There are 24 hours in a day, your day, my day, everybody’s day. Hey, it’s Marco Pelosi III, and this is the Top Cosmetic Gynecologist Podcast. If you take your 24 hours and commit yourself to a solid plan with a solid strategy and relentless action every day, amazing things can happen. You can become educated in a specific field, you can become an expert in a specific field. You can even create your own special niche.
Marco Pelosi III:
I didn’t know the backstory of the subject of today’s episode. All I knew was that he was a world expert in a special niche. Maybe you knew him the way that I knew him before our conversation, but now that I know his incredible backstory, I am uniquely impressed. And when you’re done listening, I think that you will be equally impressed and definitely inspired.
Marco Pelosi III:
Hey, it’s Marco Pelosi III, and my guest today is not a cosmetic dermatologist or a facial plastic surgeon, but his name is synonymous with one of the most popular facial treatments in the world. My guest today is not a gynecologist, but his name is synonymous with one of the most popular vulvovaginal treatments in the world. My guest today is not a urologist, but his name is synonymous with one of the most popular penile treatments in the world.
Marco Pelosi III:
He comes from a small town and practices in a city of only 15,000 people, yet he attracts physicians from all over the world to learn his techniques and his genius has taken him everywhere but the bottom of the sea. So here he is, live from the Gulf Coast, from Fairhope, Alabama, the father of the Vampire Facial, the O-Shot, the P-Shot, and a few more innovative techniques, the Iron Chef of platelet rich plasma, the one and only Charles Runels MD. Thanks for being here, Charles.
What an introduction. I’m honored to be on your show. I know you and your father have really revolutionized gynecology, so thank you for having me.
Marco Pelosi III:
Well, you’re no sloucher yourself, Charles. I was on the Google Maps just now, and I saw that you’re about three hours east of New Orleans, and about an hour west of Pensacola. I also saw that the Census Bureau came up with a word to describe where you live. They call it a micropolitan area because it’s so small that they don’t want to call it a city, but it’s big enough that they don’t want to call it the middle of nowhere. Have you always lived in Alabama?
Yeah, so I grew up in Birmingham, went to medical school there, and went to undergraduate there, and then I worked as a chemist there in Birmingham. And part of the reason I came here is, I was born in 1960, and so that was the days when Birmingham was a big steel city. Actually, the thing that put Birmingham on the map is everything you need to make steel is there in one city. You’ve got iron ore, you’ve got coal mines and so I would wake up in the morning, and sometimes you couldn’t see.
This is before pollution control, and you couldn’t see a quarter of a mile sometimes from the smog. I would help my dad wash the car in the morning, and by the afternoon, you could write your name in the soot, so I always said, “When I grow up, I’m going to go where the air is clean.” Even though they cleaned up the city when I finished medical school, I just drove south down I-65 until I hit the beach and that’s where I stopped.
Marco Pelosi III:
So what do you like most about living down there?
Well, I like the fact that, I’m sort of an introvert, I am an introvert, and so I can be outside, and as far as social distancing we’re supposed to be doing, I do that every day. There’s nothing different about that, but I enjoy people, and so I can go jump on a plane to Pensacola and be wherever I need to be but live my life in my hermit sort of way.
Marco Pelosi III:
It looks like you’re like a big outdoors man. When I first met you, I thought you were a retired pro wrestler or something. Have you been into… You’ve got that look. You’ve got a shaved dome, you’re a big guy.
Oh. Well, I never was a very good athlete, but Jack LaLanne was always my hero, even as a child, and so I’ve always tried to stay fit, and that’s the other reason I like this area. I can go running on the beach, or I can walk for a long time out in the fresh air, and so it’s a healthy place to live. But I enjoy the city too so I like coming to visit and speaking in New York and Miami and Los Angeles, wherever. But this is where I plug into my battery, down here in the south.
Marco Pelosi III:
Now, you’ve been traveling all over the place with your Society for Teaching, the platelet rich plasma techniques.
Yeah, so we’re in 50-something. countries. I’m really honored to have had some, a lot of really bright people like yourself who thought the ideas were worth talking about, so we have physicians who teach for us, and also in New Zealand we have Alex [Bader 00:06:09] teaching in Greece and London and others, [inaudible 00:06:12] in London. We have people in Spain and South Africa and Brazil, and many people in your group who speak for us, who teach around the world, so I’ve really been honored and blessed to sort of been born as kind of a mad scientist kind of guy, because you can’t…
I actually remember evacuating the house once when I think I was about… I discovered electrolysis reading in a book, or I didn’t discover it but I’d learned about it, and had managed to make a little container of chlorine gas when I was probably 12. And I remember having to evacuate the house when my chlorine gas escaped using electrolysis and table salt and some batteries, which I’m sure you remember from the chemistry how to do. So, I just, I have always kind of been… Then I worked for a few years as a physical chemist before medical school, and was blessed to be in that environment where if you don’t have new ideas, you don’t survive.
We were creating things that our Armed Forces use now to protect themselves, and I was blessed to live in that PhD world for a while as a physical chemist. So, it’s been an interesting journey, and I’ve been blessed to have been around smart people like yourself, and basically just try to soak it all up and digest it and come up with something new. It’s been a fun journey.
Marco Pelosi III:
Now, when you went into chemistry, was that a career change going from chemistry to medical school, or were you planning medical school all the way through and this was just another step in the process?
Honestly, I was one of those guys who had to apply a couple times to get in, and I had always sort of vacillated between engineering and medical school anyway, so when I didn’t get in the first time, I worked as a chemist and going to weekends and nights to study to become a biomedical engineer and working as a chemist in the daytime. And actually, I’d kind of given up on even going to medical school. I thought I was going to be the mad scientist and create the next instrument that doctors would use, so I was working on… We had a top secret lab and obviously can’t talk about what we did, but we were doing pretty amazing things.
I had pretty much discarded the idea of going to medical school, and as moms sometimes do, my mother said, “You know, you ought to just go put in an application one more time,” and I halfheartedly did and got into medical school down there in Birmingham. But in my heart, I was always sort of the want-to-be inventor, but that’s sort of like saying you want to be an astronaut, so I thought, “Well, I’ll just go do medical school and see what new ideas I can think up along the way,” so that’s kind of how it worked out.
Marco Pelosi III:
Yeah. In medical school, what specialty did you decide on?
I did internal medicine largely because I thought if my idea was to invent things and think about the science part of it, it would give me a strong face that was broad, and I could pick what to dive into, and so I dove into… For example, for a while I was doing VO2 max and was doing some clinical trials to see how Genotropin, a form of growth hormone, is affecting VO2 max and Pharmacia was paying me to do that. So, in spite of being in a little town, I managed to hook into some clinical trials, but during my training as an internist, I did ER.
I did (like a lot of people) a lot of moonlighting, so I worked in a busy ER here in Mobile, Alabama, 35-bed ER back when they staffed it with one person. I did that for 10 years, so that gave me I think an understanding of… And during that time, I ran the wound care center at the hyperbaric chamber there in the hospital base, so we treated a lot of diabetic ulcers but we also did things like necrotizing fasciitis and Fornier’s gangrene, so running a ventilator through a hyperbaric tube of wall in the hyperbaric chamber and that sort of thing. So, it gave me a good strong understanding I think of wound care and that’s part of what led to the PRP procedures with having that background and interest in how wounds heal from my ER background.
Marco Pelosi III:
Right. It seems like it is a smaller hospital, each physician is actually doing more of different specialties out of necessity and getting some really broad perspectives.
The thing that’s really been interesting to me is that something that may help some of the doctors in your group, I know a lot of the doctors in your group are connected to big universities, but many are not. Many are in, they’re in community hospitals. There is this unspoken rule, I think, that doctors pay attention to which goes something like this… “Unless you publish 20 papers and you’re connected to a big university, who are you to say anything? And if you do say something or you write a book, or you have a new idea, maybe it’s dangerous to talk about it,” and the close… Rightly so, we have to be careful to first do no harm, and so it’s not like we can just be out experimenting on people.
On the other hand, I think that we as physicians, even if you’re in a small town, have an obligation to pay attention to what’s going on, and have the courage to speak up about it, whether it’s in writing just in a local medical journal or speaking at a meeting and asking questions, or going to meetings, that’s why I like to go to meetings like the ones that you and your father put on with the ICG, because there’s this… As you know, the research lags probably what gets published, lags of maybe six months to three years, depending on the topic, to what the true leaders are doing.
So, I think this idea of paying attention and being willing to dive deep into the literature and go to the meetings and figure out not… When you say a specialty like internal medicine or gynecology or urology, that’s still very broad, but when you take a real specific problem like, say, “How can you inject around the urethra to help incontinence,” that’s a very small area that you can now go read about and read everything that’s been written about that in a week or two, and now you’re an expert. It doesn’t matter what’s your specialty.
Then, you go to meetings like what you guys put on, and you talk to the people who are the world experts, and before you know it, you’re able to take part of the conversation, no matter where you live, and no matter what letters are behind your name, if you’re thoughtful and you truly do your homework and dive into the research, and you keep an attitude of always thinking that there’s something really important you don’t know about, it can lead to a real fun adventure. So, that’s one reason I appreciate people who go do the work, who put on meetings and form societies like you guys have done with ICG because if you have that idea that you’re at home, very proud of the wagon wheel you’re building while someone across the street may be making a rocket ship, it keeps you paranoid and it keeps you out there on the street and your nose in the literature, and good things happen.
Marco Pelosi III:
Yeah, absolutely. What you were saying is, really I was doing an intro for next week’s podcast, and I was talking about how the change in technology and communications that have come about over the last 15 years have broken down to traditional academic filter system for information and have allowed people to communicate around this wall of academia at a much faster pace, and that the traditional curators of information have now been challenged by different curators with different ideas and different speeds of action, so now it’s not just one voice like it used to be, like always from the ivory tower, but it’s coming from different places. Like anything else, the more ideas that you have, the faster that you burn out the bad ideas and the faster that you funnel the good ideas.
Yes, and the other… If you think about, along the lines of what you just said, if you think about how it used to work when I was in medical school back in the 80s, someone had an idea, they did some research, they’d publish in a journal. That came out on pieces of paper, in a magazine, in your mailbox. And then, you read it and you wrote a letter to the editor to voice your opinion about it, and maybe you did another followup, research based upon that idea. That still goes on, but while that’s going on, as you just alluded to, you have… I just saw where the Newman Journal put out a link today to where an audible discussion of what we can learn from the hotspots with COVID-19, and so that’s out immediately.
And then, you have people like yourself who are doing podcasts about it, and then you have websites with blogs where doctors, instead of something getting published in a magazine and you sending a piece of paper, letter, that maybe gets published in the magazine two weeks later, you have a live blog where doctors are talking to each other, so with our organization, where we are focusing on, say, just an O-Shot procedure to help with incontinence or lichen sclerosus, we do conversations like this every week, but we have doctors sharing their ideas real time. So, like you said, it allows the ideas for us to rub minds against each other so that when you do get around to doing the research that gets published, it’s already been fine-tuned to a certain extent so that the results are more meaningful and maybe more pointed than they would’ve been otherwise.
Marco Pelosi III:
Absolutely. Absolutely. I think we’re living in an exciting time. All right, so you were working in ER medicine and internal medicine for about 10 years. Let’s explore the bridge from that to the first major hit that you had, which was the vampire facelift. How did that come to be? How did you get from point A to point B with that?
Yeah, so it’s like a lot of things, our best stuff comes out of getting beat up. I’m a firm believer when someone punches you in the nose, you should look at them and say, “Thank you very much,” because it usually motivates you to do something, and so I sort of got punched in the nose. The short version is that when I quit the ER, it was largely so I could see my children more. I would be home on a Tuesday and then working on a Saturday, and when my oldest started school, that meant that I quit seeing him so much, so I said, “Okay, I’m going to open my practice,” and I decided the best person to market to would be the 40-year-old women, because we know that women rule medicine. In every family, every doctor should know this, if they don’t they should make a poster to remind themselves, every family has a woman in charge of the health of that family.
If you take good care of her, she’ll bring the whole family. If you don’t, the whole family’s gone. And I don’t care if you’re a physician and you’re a man, there’s a woman that’s in charge of your health somewhere, maybe your mother, your wife, your sister, and we all, as ER doctors, you see it and you can talk to the rest of the family but until you find the woman in charge, they’re not all in, but if you find her, and it’s usually the daughter at the bedside or the mother, whatever, if you explain it to her, and she then, she’ll make sure all the rest of the family comes in line. Does that sound right to you, or am I off base here?
