Ep 302 Masterclass Series (Chapter 5) - Rejuran & Polynucleotides | Dr Steven Liew

Welcome to Inside aesthetics, the world's leading podcast for injectors and aesthetic businesses. I'm Dr. Jake Sloan and aesthetic doctor with over 16 years experience in facial aesthetics. And I'm David Siegel, an entrepreneur and business mentor with over 20 years of experience in our industry. Our podcasts are aimed at industry professionals and any information or advice given is generally nature. You should consult with a healthcare provider before undergoing any treatment. You can also subscribe to us on Patreon for on-demand content for injectable and business education. Hey guys, welcome to chapter five in our masterclass series. Today's topic is on polynucleotides in particular the product that's been I guess taking Australia by storm a little bit. Rijuran and we're joined by Dr. Steven Lu, well-known plastic surgeon from here in Sydney, Australia. Before we jump into today's podcast, Jake, is there any news you'd like to inform our listeners about? Well, first of all, thank you for all your supportive messages and texts and so on for our episode 300. We appreciate the support. That was awesome. We had a really good feedback. We are still running our competition, our IA competition is six days left. So make sure you get your entries in. You can get the link down below to apply. And actually all the instructions are on our real on Instagram from May the 16th if you want to get all the information on how to apply. It's a good one. We're taking someone lucky person all way to Canada to Toronto in September. Obviously your flights will be paid, hotel will be paid. We're going to a great conference that I've not been super full. We'll be Canadian aesthetic Expo. David and I will be there sort of doing our own talk. I'm part of the Kadar the lab. You're doing a business workshop. Yeah. And then there's two days of an educational sort of conference style live, injecting and lectures. Yeah. And we're doing something pretty different there but we're not going to reveal it just yet. Yes. And also the winner will get to a live mini podcast with us. Awesome. So that'll be fun. And also you get a ticket to the cocktail swery as well. Oh yeah. So there we go. Nancy. Any other news? Don't think so. No, that's it. Let's jump in. Yes. All right. So Stephen, you have been on the podcast before. In fact, you've been on Episode 61. One, two, six, one, nine, two and two, four, six. That might be a record. You're in danger of becoming our almost sort of welcome back guests. But thanks for coming back. Thank you very much. No, it's our pleasure. No, tell our listeners who maybe haven't come across you yet. They haven't listened to those episodes about your background. And also how you became the partner with the company called Rudura. I know we're going to be speaking about today. Hi. Well, guys, thank you for having me. My name is Dr. Stephen Blue. I'm a plastic surgeon based in Sydney, Australia. I've been a plastic surgeon for the last 20 years. My ear of interest is facial static surgery, as well as any non-surgical, uh, static innovation from injectable two devices, to anything non-surgical. Um, Rudurin. I've came across the name Rudurin, probably about seven, eight years ago when I was touring Asia. And then I had the opportunity to stay around with it. And then when they talk about the origin, then I got a bit excited. I think I think we, I think we all agree that things that we generate if medicine is probably the new kits in town, particularly in the last five years. There's not a lot of signs in it. But we do see those of you, including you, Jake, we've been using it and you do see patient come back for more. So clearly there is something in there. And, and while I always say, you know, there is no evidence base doesn't, doesn't, doesn't necessarily mean no, doesn't necessarily mean absence of evidence. There's something we need to be aware of. Uh, but we need to be a bit cautious. So, so I've been playing with it. It's been available in Australia. I think sometime in June, July 23. Um, it was launched in the static 23, by the way, I thought I'll throw it in and then it become commercialized since then. Um, I started playing with it just a few months beforehand, like most of you guys. And, and I said, the rest has been history. So we've been playing with for about what two, two and a half years now with a real, like clinical experience. Clearly, you know, it's, it's originally in Seoul, South Korea. They've been using it for last 10 years. So it is nothing that new. Uh, so I think most people who use it and notice that the patient come back for more. So clearly, there is some efficacy in there. We can talk a little bit about efficacy, etc, etc. So that is just my background associated with regret. Um, when you say there's no evidence, but that doesn't mean that there is an absence of evidence. Can you explain that as, like as a lay person, I'm trying to understand what you mean by that. So they, they found that this substance does something, but they don't have the clinical trials behind it. Is that what you mean? Yeah. Let's, let's bring it back. I think the major confusion in the market globally has been the so-called PN, which is called a nucleotide versus PDRN, which is called a deoxyribo nucleoside. Okay. So let's get the nomenclature. PN for rejuven, arise from the mal-reproductive organ of acidic stannin. PDRN from rejuven brand arise from the stern. Right. So, so that's the major difference. I think based on the molecule wise, I think there is new articles classifying. PN essentially has a longer molecule. I think it's about 1500 kilo delton. And it think below that tends to be long through PDRN because the function is slightly different. And the preparation is slightly different. From rejuven perspective, PDRN comes in more of a topical form. Whereas rejuven in this country, in most countries, will refer that we are referring to a injectable that is made of this marine extract. And that extract happened to be the natural occurring basic block that formed the DNA of the salmon. Right. So essentially, we are injecting segment of DNA from the Pacific salmon originated from the mal-reproductive organ. So I think that's the thing. A lot of the studies, I mean, if you look at the history in the literature, a lot of the studies has been talking about PDRN as a topical form, as a gel form in chronic wound. So, so if you look at orthopedic surgeon, general surgeon, they've been using for a long time because it is a very effective wound healer. So it wasn't until the last sort of 10 years or so people think of it as application in the aesthetic world. Hence, the PN injectable form comes in. Now, it's worth mentioning because, you know, we everyone talk about the the the condition having their salmon sperm. But so that's a PDRN. I believe correct me, J. Van Romm. The the the polynuclear tide injectable regurant form is not approved in North America as yet. What they have is more of a topical form. So they tend to apply after some needling after some lazoring to sort of things just to apply topically. A lot of the studies have been going on for PDRN, not so much on PN. We just slowly seen some early studies and we are extrapolating the result from PDRN. It's a long window. Yeah. There's a good sum. Steven, I'm going to say again salmon sperm PDRN. PN or polynuclear tide is the salmon gonad or testicle DNA because this gets so confused. I want to be really specific because it's so confused. And also when I was in America recently in February, what's really confusing is regurant is available as in the the the healer, the injectable form, but it's not FDA proof to inject it. So people are mixing these terms up because they can't use it the way that they want to. And it's just getting really confusing. Yeah. I mentioned Steven was talking about the fact that this technology was used in wound healing. I remember you put