Topics Discussed Include the Following…
[note, these weekly meetings are usually only held with our CMA members, we occasionally post the meetings for any provider who may wish to enjoy with the hopes that they may both find benefit to their patients and that they may consider joining us]
*Beauty analysis math & science of face & labia.
*The Beauty & the Beast
*New review paper of the aesthetics of the labia
*Tune Up your PRP protocol from a basic science paper
*FDA & PRP
*Strong warning about profiting from PRP kits and teaching PRP procedures [don’t]
*The Story of Altar™
*Up-coming hands-on classes with live models
Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips
Beauty Analysis. Face & Labia…the Math of Beauty
If math applies to the face, does it apply to the labia?
Charles Runels: So first, let me say congratulations to Dr. Alinsod, who just published another paper. We definitely want to get to that. I think let’s start by teeing that [research up] with some ideas that I think are widely accepted about the face. This is a website that is put out by Dr. Marquardt, who did some studies about what [mathematically] makes the perfect face, which you kind of have to think, “Well obviously, we were all made to be beautiful, and so, is it okay to decide what’s perfect?”
We’ll get to the labia. But I think most people are accepting that there are certain ideas that we recognize to be beautiful, although of course our affection for each other changes the beast into the beauty in the fairy tale. And of course that happens … It’s a metaphor for what happens when we fall in love with each other.
We know genetically we’re usually attracted to someone whose eyes are of similar color to our mother or something else about the face [that may be genetically determined by our brains]. There are certain mathematical things that go on, as Dr. Marquardt has shown with much of his research.
For example, the upper lip is usually about half the width of the lower lip [in the face of those we consider most beautiful]. I’ve put a link to this, or I will put a link right now into the chat box. Most of you guys are aware of this, because if you’re doing our Vampire Facelift, because I talk a lot about Dr. Marquardt’s work. He was an engineer before he was a physician, and did a lot of really accurate measurements with calipers before we all had computers on our desk and then translated that over. If you look at what he actually talks about here, how if you go all the way back even to, you can see, in former times …
It’s worth browsing this website because even if you look at artwork from ancient days, on every race, every race every continent, you’ll see the artwork very carefully closely matches what we talk about is beauty. I bring that up not just because many of us are doing the faces, but because it’s a major idea that is coming about in the cosmetic world, as most of you guys know. Dr. Alinsod just published something, and I’ll let you take a look at it, and I’ll provide a link to it. Let’s see. Let me pull this up for you. There you go.
So this just came out. Dr. Alinsod and Dr. Güneş … I suppose I probably said that incorrectly … published this paper where they talk about the ideas of aesthetics for the genitalia.
It’s interesting that in the days of Fifty Shades of Grey and such, in my opinion that, we can readily … The reason I started with talking about the face is…
it’s very unlikely anyone had any problems thinking about the idea that certain measurements [of the face] might be genetically embedded to our perception of why it [an individual face] might be beautiful.
And yet, when you swap that same idea [which also applies to the] figure and the breasts, when you swap it to the labia, people start to balk.
There’s a very strong political movement, both pro and con, and some of the thought leaders like Dr. Alinsod are trying to play a scientific role and leadership role and taking lots of heat for it, and teaching the world that maybe if it’s okay to think in that way with a face, it’s okay to think about it [in regards to] the labia. And so, in this review article, he talks about surgical and non-surgical ideas relating to aesthetics.
The references are very helpful, and I will put a link to this in the chat box right … Actually, it will be on the page for the recording for this once the transcript is posted (click to read).
But the couple of ideas that I would point out, and then I’ll open the mic for discussion. The things that caught my attention were, first of all, how strongly some of the ideas are opposed
and then just in general how [in following] the idea of making things more beautiful, we have stumbled upon how it [creating beauty] also is making things more functional.
Dr. Goodman was on one of our previous journal clubs, where he talked about his research showing that women actually have better orgasms and better sex when you do some of the things we’re talking about now, when it comes to just [improving] the appearance [of the labia in the eyes of the woman]. Let me swap something over. I want to show you an example from my practice. Let’s see here. So this is from the Vampire Wing Lift™ website, which if you’re doing the O-Shot®, you should have also a listing here. If you don’t, let us know about it. But if you go on the before-and-after photos, there are several here that were supplied by our providers.
Here’s from Carolyn [Delucia, MD, FACOG], and you can see there are others over here. But the one I want to bring up is this one, because I know the woman. She’s actually one of our providers. If you look at this, you’d think, “Wow. This is a lot of volume loss,” and you might think the rest of her body may look not so young by looking at her labia majora.
The truth is this woman was so fit that if she … If you saw her at the gym, you would think, “Okay, that’s a 60-ish-year-old woman, and that’s the way I want to look when I’m 60-ish,” because of course when women lose the fat in their body and stay lean, they also lose it in the cheeks [which is one of the reasons we do HA fillers and the Vampire Facelift®].
But what hasn’t been talked about is they [lean women over 35 years old] also lose it [faty] in the labia majora. And so, simply by adding volume back, with the combination of PRP and an HA filler, we’re able to easily restore this more youthful look in a very quick procedure. Now of course, Dr. Alinsod talks about surgical ideas as well in that paper I just showed you. I highly recommend this book, which also has a … And this will be the bottom when I post the transcript in the video for this webinar. I’ve already put the links here. But this book has a section on both the surgery as well as PRP and radiofrequency and laser and all the rest.
