because we are overfilling a space that just does not have the room for that volume. So if you're one of my patients with lips, I usually do lips in two sessions where I'll do a little bit, maybe a little more than a half or a half. I let it settle for a couple of weeks and then I bring you back in and then we'll put the rest in because I need you to create that room for me. So that way it settles well and it stays in the right plane. And if it's in the right plane, it's not going to move, going to stay there. And then you're at less likely to need dissolving. And the longevity is also going to be great too. So you're going to get your nine to 12 months of life of your filler, which is ideal. That's what we want. But that's just because we really took our time. And I always say to my patients like, this is a journey. We're going to be getting through this together. I'm here to hold your hand, but we have to be patient. And then pictures are everything.

(13:48):
So every time we know we do a little bit more and a little bit more, then we're like, okay, look where we started and look where we're now.

Dr. Houssock (13:54):
You can kind of get lost in the weeds if you don't do that. It's almost like

Valerie (13:58):
Absolutely.

Dr. Houssock (13:59):
And patients really just want treatment. And so it is our job to be very kind of diligent about keeping you still looking anatomically beautiful.

Valerie (14:08):
For sure.

Dr. Houssock (14:09):
In a very aesthetic way without overdoing it. And even in the best hands, migration is kind of inevitable. Your tissues are all one flow, right?

Valerie (14:20):
Absolutely.

Dr. Houssock (14:21):
So we know that over time it can happen regardless.

Valerie (14:23):
It does. It does.

Dr. Houssock (14:25):
So you don't want to add insult to that where you are pounding filler in too fast. It's similar in a crazy way to when you do breast augmentation, there's only so much space in a breast at one time that you can do. And for some people, they don't have a ton of room, especially when it comes to lips. You're starting with a small lip. You need to build on that. It needs to take time or else, just like Val said, you're going to look like you've got these big tires on your, or it's going to start to migrate above and below.

Valerie (14:52):
Correct.

Dr. Houssock (14:53):
And that whole look, it's not what you want. Nobody wants that.

Valerie (14:57):
In time it doesn't make sense.

Dr. Houssock (14:59):
No. And so you just have to trust the process. It's just like anything else. We are in a world of wanting immediacy, a same day shipping from Amazon. But when it comes to this stuff, unfortunately to get it done, it does take time and patience. And you just have to know that it's in your best interest every time.

Valerie (15:18):
And the biggest thing with overfilling is safety. So one of the number one causes of a vascular occlusion,

Dr. Houssock (15:26):
What's that? What's a vascular occlusion Val?

Valerie (15:28):
So that's actually when filler gets into a vessel and blocks blood flow. And then when there's no blood flow to an area, then that's how tissue can die. So when you overfill an area and you compress a vessel, then you're hindering the blood flow to that area. And so then that puts you at risk for having tissue death, which leads to a lot of complications where you need wound care. And it could also lead to blindness. A lot of scary things. That's the number one scary thing for injecting is causing a vascular occlusion. And no matter how long you've been injecting every patient you inject, you're like, okay, I'm going to take my time every time.

Dr. Houssock (16:09):
That's true.

Valerie (16:09):
Every time I inject on someone, I'm like, all right, we're just going to go nice and slow and that's all you can. And then just obviously know your anatomy really well, for sure.

Dr. Houssock (16:17):
Yes. But even knowing your anatomy, even knowing your anatomy, where we know that the vessels sit here and here and here, we can tell you because we've both had experiences with cadaveric dissections where people are not all created equal.

Valerie (16:32):
So true.

Dr. Houssock (16:33):
So vessels are not always where you expect them and things aren't always where you expect them. So again, thinking about who you're letting inject you, you need to make sure you understand that you need to have somebody who knows the anatomy well, but also knows how to carefully monitor as they're injecting. And then the most important thing of all, and the one that no one thinks about till they're there, is someone who knows how to handle that complication. God forbid it happens.

Valerie (17:01):
For sure.

Dr. Houssock (17:02):
There is nothing more important than that because when there is an occlusion, when there is blood flow that is stopped wherever it is in the phase, you are on a literal time clock. You are a countdown time clock, and the slower you get in that time clock the highest risk where you, you'll have permanent damage. So you need to have someone, and this is scary stuff, but everyone needs to always be thinking about this. It is not just going and getting your nails done. This is a serious treatment. So you need someone who knows what to do and how to handle it immediately because time is literally of the essence. So let's say that you do everything Val. You have injected and everything's fine, and then all of a sudden you might notice something. What would you notice if you possibly have infiltrated or occluded a vessel? What kind of symptoms might someone have?