something in your picture on WhatsApp group with this kid that had fallen over and grazed his face off. And apparently his face came back to life within a few days. Yeah. Well, maybe we'll come to that. Yeah. Like a problem. But yeah, it certainly is a healer as well as what we're talking about. Yes. As an aesthetic product. Steven, I want to touch on what you said sort of in your intro. The word or term regenerative aesthetic. I mean, what do you mean by that? Or how do you describe it? Because I think, you know, every conference we go to now, it's the buzz word and everyone's going to excited. But I don't know. Yeah. Not sure what we mean. I do. You're not the only one. I'm sort of, you know, also confused. But I think I'm just a simple classic surgeon. I keep things very, very simple. For me, I think of stem cell as the ultimate regenerative medicine. Full stop. So if you think of regenerative medicine, I think of something that's super charged. The cellular environment. environment in this skin would think about the extracellular matrix. Think about modulating supercharged, fertilized, whatever, so that it make that environment conducive for all the cells that are soomstable to be activator. And then from there, the cells that are activators going to lay down more ground substance, from the lay down collagen, lay down elastin, which is the holy grail of any useful skin fat bone, whatever. And the last part is also attract new blood vessels, so that the entire environment, it is more useful both in the currents as well as function. That's my definition of a regenerative, anything to do regeneration. And the major differences, it does not produce scarring. So because we can get to the final outcome with laser, with meddling, with other injectable so-called power stimulation, they all get to the final pathway, the end resultial scarring, regenerative medicine, injectable such a regimen, do not produce scarring. I think that's very, very important. So it might be an obvious answer, but if you can still get to the final outcome with scarring, is there a downside to the scarring? If you look at a, you know, David, you're 21 years old, you know, your nicest skin, firm and robust, if we just, you know, allow me to use a scalpel, the cut through it is nice firm and healthy. It is not full of scarring. So a lot of things that we do, for patients nowadays, a lot of injectables, a lot of kneeling those other things, we do produce collagen, but also part of it is scarring because scarring is a form of some degree, some types of collagen. So if you use something that days in day out produce a lot of collagen via scarring, eventually I will suggest that your skin and your fat will be quite sort of hard and youthfulness is not hard, youthfulness is pliable, is soft. So that is the problem. And then of course, one day you may be start to have surgery and a lot of scarring, not that we can't do it, a good surgeon will be able to go through it, just make it just that much harder, particularly when we want to see where the facial nervous. So that is what we're seeing. I'm not saying it's bad. I'm just saying that with bio-stimulator, with regenerative, I think what we will see is we need to think of a more, I guess, clever and systematic way of how we rejuvenate the skin. I think it's a good point because our patients are understandably learning from what they see on Instagram and all this drama with the plastic surgeons in America about the use of bio-stimulators and we've spoken about that before. So when I'm talking about reguran or other true regenerative products with my patients, my patients like the fact that it's literally their own cells sort of regrowing rather than I guess something artificial or not quite what they wanted being made. Well, I guess it sounds like you're like crashing your car to fix it. That's basically it. No, no, I think I think I think it's not quite that bad. You don't be able to. I think I think now is the time to think about how it works, right? So we think about as a healer, aging process is a degenerative process. Some will call it as a disease stain, right? Where they sun damage, intrinsic, etc. because the skin becomes thinner, we get wrinkles, skin become more inflamed, you get redness, you know. There's not much difference between that and healing the wound because ultimately you need new cells to grow and you need more collagen, you need ground substance and you need something to dampen down the inflammation and that's so magical. So that's why if you look at all the studies from the wound healing suddenly now is this is geared towards moving towards the aging process because aging process you think about it, we want to regenerate newer, better, more useful, robust, useful tissue and that's it. So I think we do and if you think about it, there are a number of ways what we do. Paulineucleotide longer molecular chain when you inject it, it is believed to form more of a scaffolding effect. So the key cells in our damage is this thing called fibroglas. So what it does is provide a platform for it to hook onto it to stretch it and then in doing so it activated through one way. When you inject, rejuven into your skin, rejuven is quite viscous. So it's actually stretch your skin. That itself, there's a process someone smart 15 years ago called a mechanical, construction to stretch the cell in doing so activated. And the other cellular way is from the Paulineucleotide activating certain, I think, eight or two receptors. All these, once again, laying down through the final pathway, release of all the good, good growth factors, the tracking new blood vessels and collagen in the last. I think that's probably the best way to think about all this. Yeah, that was a really interesting point you made, Stephen. I think a lot of injectors understand phylloreology and they understand things like G prime and they use that in their head to decide which tool to use. But when it comes to the juroran or a Paulineucleotide, it feels like a serum, it feels like nothing. But it has a structure when you look at it under electron microscope. And so the magic, like you said, it has a scaffold-type structure like a honeycomb. When that stretches in a fibroblast, that's what's talking to them as well as obviously docking onto the A2 receptor. So it's not just like a serum, it's actually talking to the fibroblast, but also mechanically making them more efficient. The other way to think about 20 years ago, we talked about traditional Chinese medicine. If you think about regenerative medicine, just like things like the juroran or any other regenerative property, nanofat type of things, it's a gradual process. It's not an instantaneous reaction. So it's more a repeat treatment, you get a gradual improvement and long term. That's what you think about. You look at traditional Chinese medicine techniques. It's completely in contrast to Western medicine. They think long term. So when you take, you know, some really jockey-herbal medicine, you know, you want to puke, but it's supposed to be good for you if you keep taking it. So it's a gradual, as opposed to taking a panadol, right? Instantaneous, just like fillers. If you think about traditional fillers, it's a very instantaneous result. So Botox. Okay. Everyone loves Botox because it just works. We know it works. Juroran is a more gradual process in it, repeat a treatment, just like the traditional medicine. So it's not, you know, I just want to try one. Then I'll just say, well, maybe you shouldn't be doing it because you are not seeing the result. Even if you do, it's going to be so subtle. I think that's, if someone's going to sort of adopt using this, you could think about the slight difference. I think, I think the time has changed now. I think the whole world is changing from, you know, we want something a bit more natural. We don't mind to be in a liquid gradual, but as long as we can see the improvement. And I think that's why I believe I think it