So, it’s not just for surgeons. I’ve never seen this price. It’s usually $230. I’m not sure why it’s dropped in price like that, but it’s a good time to buy it. I think I’ve talked enough.
Let me see. If anybody else wants to comment before we move to the next topic, please let me know. But I want you guys to know about this because it’s one … I would show it to your patients. Give them permission to do whatever feels natural to them. We’re not taking people and making them feel self-conscious about their body, as some might imply.
We are taking people who want to make all parts of their body well and functional, not just their bicep or their spine or their brain. Or why should we think about optimal brain function, optimal flexibility, cardiac, VO2 max, anaerobic threshold and not think about sexual function? It’s a pretty obvious, rhetorical question that some people have trouble with. So, empowering your patients by giving them links to our references, and I will post the one I just showed you at … If you go to just any of our websites, like you go to OShot.info or Vampire Facelift® or any of them, you’ll see a research tab at the top.
Even on Vampire Wing Lift®, we have actually a paper showing benefit from that procedure, Juvederm with PRP, combined in the labia majora. So there it is right there. Okay, so, I don’t see any hands up. I see Dr. Harrison on the call. I’m going to unmute you because Dr. Harrison told me about a really fascinating paper about the basic science of PRP. So, let me pull it up so you could talk about it. I’ll put a link to this one, as well. Let’s see. Why don’t I just go ahead and put that. I’ll put this one in the chat box as well.
All right. So there’s a link to get it.
So here we go. I’m going to unmute you, Dr. Harrison. Are you there, Dr. Harrison?
Dr. T. Harrison [Theodore Harrison, MD MBA ABAARM]: Yes, I’m here.
Charles Runels: There you go. Talk to us about this paper.
Dr. T. Harrison: Well we thought this was a really interesting paper. One of my Canadian colleagues sent it to me about a week and a half or two weeks ago. We have a little research group here in Victoria, British Columbia, where we have our little lab. We do a few experiments from time to time on different PRPs to try to find out what makes the best and how to make PRP and stuff like that. So when this came across our computers, we thought it would be interesting to see what these guys said and see if there was any way to make it practical, because this is a lab paper from Argentina.
It’s not very practical the way it’s presented here. What these guys did essentially was they took PRP, and they use a double-spin method for making PRP, which is unfortunately not described in the paper. But it’s referenced to a previous paper that they did, so you can find out how they did it. But anyway, they took PRP, and they did a couple of things to it to see if they could make it better. The first thing they did was they took it down to four degrees. They put it in a refrigerator and they got it down to four degrees for half an hour.
Then they tested it to see, with the various growth factors, and there are some pictures there about they tested migration and embryonic cell growth and how it affected it and the like. Yeah, you can see right there. Those pictures there are the first ones from the cold. The top graph is cell growth, the middle one is migration, and the bottom one is new blood vessel formation. They found that if you took just the … Well the control there on the left-hand side, that’s just fetal bovine serum. So there’s nothing in it.
Then the middle one is PRP releasate, which is to say, they took PRP and they activated it with calcium. I think maybe they tried thrombin too. Then the third bar from the left is washed PRP releasate. That is, they took PRP, and they did a second spin so that all the platelets formed a pellet now at the bottom. Then they removed the plasma from it, and they washed it with some kind of lab solution stuff, not really necessary in my opinion. But then they reconstituted it and activated it after exposing it to cold.
Then you can see what the results were. They got more migration, they got more angiogenesis, and they got more human embryonic cell growth from it. Also in the references, they have a good reference to the paper that gives good overview of what cold does to platelets. And essentially, what happens is, when platelets get cold, they get a lot more sensitive to activation, and they’re pretty sensitive to begin with. I mean, almost anything can cause a platelet to activate. I mean, I made a list once and it had like 20 or 30 things documented that cause platelet activation.
The only thing that keeps this from turning into a clot in five minutes is the fact that there are anti-activation proteins circulating in the whole blood. So that if a platelet accidentally tripped off, it just doesn’t set off the cascade and clot your whole vascular system. But, the fact is that they got a lot more results when they took away the plasma, and they got a lot better results when they made it cold. The second thing they did was take away the plasma.
Now, I’d heard a lot before that plasma helped PRP or helped the platelets in PRP. But these guys have some pretty interesting results here that show that if you take the plasma part away, the PRP actually does better. This is the washed platelet releasate part that they have there.
Dr. T. Harrison: Have there. So that was kind of interesting too. It doesn’t look … I can’t really tell from their data whether they cause lysis or not by doing these things. We know that lysate performs better than PRP by itself, and I guess I should define a couple of things here. Everybody on the call I’m sure knows what platelet rich plasma is and platelet poor plasma is. But there’s also a couple of nuances. There’s platelet releasate and platelet lysate. Platelet releasate is what happens when you make PRP, and then you spin it down and you add calcium to it. And then you spin it down again, and take off the remains of the platelet. So all you have left is the plasma, and what got dumped into the plasma from the alpha granules and delta granules after it’s activated with calcium, or something like that. That demonstrably performs better than just PRP by itself.