Marco Pelosi III:
No, no. That sounds like… You had, what marketing people say is you had your ideal patient, and you learned everything there is about how that patient is, how they feel and you direct the whole approach aimed specifically at that one target and you become the king of that domain.
Exactly, so I decided when I quite the ER, I enjoyed taking care of women. I pondered gynecology as a resident, and I enjoyed taking care of women, and they’re more complicated than men. They’re interesting because their hormonal milieu and the way, just their whole, the way they work to me is fascinating, and so I said, “Okay, I’m going to take the best care possible of the 40-year-old woman who’s 40 pounds overweight and feels tired and having trouble with sex and thinking, and if I take care of her, she’s going to bring the daddy and all the kids,” so before I ever quite the ER, I started going to meetings. How can I take care of this woman? How can I help her think better, lose weight, have better sex, help her think, help her with her blood pressure and her diabetes, whatever?
And so I was at a meeting, it was an A4M meeting before they were as big as they are now, in 1999, and I’m sitting there and a gynecologist presented a paper. This is one of those pivotal points in my life, I think. I’m sitting there listening and the gynecologist presented a paper in 1999, so it’s 22 years ago, and the paper was about using testosterone pellets to help women with migraines associated with their menstrual periods, and he had published the paper in neurology. So I thought, “That makes sense.” Back in 1999, to get good pellets, at least the best way I could find them, was to order them from Europe. I had a autoclavable [inaudible 00:20:43] and so when I opened my practice in 2000, so 20 years ago, when I quite the ER, I’ll be 60 this month, so when I quite the ER in 2000 and opened my practice, I introduced testosterone pellets.
And as you know, it does a lot more than help women with migraines, and before I knew it, I was doing, I had 3,000 women, 3,000 charts, most of them menopausal women, and that’s what led to the clinical trials with Genotropin and [inaudible 00:21:19], and I had the same mass spectrometer that Stanford had, was doing VO2 max and anaerobic threshold, and seeing how growth hormone was changing. And I was doing formal stem testing and looking for growth hormone deficiency by formal stem testing, not just [inaudible 00:21:36]. So, I became, I was going to the endocrinology meetings and the A4M meetings, so I became this sort of hybrid that was taking conservative endocrinology but looking for the people using the same open-mindedness as an A4M doctor.
Before I knew it, I had 3,000 menopausal women I was doing hormones on. Then came a punch in the nose, and this is what led to the O-Shot and the vampire facelift. The punch in the nose came when a bunch of things happened at the same time that felt like a punch in the nose at the time but was the perfect, exactly what I need. So simultaneously, remember I’m doing stem testing so I had a higher standard than insurance did, much higher standard, and part of the phase four study of Genotropin, but I had about 300 people, 310 people, that Blue Cross Blue Shield was paying for their growth hormone, and it was extensive, also because they had failed stem testing, and these were people that were… It wasn’t bodybuilder stuff.
It was things like, there was a woman who had been diagnosed with polycystic ovarian disease and was infertile and trying to get pregnant, 100 pounds overweight and on prediabetes medicines, but when I stem tested her, she had no growth hormone. And after she lost 100 pounds and got pregnant, and I sent her to the high risk OBGYN department down here at University of South Alabama, they diagnosed her with empty sella syndrome and kept her on the growth hormone, and she delivered a beautiful baby. So, it was those kind of people [inaudible 00:23:19] like nothing was a vet from Vietnam who dated his obesity to a head injury. Well now we know head injury can cause shearing forces in the pituitary gland and leave a growth hormone deficiency, and I had replaced him and he lost weight. Basically a lot of amazing stuff happened.
With people, these were not jocks. These were people that as an intern, I was doing hardcore medicine and putting these people in a phase four study, but it was costing Blue Cross Blue Shield too much money. And so simultaneously, three things happened. Blue Cross Blue Shield audited me, and some things happened with my marriage and all of a sudden I had three boys, ages four, six, and eight that were in my house six nights a week. So now I’m a single dad. So I looked at all that, and so when I go see Blue Cross Blue Shield, I have to explain how this feels. By the way, this has a happy ending, or it’s not over yet. I’m still out here doing stuff.
But there was a transition point because, and it was it turns out really great, because I was seeing these ladies and I really wasn’t making money because I would get maybe 80 bucks and spend an hour and a half with a woman trying to think about her hormonal milieu and these were complicated people. And Blue Cross would send me $80 for an hour and a half. So I was floating to practice on the clinical trials. I did other things with the antibiotics and some pain medicine, those sort of clinical trial for hire guys, so I could practice. So when Blue Cross audits me, I’m driving up to see them, and by the way, I buy Blue Cross Blue Shield insurance. They kind of rule Alabama, and I have it for all my stuff, and from a patient side, it’s wonderful.
But the doctors in the crowd will know all the insurance companies, in my opinion from the doctor side, they’re basically pimps. The way I look at it, the pimp tells you, “Listen. I’m the pimp daddy, you’re the prostitute. These [inaudible 00:25:26] patients are going to pay me money and I’m the pimp daddy. I’m going to decide if you get paid and when you get paid and how much you get paid, and if you don’t like it, you’re going to starve to death, because I got better looking prostitutes coming out of medical school every day.” That’s how it felt to me.
The other thing I was doing is Hyalgan had just came out and I was the number two doctor in the state injecting Hyalgan into knees because it helped my overweight patients walk. So I get up there and Blue Cross, I’m sitting at this long table, and they had an endocrinologist from the AV and a couple of people from Blue Cross Blue Shield, and I swear the table was 30 feet long for four people. So they’re doing the intimidation thing. And they tell me they’re going to fine me $3,000, something like that. And they’re going to change the policies for how a growth hormone is prescribed, because I was doing the standard higher than what they required, but when they realized it was costing them money, at that point they didn’t age adjust IGF-1s.
Think about it. We’ll age adjust TSHs, and there’s no… If we did, then we wouldn’t be treating the elderly people with hypothyroidism. And back then, they did not age adjust IGF-1. There’s no science to back up that idea in my opinion. But anyway, so they changed their policy the very next month. They told me how they were going to change it, and honestly I thought it was unethical, and it meant that they were cutting off my 300 patients, including that lady that had polycystic ovarian disease, including a lot of other people that I could tell you were just train wrecks. So they cut off my patients.
So I took a big, deep breath and I said, “You know what? I’m supporting this whole thing on my clinical trials anyway, and now I’m a single dad.” And by the way, the first week after that, getting my children six nights a week, I would take them to the hospital. I didn’t think you were a good intern if you only had 15, 20 people in the hospital, and I thought it was a good intent of this. So I would have people in the ICU. I took all three boys and I’d just stick them in the doctor’s lounge, and then after about a week of that, I said, “Okay. I get to decide. Am I going to just not come home and hire somebody to raise my boys? Or am I going to give up hospital privileges?”
And it was like falling off a ledge, because I felt like with 10 years in the ER and an interest in pulmonary medicine, I felt like I was just taking a piece of my brain and putting it on the shelf. But I gave it up. And then I started just doing clinical trials because when I told Blue Cross Blue Shield to piss off and gave up my PMD status, I found out that you can’t bill cash to Blue Cross Blue Shield patients for six months after that. So they try to starve you out with a non-compete. So for six months, I just did clinical trials, and then I started seeing patients on a cash basis, and I said, “Okay. What will they pay me for?” I said, “They’ll pay me for sex and they’ll pay me for their hormones.” So this was around 2003, 2004, and as an intern in Alabama with not many people in my county, I started doing a cash practice.
And I figured they would pay me for cosmetic work, because when people lose weight, they want their faces fixed. Like ladies who want to gain their weight back would make their face look old when they lost weight. So I found who’s the top cosmetic guy so that I can learn how to… We didn’t have Juvederm yet, we just had [inaudible 00:29:06], but I found the top [inaudible 00:29:06] in the world was a guy up in Toronto. So I went up there a couple times and stayed with him a few days, learned what he knew about injections, and I started doing cosmetic work on my weight loss patients to help motivate them to keep losing weight.
I thought cosmetic work was kind of a wimpy thing to do. But I saw it as a way to motivate people to lose weight, and then I learned how important it is to people’s psychology, and it became really important to me. So now that was the perfect storm. I’m taking care of people for cash and I have a background in wound care and I’m doing cosmetic work. Then a guy walks into my office one day, and says, “I see you’re one of the top cosmetic injectors in town. I’ve got this stuff PRP and use it like Juvederm, and you get new volume, new blood flow, and there’s never been a side effect.
And I’m thinking, “Man, I’ve done wound care for all these years and I’ve never really worked with PRP much. But if that’s true, I have a better place for new volume and new blood flows in my space, because I’m a man, right?” So I thought, “I’m going to play around with this for a while and see if, and read the research and become an expert on PRP, and if it really does what they say it will, this should be a good thing to put into the penis.” But here’s the problem I saw. Here’s the worry I had. I thought, “Okay. When you see a doctor advertising, say, Botox, if you think about what that means, it’s like advertising beef but you don’t know if you’re going to get a hamburger or a Ruth’s Chris steak, because you’re advertising the material, not the way it’s going to be used.”
So I thought, “The same thing with Juvederm and the rest of them. It’s a material, and we’re advertising the material, not the method.” So as you know, you can go into one doctor’s office and get something wonderful and then someone else can get something scary, and it’s still not managed by any medical board, even the plastic surgery boards, it’s not part of their boards. So it’s like the Wild West. So I thought, “If that happens with PRP for sexual problems, somebody’s going to get hurt.” So I had an idea to do… I was watching what physician’s weight loss had done, what synergetics had done, Priapus Shot in other arenas, not medicine, but other arenas where a trademark meant a way of doing something.
And honestly, I thought the vampire thing was just going to be a one or two month experiment. I thought, “I’m going to experiment with a trademark that means a way to do something to the face.” And if that works, I was still thinking penis, I’m going to roll out the thing with the, Priapus Shot is what it turned out to be, but I tried it out in my penis. It was working. I was doing it privately with my patients. They were loving it. But I hadn’t talked about it openly yet. So I wrote out the vampire facelift after studying things and thinking about how to design the business side of it for a few weeks, and when it went viral, it just went crazy after that.
Then before I rolled out the Priapus Shot for men, I did the O-Shot on my lover. I had followed Matlock’s work and that’s a whole different story. We can talk about it if you want. But it felt to me like women needed something more than men, so I actually rolled out the O-Shot before I did the Priapus Shot. So it all came about if I hadn’t gotten beat up by Blue Cross Blue Shield, I’d probably still be making rounds and keeping 20 people in the hospital, so it was good.
Marco Pelosi III:
Now tell me, that’s some really, really insightful marketing thinking. So you just came up with this in your head? Did you have any marketing background? Did you seek out any marketers? Or you just were a good observer?
Well, that’s stand that part of the story. If you look on the map and you look at the demographic, last time I looked, we have about 250,000 people in my whole county. That’s including the tourist area at the beach. That’s the equivalent about four square blocks in New York City. That’s what we got in the whole county. And yeah, there’s some people who retire here and have cash, but there’s a lot of farmers and people who are really good people, but don’t have money for cash stuff so much. And so I thought, when I went to all cash, 2003 was when that happened, when I went all cash, I thought, “I need to be able to attract people from other places.”
And by the way, when I went all cash, it was a very scary thing. It was not a smooth transition. The house was almost paid for and I gave it back to the bank. I declared bankruptcy. I went to the little house across the street from my kids’ school to see if I could walk them to school in the morning and they would find their way home in the afternoon, usually with friends. I became sort of after school care for four or five kids most days. And I just plowed into marketing, because I thought, remember, I had the little six month hiatus when I couldn’t bill anybody cash and was living in a couple of clinical trials, and I thought, “I need to be able to attract people from other places.”
And I started going to marketing class, and the deal, because my, again, thanks to getting punched in the nose and starting all over, my deal was whatever I spent on a marketing class, this is actually, I still do this. When I went to your guys’ meeting, by the way, that was a wonderful meeting, the ICG meeting down in Fort Lauderdale a month or two ago, I started having a rule that if I went to a class that was a marketing class or a medical CME class, I had to take at least one thing I learned and make some money back within a month. That was the game I started playing. That included travel expenses and time lost from being away from the house.