was Jake, you'll tell me there's about a few thousand clinic in Australia has been adopting this technology. I guess for the people who've never even seen Juroran, maybe our American listeners or whoever, what's the core indication for using a pulmonary platelet? Like what sort of patient, you know, should they be looking at it and what should the patient sort of be asking for from their practitioner? Yeah. So speaking from personal experience, in my office, we use it for a variety of skin of allergies from aging, being crazy skin, especially around the eyelids. Patient with inflamed skin, redness, inflamed rosacea. Patient with very, very sensitive skin, perimenopausal period, where there is a destruction of skin barrier. And then that's those are the key indicators. Now we use it as we have mentioned as a wound healing, do enhanced healing. We use it following meddling procedure. We use it following laser work just to promote healing. You get a synergistic improvement. I use it once again as an active wound healer in all my surgical, facial aesthetic patients after facelift after eyelid surgery. We do it straight away on table. And someone who just won a much better skin, those are the four main indications. The fifth one, which I am started doing this year is what we whole timing of the skin before surgery. I think with any procedure, any surgical procedure, any aesthetic procedure, we want to do a great job and hopefully we can't see any scar. So this stem from the fact that with the endurance scar, we use that to treat established scar. We see that a lot. Incidentally, we learn a lot from a European counterpart, Ukraine because I think there's an affiliation. I think the company sent a lot of the product to this war-torn country and you see some horrific injury that has been treated in combination with urine and that's where I learned from to start thinking, well, if we can use it for a stem with scar, can we prime? Can we prime? Can we get the skin to be in such a great useful supercharge extracellular matrix before I create injury? So that's what I've been doing clearly. It's not an easy project to do unless you do a randomized study, you will not be able to get meaningful, but that's what I've been doing recently. So those are my indications, that robust. I have to say I was a bit skeptical of polyneucleotides and I was taken to career by a surgeon when it first came out. So disclaimer, I'm a trainer for a surgeon, but at the time I didn't know much about it and I met a Ukrainian doctor. In fact, there was about 20 Ukrainian doctors on our bus because we had to drive four hours across from a soul to the factory where they made regurum and in really broken English, I just sort of tried to introduce myself to this lady and she told me exactly what you just said. She said that we're not using this stuff aesthetically, obviously, when we're in a war, but we've realized that we can use this on scars, on battle wounds, on burns, on all sorts of things and the skin is just healing so much better. So why wouldn't you do that? So that really got my attention because I was like, okay, well, this is not just superficial stuff. This is real medicine now. The consultation process, as you said, Steven, we have been living in a world where we all want and expect instantaneous results and I think we created a bit of a problem for ourselves with, as you said, Don't My Fillers, they gave people the instant wow they walk out and like a new person. I think part of the difficulty that injectors have today is how do you consult for this product effectively? How do you start to educate your patient on the long game? It can be a difficult process for injectors. I think this is, I think we're all including myself still learning about it because there are as an injectors in this country, we have choices. We have so much product we can use. At the end of the day, it really depends on the individual skin. So let's take one step back. We know this thing work. We know this thing work by getting you a more useful skin in appearance and function in a slightly longer period of time than let's say your traditional skin booster with hyaluronic acid. So if the patient just, hey listen, I've got a wedding next week I want to do that. This is not for you. So if the patient come in, they say, you know what I've had this time before, I just want to see what are my options in the next five years. Now then these are the ideal patients. So if you have a patient that come in, the skins are quite reasonable and all they have in aging tissues such as a creepy skin. Then this could be the first option once you talk about how many sessions you need. Basically we talk about three minimum two to three sessions three to four weeks apart. And then we might think, you know, depends on how much improvement they want to talk about a repeat treatment at about six to twelve months, more six. So this is a long-term investment, not a one-night stand. This is a long-term investment. If the patient come in and severe Sunday and drive the hydrated, then it's a different matter. You may not necessarily use a regenerance of this option. You may start some cosmaceutical together with some skin booster where the main action is to hydrate the skin. As a first option, once you actually improve the quality, then you can talk about, hey listen, this is much better now. We can think about long-term how we're going to maintain this going forward. The advantage of these is really we know from our own experience and from overseas from our Korean counterpart Asian counterparties, one of the most what I'm attracted to as a unique selling properties of this product is it has very minimal long-term problems, right? It has. I mean, you know, I'm sure, Jaguar agree, I have not seen anyone come back with a nodules. I have not come up with an ongoing inflammatory reaction, which we were seeing with, you know, all the other type of injectables. So this is a very safe product. We just have to educate the patient. Those are the reason why a lot of us are attracted to it. And patient after the treatment, they will come back for it, right? And once again, the result is never wow better. Sometimes I take a photograph, I can say, yeah, I can see that improvement. But the reaction from the patient is this proportionate to what I have seen before another photograph. So that's another interesting thing we are learning about with urine properties. Yeah, I would agree with that. And I know Steven, you've got the clinical imaging system in your clinic. So photography is kind of vital with these sorts of patients. And it's part of the consult because I don't know if you agree with this. I mean, you know, my population of patients are basically white Caucasian, you know, middle-aged women. I don't know what your demographic is, Steven, but they've kind of got the worst skin versus, you know, the Korean population where a urine is really popular. And they probably need it more than Asian patients because they haven't been looking after their skin. But it's a hard sell to sell a skin quality treatment in our clinics. And sometimes it is that want, you know, that want they want their instant impacts like they've been used to in the past. Teaching people about skin with good photography is vital because some, they might not even appreciate the change sometimes. You've got it, sometimes you've got to show them. But like you said, I noticed this first with Profiler a few years ago, the patient feedback was far more than what I could see sometimes. They feel it rather than see it sometimes. It's been the same experience with Ruduran. I can look and say, hey, you look pretty good. I hope you're happy. But I love it. And sometimes I can't perceive that because it's not my skin, but they feel it. It's interesting. Absolutely. I think for those who have never used it, my recommendation is start with the eyes, the period orbital region, right? The skin there tend to be thinner, you