Now, platelet lysate is what you get when you take PRP and you spin it down, and you take all the plasma off, and you lyse the remaining platelets. So in that case what you get is a hodgepodge of everything that was in the platelets. I mean, it lyses the platelet cell membrane, but it also lyses the alpha granules, the delta granules, the lysosomes, the mitochondria. I mean everything that was in there just gets dumped into the mix. But what happens, this results in much higher concentrations of the growth factors and cytokines. And the research so far tends to go toward lysate being even more powerful than PRP, or PRP releasate as far as growing human embryonic stem cells. I mean human embryonic cells, our concern.
So these guys did the cold, and they found that that made the releasate more powerful, and they took away the plasma, and they hypothesized … and that made things better too. Again more immigration, more angiogenesis, more human embryonic cell growth. And they hypothesized that there were inhibitors in the plasma that were keeping the PRP releasate, the regular PRP releasate, from it’s full potential, you might say. And then when you got rid of the plasma, and then activated the cells and or lyse the cells, then you didn’t have these inhibitors anymore, and that’s why the plasma-free PRP I guess releasate you’d call it worked better.
And then they did one more thing. They also tried adding cryoprecipitate to the PRP to see what that would do. And they made the cryoprecipitate by basically freezing their PRP, or spinning down the PRP, taking off the plasma, and then freezing that plasma. It’s basically fresh frozen plasma. But they froze it for 24 hours. And then they warmed it and centrifuged it again to get the precipitate, which is mainly fiber and fibrinogen, von Willebrand’s factor, and a few more proteins like that. And so they took that precipitate, and they added that to their PRP as well. And they didn’t quite document so well what happened there, but it does seem like these proteins form a matrix which allows better migration. And it also has a little more effect on proliferation, though I think it didn’t have much of an effect on angiogenesis at all.
So basically they got three different ways they could make PRP better. You know, make it cold, take away the plasma, and add cryoprecipitate. So, I dunno, for office purposes, making the cryoprecipitate’s probably not very practical. But the other two are probably pretty easily doable, so we ran a little experiment ourselves here. Basically we took some PRP and we took a 3 cc syringe of PRP and we wrapped it in an ice brick. You know, one of these bags full of something that freezes really easily that you put in the freezer and then you put in a cooler or something. We just wrapped that around the 3 cc syringe, froze it, and then we took out the or empty 3 cc syringe, and we put in a 3 cc syringe full of PRP, and we took the temperature to see how long it took us to get down to four degrees. And it took about four and a half minutes to get the temperature of the PRP down to four degrees, same temperature as they used here.
And then we ran it through the hematology analyzer to see what happened there. And we found there was probably a little lysis. But not much else happened. It didn’t look like they were activated yet at that time. So for practical purposes, it looks like you can make PRP cold in about four and a half or five minutes. So that might work in the office pretty well.
And the other thing of course is just taking the plasma off, so it doesn’t inhibit the growth factors and cytokines that are released when you make releasate, or when you make lysate for that matter. And that’s just easy to do. You just after your second concentrating spin, or maybe during your second concentrated spin, you just spin it hard enough so the platelets form a pellet down at the bottom. And then you just take off all the plasma. And then you can reconstitute it with water if you wanna get a lysate. Or with D50 if you want to get a combination lysate releasate. Or maybe with normal saline if you wanna just get a releasate out of it.
So that’s pretty easy to do too. So from a practical point of view in the office, you could do about two thirds of the things that these people did to make their PRP more effective. And you can see from the graphs, that they got anywhere from 30% to 50% improvement in their PRP results when they did these things. So it looks like it might be pretty effective stuff.
This is only one study, and I hope other people will do other studies that’ll confirm this. But it is pretty exciting that you can increase your PRP effectiveness this much with some pretty simple things that you could do in the office.
Charles Runels: That’s very fascinating, and I was not even aware of this paper, so I’m sure everyone’s cheering you for, and just the fact that you told me that you went and counted by reading the research 30 different ways to activate platelets, I’m impressed and very grateful. My impression is that if anyone studied this paper in detail, they would have to come away understanding platelet rich plasma in a deeper way whether or not they adopted the techniques or not. You know, just the reading of the introduction to me was encouraging. Just as a reminder, as they go through as their intro for the study, the safetiness of it, and they go just these three words: recruitment, proliferation, and differentiation of stem cells. We all know that, but just to be reminded, all those things are happening, especially to those on the call who are new to platelet rich plasma. That’s what you’re doing. That’s a powerful statement.
And then on this next page, as you were mentioning, they say surprisingly, I think that’s an understatement to say that in something called platelet rich plasma, the plasma’s actually decreasing the effectiveness of angiogenesis. And they talk briefly here about why that could happen and give a reference. Anyway, you’ve done such a wonderful job of talking about it, I’m not going to muddy the waters anymore. But could you expand more on, having read this now, has it changed your practice as far as your daily … and you know Victoria Canada, like when you take the boat from Seattle up to that beautiful, amazing place right there. Is that where you are?
Dr. T. Harrison: Yep, that’s where we are.
Charles Runels: Wow, I was there once. I don’t see how you get any work done living in such an amazing place. It’s so beautiful there. I would just be outside, gawking all the time. So how has this [research under discussion] changed what you do? Or has it?