And back then for example, I was doing a clinical trial that involved investigators meeting in San Diego. And so I literally, after that meeting, I could afford the airplane ticket but not the hotel room, so I slept out by the pool at night and went to the meeting. But again, this is not a sad story. This is just a kick-ass story, right?
Marco Pelosi III:
Nothing was going to stop me, and because my back was against the wall, if I was to learn something, I had to implement it in such a way that people got well and I made money. And this was something that a lot of doctors I think skip over, but if you stop and just think about what that means, if you’re charging a patient cash, then unless you are a thief, which we are not, and by the way, if you’re a thief, you’re going to go out of business because people will figure out you’re a thief. So if you want to make money by people giving you cash, it meas you have to do something profoundly good for that person that a doctor taking insurance cannot do. I’m going to say that again.
If you’re going to take cash from a patient, you better be effing good at something, and so much better than the doctor taking insurance, so much better than that doctor that the patient is glad they gave you the cash, or else you’ll be discovered to be a fraud and you’ll go out of business. So I became even more passionate about learning and learning medicine and learning marketing, too. So it’s not an exaggeration to say that I’ve spent over $2 million on my market education. For example, I paid one guy $1,200 a month for three years for just one hour a month, but the guy still marks over 10 million a year just writing emails. And so he would read my emails and think about what I was doing and advise me, and then I would take what he taught me and I’d send out an email and I’d have patients come and see me.
I couldn’t afford to hire somebody to build my website, so I studied how to build websites, and I still do that. For the past six years, I’ve paid a couple of programmers $2,000 a month, so do the math on that. $2,000 a month, one hour a week, you look at my websites, I have 31 websites that make money for me. I have over 150 websites that are out there feeding the other 31. And so we just look under the hood, by the way they look under the hood and how the software works, you make them work harder. So that website that we just threw up, COVID-19 switchboard to help people find people who have COVID-19, help their doctors find people with convalescent plasma, that took about three days to build, and it came from that background of having to do my own websites.
So yeah, I’ve studied profit models, like one class I did last year cost me $35,000 for one class. But one of the guys in the class who spends $500,000 a week on his TV ads. So as I learned more, the classes became more advanced and the people I was hanging with became more hardcore, like the guy that made Taylor Swift famous was in one of my classes. He was actually hiring Taylor Swift’s father as a physician who paid this guy $250,000 a year to make her famous. And so it’s been a really… By getting beat up and going broke, it forced me to work my brain harder and it gave me an understanding. I know what it’s like to be the primary care doctor who has three babies sleeping in the room next to you, single dad, and wondering how you’re going to feed them, and waking up in the middle of the night wondering how you’re going to take care of them and take care of patients.
And there’s a climate for physicians has gotten worse. It’s given me a real heart for the doctors who are struggling, and it actually was a really blessing to me to get beat up and out of it came this interest in marketing. Marketing, good marketing makes you a better doctor because if you’re a really good marketer, you realize you have to tell the truth and if you’re going to have people give you money, you better get to be really good at what you’re doing. So we kind of feed off of each other.
Marco Pelosi III:
Sure. When did you start teaching doctors your procedures?
It was about a year after I’d been doing them. I started with a P-Shot idea, but I started doing the facelift as a way to combine a specific manner of fillers with PRP. And I had developed I think an expertise by doing what we talked about. Finding the wizards, who’s the best at this? When I talk to surgeons when I’m in London, they know the Pelosis. When I’m in Madrid, they knew who the Pelosis are. I’m talking to gynecologists around the world, they know the Pelosis. So there’s those wizards in other arenas as well. So I had the guy that taught me Juvederm and Botox was the top [allergen 00:40:11] account because he was a wizard.
So I had developed an expertise there that surprises people still, thanks to my teachers. So I started teaching after about a year, I started teaching the Vampire Facelift® first because I know this idea of being [inaudible 00:40:29] at risk of giving the… There’s so much hokiness around penis growth and such. It’s becoming less so now that we have legitimate surgeries and such. But 20 years ago, it was not so much out there and you were at more risk for being labeled a quack if you talked about penises. So the first class just taught the vampire facelift and Botox and Juvederm, and then I started teaching the O-Shot after I developed that.
And I probably had… I was still doing everything else, but after about two years and having some of the physicians whom I taught tell me that the O-Shot® was really working surprisingly well for incontinence and some of these problems. So two years after developing the procedures, I started offering a class once a month and then helping other doctors fill their classes. So we’re up to now we have 80-something doctors who teach our procedures, and [inaudible 00:41:29] teaches his laser classes. So I’ve really been blessed to have some of the wizards think about this stuff and help me think about how to make it better.
Marco Pelosi III:
The first time I heard about you, I said, “That’s the Vampire Facelift® guy, and he came out with the O-Shot®.” But people that I trust love this thing and they’re having a great experience. I was really impressed. I said, “This guy is an interesting guy.”
Well, thank you. There’s a little trick about the face that I don’t usually talk about except in my classes, but part of what gave me the idea of the O-Shot is really three things that happened. One is that by doing, as you know and doctors who take care of women know, but most people don’t know this, is that even now, most women who’ve had sexual problems, they don’t talk about it much. Unfortunately, sexual problems are like psychological problems. Consider this. If you have pneumonia, if you have COVID-19, if you had a broken arm, your family asks people to pray for you and everybody talks about it. If you’ve got schizophrenia or major depression, you don’t.
There’s this stigma for psychological problems for people who are embarrassed by them, even though there may be a neurological problem or a chemical problem that causes it, people are embarrassed by, and it’s the same with sexual problems. People are embarrassed. Like you’re never going to see a celebrity endorse the O-Shot®. Even though celebrities and movie stars, they’ve been in my office. Yeah, they come to Alabama. They still pee on their leg and they still have dyspareunia and trouble with orgasms, but you’re not going to see a movie star talk about dyspareunia because it kills the image. So sex problems are a secret, and they’re not talked about much, but if you’re taking care of women and you make it safe for them to talk to you, they will open up to you and they’ll start crying because they’re afraid to tell their husband, afraid he’s going to get his feelings hurt. They don’t tell their girlfriends because their girlfriends don’t give any sympathy most of the time.
And so they just kind of keep it to themselves. And their doctors, you and I know, most of the doctors will cut off the conversation after one question. So they’re suffering. I’m watching Dr. Matlock with his G-Shot, and I’m watching what he’s doing. I’ll never do this because as an internist, as you know, there’s a risk of granuloma, urinary obstruction, and so I don’t want to be making a problem I can’t fix. So I never did it, but I was watching his work. Now when I started doing the face, here’s what gave me the idea for the O-Shot®. First, I had a heart for women. I’ve been doing their hormones and many of the problems they were having with sex they weren’t telling people about.
Second, I’m looking at all this stuff with wound care, but when you shoot PRP under the eye, when I shot PRP for the first time into the tear trough under the eye, it causes aqueous. You can just see it hydrodisect. And I thought, “That would be the same thing around the periurethral space.” So again, I’m not a surgeon, but I know you guys hydrodissect that space when you’re getting ready to put in a mesh and a lot of other things. But I shot that in there and I thought, “Man, that might help incontinence, because you can do what Matlock does, only you wouldn’t have to worry about granulomas, there’s never been a granuloma from PRP, and it would take on the shape of that space without worrying about causing any problems, infections or neoplasia or anything like that.
So doing the face really, had I not done the face first, I would have not gotten the idea for the O-Shot® procedure. The other thing that’s kind of weird probably for most people is to think about that I don’t talk about much, but I might as well confess to your people, is that in the process of taking care of those 3,000 women and just from my personal experience, I had written a book on how to teach a woman to ejaculate. And I was fascinated by the physiology of it. I’ve read probably everything that’s been written about in the medical literature as well as every book on Amazon about it and too many lovers that a man shouldn’t even be talking about.
And so I had developed a way to teach a woman to ejaculate, clearly ejaculate, as in from the Skene’s glands and the periurethral glands and had written a book and it was one of the things I was selling on my website. So the first time I did the O-Shot, I’d like to say that I had thought about the incontinence thing. I really hadn’t. I was thinking more in terms of sexual function. So the place where I put it, I put it more distal from the bladder so that I could wake up the periurethral glands (the Skene’s glands), and then I put it in the body of the clitoris so it could hydrodissect in the corpus cavernosi and helped with that because we know from research that the development of that and the distance from, we know from the eye study, the distance of the corpus cavernosi, the clitoris correlates with a woman’s ability to orgasm.
So that was the thoughts behind it, and then when my lover at the time just went ape crazy, I thought, “Well, let me try it on somebody with a problem,” and my next patient was a woman who’d been physically abused in the genitalia by an ex-husband to the point she had dyspareunia, and really lots of trouble with anorgasmic and dyspareunia. And after treating her, three months later, dyspareunia’s gone, she was engaged to a high school sweetheart, that’s when I kind of had something. But she’s the one who told me, “Hey, this stopped my incontinence, too.” So it was really accidental, that part of it, that I was thinking more in terms of healing the scar tissue and dyspareunia and not so much incontinence. My patients taught me that.
Marco Pelosi III:
Now when we treat incontinence as gynecologists, we stratify up the diagnosis to see which specific type of incontinence we have. Now in your practice, do you just tell the patient, “Let’s just try this,” or do you have them analyze for the specific type of incontinence?
Yeah, so it does matter, but there’s a couple of things that make it interesting in that I know there’s urge and there’s stress incontinence and there’s all sorts of things that can happen. Mechanically, if you just think about the cause of disease, you’ve got hormonal and you’ve got mechanical problems that usually you need to treat surgically and you’ve got autoimmune and all these different classifications of disease processes. But again, I just discovered it by listening to my patients, and then I thought, “Well, how is this working?” So before someone comes for a cash procedure, they’ve already had a workup by at least two different doctors who take insurance, as you know, because as they should.
And so the common and most needed tests have usually been done. But surprisingly, people with mixed incontinence or even a large part of it being urge incontinence still get better and I’m guessing here, but my thinking is that there’s probably some help with the nerves of micturition, that if you go in the literature and just start reading PRP, you go deep into the science, there’s over 12,000 papers now in pub med about platelet rich plasma and appears that, and it’s quite a number about regenerating nerve, there’s some about Bell’s palsy, it’s antiinflammatory, it down regulates autoimmune response and is shown to help with rheumatoid, and we have three papers now about it helping lichen sclerosus.
So my thinking is that the PRP is way smarter than I am, and it’s maybe doing more than I ever expected it to do. And it’s going to, it’s like anything else. Once you figure out something works, there’s an infinite number of ways it could be done, and it’s really a small need for people like you and the others in your group to learn more deeply about what’s happening. And I can tell you a dozen studies off the top of my head that need to be done about figuring it out. If you just take the PRP itself, there’s a lot easier ways to make it. We know if you cool it, it works better. You can wash the platelets. There’s things you can add to the PRPs. You know, people are playing around with amnion and [inaudible 00:49:55] and all sorts of things to add to the PRP, stem cells and such.
But then there’s where do you put it and how much do you put it? And I’m hoping that over the next five to 10 years, I’ll see more research about variations on how the O-Shot can be done based on the problem you’re looking at. For example, someone like yourself who knows anatomy the way you do, much better than I, you might be more specific where you put the PRP. As I’m putting it in the anterior vaginal wall, very distal from the bladder, just literally millimeters on the other side of the hymenal ring, and sliding a needle and so that stays between the anterior vaginal wall and the urethra, anybody on the call could go, we have videos they can go watch, they can go to my website O-Shot.info and we’ll send them all sorts of stuff for free if they’re a doctor.
But I think what, for example, we found putting the material there workers better than putting it back closer to the [inaudible 00:50:56] junction and that happened accidentally because I was trying to get the Skene’s glands involved, but it turns out it works better that way for incontinence as well. The other thing, okay, so injecting the body of the clitoris trying to get PRP into the corpus cavernosi, as you know, it’s more of a valve in the sphincter that works to help with incontinence in women, and some of the… There’s actually erectile tissue near the urethra. So it could be by accident that I got lucky and injecting the clitoris itself is also helping with the continence mechanism.