Valerie (17:53):
The patient will definitely feel some discomfort. Absolutely.

Dr. Houssock (17:57):
More than typical.

Valerie (17:58):
More than typical, to a point, it's very uncomfortable. And then you're going to start to see some blanching at the area.

Dr. Houssock (18:04):
What is blanching?

Valerie (18:05):
Like normal tissue skin is, this is normal. You'll see just kind of a white little tinge to that area. And then when you go to press on the skin, if it doesn't go back to the original color and it stays white or blanching, then that shows that that vessel's being hindered and something's blocking blood flow in that area.

Dr. Houssock (18:25):
So what's the treatment? What do you do if that happens?

Valerie (18:27):
So we have a product called Hyaluronex or Hyaluronidase, and that is the component that we use to dissolve the hyaluronic acid. It breaks it down immediately. There's also ways to help open up the vessel. So putting them on aspirin can definitely help. Heat is really good to help dilate the vessel as well too. And really the biggest thing is you're just flooding that area with lots of hyaluronidase.

Dr. Houssock (18:52):
The idea being, get rid of that filler as soon as possible. Try to de-clog or unclog that vessel.

Valerie (18:57):
Exactly. And massage, massage, massage.

Dr. Houssock (19:01):
And the crazy thing is, her and I and Lindsay can, we could tell you that in our sleep, we could do it in our sleep. And if I'm completely honest, I've never actually seen it in real life yet. I have yet to see it in real life. But I can tell you that we are so up on it and so prepared and worried about it that we know how to handle it. And the reason why we haven't seen it, I will not say, I will say it's because we're diligently intelligent enough to watch our anatomy and also be aware of not the things that she had mentioned, not overfilling, but some of it is because it really is that rare. So whenever anyone's thinking about getting filler, I don't want to terrify everybody of like, wow. But you do need to be thinking about it just as much as we need to be thinking about it.

Valerie (19:53):
Safety. Safety is everything.

Dr. Houssock (19:55):
Alright, so enough of the scary stuff. So let's talk fun stuff. When it comes to your filler, give me your top three treatments at this point and any new caveats to them that you're working on right now. What are your three favorite things to do?

Valerie (20:10):
Okay. So I love lips. It's probably my number one favorite thing to fill.

Dr. Houssock (20:14):
Val is the lip girl, for sure.

Valerie (20:16):
Love it. I literally watch videos multiple times a week in bed just of injections and I'm pretty obsessed. So I do a lot of lippy. I go back and forth between two products right now. I'm really a huge fan of the Revanesse Lips Plus, just because it's butter, it injects so nicely, it's very moldable, it's very forgiving. So you can massage it into the area you really want to put it in. Lasts about nine to 12 months. So I'm really huge fan that also I love that gives the lips too a staple. I love the crisp borders, it gives the lips. It's got good structure for sure. It's really nice in my younger patients. So I go back between both of those products. I'm also really loving Skinvive right now.

Dr. Houssock (21:00):
Tell me all about Skinvive. That's like the newest thing right now. As far as our practice goes, when it comes to filler.

Valerie (21:04):
So that's like skincare in an injection. So it's not like restoring volume loss or building up bony areas. It's really to help improve that texture. So it's a hyaluronic acid filler. It draws water really nicely to the area. It's just really good for that superficial fine lines and wrinkles. Or if you just see someone who's very dry, especially this time of year, I have a lot of patients that right now are benefiting from it. And it's just, you kind of just scatter it around the area nicely. And like I said, gives that glow.

Dr. Houssock (21:39):
It does.

Valerie (21:40):
It really, once it settles, I would say probably by the two week mark when it's fully integrated into the tissues nicely. You'll look at someone, I did Lindsay about a month ago, and I was like, dang, Lindsay, your kid's looking real glowing. And she's like, it feels nice.

Dr. Houssock (21:56):
The hydration is something.

Valerie (21:57):
Yeah. So right now that's my skincare in a syringe.

Dr. Houssock (22:00):
I love it. I love it. Cute.