Dr. T. Harrison: Well, we haven’t really tried this on patients yet, but we’re definitely going to, because it’s really easy to just put your PRP in a freezer brick for four or five minutes. And it only adds a little bit of time to the preparation, and it’s pretty easy to take off the plasma after a second spin, and then reconstitute it with something. Now the question that we have is what do we reconstitute it with? Because we did a study earlier this year, which we presented at the AALM Conference, where we took PRP and we diluted it 50/50 with different concentrations of dextrose. Because we’re really interested in prolotherapy and using this in joint. And dextrose has been the main deal for prolotherapy for many, many years, ’til people started using PRP. We thought the two might be synergistic, so we decided what would happen if we added them together?
So we did different dilutions, from basically to sterile, distilled water, all the way up to D50. And we mixed them half and half with PRP, regular PRP, to see what would happen. And of course when we mixed it with water, we got about 80% lysis of the platelets. So it was almost a perfect lysate. Not quite, I don’t know why those last 20% of platelets didn’t lyse, but they didn’t. And at D5, D12.5, and D25, we got about maybe 15%-20% lysis. There seems to be something in dextrose that platelets are sensitive to. At least some platelets are sensitive to.
But when we got to D50, and we added one cc of D50 to our one cc of PRP, we still got 20% lysis, just like we had with all the other dextrose concentrations. But the other 80% of the platelets activated. The lower concentrations of dextrose did not activate the platelets, but at D50, all the platelets activate. The rest of the platelets activate. So you get a combination of lysate and releasate at that concentration. So that’s what we’ve been using for prolotherapy.
Charles Runels: Interesting.
Dr. T. Harrison: Now, for other uses, I’m not sure whether that would work or not. It certainly gets you activation, and dextrose is good for platelets, because platelets use dextrose. They eat it. They feed off it. And when you give PRP normally, the platelets don’t just dump all their alpha granules and die. They continue to live for about five to seven days, and they release further alpha granules in waves. So it’s not all the alpha granules that get dumped. And when you activate with calcium or with thrombin, it’s only the first wave. Because the alpha granules contain both pro-angiogenesis factors, and anti-angiogenesis factors. They are pro-inflammatory and anti-inflammatory. And they have both pro coagulation and anti-coagulation factors in them.
So it wouldn’t make any sense to dump all the pro’s and anti’s at the same time. And so they don’t. You get a first wave that’s probably mostly the pro-inflammatory, pro-coagulation alpha granules, and then you get a second wave, maybe within the next day or two, that has the anti-inflammatory, and maybe the pro-angiogenesis ones, and then so forth. They go through five to seven days of releasing new waves of alpha granules as they do their job. And it ends up the last wave is gonna be the anti-angiogenesis as they knock off all the little blood vessels that they made that they didn’t need anymore once the healing is all finished.
But when you make regular PRP and inject it, that’s what you get. The platelets stick around, they release their alpha granules in waves, it’s sorta like the normal healing process. When you make a lysate, all those guys just get dumped together. The pro’s and the anti’s and everything else, from the lysosomes and mitochondrian. It just all gets dumped together. But it seems that the much higher concentrations of growth factors that you get from that outweighs the presence of the anti-coagulants and the anti-angiogenesis. You know, the other factors that would normally work against the new migration growth, cell growth, and all that sorta stuff.
So, so far at least, it looks like lysate’s the most powerful PRP preparation. And so we’re thinking maybe we outta cool it, or maybe we oughta wash it, and then cool it, and then reconstitute with water, and see how much of a lysate we can get from doing that to get the maximum potential out of the PRP.
Charles Runels: Wow, what a wealth of knowledge. You should be teaching. It sounds like you probably are, but if you ever want to teach our procedures, I would certainly show up as a student to see how you’re thinking about it. One other question. If you look at this just as a reminder, and you’re doing this, when they talk about how PRP is used in regenerative medicine, it mentions of course muscle damage which you guys are doing as doing prolotherapy, I’m sure you’re treating that already. So if you were, as we’ve developed our O-Shot® techniques around the pelvic floor and the vagina and the urethral space, if you were treating a woman who had dyspareunia and had pelvic floor tenderness, or if you were just treating incontinence and using PRP in combination with an Emsella machine, where in theory, you’re causing strengthening of the pelvic floor, in those two cases, if you would … Because the thought is, of course, that perhaps you could inject the pelvic floor if you’re trying to strengthen it and then do your m-cellular treatment with the electromagnetic stimulation of the muscle, and maybe get a better result than if you did just one of those alone.
Note…we offer an icon on our directory to identify O-Shot® providers who also offer Emsella, radio-frequency, or laser in conjunction with the O-Shot® procedure. If you are offering these combination therapies, please let our office know so we can add the icon to your name on the directory (firstname.lastname@example.org).
Where would you inject, and how would you treat your PRP before doing something in the pelvis or vagina, where the idea was treating either dyspareunia or pelvic floor laxity, to help incontinence?
Dr. T. Harrison: Well, if it was for stress incontinence, I’d be fairly cautious because, you guys have run into cases where basically, you caused urinary obstruction from people injecting too much PRP around the urethral area. And since this is more powerful PRP, I’d want to sort of proceed cautiously there, using this sort of enhanced PRP stuff.
Now, for pelvic muscle floor, I don’t think that would be so much of a problem. And if you inject along the top of the vagina, out to the sides, along the course of the urethra using these more powerful solutions, you might actually be able to strengthen the whole pelvic floor that way.
Charles Runels: Or, if you were, say, treating pelvic floor tenderness, a trigger point injection for dyspareunia with pelvic floor trigger point reproduction of the pain, you would do … When you say that way, would you do your lysate with water and cold technique? Would you expect that to work better?