know, even, even, you know, patient in their late 20s, early, mid 30s. You can start to see the dehydration, fine lines and all this stuff. That's the one that will be consistently, right? You will see the patient come back to I love it. But once again, once again, you take a photo of just saying, hey, some improvement, they love it. And then an artist, you know, spoken to so many patients, I think my conclusion is when you look at yourself, particularly when you look at your eyes twisting in the morning, remember? They remember, first in the morning, you look at yourself. And you tend to look closely at what they see, firstly, is the brightness. Right? The skin is smoother, more supple, and you get that brightness and reflection. And that's what they see. Right? When you take a photograph, it's different. It's very hard to show the brightness. And all you see is improved in texture, which you do see. And that's why the patient like it. And so the audience would never use it. The eye, period orbital region, especially lower eyelid, will be the first part that I would suggest you to do because consistently, smaller area, you will get a much better, sort of, from, how should I say, satisfaction from your patient and to come back home all? Yeah. I mean, would you agree that 95% of your patients are doing eye? Yeah. Yeah. The eye is number one. You make a very clear point. In Australia, particularly, we do know that our population age at least 10 years faster than our counterpart, whether it's Asia or North America, if you just matched on base or not, nicotine raises a full stroke because of a harsh environment. Right? So it is hard when someone comes in with such a severe sun memory skin throughout the face and neck. You don't really know where to start. Right? You don't know where to start. And even when they get a 20% improvement, it's like, okay, a needle in the haystack. So it's very, very different demographic to our Asian counterpart who prize their glowing skin. You have a 40-year-old come in, hardly any wrinkle, and yet they think that they're aging badly. So it's a very different way of consulting descriptions. Okay. So there's a few different versions of a Juara available. So can you explain the difference in and when you might use one over another, I know that there's some ways that the technology changes the density of the PNs as well. So can you just break that down a little bit for us? Okay, so it's pretty simple really. You talk about rejurem i, you talk about rejurem and Sheila, which we call a classic and the rejurem scar, they all have the same concentration of PN, which is 20 milligram per mil. What is different is the viscosity. The i has the lowest viscosity, viscosity because the i-lit skin tend to be thinner and more friable and then move up to the scar because scar tend to be really dense and hard. So you need to be a lot more viscous to stretch that little structure within. That's how we should think about it. Did you do much scar work? I'm and use as a lot in your clinic. So we don't do a lot. The little that we do, we tend to use rejurem as a combination. So they tend to get some CO2 laser as well as injecting the rejurem directly into the scar. So I'm probably not an expert in talking about scar, but we have seen the effect from a Ukrainian counterpart. I'm sure you've seen that photo would be like, wow, right? So clearly once again it's a repeated treatment. Scar is another complex thing. Normally you need combination of modality including rejurem to really supercharge the eating process. Just one more question about the the console. How do you explain to your patient the difference between, I don't know, crepiness and hydration? Yeah, because we've got different products on the market. So how do you steer them towards? No, you need rejurem in this circumstance versus something else in another. So patient comes in, if you look at their skin's very very dull and there's no elasticity. If you look at overall condition, they're scaly and all this stuff. For me, there's a very dehydrated skin. So I want to perhaps start off with something that I know is going to work very, very quickly so that they have the confidence that this is actually doing something followed by once I once I treat that area, I will use rejurem in that region. Let's suppose to let's say low eyelid. When you look at someone's lower eyelid, you know, the rest of the skin looks fairly healthy, you know, not dry or peeling. Then in those cases, I will rejurem as a first go. Hopefully it makes sense. It has on dehydration versus crepiness. And then you mentioned the protocol of minimum three, and in Korea, they love it. They'll probably do four or five, but minimum of three. How far apart do you do them? Why do you do it that way? So firstly, I think people should know this is not the most comfortable treatment. I think we need to clarify that. This is not the most comfortable treatment because the product is quite viscous. You are injecting into the dermis. You are stretching the dermis. That is self-caused quite a lot of discomfort. So I think there's no chance to get patient coming back every week. So you are injecting multiple dots. And that can take up to two to three days, depends on how thin your tissues is, which is fully resolved. So there will be a period of adjustment and healing. I think the four weeks or weeks seems to be something that is tolerable for most patients. And I'm sure there will be some reason why the four marks will be to do with the half-life, I'm not so sure. So that's what we've been taught and that's what we've been doing. I think for me is a minimum of two, three will be better than two, but it really boils down to acceptance and cost at the end of the day. Okay. So you obviously we talked about treating the eyes. Are you treating the whole face? That is well with an odd knee, neck, deck, lethargy. So in my office, at the moment, we tend to deal a lot just with the face and the eye. The neck, not so much at the moment because the neck in most Australian patients are difficult. Okay. It's a big area. It's really, really thin. And I think that compared to Asian counterpart, you need a lot to actually see some improvement. I think it may just be cosperatively expensive to be able to do it. There will be some patient willing to pay for it, but I think we will look for other combination that will maybe heightrate the skin a little bit more. So, rejuring, I cannot do use it at this stage simply because costs are on pollution. Yeah, I have to agree with that, Stephen. And if you look at a Caucasian neck that's undamaged, it needs a lot more than just a part. The neck is to hardest, not necessarily just for rejuring for every single injectable product in there. It's thin skin, it's creepy skin, and then combination of underlying muscle. So it's not just like a face, a face is thicker. So neck is a completely different category. I do find it hard to explain to injectors when I'm training why that's the case. They just see skin and say, "Ah, I'll just use some rejurian." They don't seem to be able to tease out laxity, elasticity, thickness, trinus, redness, they just see skin. I'll give it a go. And obviously some patients aren't going to respond to that. And then they pay the product. But that's just about patient selection. Yeah, absolutely. Beware of the neck skin. You get a lot of good result from the face. The neck you need a very different look at it. And you need to have, as you say, think about the diagnosis. What is that you're treating? Just because there's wrinkles in there, it could be just laxity. The skin just falling anteriorly and you stretch it. The skin looks better. So no amount of injection will do it. The patient needs a surgery in those situations. Yeah. Okay. Let's talk about your injection technique. You mentioned a few moments ago. Lots of little dots. I'm hearing a lot of debate around cannula use. Can you just explain, how you go about the industry and the product? Yeah. I