Valerie (22:01):
Yeah. If you need just a little oomph or just a little glow, I would kind of plan it a couple weeks before an event or a trip. And I think that really does just give that skin just like that really nice touch for sure.

Dr. Houssock (22:15):
Is that a yearly treatment or how often?

Valerie (22:18):
Every six months.

Dr. Houssock (22:18):
Every six months. Got it.

Valerie (22:20):
Yeah. So it breaks out about six months. Definitely plan it around something like that. But yeah, I've been really into that. And I'll say my third one that I really also have been loving too is temples. I feel like we do not focus on temples enough. We really focus on midface and lower. And temples is also a good one too. So I really like something with a lot of structure there. So Voluma is really great. That's also a Juvederm product. If you want something just to help fill in collagen sculpture is amazing. Lindsay's our Sculptra queen.

Dr. Houssock (22:51):
Yes. Sculptra is a whole different animal. It's not a hyaluronic acid filler. It is a permanent concept and it really, its idea is that it builds collagen over time. It almost acts as like a scaffolding for growth. And so that has to be done very elegantly because it has high risk for granulomatous growth or bumps if it's not done number one appropriately, but also good aftercare. But it is a killer. And we'll have Lindsay on at some point to talk specifically about Sculptra because it really does have its amazing place.

Valerie (23:28):
It's a great product.

Dr. Houssock (23:29):
Especially when you're thinking about big volume, like you're saying temples or people who have had a

Valerie (23:33):
Lateral cheeks.

Dr. Houssock (23:34):
Yes. Yep, but I kind of see Sculptra or some of the other permanent fillers, which we've done in the past. We've had Radiesse in the past, we've had Bellafill done it all. But I will say this pendulum is really swinging except for Sculptra, which has really been formulated a little differently over the last few months or up to the last year. The pendulum is very swinging, kind of swinging back to a lot of hyaluronic acids. And that's the one that can be dissolved. And I think there's multiple reasons for it. I think one, it does make it safer. It can be dissolved.

Valerie (24:09):
That's my biggest thing.

Dr. Houssock (24:10):
Yeah, I mean the permanent ones, there's nothing we got for you. So if you get a complication, if you have an occlusion of a vessel, we're in trouble. That's number one. Number two, if you don't like it, we're in trouble. Also, number three, as you age, it's going to still stay there. So as your skin descends, the filler's going to go to a different place. And you have to think about that when people also do fat grafting, because fat grafting is live permanent tissue too. So the joy of hyaluronic acid is that it can fluctuate with what your needs are in the moment. The other thing is that I think as exciting as some things sound when we say that it lasts a long time or it's permanent, that sounds financially fantastic. But I can tell you from our experience, people want to visit us.

Valerie (24:58):
We have a good time.

Dr. Houssock (25:00):
And so what we find we struggle with is patients want something done. They want to freshen up, they want to freshen up. I think that's why I've been harping so much on these other modalities because we have patients who want to be here and their fillers lasting. And because of that we have other things that can make you look great in conjunction with your filler. You can still come see us, but you may not need filler.

Valerie (25:26):
We might change up your skincare regimen. I think it's super important to really change up your skincare regimen about every season. So if someone comes in and they're just not ready for ejection, I'm like, let's talk about your skincare. What using right now.

Dr. Houssock (25:39):
Absolutely.

Valerie (25:39):
What are we going to change?

Dr. Houssock (25:40):
Absolutely. Botox is going to be every three to four months. You're always going to come every three to four months. Your filler might be every six to 12 months. But then if you really think about it, if every three months you want to do something more than your Botox, you could be doing a microneedling treatment, you can be doing a facial, you can be doing a diamond glow. There are tons of things, and I harp on this so strongly because everyone on social media now sees how all these superstars are not aging. And I promise you, they look like they're not aging because they are doing a multimodality approach to their aesthetic health. And that's it.

Valerie (26:14):
They're taking care of their skin.

Dr. Houssock (26:15):
They sure are. They are not just throwing fillers in, and actually the ones who are, everybody knows.

Valerie (26:20):
Oh yeah.

Dr. Houssock (26:21):
Monica from friends. We talk about her, we talk about you talk all of these people, you're like, what happened to her? What happened to Madonna? What happened? It's overfilling. But if you look at Julia Roberts, you might say she's getting nothing done, and that is not true. She's getting a ton done, but in the right way.