But all that needs to be looked at with ultrasound and MRI studies and you guys as surgeons thinking about where else and what variations could be done to improve what it’s doing. It’s never going to take the place of surgery, but either used as an in between step for those who might not be ready for surgery or as an adjunct to surgery… There was one study looking at… I could go on and on. I start ranting because to me, it’s like we just started and I know that your listeners are skilled enough and bright enough to take it and think of 100 things that have never even occurred to me. So I hope they’ll dive into it deeper and figure out better… Like we know, Oscar Gary and other urologists in our group, [inaudible 00:52:24] have told me repeatedly they’re just shocked at how some of their chronic long-term [inaudible 00:52:31] patients are getting better, and we don’t know a good reason. We’re just doing it the normal way, just hydrodissecting that space.
And so if I was going to have one thing come out of our conversation, it would just be that the people in your group, I know they represent the kind of people that are… I call them sort of like King Arthur and his knights or Lancelot, I call them the Sir Lancelots of medicine. You remember why Sir Lancelot was waiting by the bridge when King Arthur came along? I know this from reading books to the three boys. The reason Sir Lancelot was waiting by the bridge is he could kick everybody’s ass, and he didn’t have a king that he thought was worth taking up for. So when King Arthur come along, kicked Sir Lancelot’s ass, partly by cheating, because he had the magic sword, then Sir Lancelot, he said, “Okay, I’m going to be your knight.”
To me, that’s the people in your group. People that have already mastered their specialty. They’ve become extremely good at the thing they do, so good at it they’re looking for the next king that’s worthy of their sword, their brain. The next idea that’s worth their thinking about. And my hope is that the people in your group will at least consider thinking more deeply about how to use injections, either before or to prevent or a long-lived surgery to enhance the magic they’re already doing with their skills of the surgeon. I think there’s going to be a lot of research around the idea of using cellular therapies to down regulate autoimmune processes, to increase…
Like there was a real good study of menopause using PRP to help them with dyspareunia, secondary to dryness. We’ve had breast cancer, and shockingly, most gynecologists still haven’t read that study. But it’s one of our easy wins. You do the O-Shot on a woman with pain from dryness, you can’t [inaudible 00:54:39] hormones, you’re afraid of them because of breast cancer, it’s a slam dunk for us and those gynecologists don’t know that yet. But even if they do know it, now there’s instant varieties about how that could be done. Wherever you put it, how you put the plasma, I guess I sound like I’m pleading now because I am because I know there’s so many smart people that listen to you, and I hope that they’ll take their brains and I know some of them in your group already have, it’d be great if they would jump on our website and look at what we know already and figure out what the next thing might be to try to do.
Marco Pelosi III:
Now as I was going through your about page, I realized that you are a human guinea pig. You’ve tried all kinds of crazy things on yourself.
Yeah. I’m afraid I have.
Marco Pelosi III:
So let’s see. You’ve run marathons, you’ve fasted, you’ve stayed awake for days trying to alternate your day and night, all kinds of body hacking kind of things. So do you have a routine that works for you right now as you’re going to hit 60 years old that’s keeping you fresh and energetic?
Yeah. I think I’d like to remember what Abraham Lincoln said, “If you had [4 hours] to chop down a tree, you’d spend three hours sharpening the ax.” And when I was chopping the tree, our bodies and our brains and conditions are, that’s our ax. And unfortunately, we have a personality that we want to sacrifice and take care of other people and we have to do it to a certain extent and ignore our own health. One of the people in our group just got off the ventilator. He’s a family practitioner, he does my O-Shot® and teaches for us, and I don’t want to break confidentiality, but he was in New York and he was on the ventilator, almost died from COVID-19. It’s what we do as doctors if we know there’s going to be some beating up of our bodies.
Actually as a kid, I was a lifeguard once for, it was a pool party for children with cystic fibrosis. And that was the roughest, toughest bunch of kids I’ve ever seen in my life, and I asked one of the mothers about it and she said, “Yeah, we know our children are going to get sick. So we make them tough so that when they do get pneumonia, they’re more likely to survive.” And I thought, “That’s really how we all should live in that we know as physicians we’re going to be exposed to all sorts of pathogens and stress,” and everybody on this call is tough or they wouldn’t have survived medical school. But maybe I take it to a different level.
Like I said, I’ve been a fan of Jack LaLanne since I was a kid, and my routine is I try to do… Jack LaLanne always says, “Fast one day a week on juice,” so I usually do that. Since I was a teenager, I’ll do once a month, I’ll do a day with nothing but water. Once every quarter or so, I might do a couple of days of no calories. But I think there’s also a need for walking. If you look at the research, just walking, most people don’t do enough of it, but just walking somewhere between 20 and 25 miles a week, it cuts your all cause mortality almost in half if you just look over large populations, these studies have been done more than once, and it cuts your risk of heart attack, it does all these different things for you.
And so I think if I were to pick the one habit that most people don’t do enough of, it’s just getting out on the street and walking 20, 25 miles a week. I’ll layer that, I’ll do my phone calls or I’ll listen to books while I’m doing it, so it’s not completely dead time. And that’s probably good. I can go on, but that’s maybe my… I don’t drink alcohol. I don’t think there’s anything particularly immoral about it. I like it when my date has a drink or two, but I don’t drink alcohol. I don’t smoke. I try to be like one of the artists said, “I don’t do drugs. I am a drug.” And so I live a pretty clean life as far as what goes in my life.
Jack LaLanne says, “If it tastes good, spit it out.” I don’t know if I’d take it that far, but that’s pretty good advice.
Marco Pelosi III:
Yeah, yeah. Do you come from a long-lived family? Jack LaLanne went to about 96.
Yeah. Actually my grandparents, I do have grandparents and great-grandparents that lived a long time. My dad’s 82 and still walks every day, and Mom’s healthy. I’ve been blessed with some good genes. I feel like if you’re blessed with good health, that’s why we went into medicine. If you’re blessed with a decent brain and good health, it’s not something really to be proud of. I didn’t somehow earn this body. I just was given it. And to not take care of it and not do something useful with it is almost unethical. And there’s a letter that George Washington’s mother wrote to him after he was president, kind of giving him hell. It went something to the effect of, “Don’t get too prideful with your good brain and your good genetics and your good upbringing. You should have done something good. If you hadn’t, you were goofing off.”
So I feel like I was blessed with good health and I do some things to try to maintain it, but part of it is just I could have been born with lots of genetic problems, and I think as doctors we get it, and I’m preaching it to the choir. But I feel like it’s our obligation we went into this, not to make money, if we wanted to make money we’d be selling real estate or in the stock market. We went into it to help people. But part of that is to treat yourself like you would someone else you were responsible for taking care of, it’s good advice. Like what would you do for the guy next door if you were responsible for his health? You do that for yourself.
Marco Pelosi III:
Right. I think we’re going to wrap it up, and I want to leave the listeners with a couple of ways to reach you. So for physicians that are interested in learning your techniques and for patients that are interested in having procedures done by your techniques, by people that have been trained in your techniques, what references can you give them?
[inaudible 01:01:20] is called the Cellular Medicine Association, and we have a website that goes by the same name. Cellularmedicineassociation.org. For the various procedures, there’s a place for patients to look to see if maybe the procedure may be of help to them. On the Cellular Medicine Association, there’s a directory of our teachers across the planet, and on the various procedure websites, there’s a place for doctors to get [inaudible 01:01:55] actually put a stamp on something in an envelope and send it to them and send them some videos and things they can look at to see what it is we’re dong.
Marco Pelosi III:
Now we talked about the Vampire Facelift®. We talked about the O-Shot®. We talked about the shot for men, the P-Shot®, the Priapus Shot®. There’s a couple of others, right? Which ones are they?
So I have ideas, but I try not to just dump them all out at once. You almost have to wait until the world’s ready for it. But we have a procedure for the breast. It doesn’t make the breast larger, but it can do things with PRP like restore sensation, because we know it helps grow nerves, you can put a little PRP behind the nipple and help with women who have lost sensation from breast feeding or from implants, not from reconstruction for breast cancer, that’s some milder damage from, help with some of the defects, symmetries that happen. We have one for the labia majora, it really surprised me, it wouldn’t surprise you as a surgeon, but as you know, a lot of women, their labia majora goes flat out and it gets darker, and they were often, say, you know, it just doesn’t look as pink and happy as it did when I was younger.
And if they need a lot of volume, they need the fat that you guys do as surgeons. But for a 30 to 50-year-old woman, I can do the same things we do with the cheek. We call it the Vampire Wing Lift®. I like all the names to be G-rated. There’s an old Rod Stewart song where he talks about the labia being wings. If you go back and listen to Tonight’s the Night by Rod Stewart, he talks about wings. But anyways, so we call it our Vampire Wing Lift®, we use PRP and Juvederm to restore the labia majora in a younger woman who doesn’t need a fat transfer. So there’s another thing coming down the pipe, but that’s the main things that are out there now.
Marco Pelosi III:
All right. Well, thank you for spending some time with us. I learned a lot of things, and you have some very, very innovative ideas. And I didn’t know about your marketing side. I’m even more impressed now.
Cool, thank you. I always come to your guys’ meetings with awe, and surgeons talk about the Pelosi dynasty, and there’s some things that… Part of the cool thing about my procedures is they’re easy. I can teach most people with a decent hand to do them. But some of the stuff that you guys do is just like, you know, you have to be a wizard to even think about doing it. So I’m in awe of you and your group, and I appreciate you-
Marco Pelosi III:
… being interested in some of my ideas. Thank you.
Marco Pelosi III:
Well, thanks, man. So stay safe and we’ll be in touch.
Thank you. [crosstalk 01:04:41]
Marco Pelosi III:
All right, bye now. Share this podcast and this website and this blog with the people in your life who you feel would benefit from this information.
*The COVID-12 Stats and Why there’s a coming boom *Tips for the Vampire Facial (doing and marketing) *Tips on pricing packages of Priapus Shot® with Shock Wave treatments *Tips on making the Vampire Facial® painless
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Members…watch for a series of emails…”60 Days to Catch the Wave.” Dr. Runels will be giving a step by step plan to catch the coming boom and help your patients survive the rest of the COVID plague.
*Starting the conversation about sex with your patients–in order to grow your sexual medicine practice *How to choose between radiofrequency and lasers for vaginal therapies *Research about using PRP to help post-menopausal women to conceive *Research about using PRP to help with Asherman’s syndrome *How and why your aesthetic practice can thrive and grow in times of disaster *C.S. Lewis on Functioning During Times of Disaster
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
C.S. Lews on Thriving During Times of Disaster In one way we think a great deal too much of the atomic bomb. “How are we to live in an atomic age?” I am tempted to reply: “Why, as you would have lived in the sixteenth century when the plague visited London almost every year, or as you would have lived in a Viking age when raiders from Scandinavia might land and cut your throat any night; or indeed, as you are already living in an age of cancer, an age of syphilis, an age of paralysis, an age of air raids, an age of railway accidents, an age of motor accidents.”
In other words, do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.
This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds.
*Vampire Facial® techniques reviewed in Facial Plastic Surgery Clinics of North America, August 2019 *When to activate PRP with Calcium (chloride or gluconate) *Tear Troughs & Bags Under the Eyes *PRP with or without Amnion in the Neck *Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure *Selecting the Best Patients for the O-Shot® Procedure *Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure *2 Guiding Principles That Bring More Patients and Provide Better Care *Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure *Pelvic Floor Spasm *A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Vampire Facial® Procedure in Facial Plastic Surgery Clinics of North America
Dr. Runels: This should be a really wonderful meeting tonight. We’ve got new research, and we have the amazing Dr. Edward Tangchitnob who is out in California, award winning for his practice, and brilliant gynecologist, and surgeon, and teacher of our procedure. This should be an interesting call. We have some new research I want to just bring up very quickly. First, let me bring Dr. Edward onto the call. Let’s see, hold on just a second. I’m going to unmute you here. There’s a couple of research things that are out that I think are really nice. Hold on just a second. Let’s see.
Edward, I’m not sure what’s going on with your mic. I don’t know if you will need to call. It looks like your audio might be turned off or something. Let me go ahead and bring up the research and as soon as I see your mic light up I’ll unmute you. Let’s see if there is something here. Anyway, so I’ll be watching for that. I can see Dr. Tangchitnob on the call but I don’t … Okay, there it is. There’s your microphone. Here we go. Beautiful. There you are. Can you hear me.
Dr. Edward T: I can.