think if we are looking at the facial skin, not the eyelid, I think it's thicker. So if we're really, really tying the dermis, I would prefer to use needle. Eyelid skin is very different. Eyelid skin is a lot thinner. The older you are, the more sun damage. We're talking about a millimeter max, a 1.3 millimeter max in a lower eyelid, as opposed to 2.5 millimeters in the cheek. So in those situations, I think the career as well as some of our Thai doctors have done some studies comparing needle on side versus cannula. And I think the consensus is there's no difference. Now, last year, I presented something in Korea where I talk about a combination technique for the lower eyelid. So I've been using cannula, not just as injectable, as in using cannula to basically undermine the entire lower eyelid skin as though I'm doing surgery, lift up the entire skin off the muscle. Then I'll put the regurant underneath it. Then I'll supercharge it by doing a sandwich. I'm still using needle on the surface to try to maximize my injury to the skin and get a maximum result from the healing property of regurant. And I think, hopefully in a few months, I should be able to to announce the results. It should as a healer, accelerate the healing, but in the same time, regenerate the, almost like a wound repair tissue repair also improve that quality of the skin. Just like we talked about combination therapy, when you do a radiophrequency needle, we use the regurant at the same time. So we know the injury from radio frequency is going to improve the quality of skin together with the regurant. We're looking at the synergistic effect. You're utilizing two of the properties of regurant. So healer and collagen stimulator, is maximizing the efficiency of two mechanisms. The downside is it's going to be a longer recovery time because I'm causing more swelling. Go back to the injection technique, the sort of the microbalm illnesses. Do you have any top tips for injectors? I mean, I've learned that even though I thought I was doing it correct right at the start, I was probably going too deep. So top tips for people. Yeah, I think I go as superficial, possible, obliquely at an angle, depends on where you are. If you think you're superficial, go even more superficial. And sometimes you actually see a little bit of the product leaking out. That's what you want. You really want to stretch that nervous. If you see, I've learned this from our pre-encounter part and they do go very, very superficial. And sometimes they put so many dots, it's almost like 50 dots become almost one they've done. Yeah, I think so. I want to have learned is try to make the most tight wheel as possible. If you're not seeing that, you're probably too deep. Correct. I'll tell you Joe, you know, we talk about dot technology, but they first show it to me, I thought that's what it means to multiple dots, not knowing that it's what it's in our DNA optimizing technology. I, you know, it's a simple plastic surgeon for just use and dots. Yeah, well, actually cover that term is probably important because it's proprietary to Rijurana. What is it? It's been a nutshell. I don't think neither of it. I think it's very proprietary. They talk about using that DNA, how they purify, how they handle it. That's why they call the optimized, optimized technology. You know, there are other products out there. So I don't think we will ever know what it means. Hopefully, we hear more when some of the experts and some of the the company people or the scientists come to Australia in very soon now in a few weeks time. Is that Jay? Yes, we'll talk about the end. I mean, my understanding, like you said, there are other brands in Europe. There's, you know, Italians, makers and so on. And when my peers talk about European polyneucytides, they're assuming that they're all the same, but they can't be. It's like comparing one filler to another. They're slightly different, even though they're similar. So doc technology, yes, purification process, but it's also like we said at the start, it's about creating that structure, that honeycomb. And in the three-roger and subclasses, they're different. One is watery, one's more solid. So I'm assuming that the doc technology somehow creates that structure, but don't worry about that, but that's where it comes into its own. And I don't think we can talk about all brands as being the same. Correct. I fully agree. I mean, they tell them, Brian, I think first of all, the source is from Trump running from salmon, right? So and then we can go through the argument about the DNA similarity. You can try and stand in versus human. I think there'll be another podcast really. Right. Then it's wild salmon that are utilized in Korea, whereas in Europe, they tend to be farmed, trout. Now, of course, you know, do you want farmed chicken to heat or do you want organic sort of, you know, there's that sort of purity of quality that I think I would buy into if I had a choice of a product, but also just seeing the process, going to the factory and seeing these like really, really strong. I mean, you've done the whole thing where you catch them. It was amazing, wasn't it? It was amazing how they go through the cycle of the salmon, sort of migrating, you know, through the Pacific from one to the other, how they tag them, the age of the salmon. It, it truly, I mean, from there, I have to say, for me, it's a, it seems to be a very ethical process. Nothing is being wasted. That's the second thing. So that to me was very, very impressive. Yeah. And actually, the Korean fisheries department managed the whole process and they're counting the number of salmon every year. And if it gets too low or too high, they're overseeing it. So I kind of felt like, you know, it's pretty cool. It's sustainable. Yeah, sustainable. It's great. Yeah. So we spoke about technique, but you also touched on pain. Have you had a job? Do you find it a bit spicy? It was pretty hot. Yeah. Okay. You know, I can see some of my patients not happy. It brings a tear to an eye. You know, it's not uncommon to see them when they get the bill as well. Yeah, exactly. You know, it's, we want to obviously do everything in our power to keep our patients comfortable, especially when they're so used to most of the techniques that we do being, you know, quite easy. So any top tips, Stephen, about how you might manage pain? The usual thing we do with numb them, a lot. That's number one. We also use all a blow on to it as we inject a sample. We do a laser or any painful laser work. If that seems to help a lot, but you've got to warn the patient. It is uncomfortable. It's one of those things. We have not tried mixing, like the cane. I'm not sure whether that will help that much because a lot of it, as we say, is a stretching of the dermis, right? So not like putting H.A. fillers in a deep space. This is a stretching of the dermis. So that's why I'm not adding that thing in it. I've said that, rejuring, as some say, I'm sure I hope will bring the next hero product in, since the one that mixed with the H.A. and LIDAR cane, so I've not heard or discussed with my colleague to see whether that was more comfortable. Yeah, I have to say I'm a bit of a purist. I haven't mixed it with LIDAR cane either, because I'm relying on the property of the stuff to the viscosity, because you're going to change the viscosity of the product. But yeah, there are colleagues doing it, saying it apparently works fine. How much do you need to treat a face? What does it come in? Is it a tumile preparation? I think the more the better. That's the thing. And there was again, you know, if you know, cost becomes relative. I think for full face, we tend to use tumile. Or I like to use one mill on each time, if the patient afforded. And I think I truly believe that in this particular case, a rejuring eye comes in one mill, 0.5. I just think that's not give the same result as one mill. So that's for someone with every user, that's something important