Valerie (26:40):
What about Usher? Usher's aging quite well.

Dr. Houssock (26:41):
Crazy Usher.

Valerie (26:43):
Man.

Dr. Houssock (26:43):
I wouldn't be surprised if he's not doing good skincare at home and some microneedling treatments and all of that because his skin is flawless.

Valerie (26:50):
Yes.

Dr. Houssock (26:50):
And some of it can be genetics. I mean obviously some people are lucky, but every superstar in the world is not just lucky. I promise you. The reason they look as good as they do is because they are investing over multiple levels. And I don't mean a million dollars, I really don't. I don't mean that you have to spend a million dollars to have good skin, just we need to focus it in the right place. And the other side of that, which I have to hit home, is that you want to find a practice that offers all of that. Because if they only offer filler, they're going to fill you every time.

Valerie (27:27):
Exactly.

Dr. Houssock (27:27):
If they have other things to offer you, they're going to be more, I hate to say this, but as much as we are a medical practice and we think all the time about your best interest, this world is also a business and everyone doesn't have your best interest at heart. So you have to be your own advocate and you need to just hear that being filled every time you go to a visit may not be the best thing for you.

Valerie (27:55):
And that's the one thing that we definitely promise to our patients that we're going to definitely recommend. What makes sense at that visit and what's going to get you to your goals and what you want to focus on. And you might not need filler that day. So if I say, no, sorry, but we'll talk about something else.

Dr. Houssock (28:12):
Or because of social media, it's my last point for today is because of social media, a lot of patients will come in thinking they know exactly what they need. For instance, I had a lovely patient who came in and instead of telling me what her concerns were, she said, I'd like Kybella here and I'd like Restylane here. And I said, back up a second, instead of you telling me what treatment you want, this isn't like a grocery store where you're picking out your food for the night. Tell me your concerns and then that way I can really guide you and come to find out the things that she was concerned about would not have been treated with those two things. And if I wasn't the practitioner to tell her that I would've done those two treatments on her and she would've been unhappy.

Valerie (28:56):
And wasted her money.

Dr. Houssock (28:58):
Correct. And so instead, she expressed that she was concerned about laxity here and crepeness in her under her eye. And so we ended up guiding her towards radiofrequency microneedling and doing no fillers. But the only way we would've done that is if we get to ask that question for you and you trust us that we will find you the right modality. It's an exciting time to be a part of aesthetic medicine isn't it?

Valerie (29:21):
It really is. We're very lucky to be in this industry and just how much wake we're exposed to and just every day it's something new. And I love it. I love it.

Dr. Houssock (29:32):
Always learning. Always learning.

Valerie (29:33):
Absolutely.

Dr. Houssock (29:34):
So if you're interested in some injections or you just have a concern and you want to bounce it off of us, you can always get a consult with Valerie. Valerie is doing injections four days a week really? Right?

Valerie (29:49):
Yeah. I'll do Mondays and Wednesdays after surgery, but most of the time it's Tuesdays and Thursdays. So yeah, I'm here Monday through Thursday.

Dr. Houssock (29:54):
Yep. So you can come and see Val. She'll be very honest and upfront with what you need and what you don't to make sure you look beautiful, but also natural.

Valerie (30:04):
Absolutely. Absolutely.

Dr. Houssock (30:06):
Alright, anything else? Did we miss anything? Anything else you wanted to mention about fillers?

Valerie (30:11):
Fillers? No, I think we got everything. One thing I did want to say though, if you're thinking about doing surgery and you don't want to be awake for any of the stuff, that's the perfect time to do things.

Dr. Houssock (30:19):
This is very true. There are definitely some nonsurgical items that we add to our surgical regimen because since I'm usually working on the bottom half, Lindsay or Val can be doing something on the face at the same time. If I'm doing something facially, then they can do it after. But a lot of our patients these days will now add their non-surgical treatments to their surgery because you're asleep and why not?

Valerie (30:44):
And one recovery for everything.

Dr. Houssock (30:47):
Yeah. Yeah, for sure. So, alright sweetheart, well carry on.

Valerie (30:51):
Carry on.

Dr. Houssock (30:52):
Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEV plastic surgery.com or follow us on Instagram at DR Care Houssock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, apple Podcasts, Spotify, or wherever you'd like to listen to podcasts.