Dr. Runels: Beautiful. Look at this. Just a review article but it came out in here it is, in Facial Plastic Surgery Clinics of North America, August 2019. I don’t think you could see a better endorsement. I mean, there’s the abstract. “Platelet rich plasma has gained popularity in facial plastic surgery because of it’s healing and growth factors.” But then this is the part I love, “One of the most popular uses facial skin rejuvenation in the form of injections and topical application during microneedling …” That would be in for a facelift and facial, “… and the promising nature makes using it for injection or conjunction with microneedling a good addition.” Beautiful. That sounds like a pretty strong endorsement in that journal, or in that periodical. This is the article I wanted you, and I put a link to that. Actually, I didn’t yet, but let me put a link to that into the chat box, you guys.
Using Scientific Research to Educate and Market To Your Patients
That’s a good one to take … If you just take this link ( https://www.sciencedirect.com/science/article/abs/pii/S1064740619300331?via%3Dihub) and you put it in an email or a Facebook post and you shoot that out to your people and say, “Hey, here’s some research that came out this month.” Here’s a little trick about … It’s just commonsense, actually, for how to talk with your patients, is make, when you have this this counts as news. We’ve all heard on CNN or whatever news channel you listen to where they talk about something, they usually report it out of the New England Journal, because the guy on the street knows that’s a reputable journal. But, often it’s the news reporting on the news. This is news, and you could call up your news channel and say, “This is what I do.” You could also just post this to your social media, or an email to your people and say, “Hey, look what came out this month, more nod of approval from the the powers that be, that this is something that’s useful, and this is what I do.”
I want to shoot over … Any comments about how you’ve been doing that, Edward? I know you’ve had some success with your marketing. Talk to us about how you’ve done things like this.
Dr. Edward T: I think that there’s a lot of information out there at the fingertips of all the patients. They’re getting bombarded constantly from their Twitter feeds, their Instagrams, their Facebook. I think everyone, and anyone, really can be the so-called expert on a particular topic. When I’m emailing my patients, and I make a habit of it every two weeks using Ontraport email client,
I think that we have a very captive audience, because the patients already know and trust us, and the open or the click rate is a lot higher, especially when it comes from us. I’ve also played around a few times with the subject line. I’ve done split testing to kind of see what kind of topics and what kind of tone of the subject, or the copy, can resonate with my patients. I’ve been actually surprised a few times in the split testing. That was something I kind of picked up along the way.
Just to kind of give you an idea, a year ago I didn’t even know what Ontraport was, or an email client was, let alone what split AB testing was. But, as I’ve come along on this journey I’m finding that my ability to communicate to my patients in sophisticated ways is being appreciated. The way I’m measuring it is that I’m able to see that the number of conversations, booked appointments, and paid procedures is going up. Just as you’ve said before, the more we seem to email and communicate the more the patients are aware of the procedures that we’re performing, and the more that they’re aware that their procedures are available from the physician, or the practice they’ve trusted all these years, the conversion rate, I think, is a lot higher.
Dr. Runels: Yeah, let me expand on a couple of important points you made that I failed to make. One is that people are bombarded, but for your patients, you being whomever is on this call, and for my patients, and Edward for his patients, they are more interested in … Because they’re bombarded it’s confusing to them. As you just said, Edward, they want us to curate that and point out to them what’s important and occasionally, I think the ratio should be mostly what’s good, but occasionally point out to them something that may be popular that you don’t think is as useful. As a general rule that’s more of a waste of our energy to talk about what’s not good, but being the curator I think we tend to think, “Why do they care about what we think since they’ve got CNN, and the Mayo Clinic Newsletter, and the Cleveland Clinic Newsletter?” I actually talked to a man today that helped the Cleveland Clinic start their newsletter. They’re doing exactly what you just said, for people who wind up going to the Cleveland Clinic they want to know what the Cleveland Clinic thinks.
My patients, and Edward’s patients, and everybody else on this call, they’re more interested in what we think than what the Cleveland Clinic thinks. So, sending that out every couple of weeks, and making it something that reports, this is your perfect … This is what you wait for, and you don’t have to wait long on their procedures because we’re in the news so much. But, you shoot this out and now you’re not spamming people, you’re reporting on the news just like CNN does.
The second thing you said is that just the general idea that when I said expand on this, the idea that email still is the powerful way. Even when you post to Facebook it doesn’t get shown to all of your friends, and they’re so bombarded, and it’s limiting the conversation. Sometimes it gets banned if it’s some picture about, or something about, sex. The old email to your patients is still, in my opinion, the most powerful way to get things done.
When to activate PRP with Calcium (chloride or gluconate)
Okay, let me pull up this other … You know, I think I’ll hold off on the other research. There’s something here about … I just wanted, since you’re an expert surgeon I wanted to talk some about how PRP’s been used in surgery. Let’s skip over that and maybe do a question. This one comes up occasionally about calcium chloride. “I used to use calcium chloride. I started with Selphyl,” so the short answer to this is if you Selphyl it comes with a kit. With the others you can either order it as, it’s the same calcium chloride that’s in your crash cart or, and here’s … I’m on the O-Shot website. The reason I’m not pointing it out to the Vampire Facelift website is I quit using calcium in the face. It makes it hurt more. If I have a Selphyl kit I just leave it out.
But, you can use the same calcium that comes in a crash cart and mix it in with … So, I took it off the Facelift site, but you can mix it with the PRP. This is a video showing you how to do it, so you can take that ampule, mix it in to just a 10 cc syringe and then use that syringe as a dispensing vial into an empty syringe and then put your PRP into that, obviously not cross-contaminating that. You can make this into a multi-dose vial.
There’s a source of it at mrcrashcart.com. It’s where you get your calcium chloride. That’s 10% calcium chloride. Also, you can get it at McGuff, which is the same place where we get our syringes, and it’s on this supply list that sits up here. There’s your supplies in the PDF file right there, and where I get some of it. There’s the phone number, there’s the email for McGuff, and that’s basically if you order everything on that you can do pretty much all of our procedures if you have a PRP kit.
What’s your … Edward, I know I really stress using calcium chloride for the O-Shot® and the P-Shot®, and if you’re trying to grow nerves. Say you lost the sensation in the breast. I’ve quit stressing it. I don’t see people talking about it much with hair anymore, or with the face. Is that still what you’re doing, or have you altered that in any way? What are you doing when it comes to calcium chloride, or calcium?
Dr. Edward T: No. I still follow the teaching that I was given originally, which is exactly what you had mentioned. I’m finding, particularly, with the Vampire Facelift®, for example, the ability to kind of spread over the cheeks and in the nasolabial folds, as well as run down very finely in the tear trough, I don’t use calcium chloride to activate. It would be a little bit to viscous, in my opinion.
Tear Troughs & Bags Under the Eyes
Dr. Runels: And there is that idea that, which you just mentioned, is that with the O-Shot® you want it to gel quickly and stay in a pretty small area, relatively speaking, where with the scalp and the face you want a more diffuse spread. This right here, I think, is a really important point. Dr. Hamilton has someone who has some bags under the eyes after injecting. I recommend, and the question is, “What do you do?” Absolutely I’ve treated a lot of people who came in with … The tear troughs, not so much in the lower lid, but in the tear trough area if it is convex I can almost guarantee you there’s filler in there. I’m seeing people say, “No, it’s not filler,” and then I put a hyaluronic base in it, just a little dot, and it goes away. When I say a dot I mean one unit on a 30-unit insulin syringe is what I do with a 31 gauge insulin syringe and just put 0.01 mL in there, or one unit on that insulin syringe, and it goes away.
But, if you don’t have a lot of experience with using fillers I just wouldn’t use. I would use PRP as a stand-alone in the tear troughs, or do a mixture of one part JUVÉDERM® and nine parts PRP, so 0.1 of JUVÉDERM® and 0.9 of PRP in a 1 cc syringe, swished around, and use that and this is less likely to happen. But, it is fixable. I know you sent me some amazing pictures, Edward. Do you have any of those handy that you could show us? And, you can talk about what you’re doing, because I know you’ve developed some pearls around the face. Do you have any of those handy that I could just hand you the screen and you could talk to us about what you’re doing?
Dr. Edward T: Sure. Give me one second here.
PRP with or without Amnion in the Neck
Dr. Runels: Yeah, that’s cool. I’ll talk about this next question while you’re pulling that up. “Any protocol for injecting PRP with or without Amnion into the neck?” I think we covered this, actually, on the last call, but just to review. I think if you’re working with the neck I’d do three things. Again, if it’s a turkey neck they need a surgeon. I send lots of people for blephs, and for neck lifts, and facelifts. If it’s just necklace lines, or if there’s some platysma looseness that I can fix with Botox® then I go for it, and people love it. I charge for the PRP part of it 600 bucks. What I’ll do is … I treat it like a scar, basically. So, in the necklace lines I’ll put 27 gauge needle into the necklace line and inject intradermally and subdermally with PRP, and then microneedle PRP on top of that.
Then, if you’re going to mix Amnion with it, I just use one of those half cc Vampire Amnion. You know we have our own brand now that’s about one-fifth the price of what most people charge and it’s good stuff. You put a 0.5 cc of that, or a half a cc of that to 5 cc of PRP and mix it up and then inject it. Then, Botox® 2 units along the line about every inch or so apart, and then put them on a good cream, put them on our Altar® Cream. If you want to go all out, put them on Retin-A 0.1% cream at night and our Altar® Cream in the morning and they get amazing results. You found some pictures for us, Edward?
Dr. Edward T: I did.
Dr. Runels: Okay.
Dr. Edward T: Let me see if they-
Dr. Runels: Yeah, I’m going to hand you the … By the way, you guys, Edward teaches a great class where … Actually, let me just give you the screen. I want you to show us your pictures and then we can talk about your class. Let’s see.
Dr. Edward T: I’ve got a great story about this first case, if I have control of the screen here.
Dr. Runels: All right. It should be offering it to you right now.
Dr. Edward T: Do you see what I see here?
Dr. ‘Tangchitnob’s Pearls About Doing the Vampire Facelift® Procedure
Dr. Runels: Yep? I got you. She’s 55-60 year old woman treated with Vampire Facelift®.
Dr. Edward T: Originally, to take us back, this patient found me. She had actually moved, her and her husband from Tennessee and found me for an O-Shot®.
Dr. Runels: Beautiful.
Dr. Edward T: We ended up doing an O-Shot® on her and there’s so much crossover with the PRP procedures that she asked about the Vampire Facelift®. Naturally, we ended up doing a facelift on her. Now, this was one of my great kind of before and afters, because she had such a great result both from kind of the textural component as well as the shape. Staying with the classic form here I ended up … I just used one syringe. I used [inaudible 00:16:07]. I did some [inaudible 00:16:08] around her PRP, and that’s the result she got. My pearl is with this particular case I remember … I think that I was able to achieve the lift I did really by pulling, doing a pulling technique. When I first started doing these injections I would go right on the periosteum, right where the zygomatic arch is.
I still do that, but now I pull up very aggressively, and I draw Dr. Hinderer’s lines, which you can see here kind of mid [inaudible 00:16:41] down to the lateral aspect of the nose, and the lateral canthus down to the mouth. See where my finger is, this pointing arrow what I do is I lift and pull up really, really high on the skin and you can actually see where that line used to be, the one I drew when you kind of pull the skin up taut. I inject where the line used to be. What I mean by that is that for patients who are over the age of 40 who have a little bit more heaviness and need more lift I’m really kind of pulling up and I’m using the filler as a tack.
Dr. Runels: Interesting.
Dr. Edward T: I think before I was, basically, just filling down to the level of the bone hoping that it would just raise the skin. But with this technique when I’m drawing Dr. Hinderer’s lines I’m pulling the skin as high as I can. I inject with my right hand, so I pull with my left hand, and then I kind of see where that line used to be and I inject there. Obviously, when you pull the skin up with your left hand here, the line you drew goes up. So, the line you can imagine that used to be there is where I inject. That’s kind of the after that I get here. There’s a lot more kind of superolateral projection doing this pull and lift technique. I started developing this because as I’m getting into the more longer-lasting fillers such as Voluma®, that’s actually how Allergan teaches it. Now, I’m combining this lift and pull technique with the Vampire Facelift®, which was my introduction to facial aesthetics when I first learned this from you, Charles.
Dr. Runels: Beautiful. So, can we go through that again? So, you draw the lines and then you pull-
Dr. Edward T: What I do is … Right. So, I draw the lines and then I pull up on the lateral aspect of the cheek just as high as I can with my non-injection hand. Where the line used to be, now that it’s been moved up, that’s where I inject.