to know. Yeah, I actually use the healer for the eye for two reasons. One gives me more product. Two, it's a little bit, you know, it's a more punchier sort of potent product, if you like. So instead of doing half a mill of eye three times, I'll do one mill of healer three times, which is effectively double the dose of the eye. I just think it gives you quicker results, better results. So I'm a more pain. Maybe more pain, but you know, no pain in a game, Steven. No pain again. Yes, I agree. Well, speaking of pain, we'll be remiss if we didn't talk about things like complications or things that can go wrong. Steven, you alluded to the fact it's very safe treatment. Anything that we should be aware of? Well, yeah, I think we all have seen some patient with that swelling, the last a little bit longer, slightly more than a week. We did have one patient, the clinic. This is a patient who had a lot of phillus, HFillus around the period of the region. I think that's something you need to be aware of. Patient work, a lot of phillus in the period, orbital in the cheap region, because this also, you know, hydrate the skin in that region. So clearly it's going to attract more fluid. So those are the patients that I want a little bit, but apart from that, you know, it will supply on its own record. So I have certainly not seen it. While we're on that topic, I think we need to also be aware that this is an injectable. You still need to try to do it in a very septic technique, remove all the makeup, because, you know, contaminant can cause infection if you have nearby phillus. It can also trigger some sort of, you know, chronic inflammatory or delaying family reaction to the HFillus in a surrounding area. So be mindful, this is a basic common sense that we should all apply when sending injectors anyway. But overall, I think it's very, very safe, not seen any long-term chronic infection inflammation, the sort of thing. We're talking about this before allergy. It's one patient with a seminology. You can absolutely, you know, bless your soul with your allergic to salmon, because, you know, we all love sushi in this country, in a lot of countries. When you're allergic to something, you're allergic to the protein, right, of the flesh. So in this case, this is a DNA, which is not a protein. So you absolutely can have this injector with no concerns whatsoever. Yeah, that's a good point. I mean, the obvious thing is bruising. I don't know if you're more meticulous than me, Steven, but, you know, I think bruising, especially around the eyes, is almost impossible to avoid. Have you tried using the little nano needles or the multineedles? Yeah, yeah. I've improved your bruising rates. Yeah, I use multineedles. I think, yeah, it really depends on the type of skin really, right? In that region, there's so much blood, there's so some tiny little vessels. So it is one of those things you have to warn the patient. I guess, I guess you can use ice to vasoconstrate before inject. I've never used it. I just want to get it over and done with. I like the multineedles, because I like, I like to have multiple little injuries for the reason that we talk about, just create an injuries. Yeah, it's a lot faster too. Are they the brand called EMOTEC? I've tried those ones. Yeah, yeah. I like the EMOTEC, the one millimeter EMOTEC. Yeah, I mean, they definitely work and they definitely cause less bruising. I just found that, you know, to get it flush on the skin, you sometimes have to use a bit of pressure and sometimes your angle isn't, you know, nice around the eye with its contour, but it's definitely worth trying. It's a, see, in my case, I'm doing a sandwich technique. I've really put redure and rectangular underneath it. So I created a nice platform and it's slightly more rigidity for me to actually use a multi needle on doing it. Yeah, it's interesting. I'm assuming you agree that something like LED would help improve bruises if you bruise them. That's a nice reason you're trying it. So, yes, patient get LED, immediately after as part of the patient experience. A lot of patients nowadays have LED. I certainly encourage them to use it. If they don't have it, I'll just use eye-spec, eye-spec, you know, no strenuous activities or exercise, no pelardi, no downward dogs, double things for about 24 hours and the rest it will just take over it so. Do you believe in Anika? Not. I do, if they believe in it, I'll say go for it, just like, if they use it, they have it by all means use it. Combining, or sort of these cocktails that people put in together, tell us some of your magic potions that you've come up with and what works well for you. With Rijuran, I have not mixed any cocktail in there because it has free generally property. It's not like H.A., which is rely on a lot of the mechanical property. So, Rijuran, I'm become very, very pure, I just do pure Rijuran. I've not mixed line of cane, I've not mixed anything that I see in there. Yeah, I guess combining with other treatments as you said, other modalities. Yes, correct. So, any form of devices, I'll go for it, including surgery, as I mentioned before. When would you do it say after, I don't know, CO2? Do you do it immediately after? Yes. And do you inject it or just drizzle it onto the wound? With CO2, you can drizzle it because the channel is so. With needling, I'm not seeing the signs, I don't know how long the hole is going to be open for. So, that's why with that, I'm still injecting to it. Yeah, I've spoken to about 100 derms about this and no one can seem to agree on what whole size it needs to be to be applied. So, I agree, unless you haven't stripped off the skin like CO2, I think you should be injecting it. Yeah, correct. So, you're getting more collagen induction by actually needling it as well. True. Yeah. You tell us about your device story now? Oh, well, yeah. Well, yeah, it's a good time to talk about that. Anyway, this is sort of completely anecdotal and very off-label. So, you know, I'm not recommending that you guys do this. But a friend contacted me about, I don't know, two months ago, and his son's in my son's year at school, and he basically face planted at school and scratched along the concrete floor. And that's good. The host was, you know, he had a nasty bump on his forehead, which is sort of rounded and bruised. But it lost, you know, braised his skin essentially. So, road rash, we would call it a hospital. And anyway, so they cleaned him up and basically sent him in that home and said, "Oh, here we find." And I said, "This is a bit hair-brained, but I want you to. " Well, if you're up for it, I want you to try and drizzle this stuff on. And it was Jurend Heeler, I use Heeler. And so, I showed his parents how to do it. And, you know, just after he had had his bath, et cetera, we just used a quarter of a two-mil serine. So, half a mil on all of the wounds, essentially four times. And he sent me a photo six days later. And, you know, this is in our Patreon. So, if you'll never look at you can. But I was astonished. His parents sent me this photo six days later. And it looked like he'd basically, nothing had happened. A little scar just under his eye where he'd really, you know, sort of almost like a third degree, sort of lacerational, lost all of this skin. I just couldn't believe it. Here I saw the photos, quite with pretty impressive. Yeah, and look, that's a case of one. So, he may have healed on his own. That's true. Children heal very well. But I just thought it's something that, you know, from my experience, was speaking to the lady from Ukraine about wounds and scars. Why not? You know, you don't need him to scar. And it was completely easy to do. Non-paying for no injections, just drizzle on the wounds and hope for the best. So, yeah, that's my story. And it could stories of trauma that you've tried to even know. I'm pretty boring that way. But that's with the surgical scars. Yeah, no. The priming thing is something that I have some profound interest