Eva Sheie (00:00):
You're listening to Where Before Meets After. You both mentioned RenuVion at some point. For those who don't know, what is it? And to me it sounds like it's almost become universal, like this is something we're all relying on. Is that accurate?

Dr. Epstein (00:13):
Yeah. RenuVion is skin tightening using radio frequency. And skin tightening is the last hurrah in plastic surgery. When you solve that, you solve a whole bunch of problems. And I've been doing radiofrequency skin tightening for about 12 years now. This is the third system I have, and I would say the first one that really works and very, very, very little risk and complication.

Dr. Nykiel (00:37):
And I think to answer your question, we both mentioned RenuVion, it's a radio frequency and plasma, it's basically energy delivery system to help tighten up our skin. For me, I usually get about a third. And the way I kind of look at this product is similar the way I looked at Vaser ultrasound. When Vassar ultrasound came out, it was a new product. People were kind of like, oh, is a vaser. And now it's just called ultrasound, right? Vaser still has a brand name recognition, but it's ultrasound. And when you look at most individuals I think that do good body contouring in any part of the world at this point they use ultrasound. And I think you're seeing that same sort of revolution with the ability to tighten skin because with ultrasonic liposuction or Vaser Lipo, we're able to reduce blood loss and we're able to free fat up easier. So many of the risks and complications from lipo of blood loss start to fall out or at least decrease when using ultrasonic lipo. Would you say that's fair, Mark?

Dr. Epstein (01:31):
Yeah. There's less blood loss, less trauma too, because you're emulsifying the fat before you're even removing it.

Dr. Nykiel (01:37):
Absolutely. Right now, as body contouring experts, it's not can we remove the fat? Well, what are we going to do with all this skin? And that was the main rate limiting step, right? And then what that addition of radio frequency, RenuVion is not the newest one and I'm sure there's going to be other ones after it. It worked quickly. The other devices would literally take an hour to work and you don't have an hour in an operating room to do just one portion of the procedure would become, and when I say an hour, that's to do both arms. I mean, that's not even the torso. It would be not feasible from a safety standpoint.

Dr. Epstein (02:12):
The beauty of the RenuVion is that it brings the tissue up to the temperature 85 degrees C, where you see really good tissue tightening. It does it for a blink of an eye 0.4 seconds, and then the tissue cools. So you don't have risk of a thermal injury, but you get 3,500 times the ability for the skin to contract than you do with something like BodyTite, which struggles to bring the tissue up to 65 degrees. And there's more risk for thermal injury for having burns on the skin. So for me, once I got my RenuVion, the body type machine has been parked in a corner.

Dr. Nykiel (02:47):
I feel like in full disclosure, we both need to just say we're both KOLs, teachers for RenuVion, and just for other people listening, I love the product. I think it's a good product just as we're,

Eva Sheie (02:56):
I don't think either of you would even be a KOL them if you didn't believe in it. I don't think, neither of you is the type.

Dr. Nykiel (03:02):
I don't think we would either, but I just want, just in case anybody's Googling as they're reading, they're like, oh, this guy, they talk for them. And we do. One other point about the skin tightening thing that I think is super interesting is the skin tightening is also another piece that we don't often think of in that body balancing, right? When we talk about the back bra rolls, when we talk about the waist, that ability to tighten that skin up. For me, I usually tell people it's about 30%, but by getting that skin to snap back by about 30% just gets that little bit more shape. It shows a natural definition. I think there's a lot of debate about how much definition's, too much definition for the most part. Everybody wants some definition. Everybody wants to look like they at least go the gum. They may not be like the bodybuilder, but they want to be like, Hey, I'm eating healthy and I'm working out. They would love to have a shape that looks like that. I don't think anybody's going to be against that.

Dr. Epstein (03:53):
There's very few people that have just one problem, loose skin or excess fat. It's usually a combination. So I explain to the patient, you have two problems. We have two technologies, two solutions. Lipo doesn't take care of loose skin, RenuVion doesn't take care of excess fat. Put the two together and it's an incredibly potent combination to get a better result.

Eva Sheie (04:16):
So in this progression of RF devices that we've been seeing over really 20 years, right?

Dr. Epstein (04:23):
Yeah.

Eva Sheie (04:23):
This one requires you to be under general anesthesia. Is that because of the heat or can you do it without anesthesia?

Dr. Epstein (04:29):
No, I've done 'em under local.

Eva Sheie (04:30):
You can.

Dr. Epstein (04:31):
What matters is the total area that you're putting the local anesthesia in because there's a limit to how much lidocaine you can give before it's toxic. So when someone is asleep, I'll put 0.04% lidocaine in my tumescent solution. Technically you don't need to put anything in because, they're asleep. But I found that when I use 0.04%, the patients wake up far, far more comfortable than when I didn't. And then if I'm doing so on awake, I use 0.1%. So it's two and a half times the lidocaine concentration. So there's a limit to how much you can give before you reach a toxic level. So that's the rate limiting factor more than anything.

Dr. Nykiel (05:10):
And anything when you're talking about awake versus asleep, I think it's also just an important point for people I listen to just that it really depends on who you are. Some people are totally fine seeing things being pushed in and out of you, hearing noises, smelling smells, and other people are like, absolutely not. I do not want to see that at all. I think that's a big portion of whether or not you could tolerate really any procedure awake versus asleep. Some people do breast augmentations awake. If you find the right patients in that they can tolerate it and they'll remain calm, then it's good.

Eva Sheie (05:42):
Alright, give me your Instagram, your website, and where to find you.

Dr. Epstein (05:45):
Epsteinplasticsurgery.com. And our Instagram is Dr.mark. MARK Epstein. You can find me on Long Island in Hauppauge. It's in Suffolk County.

Dr. Nykiel (05:56):
And I am SoCal plastic surgeon, Matt Nykiel in Newport Beach.

Eva Sheie (06:00):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.