Dr. T. Harrison: I think I would expect it to work better than just plain PRP. Yeah.
Charles Runels: Yes.
Thank you. That’s helpful. To think about the overflow incontinence just to … Thank you for bringing that up, just for the rest of the people on the call, if you haven’t heard of that, we’ve had so far, I know of three cases. In every case though, the reassurance is that the volumes injected were 7 CCs or more, and so it’s yet to happen with our recommended 4 CCs. If you look, inject 4 CCs, it may not sound like much, but if you injected say … Imagine injecting, if when we do the face, we just inject one, it’s a pretty large volume. So, our thinking is, it’s probably more from a volumetric fact, but I appreciate your caution, would maybe if you had more platelet-rich fiber matrix formed, because of changing the consistency, perhaps that might cause it as well.
The other reassurance is that, in all three cases that I know of, that it within a week of an overflow obstruction basically from having created artificial hematomas, is really what you’re doing, it resolved, and the people did very well with the eventual resolution of their stress incontinence.
It’s pretty scary, though, when your person comes for stress incontinence and then they have to wear a diaper for weeks, because they’re dribbling all the time.
So, people don’t usually like that.
Dr. T. Harrison: Yeah, and the other thing you want to remember with using at least the plasma-free technique here is, you’re not going to get a fibrin clot, because you’ve taken all the fibrin, fibrinogen, and stuff away, so if you’re using it for maybe things where you want the PRP to all stay in one place like the O-Shot and scalp type things, where you don’t want it just wandering off, and diffusing really rapidly, you might not want to do this.
Charles Runels: Interesting. Yeah. Very good.
What a wealth of knowledge you are, I would want to spend the next two hours talking with you.
One of our physicians, Pamela Kulback, who’s one of the interventional radiologists in our group, typed in the question, about using, perhaps, the centrifuge. That is itself cool.
Do you know of such a device? Or do you have something in your-
Dr. T. Harrison: Oh yeah. We don’t have one, but refrigerated centrifuges, well they’re a bit expensive of course, but they’re easy to come by. All the labs have them, and you could do it that way.
The thing is, if you put the PRP in a refrigerated centrifuge, you would refrigerate it before you removed the plasma, because the plasma is still in there when you do that, and you might pre-activate some of the platelets when you did that.
So we prefer the technique of getting rid of the plasma first and then making it cold, so that we don’t have the plasma interfering with stuff while it’s in the centrifuge.
Charles Runels: Beautiful!
Well, stay on the call because we may want to pick your brain again. I think that covered the research we were going to talk about today.
FDA Approval of PRP
There was one question on the membership site that brought up the FDA question again, so I just want to remind everyone where I put that, of course thankfully, the FDA doesn’t drift all the way up to Victoria, but some of us have to think about that, so I’m going to open this where you guys can see where it lives.
And again, this will be posted to all the membership sites. But I’ve kept this page as up-to-date as I can (if someone finds another paper, let me know) but I’ve put here actual articles by the FDA where they have talked about, in very specific terms, they do not regulate platelet-rich plasma.
In the United States, they do regulate the devices and I think you’re safest in the US by using a device that is approved by the FDA to prepare plasma to go back into the body.
Now, in other countries, maybe that’s not such a big deal, assuming you have the depth of knowledge you just heard displayed.
There actually are people in the US who have a different level of laboratory that they’ve had approved by the FDA, essentially, the FDA has come in and said, “Yeah, you’re able to do this.”
But unless you have that in the States, I’d recommend you use one of the kits.
So the short of all this, and again, I have multiple references here, where the FDA is talked about … this isn’t second-hand knowledge, they’ve done articles for the New England Journal and their own website, and I have a video that explains at least my idea about it, and a transcript.
So anything that has to do with the FDA and PRP, we are in good standings.
The one thing that I would be careful about that I see going on and it’s nothing unethical about the intentions, but as far as the FDA goes, you could get slapped around some, is, if you are a physician and you are doing these procedures, and you are also selling therapy kits to physicians, as in, you are teaching usually, and you are either directly or indirectly profiting from selling PRP kits, in my opinion and in the opinion of the FDA (so I’m giving you a very gentle warning), the FDA has shut down sales people who teach what to do with the plasma because you’re teaching what the FDA has not said the device is able to do, they’re [FDA] only saying the device can make the plasma. The FDA doesn’t approve specific use for it.
WARNING! So if you’re profiting from the device, and you’re teaching something that no one’s proven the device is capable of doing, whether you’re the salesman who’s selling and teaching, or you’re the teacher who’s teaching and selling, you should be looking over your shoulder, because the FDA could come slap you around in a pretty dramatic way.
But other than that, as far as using it, if someone else is selling it to you, they’re profiting from the kit and now as the physician, you’re deciding what to do with the blood or the blood products, the FDA is very plain. They’re not at all bashful about telling you, they have no interest in telling a doctor what to do with blood, as long as you’re not manipulating the tissue to the point that it becomes a drug, and part of the point of a lot of these articles is that, when it comes to stem cells in the US, once you do a certain amount of manipulation, it gets reclassified, and now they are very interested in what you’re doing with it and again, unless you’re in a study, you should look over your shoulder in the US.
So that’s the quick version of that.