because that's the plastic surgeon. You know, we talk about making wound all the time. We talk about closing the wound. We know tension. We talk about aceptic. But we have to talk about proactively minimizing wound even before we actually inflict that injury. So, I think that's when I, when I, you know, saw those photograph from our Ukrainian counterpart, that's when I thought, you know, what, maybe there is something. So, we should see, hopefully, at some stage, someone would do a large randomized control trial. One side is the other side with the facelift. Who knows? Well, correct me if I'm wrong. I thought that previously on your infant memory scarf, breast augmentation, you're using botulinum toxin there. Yes. Yeah. But so that is, yeah, that is not, that is not a control. I use that on patient that prone to have bad scars, specifically kiloidscars. So, basically, patient was, you know, darker skin, Asian skin type of patient. So, that, and then this, this is off the track of some studies of doing some injectable intradermal botulinum toxin. So, that wasn't trailing. That was based on some papers. So, that, that I'm still doing it. But this is a completely new thing. I'm talking about someone who is not, you know, I'm talking about every day patient that I'm doing with facelift. That we know that, you know, we might be playing facelift. I can almost say at three months, we probably can't see the scar. I want to see whether we can actually a, accelerate that that healing process. So, hopefully, by about that's in three months, the scar will be much better. So, that's probably harder to prove. So, when do you do your preoperative regural and presumably have to mark them up, you know, in your clinic as if you're going to start? Yeah. So, at the moment, I inject them a few weeks beforehand. So, I inject them where I know where I'm going to make that incision. Now, the other part is where I can predict the other part of the wound where I'm going to. So, that's when I'm also standing in at the end of the procedure. Okay. What was the learning kind of like curve, like introducing it into your practice, I guess, getting your staff comfortable with it? How do you expect patients and so on? Yeah, I think the learning curve is easy. All right. So, it's an intradervable. The new ones is to be a lot more precise, the Jack mentioning it to be as superficial as possible. We tend to think we're superficial, but we tend to go a little too deep. All right. So, that's that's number one. That from a technical perspective from my staff who are all experiencing Jack, that is an easy thing. The harder thing is to patient selection. I mentioned all the different skin type we do. I think patient selection. I think the rosacea works well. Patient with red skin works well. Patient lower eye-lead skin works well. And paramedicals of skin work very well. Those are the three consistent ones that you may want to start. Patient with a really, really bad skin, hard skin who expect a lot. That's the one that you need to be a little bit concerned managing the expectation. I don't know if you remember the launch at the symposium at the W Hotel you came straight on stage after my talk. And I had said, hey guys, this is quite exciting. This is one of the few products that you can talk about on your social media and website, etc. And you came on and you sort of reeled it back a bit and said, I don't know guys, you might want to be careful, but what's your stance on advertising in Australia? Because rules are tight, but when we can talk about something, I think we should. Yeah. So, I have to apologize for that. Clearly, is it necessary? I think that was when we first have to, you know, TGA impose on can't talk about. So, I guess I would just be a little bit mindful. Yeah, I mean, it seems to be the only thing that we've been talking about. So, I was encouraged you to keep talking using the brand as much as possible because we're not breaking the rules and not breaking the law. So, yes, we do have stuff to talk about it almost every week because we can talk about anything else. So, yeah. Where do you fit this into, I guess, the profitability perspective and what treatments has this replaced in terms of how does it weigh up against the results and I guess the performance from a business perspective? All right. I think it is two parts. My view is quite different. When it comes to things that we're doing, where the skill is only about picking the patient, picking the right choice of patient, once you've done it, it feels pretty easy. And the rest is just a technical exercise. But to be honest, this is not the most creative, this is what the most interesting we're doing it because for me it's a boring injection. So I don't see these, that is we don't have a big margin for this. I just want my patient to have the best quality skin knowing that this is part of the added service that I provide. I suppose there's something that require a specific skill set such as doing a beautiful lip injection, doing a beautiful cheek injection. For me, yes, there's a tool, but the rest also depends on your technical skill, but also how your assessment is where you're going to put it. And I think that is the two differences. Yeah, if you understand what I mean. I think the beauty of a treatment like this is at least in that initial phase, you've got three treatments, so three clinic visits. So it gets your books busy quite quickly if you've got a number of patients doing their initial sessions. And like you said, you don't have to charge top dollar per session, but you're seeing them for three sessions on profitability perspective that's good. And it's like an adjunct or precursor to other things that you're going to do in your in your in your clinic. So yeah, if they're game for doing Rajuran, presumably they game for doing toxins and other things in your as well. Yeah. So I think it's not only that they will come back. This is a long term. This is not just one of three sessions. That's it. Yeah. When they see the result, they will come back. So so it will basically, it's as I said, you know, per session, you're not going to charge a lot, you're not going to make a lot of money, but the long term longevity of that patient in your clinic. And they get the result they want. They are happy. Then there's this truss and report with your clinic, your comeback. Yeah. For other things. Yeah. That's how I look at it. Did you do with toxins on the same day or fill it same day? What do you do? So no, we tend to do toxins, but not the fillers because poor thing, you know, it's it's the the walker if you do the whole just the eye, they walk out with a 100 dots. I have one and a dot. So so some say that just think and any discomfort we talk about. So we don't would traumatize them too much. Yeah. I think it's worth hammering home what you said earlier, Stephen, about don't put Rijura and wave done a cross linked filler in the same plane. Stay away from it. There's just some rare cases of that sort of the histori, it looks like a lumpy appearance and it's quite difficult to manage. So just stay away from there. Yeah. Yeah. Jevany advice for injectors that would I guess have trouble deciding what product is going to be best for what patient. We've got so many treatment modalities now. And I think there's a lot of confusion about which product do they reach for on the certain circumstances. I know we kind of alluded to it in some of the discussion, but if you could be maybe a little more direct about it. Yeah. I think if you look at just the patient coming in, right, you need to look at the aging process. What will be your number one priority? If the patient is so severely volume depleted or has such a severe dynamic wrinkles, you know Botox will always going to be your number one thing because it works is efficient. People love it. People see it. They'll come back. You want to create that report for you. If the patient comes in so volume depleted and you just say