Dr. Runels: While you’re holding it up?
Dr. Edward T: While I’m holding it up.
Dr. Runels: Okay, beautiful. You’re directing all along the lateral zygomatic arch there. Is that what you’re … Okay.
Dr. Edward T: I’m doing the 0.15 and the 0.5 is classically descried by the Vampire Facelift®. I think I’m getting more bang for my buck when I’m thinking about using it as a tack rather than as a fill, and then I put the PRP over it and it seems to work really well with that lateral superolateral projection.
Dr. Runels: That’s some beautiful photographs. What are you doing around the tear trough area? I hear lots of different techniques for the tear trough. I like that technique where you’ve taken the best of Allergan’s teachings and then one upped it with your Vampire ideas. Talk to me about … By the way, if I were defining the Vampire Facelift® it would be like this. Take a syringe of filler, do your best work with it, polish it off and think of that as reshaping the mattress, keeping in mind the ideas that you just mentioned about shaping the, restoring the youthful shape of around the eye and the mid cheek area especially, because that’s where research shows that we first get an idea about our perception of how old someone is. So, that’s where you start and then you think about the other things that are described on the website based on your understanding of the face and your understanding of your best technique.
I never expect everybody to do it exactly the same way. We all have different eyes on different days and with different people. As long as those techniques are used then they’re going to have the best result possible. It’s just what’s going to happen. So, that’s the Vampire Facelift®. Around the tear trough, and we all have a different way of seeing it, but we’re all following that basic principle, using HA, make your best useful shape, polish it off with PRP, and then if you need more HA that’s fine go for it, but let that be additional cost to the patient since it’s additional cost to us, and that way we’re all going about the same guidelines as far as our pricing, as well. The tear trough, though, is where I see the most variability, so talk to us about what you’re doing since that was one of the questions tonight.
Dr. Edward T: Absolutely. I get very, very medial all the way up almost to the nose, and then I inject and I’d watch the PRP fall backwards. I don’t activate, by the way. One of the risks that I … Actually, one of the side effects of this particular technique is I almost always get a little bit of bruising, and so they get kind of that darkened shadowing after I do a Vampire Facelift®. It goes away and I assure them of that, but I’ve been getting really great outcomes with it. I also get better outcomes I’m finding when they come back four to six weeks later, and I only inject their tear trough with PRP. I think sometimes the first PRP injection might not be enough, particularly if they are almost on that borderline of needing a lower bleph. I also finish it with Lytera®, which is a skin cream made by SkinMedica® that helps with pigment. I learned that one from an oculoplastic colleague of mine who gave me that pro tip.
Dr. Runels: Beautiful. Thanks for the pearl. That’s why we do this at night. Let me ask you for a little bit more clarification, though. You started that explanation by talking about doing something more medially. Can you talk more about what you meant by that.
Dr. Edward T: Absolutely. If I may use my … If you can still see my screen here, I’ll use this picture. My needle originates or goes in here and goes all the way to the most medial aspect of the eye near the nose here. I’m going to zoom in here slightly. To me I see this triangular shape here that I want to fill, because when I go through this crepey, or there’s almost always kind of crepeness here of the skin. The bag, or the space here, is so thin here it fills so well with that unactivated PRP that it filled all the way up to here and comes back. I don’t know if that was by design or not. I suppose to try to get rid of your tears as you kind of tear, but it’s natures way of very efficiently kind of whisking away excess fluid there. I’m just kind of leveraging that shape.
Dr. Runels: Interesting. Would you say the name of that cream again that you’re using, and you’re using it for the crepe papering in the lower eye area? Is that right?
Dr. Edward T: Correct. It’s actually Lytera® 2.0. It works great because it works well for the color. In those patients who have an ethnic predisposition to bags under their eyes this alone works fantastic. That’s where I got the idea to begin pairing this with that part of the Vampire Facelift® that involves injection of PRP under the bags of the eyes.
Dr. Runels: Just so you guys know. You may have picked up already, Edward has a strong background in mathematics as an engineer and then is a world-class and award-winning robotic surgeon and gynecologist there in Southern California, and does a really beautiful job of teaching combination therapies, teaches BioTE®, so he teaches hormones and he teaches lots of ways of thinking about how these procedures can be combined with energy sources and surgical techniques. With that introduction, can you pull us up some pictures and talk to us some about your ideas about the O-Shot®, starting with maybe, if it’s handy, maybe that picture you have of the urethra, which I think is amazing. But, talk to us more … I want to get back to marketing, because you’ve been really successful with the marketing.
Selecting the Best Patients for the O-Shot® Procedure
First, talk to us some about your ideas about patient selection. I never want to get away from the idea that the better we are about patient selection, that’s the first step to having great results. All of us want to have wonderful results and be paid appropriately for doing, basically, miracles with our patients. Can you first start with explaining this picture and then some patient selection pearls?
Dr. Edward T: Absolutely. To kind of go a step back, as an engineer I think that it’s very important to define and measure all the activities we do. As a physician I try to look for those tools in our clinical toolbox to measure these outcomes. When I had done my fellowship in robotic and urogynecologic surgery at Scripps Clinic in San Diego, one of the kind of key aspects of my training, even before I started doing pelvic surgery, was urodynamics. Urodynamics to me is the gold standard for actually assessing the different kinds of urinary incontinence. Does the patient come with a pure stress urinary incontinence? Do they come with a overactive bladder picture? Or, is it more commonly the most common kind, which is mixed, which is actually the most difficult to treat. So, when I do my assessment of the patients for their candidacy I think it’s ideal when you do the full work up, although it doesn’t happen every single time, to have some kind of urodynamic evaluation.
The area that I look at, and I’m most interested in … Actually, I’m going to scroll down here, is the intrinsic sphincter deficiency assessment, or the urethral closing pressure, because I really want to know at the urethra what the degree of damage or the degree of strength that resides. To me at one end of the spectrum you have a very healthy urethra that upon closure can actually withstand the increased pressures that are created when the patient laughs, coughs, or is a little bit heavier. That’s a young patient, maybe they’ve not had kids before. They cough real hard they’re not going to leak, because the urethral pressures and that intrinsic urethral strength is quite strong.
On the very other end of the spectrum, you have a patient who has intrinsic sphincter deficiency in which the urethra takes on more of a complete pipe shape and function. In the case of the patient with intrinsic sphincter deficiency, when you perform urodynamics on them you will see that their urethral closing pressures are way less than 50 mmHg. They’re actually quite low. In my opinion, the patient who is healthy, who can be continent when they cough really hard, versus the patient who has intrinsic sphincter deficiency, somewhere lies in between the ideal patient for doing an O-Shot® for urinary incontinence.
I’m thinking, in my mind, Charles, that the patient who doesn’t have a lot of tone to begin with … You could probably do four or five O-Shots® on them, several lasers, even putting a sling on them, and it may not work. Why? Well, I think by nature that urethra it’s too damaged or it’s not functional. Many of our procedures that are noninvasive, such as doing an O-Shot®, or doing two, or even giving them testosterone in the form of a pellet that causes hypertrophy of the muscles that surround the urethra, may not work. In fact, when you kind of do the literature search, one of the gold standards for performing a treatment on someone with intrinsic sphincter deficiency is to do a TVT, or perform a TVT, a transvaginal tape, in which it’s a lot of back support against that urethra does not work that well.
If you look at … I’m a big fan of the mini-sling, the Solyx. For those of you who are on the call right now, mini-sling is a very small sling that’s usually called the minimally-invasive sling, because it’s so small and doesn’t pierce through any of the spaces, may or may not give as much of that backstop support for someone with ISD.
What does that mean for all of us performing and looking for the ideal O-Shot® patient. Well, I would actually really use the history to try to guide us. How long has the incontinence been going on? Are there things that you can do, or things that you’ve tried? Some patients have been very good about doing Kegel’s muscles and Kegel training. They get some improvement upon doing these Kegel muscles. They just can’t get to it every day. I mean, we have such busy days. To do Kegel muscles with intent it’s just so difficult. That patient is a good O-Shot® patient, because they can demonstrate that with some exercising they could bring back that tone.
Someone who has had … I actually saw a patient today. She had had two C-sections. I’m about to do an O-Shot® on her next week. I think she’s a good candidate. We just did her urodynamics. We’ve proven that her urethral closing pressures are well above 50 mmHg. It makes sense in her history that probably with time, age, and the decrease of hormones that that tone or incontinence is changed. I think she’s going to be a fantastic candidate for an O-Shot®. These very soft findings in the history, not all of us have urodynamics ready to do in the office, I think really guide our ability to find that O-Shot® patient. Sometimes it might take another O-Shot®, for example.
Dr. Runels: Can I ask you two quick questions? First, for the person who doesn’t have the ability to make those measurements could you elaborate more on what clinical history or physical findings they might use that you’re correlating with those measurements? Second, do you have the beginnings of a data bank measurements before and after an O-Shot® that we could publish somewhere?
Dr. Edward T: I’m beginning to collect that score, because very early on, which is why I’m referencing this picture, I wanted to find a way to measure, if not visually, at least quantify the difference in the closing pressures after doing an O-Shot®. Now, this particular publication, or this article submission, was a case report of a 48-year-old gravida 5 para 2 … Actually, wow, last year. Almost by design a year ago that I had published, and this was after we did an O-Shot® in the operating room for a patient we did robotic surgery on. You can see here before the O-Shot® I put the cystoscope in. This was a 30-degree Stryker cystoscope, and you can see what the urethra looks like before the O-Shot®, and this is immediately after. I can imagine with time that the O-Shot®, the effects of the O-Shot® platelet rich plasma probably would just improve the tone of the urethra.
I actually don’t have, and I wish I did, pictures in a series of what happens at 30, 60, and 90 days, because I don’t know how I would consent a patient to do cystoscopy just to see how the O-Shot® is doing. More rather, bringing the patient in and just kind of asking what their incontinence level is.
The second part I think you were asking is, looking at a questionnaire, which is what we did, I’d be happy to share with the group, too. There’s a great one developed by LABORIE who makes my urodynamics equipment. It’s a checklist of about ten questions that, basically, look to see, Do you feel like you have to pee as soon as you put the key in the door? We call latch-key urinary incontinence, which really speaks more towards overactive bladder. Or, Do you leak when you cough? How many pads are you using a day? You could almost get a gestalt on whether they have stress urinary incontinence or overactive bladder, for which the two treatments are different. I am seeing almost in colloquial, or kind of informally, that the patients with overactive bladder are needing to use less Detrol, something about their O-Shot® and rejuvenating some of the vaginal mucosa immediately underneath the bladder helps with overactive bladder.
Dr. Runels: Anecdotally we’ve had some people with very severe cases that have made remarkable changes, so hopefully you can get us some objective numbers that we can publish somewhere. Can you give us your pearls about actually doing the procedure, and thank you for showing those pictures and, yes, we would like to see that survey you’re using for measurements.
Dr. Edward T: I’ll get that to you and maybe you could distribute it out to-
Dr. Runels: I’ll just post it on the web … Is it copyrighted? Is it something we can post?
Dr. Edward T: It’s pretty general.
Dr. Runels: Okay, I’ll post it to the membership site for people to download. Would you talk to us about your pearls about how you think, what you’re thinking, when you actually do an O-Shot®?
Dr. Tangchitnob’s Pearls for Doing the O-Shot® Procedure
Dr. Edward T: Absolutely. So, when I talk about … I’ve experienced in two realms and I’m very fortunate because, I think I’ve told you this before, my hospital system has been extremely supportive with regenerative medical techniques that I’m doing in the OR. My story in terms of the OR, versus doing it in the office, which I’ll talk about in a second, really stem from a product made by Stryker. Stryker made a product called Vetigel® and Vetigel® is a combination of autologous PRP in which the scrub tech or the nurse that would have to draw the patient’s blood and then mix it human thrombin and that’s what our GYN oncologists and I were using to put on the vaginal cuff before I even took your class, Charles. This is …
Dr. Runels: Interesting.
Dr. Edward T: … before I took your class. We were finding that the rate of vaginal cuff dehiscence and post-robotic hysterectomy spotting went to nil. One of the most frequent calls that we get as a gyne robotic, or any kind of gyne surgeon, is post-hysterectomy spotting, because the cuff has little pores through it. We were just plugging the Stryker Vetigel®, which is really just PRP plus thrombin, over the cuff and the patients had less pain. They were not spotting. We had less calls. We were happy.