We’re coming up on the end of the hour.
If anyone else has some questions they want to throw in, I’m getting close to our topic list here.
This, we just posted, I’m not going to waste your time getting there again, but with [inaudible 00:40:24], I posted a video, actually had a interview with the guy who patented the ingredient … a cancer researcher at Harvard, then a cancer cell biologist at Berkeley, it was shocking to me when he told the whole story about how this product came about. I knew there was a lot of thought in it, but I didn’t know that it had directly six years of research on that level and a $2 million NIH study behind it, initially for the study of wound healing, which of course is related to cancer, as it involves cell growth.
I feel blessed that we [member of the CMA provider groups like the Vampire Facelift® and Vampire Facial® and O-Shot®] have the exclusive on this.
So it’s an idea to use post-treatment for the face, for the labia, (even for the penis) and I just wanted to remind you that it’s there and we also have classes coming up,
so if you want to check that out, and I think after that, that’s all I have to say today.
I can’t tell you how grateful we are, Dr. Harrison, for that amazing discussion about platelet-rich plasma. That’s just maybe the most detailed, informed explanation maybe that I’ve heard of the research on these calls so thank you for being on the call.
Okay so I don’t see any other questions, so I’m going to shut this down. You guys have a wonderful week.
Cellular Medicine Association
Relevant Links (listen to the end for a do list that brings new patients who need you)…
- The new Vampire Wing Lift™ website. VampireWingLift.com
- Where Vampire Wing Lift™ providers may be found. VampireWingLift.com/members/directory
- Where providers can login. http://vampirewinglift.com/members/wp-login.php
- New research by our providers…
Lichen Sclerosus. Kathleen Posey.
O-Shot® for incontinence and sexual function. João Brito Jaenisch Neto
- Post reviews to Priapus Shot® click
- Post reviews to O-Shot® click
- More marketing tools<–
- Pre-written emails and web page<–
Hope this is helpful.
Charles Runels, MD
Cellular Medicine Association
From an open-mike discussion sponsored by the Cellular Medicine Association (for our members only)
Transcript of Webinar<–
Charles Runels: So thank you guys for coming. We have quite a few questions. Before we get started with the questions, I thought it might be helpful to talk about what I call flow marketing, or you can call it vampire marketing, if you want, but the idea is that instead of trying to spend a lot of money trying to be how big you can be, it’s to [00:00:30] use something that’s already big, and then tap into that, to bring attention to what you’re doing.
Flow or Vampire Marketing
For example, when something is hot, like when I came up with the Vampire Facelift name, all the vampire movies were popular at the time, and so it helped promote our name, it blasted off, and then by that same token, for example right now, it’s the Halloween season, [00:01:00] so you’ll start to see things like this. This came out today. October 4th in today’s New York Post, and every Halloween the news loves to talk about our procedures, but the vast majority of our people never take advantage of that. Consider another way to think about this is think about this would be like you are tapping into … It’s like putting your paddle, your windmill in [00:01:30] the wind, or putting your paddle wheel in a stream.
So whenever everyone’s, a lot of people are thinking about Halloween, that’s exactly why you’ll see the newspapers start talking about Halloween stuff, because they also know that that’s going to bring a lot of readers, which is going to make people click on their ads, which is why they stay in business and get to buy groceries, [00:02:00] by having a website. So you can do the same thing. Now, if you go onto our … Well, let me give you specifics of what I would do right now.
This is the time to take something like this, and I’m going to put this link into the chat box, and I would take this link and put it wherever you’re putting things, like you can put it in your … Okay. Wait a second. Let me paste it. [00:02:30] There it is. So wherever you can put that on a Facebook page, if you have it.
Here’s 2 Pages to Share if You do the Vampire Breast Lift…
You can go into an email that can be simply three lines. It could say, “Hey, check out this thing on the New York Post where they were talking about increasing or improving the appearance of the breast using the Vampire Breast Lift, similar to the Vampire Facial.” So what you’ll see is our procedures all promote each other.
So for example, on the Vampire [00:03:00] Facelift website, I have a link that goes to the O-Shot. On the O-Shot, there’s a link that goes to P-Shot and back to Facelift, so they’re all talking to each other. It’s very similar to, say if John Grisham has a book, the best way he sells all his books is to come out with another book and then on the back cover of every book, there’s a list of all the previous books, so if you happen to read one and you like it, you’re going to read the others. So that’s how this works.
I call it flow marketing or vampire marketing, where you don’t [00:03:30] use your energy. You tap your marketing into someone else’s energy. Now I put a whole video just about that. I want to show you. If you go to the Vampire Facelift page or the O-Shot page, and then you go to the marketing part. I’ll just go. Let me log on. I’m on the O-Shot webpage. Let me go to the marketing so you can see. Then I’ll come back and answer some of these questions.
[00:04:00] Of course, is just you want to take care of your people, which our people do. That’s why the people who go to the extent to learn new techniques spend the kind of money and time that you guys do to try to take better care of your patients. I’m preaching to the choir, but the thing that doctors do forget, and I have to remind myself sometimes, is that it is not your patient’s [00:04:30] responsibility to know what you’re able to do, so I’m going to say that again. It is not your patient’s responsibility to know what I’m able to do. So lots of us don’t really enjoy making videos, including myself. I do it, I don’t pay as much attention to it as I used to. I’ve become more deaf to the criticism that happens and always happens, but if you forget yourself, that’s being self-centered.