go for a rejure and who is a slow process, they're not going to come back. So that's number one thing. So for me always go for the priority. If you're so depleted, put the volume in there because you look at it, they get compliment from all their friends. Right. No matter who they are, how old we are, male femur, we all love to get some compliment, unsolicited compliment is your best friend. Then we'll come back because it gives them validate, invalidate that what they have paid for is worth the money. Right. And then they'll come back. Then that's when you actually say, well, fine, it's your treatment plan. What is the next priority? It is a skin. Let's talk about your skin that maybe that's the time there's a hey guys and notice that it's a creepiness around the eye. Let's talk about it. How do we manage this fully? So even within rejure and think about your eyes first. Right. Don't go for the neck because once again, you know, you go for the neck. It's like bottled and spit. You're not going to see the result. So once again, it's about understanding, using your skill setting assessment to pick the right area, even using the same product. Yeah, I couldn't agree more. And something that I do with my patients is, you know, in the consult we can talk to them about product and so on. I just tried to make it very tangible. So I'm reaching for this tool because it's a hydrator, but I'm reaching for this tool because it's a skin thickener and particularly around your eyes. Or I'm going to use this one because it's a muscle relaxer and just keep the terminology simple. But just tell them, why have I chosen that tool? And does that tool match the thing that you're looking at in the mirror saying, I don't like, you know, if they don't, you know, if they don't match, then that's the wrong tool. Yeah. So it sounds like this isn't a treatment for a new entrant into, I guess, the anti-aging world or the treatment world because you're not going to get that wow, you're not going to, they're not going to be able to see that result. And it's, I guess, the new relationship, so important to build that trust, get them happy straight away. And this is more of a long term sort of second and third stage introduction and then ongoing. Well, unless the patient is so fitable, right? So you have a patient in their early 30s, always a beautiful skin. There's nothing wrong with the volume, minimal dynamic wrinkles, who just want something that is in very common slower, more natural long term thing, they could be the right person. Right? I mean, it's not common, but we do see them. We do see them. So those are the ones that say, okay, fine, so we join here to the trial. Yeah, I agree. I've had a handful of patients, you know, they've done their research, they want, they've been to career, they might have had one session ready. And they're just there for more regurant. Yeah. And I think that's completely reasonable. But you've got a new patient who's never dipped their toe into aesthetics and they're coming to you with multiple concerns. It probably wouldn't be my number one, but it definitely would be on my list of stage two, stage three or whatever. Yeah. Yeah. We've just got a couple of listener questions. In fact, I think we've answered most of them, but a few people were asking, or I'll just quote their name to shout them out, Maria Reed, Marie Treesna and Dr Victoria Scott Langley, Roland R. Patron, they're asking variants of the same question, this post regurant eye swelling, or let's call it post polynucleotide eye swelling. I personally haven't seen it. I don't know if I'm doing something different to other injectors, but what's your experience with the swelling and how problematic can it be Steven? Yeah. I don't think I have seen it. I expect the way I'm the way that I've done the patient, they'll probably get swelling for about four or five days. Right. The way I've done it, we are really, really go for it. If you just use some needles with 50 dots on each side, then I'll still say about three to four days, but nothing longer than a week. So far. And I said, the one that we have seen referred to us, is a lady that who had a lot of fillers in the tier 12 region. So those are the one that you know is going to perhaps have more swelling linger on. And you mentioned it too is people who have a lot of fillers in that region. If your technique is not a septic look to like it, it can trigger off some other problems that we have seen from contamination, such as you know, inflammation in the H.A. region. So not sure whether we can answer to your listeners is I have not seen them. When is a long call long? Do they mention how long the swelling? A few weeks, few months. Yeah, I don't know. I've not seen it myself in at least two of these people are not in Australia. So they won't be using redura and ones in Ireland, ones that you can Dubai. So maybe using different brands. So yeah, I mean, look, I would probably look at like you said, backing off if they've had any other fillers around the eye, making sure your depth is correct. And you know, if the skin is very lax to start with, maybe just reducing my dose just to see how they go. Those would be my top tips. Yeah. So any sort of summarizing comments, Steven parting comments of, you know, someone new to this thinking, hey, that podcast sounded interesting. I want to get involved, but what are your top tips? Top tips are this is this works. This is a gradual process. Pick your patience. If you're going to try just pure static, your period of it all will be your best friend best place to start. In the eyelid, to me, in Australia or in most countries, I still say this is the safest injectable in the eyelid skin with no very minimal long term problem that we are aware of today's for us in this country, but using for closer two years and for colleagues overseas. This is truly what I call, you know, the safest product to the lower eyelid to produce the skin quality. Yeah, excellent. Fantastic. Thank you, Stephen. We just got one, I guess, announcement or message. We alluded to it right at the start. There's a Regurian Academy here in Sydney. That's actually tomorrow, by the time this podcast is out during the first. That's at the W Hotel, the programmes for all levels, whether you're a beginner, never touch Regurian or you're an expert. There'll be something there for you. There'll be some local KOLs, international KOLs. I'm attending, but I'm just going to be enjoying. I don't know if you're going, Stephen, will you be attending? So, unfortunately, it's a day I fly out of this country. I think the company did it intentionally. I think this is a good initiative. They're trying to get all the practitioners, workers who are interested, who's been involved with it to create a network, a local network, to learn from each other, local, as well as international experts, because there's so much things that is still used to be explored. Every one of us does it differently. I think this is thing that we can learn from each other. How to minimise pain, as you mentioned before. What are they doing it differently now? What are the things to come? I'm so sorry that I'm going to miss out, but I will have been tasked to film the videos to give some of my insight things I've learned about Regurian, particularly my new technical of doing it. So, yeah, I think everyone should go. If you're interested, you're remotely interested, or you're nervous, or you are expert in regurian, I think you'll learn something. Do me a big event. 400 people get on something. Wow. Yeah, be good. Be people. Yes. Well, thank you very much for your time, Stephen. It was a pleasure to have you on and sharing your knowledge and experience. Thank you very much. Yes, your fifth of course. Yeah. I hope you're on the big list. Well, I think the next one will be the best that we're going to do even more. Yeah, we're looking forward to it. Okay. Thank you. See you later. See you.insidersetix.com/patreon for more information.