Then about three months later it made me so sad because Stryker pulled the product off the shelf. In my very engineer mind I said, “You know what, this is just too good of a product to not have on the shelf,” so I started looking at other companies. We use Regen. We were able to replace a pre-existing product in our hospital OR with a similar product. I think I found a very pleasant loophole, right, because I had to have something to replace it, so we found something to replace it that ended up being a lot cheaper.
Dr. Runels: You’re referring to Regen when you say there’s something to replace it? Regen Therapy?
Dr. Edward T: When I do it with my hysterectomy, I do make it with a gel, and I [inaudible 00:36:47] calcium chloride, and I add about 0.1 of thrombin, that is autologous thrombin.
Dr. Runels: Yes, and Regen, just so you guys know, Regen has a kit that comes with thrombin …
Dr. Edward T: Exactly.
Dr. Runels: … or a way to make thrombin, and they also have a setting on their centrifuge to make a gel. Am I understanding properly? Is that what you’re doing? Are you using that thrombin kit?
Dr. Edward T: That’s exactly what I’m doing, but I’m doing that above the vaginal cuff. When I undock the robot and I’m done with the … Actually, I did the same exact same for a stage IV endometriosis patient today. She’s on the floor. She’s doing great, and after I undocked the robot then I used my PRP kit, and I do a classic O-Shot®, and that’s it.
Dr. Runels: Interesting. Beautiful. That’s pretty amazing combination therapy. Do the people that are getting hysterectomies from you, do they realize what a higher standard that you’re taking this procedure to? I guess they do. Tell it to me more about, do they find that out when they show up for surgery? Are you advertising this combination or way of doing hysterectomy, because it sounds like what I would want my loved one to have?
Dr. Edward T: I think that at the end of the day I’m guided by the same principle that my father, who I operate with still today, actually we just did the case together, has always taught me, which is be very patient centric. I just want to take care of my patients. The money part, and the finances, and the marketing sometimes, as you know, Charles, can get in the way of that.
Dr. Runels: Yes.
2 Guiding Principles That Bring More Patients and Provide Better Care
Dr. Edward T: It’s kind of a very means to an end, I suppose. But, when I start counseling the patients about what we do I start out by saying that we want you to recover as quickly as possible. So, when I lead with that, and I also followup with the fact that we utilize the newest and latest technology in regenerative medicine, the patients begin to understand that their body actually does have a natural mechanism to heal itself. If not using parts of their own body, why would I reach for something on the shelf if I didn’t have to, if I could use their own PRP, and their own thrombin, autologous, to help them heal? I think when it’s set up like that it’s an easy sell.
Dr. Runels: Well, and part of the reason I brought it up was that I feel like, as your father said, Part A is that the want to be patient centric and make sure that we’re always doing the best with the least amount of risk. Then, Part B is that, I think, it’s our responsibility to make sure that our patients know what we’re capable of doing. I think that’s a different way of thinking about it than the way, and I know that’s the way you think, as well, but some people think, “Oh I just want to do it but I don’t want to have to sell it,” but if you use a different way, and it has to be sincere, of course, but if your way is not trying to get people to do things, but your way is taking responsibility for educating people in what you’re able to offer them as an option, and then they decide what they want based on a fully-informed description of the possibilities.
That, I think, is really what we’re supposed to be doing anyway, whether we’re taking insurance or not. If it happens to be something that somebody could pay you for, well that’s wonderful, but it’s kind of what we’re supposed to do anyway, and that is the best way to “sell stuff.” As you know, I never script these conversations with our teachers, because I like the serendipity of discovering along with the people on the call what might be possible. Have you had any of the gynecologists reach out to you, or do they even know it’s a possibility the ones who come to your class for you showing them this way that you’re doing a hysterectomy, or is your description you just gave enough for them to take it and run with it?
Dr. Edward T: Well, I think that they understand it. I always get a very academic nod to what I’m doing but to your point, Charles, some of the GYNs that I train, they’re my colleagues, they’re a little bit slower to adopt, because we’ve been kind of put into a corner with our Board certifications, and you’re supposed to do it this way. I’ll be honest with you, if that’s how we did hormones then we wouldn’t have any progress.
Dr. Runels: Yes.
Dr. Edward T: If all we did was treat to the exact specifications of what [inaudible 00:41:25] put in brackets, none of our patients would feel better. We would still have all these issues.
Dr. Runels: Is there something you can measure, for example, that postop spotting that you were talking about? Is there something you could measure where you could do the next 40 patients, 20 with and 20 without that? It would the great to have some sort of paper where we could let people know what you’re doing. You know, I just put a link in PubMed where there is some discussion already. I couldn’t find the one … There’s one out there somewhere about using PRP as part of the hysterectomy process. I guess it came out of the people who did the research for the last product you mentioned, but I can’t find that paper right now. Anyway, I won’t dwell on it too much, just to let you know it’s something else that would help the whole group, because there’s lots of GYNs and urologists in our group.
Dyspareunia after radiation–Can/How improved with the O-Shot® Procedure
Okay, we’ve got a couple of questions, and I’m going to unmute Stephen Carp who has a question for you. Let’s see if I can unmute him here. Let’s see. I’m just going to let you ask him instead of me trying to slow down the mail. All right. Dr. Carp, you’re unmuted. Go for it.
Dr. Stephen C.: How are you? Good evening.
Dr. Edward T: Hi.
Dr. Stephen C.: I’ve got a patient that came in, been a long-time patient, who came in just looking for a potential solution. Had endometrial cancer. Had a hysterectomy with radiation and has some scarring that’s tender, and discomfort, a few cm proximal to the introitus that’s probably from about 5 to 8 o’clock or so. She came in because she’s actually a physician and wondering if PRP might be something that could help soften that, might help with that area. Have you had any experience with any PRP in post-radiation in the pelvis?
Dr. Edward T: I have not, but when I think about the three or four cases of patients who have had traumatic vaginal deliveries, they create quite a bit of scar tissue in that fourchette. The success cases I’ve had for those particular ones required more than one O-Shot®, and by O-Shot® I mean doing the classic O-Shot®, but then also doing focal 1-2 cc of activated PRP right into that area of the scar tissue to soften it up. I would also go so far as to maybe use vaginal dilators and, depending on the comfort level of the oncologist, there’s a great product that has compounded DHEA that could definitely soften that fourchette. DHEA with history of gynecologic malignancy is still kind of up in the air, but I have a lot of breast cancer survivors. We’re right next to City of Hope, my practice, and we were using a lot of these nontraditional therapies to help these patients out. I can imagine the irradiated tissue is very similar.
Dr. Stephen C.: Yeah, I would think so.
Dr. Runels: Let me add to that in that my position that I am grateful every day is now becoming described in the Earpiece for lots of brilliant people like you guys. I’ve had quite a number of people, probably a dozen different providers, call me and tell me about similar cases, several cases of dyspareunia post radiation. One case in particular comes to mind where a woman had repeated tearing and pain in an old episiotomy scar, and just like you just said, Edward, it took three treatments with injecting, basically infiltrating the areas if you’re getting ready to suture it intra and subdermally with PRP, and then waiting four to six weeks and doing it again, and doing that three times, and then the woman was without pain and without bleeding. It was something that was a nuisance for quite a number of years. Another case of radiation that had some scarring and pain around the anus, as well. Yeah, so it’s been done and it’s been helpful, and hopefully some of you guys will publish a case report.
I had a case ... While we are talking about dyspareunia, I had a case of scleroderma that got well, but just one. These are … No one person has enough to do a series, but maybe we should some case reports, or try to pool it. What else? Anything else, Dr. Carp?
Pelvic Floor Spasm
Dr. Stephen C.: I’ll just as an addition to that, have you had any experience, especially with urogynecologic, with Botox® for the spasms that they get in the pelvic floor?
Dr. Edward T: I have not done that, although many of my colleagues have. One of the risks of doing that is if you do it too much they go into retention. I have not done that particular method. I have used CO2 fractionated laser. I’m a big FemiLift physician. I use FemiLift quite a bit for overactive bladder, as well as the compounded vaginal estrogens work very well. I think there is a great deal of dysfunction at the level of the vaginal epithelium, that thin layer that separates the bladder from the vaginal canal that needs to be addressed. It gets irritated in these patients with overactive bladder.
It’s really interesting, because one of the gold standards that the insurance covers is the administration of Detrol, or an anticholinergic, which many of my patients within about 30-60 days will self-discontinue due to the side effects, the dry mouth, the dry eyes. They might have less overactive bladder but [crosstalk 00:47:28]. There’s some brain slowing, especially in the older population.
Dr. Runels: Yeah, there was actually a paper out about six months ago that was pretty compelling that there really is an increased risk of dementia long term, as well.
Dr. Edward T: I can see why. You, basically, create that parasympathetic overabundance or push the parasympathetic system to try to dry everything out, well it’s probably going to slow your brain function down, as well. The patients are getting forget. I think it’s very high risk in the older population due to polypharmacy.
Dr. Runels: Anything else, Dr. Carp?
Dr. Stephen C.: No. Thank you.
Dr. Runels: Thank you for the excellent question. There was quick question from Dr. Vora about Emsella, and the answer is, “yes,” some of us are combining Emsella with results. Some are using the intensity vibrator that has contraction component to it. Are you doing any of that, Edward?
Dr. Edward T: So, I was using the [Visa 00:48:30] Plus for a while. I don’t know if you’ve seen that as a at-home device.
Dr. Runels: Yes, talk to us about it.
Dr. Edward T: So the Visa Plus is something that the patients were using. They would take home, use as a light therapy that helps with collagen generation and urovascularization. There’s two versions of it. There’s a version that’s available in the United States, and then a stronger version which I think is only available in Canada, is one of the examples of, I think, an at-home treatment that the patients can use.
Patients always want one and done. From the very beginning I try to tell them, especially when it comes to some of the dyspareunia associated with the menopause state, once estrogen runs out and the vaginal epithelium begins to change it takes a variety of different approaches that begins in the office and really continues with the patient at home. I might do an O-Shot® on them and have them go home with something called … There’s a commercially available medication called Intrarosa®, which is compounded DHEA, or I would use vaginal estrogen. They’re going to work on that at home for the next 30 days. They may come back. I do another pelvic exam. Maybe the grade of the atrophy changes, or improves, or they could have one more sexual encounter that month. To me that’s a win. Then we will add a vaginal laser.
The in between treatments, whether it’s a device such as the Visa Plus or these creams are very, very important, whether you’re talking about vaginal health or you’re talking about aesthetics in the face. I think really beginning to set that as a proposition to the patient, “You’re going to be doing things at home, that are going to help.” Certainly having multi-modality.
I have colleagues of mine in Southern California having great success with the Emsella®, to strengthen the pelvic floor, as well as doing an O-Shot®, looking back at our … We have about 300 patients on pellet treatment right now. Many patients will cite that their urinary continence has gotten better within the first treatment of testosterone. How do I know that? It’s because they won’t show up to their urodynamics test, and so I know something is there. Having that multi-modality approach for urinary incontinence, intimacy, even aesthetics I think is going to be key.
A Nine Minute Cram Course on Marketiing Your Mecial Practice, Timeless Intimacy™, and Virtual Assistants from an Engineer/Physician’s Perspective
Dr. Runels: Beautiful. We’re going to talk … We have about nine minutes left and Edward has some interesting ideas about when it comes to marketing with trademarking and not just our procedures but you as a provider and expanding upon that idea. So, we have about eight minutes left, Edward. Before you do that, though, I just want to tell you guys that Edward is, obviously, brilliant and excellent teacher, and excellent as a provider for our procedure, so highly recommend his classes. He’s got one coming up July 27, which is pretty close, but I don’t know if he’s got slots left, but I’ve put a link to that. If he doesn’t have slots in that one I’m sure he has another one coming up soon. With that, Edward, if you don’t mind, talk to us some about, I know you’ve thought a lot about that idea. Can you expand on that some and then we’ll close it down for the night?
Dr. Edward T: Absolutely. So, as I’m going through the mental exercise and thinking about how to combine all the different procedures and finding that a combination of different approaches that hit different aspects of what I’m doing is the best, I really did a deep dive and found that my main focus is intimacy, how to restore it, how to improve it, how to educate patients on it. I was very happy when my trademark, actually I have a copy of it here, by the U.S. Patent Attorney Office was accepted now with for the second year in a row. I’m ready to defend it, because I came up with this idea of Timeless Intimacy. You can see here, this was actually from my-
Dr. Runels: One second. I took the screen back. I’m going to give it back to you. Now you can show us. Go for it.