If you forget yourself and you think of only two [00:05:00] things, you think of the person who has pain that you know how to take care of, and you think of all the solutions you know, not just the thing you’re trying to sell that day, but all the solutions you know of to make that pain go away, now you forget yourself and you just become all about letting that person know what you have in the easiest, cheapest, best way because that means you have to spend less resources to get that message out, which means you can put out more messages, so this is not just marketing tricks. These are efficient, [00:05:30] ethical ways to help you heal more people who are suffering.
So that’s what we’re doing, and it’s not about making yourself look big. It’s into tapping something. So let me get to where you can see this. If you go into this marketing part right here, there’s a video that I’ve put up that you might want to see later. If you want to make a do list for this call, I would say one of the things would be go to this page, and go to [00:06:00] this one. Leveraging the national press to bring patients to your office. 41 minutes. Leveraging national press to bring patients to your office. You can also say that tapping your practice into this, so what would it cost you to put an ad in the New York Post? But there’s an ad in the New York Post. It’s an article, which is much better than an ad, but your patients maybe don’t see this page, and if they do, maybe they don’t know that you [00:06:30] know how to do that.
So I just gave you a simple way to take … I just put in the chat box. You can take that link that I just put in the box, and you could put that in a Facebook post, and when you do that, it looks like this. That’s how it shows up, and I’ll show you what that looks like so you could also just click this link, but you could also go to a page, so I’ll go to the Vampire Breast Lift page and let you see how this works in real time. So if I go to [00:07:00] our Vampire. We have a Vampire Breast Lift page. Where is it? Well, I don’t see it right now, so I’ll put it on the Vampire Facelift page. How about that?
So if I go to the Vampire Facelift® page and I just copy that link, so I’m just copying it out of the URL, and then I make a post, watch what the software does. So I just [00:07:30] posted the link, but then boom, it pops the picture, it finds the link and pops it in there, and now I can actually take this out and type something in. Do you see how you did that? You can do that very same thing with the link I just did, put that in your Facebook page, put it in your whatever, [00:08:00] and then yours, instead of saying up here, Just in Time for Halloween, you can say, “Offered in our office. Call us.” Tell people what to do. “Offered in our office. Would love to take care of you. Call us.” Something like that.
And then what they do is they say, “Oh, my doctor knows how to do this? That’s cool,” and then they call you. That’s called tapping the flow, and you’re constantly looking for what’s out there, not even what’s specific to the procedures you’re doing, but maybe they’re related, [00:08:30] so maybe Kim Kardashian or some movie star just did something that’s related to what you do, but not exactly, so then you could talk about that, and then say what you’re offering, so I call that tapping the flow, and along those same lines, I intend, because it’s Halloween time, to push and talk more about this month, I will be talking more about the Vampire Wing Lift because it’s time for something new.
We’ve all been following this, but many of us who do the O-Shot have been doing that [00:09:00] now for the past five years. I’ve been teaching it for the past four, and many of our providers have been doing that, so it’s time to start rolling that out and letting people know about it, so if you want to tap into that, if you go to our regular website. Let’s see. I’ll try to log in here. I’ll show you where you can see more about that because we will be talking about that this month.
[00:09:30] So we’re coming to questions. I just thought we’d start putting some marketing parts that are relevant and timely when we do these calls, and again, I always try to keep these less than an hour, hopefully shut them down in 45 minutes and they’ll be recorded and posted. So a lot of people were having trouble finding things. When you log in, this is our straight-up how to do the procedures page, but if you look to the side, what I’ve started doing is posting some of the blogs’ material over here, so here’s the [00:10:00] Vampire Wing Left [inaudible 00:10:02] labeled treatment-
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Section 2 of 5 [00:10:00 – 00:20:04](NOTE: speaker names may be different in each section)
Vampire Wing Lift®
Charles Runels: Vampire wing lift. Label treatments for orgasm, amnion, and then here’s some of the recent question and answer sessions. There’s last week’s sitting right there. So if you want to view that.
Really, really, useful, mostly about O-shot talk, where we interviewed Dr.Owings and Dr.Pose who had some very interesting things to say about the procedure.
Here’s about the amnion, which can be used for all these procedures. Talks [00:10:30] about it, you can order it there (that’s our special pricing) But here’s the Vampire wing life. I may not be able to do this, but I intend to make this (silence)
So [00:11:00] a video that shows you how.
The big thing I would say here, is that when you do this do not inject them separately. Mix the Juvederm in with the PRP, and it tells you how there. Mix it in with the PRP before you do this procedure so you get a nice emulsion and it’s not lumpy.
The other pearl I would say, is whatever [00:11:30] amounts of material you have put two thirds here and one third down here. So two thirds goes in the upper one half and one third of the material goes here. It looks odd and just looks unnatural if most of the material is down here. So that’s the way I distribute the material.
Okay. Vampire Wing lift, it’s a good time to talk about it. And this is the member side. If you want something to link to on the patient side and start putting something out there. Because whatever you put out there, [00:12:00] the first one to put out, search engines like it better. So if you just go to the patient side, and go to oshot.info and you want to tap into the Halloween thing. What you can do is you can make an email or a post and say, “Hey the New York Post is talking about the Vampire Breast-lift.” And you can see the actual article mentions the Vampire Facial, they goofed up and didn’t put our trademark there. So we’ll have to see if we can get them to correct that. But that’s okay they got our [00:12:30] name out.