Dr. Edward T: I applied for a Trademark. It was actually more of an activity than anything else, and it was successfully accepted by the U.S. Patent Attorney Office. This was a recent email, actually July, by my attorney and I was able to submit it again for the second year in a row. The Timeless Intimacy trademark basically encapsulates performing a minimally invasive vaginoplasty, performing an O-Shot® and followed by a laser, in this case a CO2 FemiLift at a particular setting to help heal and to help reconfigure the vaginal vault to take on a more youthful function. I would always tell the patients, if you want a certain tightness or a certain kind of friction coefficient in terms of the sexual intimacy that you were at 21 we’re not going to go past that, right. We want you to be in a place I would say, ideally, between 20 and 30, in a place before you had children, in a place before you entered menopause, such that you could resume intimacy again comfortably and pleasurably with your partner.
As a part of that I then went on to develop Timeless Health Solutions, Inc, which is my Med-Spa or my functional wellness practice. That’s now being developed as its own entity. It has its own collateral. There’s a voice that’s being developed in which the girls in my office are trained to pick up and talk to the patients with a particular voice.
I’m finding who I am as I’m going along in this journey, that originally I started as an engineer. I think I have a very compelling story to use technology and, basically, give that technology and distribute it in such a way to help patients. I’ve become a surgeon in the last few years, a robotic surgeon in the community, helping women have surgery in a minimally invasive way and get back to life sooner, and putting it all together. I think that’s really what the Timeless Experience is. I think it’s really garnered a lot of attention in our community. I know it’s being recognized at the level of [inaudible 00:54:48] hospital systems. I’ve been recently kind of given this idea, this honor, of being a social media expert in women’s health. Now I have this wonderful platform to get all these ideas of regenerative medicine, minimally-invasive surgery, and to be able to talk about intimacy in a way that’s never been done before in my community.
I’ve been very kind of passionate. This was actually what I was going to talk to you about tonight, and I’m going to highly the second point here. I would say, Charles, right now in the last few minutes that I’m in lean startup mode, and I looked at my colleagues, my engineer friends up in Silicon Valley, and there’s this wonderful book by Eric Reese called The Lean Startup. What that means is creating these very small … Let’s see if I have a picture of it. … MVP, that is a minimum viable product, and really getting it out there to see if the population, or the market, is interested in it. What that means for us as busy physicians is before we buy that next laser, or before we buy that next cool sculpting machine, can we create these minimum viable products and test our market, and how convenient is it that our market are the patients who have been following us all this time.
Dr. Runels: Yes. Yes, we already have an audience.
Dr. Edward T: We have a captive audience. In this world of marketing you actually have to pay for these focus groups.
Dr. Runels: Yes, and let me emphasize that real quick. I don’t want to slow down your momentum, but everyone needs to remember, you are marketing to your people. If you [want to 00:56:27] market to the whole world that’s fine, but you need to start with your people. If you don’t have a group of people that you call your people, in my opinion, it’s difficult to have a steady flow. You start by building a fan base of people who love you, because you’ve done good things for you. Now you can do what you’re talking about. Okay, keep going.
Dr. Edward T: I think every once in a while when I get stuck, Charles, I put my engineering hat on and I think about what an engineer would do, because if I think about what a doctor would do, I would probably take on another [inaudible 00:56:58] contract and working harder and I’d probably be- [crosstalk 00:56:59] Just being honest with you. I’ve already seen this. I saw what happened to my father, right? I think desperate times call for desperate innovative measures, and I put my engineering hat on and I found this, and I’m just sharing this with our group, lean startup. In the last minute here I encourage …
Dr. Runels: You know what. Keep going, go a little over. That’s fine. I think this is good stuff.
Dr. Edward T: … and want all of us in the call, the physicians, to really become lean again. I think that all of us as physicians need to find a way that we retract because the environment right not conducive to us expanding aggressively. We must all come together and retract and regroup, much in the way that Sun Tzu says in The Art of War about looking at our enemy and knowing that we are not ready, and we are not powerful enough to be out there and fight. So, we have to retract, and in this very lean startup manner regroup and see what anchors us.
Dr. Runels: Yes.
Dr. Edward T: It’s very easy because all of us in quarter four … I know I’m speaking to everyone on the call right now when the tax comes all of us who are on the call most of us are in private practice, and we are lured by the laser companies, and by a big company to do that capital investment just to decrease our taxable income. Really understand what it is that our market is demanding. We can do that by creating these very small value propositions and testing it. That’s why doing a class on injectables, or learning how to do an O-Shot® is so valuable, because it may be caused that initial fee, the tuition, and that’s it. That fee is the minimal [crosstalk 00:58:47]
Dr. Runels: Then you take the money from that and do the next thing, yes.
Dr. Edward T: You got it, because what makes you think, and forgive me for saying this, that you’re going to be able to make a vaginal laser which can cost up to $100,000 work if the patients in your group don’t even want an O-Shot®? To that same degree, what makes you think buying the newest fractional CO2 facial laser is going to be appropriate when the patients don’t even want you to do a Vampire Facelift® on them?
Dr. Runels: That’s right. The guy who taught me Botox® was doing … He was the top Allergan account in the world, we talked about this before, and he always said, “Get your Botox® practice going then buy the facial laser.” So, exactly that’s the right strategy. When you get to where you’re one or two O-Shots® a week now you can take the money and take the flow, and you know that your laser’s not going to gather dust, or you’re radiofrequency. I’m loving this. Tell us about the next thing on that list.
Dr. Edward T: I guess the next thing, …. Forgive if I’m going over here but-
Dr. Runels: No go for it. We like it.
Dr. Edward T: In addition to retracting … This is what I’ve been doing. I’ve been retracting, rebuilding, regrouping, and creating my brand. The brand tells a strong story that I’m infusing technology with medicine. I actually had a doctor friend of mine, Charles, reach out to me, and she asked me how I’m seven places at once? I said, “What do you mean?” She’s like, “I’m watching your Instagram, man, and you’re like seven places at once. I’m like, “Thank you, I’m not.” I have virtual assistants. I try to automate and eliminate, and I’m doing this because I have a virtual architecture and I check in with this lovely girl in the Philippines. I give her a list of things to do and in the morning it’s all done because of the time zone difference. It could be something as simple as arranging for my dry cleaning, or figuring out a logistical issue for a seminar that I’m going to be teaching out.
But, when I’m able to do that and create that virtual architecture she learns from me. We talk about, as engineers, machine learning, and we talk about artificial intelligence. You don’t really need that when you could actually have bonafide intelligence. These virtual assistants, it’s a skill and I’ll be honest with you, coming out of fellowship I didn’t really know how to manage people that well. I’ve learned more about managing people, and learning how to lead working with these virtual assistants than I have in all the time I’ve graduated, because you learn about time management, because now I know what the value of time is in a quantifiable way. I’ll give you an example.
I found out that it’s actually a lot easier to click with my thumb Expedia and book a flight, and look for a flight than it is to go in almost two hours back and forth in different time zones to get my virtual assistant to book it. That’s a great example, right? But, for something that takes a lot of different steps, like research, I’m trying to find a cheaper way to bring in needles or syringes to my office. That’s an hour affair. I’m putting that to my virtual assistant, so now she does my supply chain and I’m like, “Oh, there’s something called supply chain. Let me learn about how to do supply chain management.” It didn’t cost me that much, and so that becomes part of my virtual architecture. It becomes part of my virtual corporation, my virtual timeless structure, and that’s the virtual architecture that’s rising me, or raising me, to make me look like I’m in seven different places at once. It’s because my virtual architecture is raising me, it’s giving me more time.
Dr. Runels: Beautiful. Both the virtual assistant and someone in the office who functions like an executive assistant, not just doing the nursing work, but they are willing, and expecting to do things like drive your car, or go buy your groceries, that sort of thing, I think when you value your time at at least $1000 an hour, which everyone on this call should be doing, then that person if they save you an hour a day, you can pay them a reasonable rate and still do well. What’s next on that list?
Dr. Edward T: I suppose the last thing … Let me give you the website that I use, and I explore …
Dr. Runels: You can just throw it in chat box and everybody will have it.
Dr. Edward T: It’s onlinejobs.ph. You actually see it.
Dr. Runels: Okay, there you go. Onlinejobs.ph. I concur with you in that the people in the Philippines they like Americans and unless they’re having a typhoon where they lose their internet they are as a rule usually reliable, and they are grateful. You can pay them what for her is not so much, and you can be helping someone have a whole different lifestyle in the Philippines. I highly recommend what you’re doing.
Dr. Edward T: The last part of my pitfall, so I will try to wrap all this up, because between becoming lean, creating a virtual architecture, becoming proficient with all of these advanced regenerative medical procedures, and learning how to do aesthetics with an artful aye, I’ve also learned along the way. A lot of the pitfalls, I think, stem from paid advertising. I think in the group whoever is still listening left, all of us, I think, have all tried to pay-
Dr. Runels: By the way, it’s everybody. Nobody’s dropped off. They’re listening.
Dr. Edward T: Anyone who’s tried to pay for advertising finds it very difficult to measure a return on investment, because in my mind as a physician if I pay for advertising it means that there will a measurable return for a booked and paid patient. However, with marketers and paid advertisers out there, their metric is leads, or …
Dr. Runels: Yes.
Dr. Edward T: … clicker rate. Things that are not as relevant clinically to us and to our bottom line. I think there’s a big discord.
Dr. Runels: They don’t pay the groceries. Clicks don’t pay the groceries do they?
Dr. Edward T: It took me a long time to learn that at the very visceral level, that we have a disconnect here. That disconnect is what’s actually preventing, in my mind, marketers and physicians from really aligning together. I think that if there was a better, more kind of physician-centric way to create paid advertising … You know it’s good that all of us on the call know the basics of marketing and advertising, but the the end of the day we are doing all this to try to get back to what we signed up for, which is to help patients and do medicine.
Dr. Runels: Yes.
Dr. Edward T: As a pitfall I think what I’ve been guilty of is going down too far and kind of veering off course, and there’s so many tools, and so many virtual assistants, and so many Ontraports, and mail … I mean, there’s so many digital pools out there that I think every once in a while I have to pull myself back, not as an engineer now, because that’s all we do is create tools, right, for better solutions, but pull myself back to the medium, which is the physician in me and go back to doing medicine. I would say that’s a pitfall that I’ve realized that it’s very easy to go down that rabbit hole and find that next digital tool, that next widget, that next app, and forget what we kind of signed up for.
Dr. Runels: Just let me expand on that just a little bit and then let’s call it an night. All wonderful stuff, Edward, by the way. There are so many tools, and I’m literally at a class now in Cleveland that cost me 30 grand. I’m in a class today, earlier today, with a guy that made $900,000 in two weeks online. These are high-end people, high-end in that they know how to make money online. It’s interesting, what I’ve noticed is the people who are making 10 million or more on the internet, they’re still doing the basics, and it’s not just online. The other thing that these guys with real businesses with tell you is that you bring it offline as soon as you can. It’s handing out the brochures to your patients, or your just physical card and saying, “Hey, if you know somebody else I can help, would you give this to someone.”
Using the tools, just the basic tools of a video so you don’t have to keep explaining it, emails that you send to your patients every couple weeks so they know that you’re there, that are not fancy, that are messages that give them the things you would say to them if they were in your office anyway about what you want them to do to be healthy, and what you’re able to do for them with explanations and clicks to show them the research. So, a video, a web page that’s helping you let them know what you’re able to do, and then instead of doing all your time marketing you’re doing something, it’s a practice, and so you’re practicing it. But, here’s the fun part, you’re practice of marketing is actually making you a better physician, because you’re teaching your people how to be well leveraging digital tools.
I know if people are on the call that have done it on Instagram and Facebook and all the other tools, and I’m not saying you don’t do those things, but for these procedures what you just said is the formula that works, an email, a video, a web page. Deliver good messages and then while that’s doing you have more time and more money to go take care of your people, sometimes for free because the money’s flowing.
Edward, always a pleasure. I know people, I’m telling you the stick rate was amazing tonight. Everybody was listening, so I know they loved it. One last thing, guys. Edward does a mean class and you can tell he’s on top of all dimensions of this. So, have a great night, and I’m honored always to have your attention. Bye-bye.