But then in the same text you can say, “You might want to check out the Vampire Wing Lift.” And then if you go, same thing, now on the patient website for the o-shot. And right here I put a page, if you look in recent posts, I put a page over here, Vampire Wing-lift. So you can put a link to that page.
Now the thing about the wing-lift though, because it shows a picture of the labia, I would be careful [00:13:00] about posting this one to Facebook. It could be in a Twitter post, it could be in an email. But if you post this direct link to this page about the wing-lift … Well, it doesn’t’, it just has that video. So you could probably get away with it. If it had the picture then not so good.
If you play that video you’ll see why I have Rod Stewart in there. Wings are actually in one of his songs.
[00:13:30] And I’m going to go ahead and post this link, also. You can find it but I’ll go ahead and post that in the chat box too so you’ll have it.
Okay, I think that’s probably enough about marketing for now. Let me look at some of the questions.
Oh. I did want to bring up something that I think its huge, huge, huge, that a lot of people … I do it in my Hansel workshops but I’ve never had it on the [00:14:00] online workshops. I go through a little exercise here … I intent to post this to the memberships sights. And I recommend you guys watch this, and it will be in the marketing sections. 13 minutes about why you should offer money back on everything you do where you take cash. You will make more money, and you will have much happier patients, you’ll sleep better at night, life will be better for you in every way. People are afraid they’ll lose money by doing this. You will make much more money, and you will have much more patients [00:14:30] who are happy with you. And this tell you why and how to do that. And I will post this in the members section. So watch for it and I’ll send an email out when it’s done.
I call that marketing but you’ll actually wind up seeing more people for several different reasons. And you’ll see when you watch that video.
Okay, so I think that’s enough … Oh, one other quick thing about marketing, I promise this is the last one. I’m actually [00:15:00] in San Diego now, in a marketing class. Some of you guys who know me well know that I spend a lot of time and money trying to stay up to date so I’m sure I’m bringing you the best of the best. And I’m at a class in San Diego that’s put on my the Ontraport people. And some of you guys have signed up for Ontraport and maybe haven’t implemented. It’s huge, huge, huge what you can do with this. This is not just emails, and it’s not that complicated. But to implement please make use [00:15:30] of their help people. You just call the Naomi and know the guy the company, who started the company, and they take very special care of our people. If you call them after you sign up they’ll take care of you. Some of you have already signed up where I actually give you emails that were written in Ontraport, and there’s a reason I do that. Ontraport does things like postcards and a lot of other things that [00:16:00] A Weber and Constant Contact just can not do.
Even though I’ve use Ontraport for about seven years now, I haven’t really recommended it much until the past six months or so. Because I thought their tools were too technical and not user-friendly. But they’ve made them user-friendly. A good way to get started is just to go to oshot.info/tools and download this free book about how they think about emails. How they recommend it, [00:16:30] and then if you wind up getting Ontraport, I have a way of giving you 22 emails for free to send up. Go here, and sign up and read that thing, and implement it. It’s really easy. I’m going to put where that … I have that listed again in the chat box so that you can go get it.
Let’s see, hold on a second. It’s the same page where we sale other stuff, so some of you are already handing out books [00:17:00] and such. So that is oshot.info/tools. That’s where you get that free e-book.
I also still use Constant Contact, A Weber, Mail Champ, Ultra Cart, One Shopping Cart, Click Bang, so many different things. So when I tell you this is the best … Oh I’ve also used, Infusionsoft, and [00:17:30] I don’t know. I’m going to bore you if I tell you all of it. But too much money, and too much time. So when I tell you that this is the thing to do, I’m not guessing. I’ve spent money and a lot of time trying to figure it out. So oshot.info/tools.
And not everything that works for Mcdonalds or IBM works for a doctor’s office. So I’m telling you what works for a doctor’s office. And when I say that I mean ethical, educational, inspiring, helpful [00:18:00] ways that you can communicate with your patients and a side-effect is they know what you have to offer. And they’ll find you and not have to spend a lot of money doing that educational type marketing. So oshot.info/tools.
Okay. And when you get there, of course, there are other things that you can … Posters and such. But the main thing I’m telling you right now is go get this. And this is free by the way.
So I think it’s time to answer some questions now. And I’m glad we’ve got quite a few people on the call [00:18:30] so we can get some participation in getting these answered.
So I am on the … We’ll start with the Priapus Shot, it’s kinda been ignored for a while. So let’s go into Priapus Shot and see, here’s one of the questions, see what it has, and hopefully you guys can help me answer.
And I’ll just unmute your mic. If you have a question [00:19:00] ask that too. I see Dr.Kelly has one, I’ll get to you in just a second Dr.Kelly. Let’s see, okay here we go.
Here’s the question, “Per your above education. I think the procedures work better if you activate the PRP with calcium chloride except with micro-needling where the tissue injury releases enough Thrombin to activate. Do you believe that PRP hair restoration should also activate [00:19:30] with calcium as well, prior to injecting?” Anybody doing hair that wants to comment on that? I’ll unmute your mic for you.
So, here’s what I think. I think with all the procedures you could make the case that they may work better if you activate it. My thinking though is that we’re seeing great results without activating, when it comes to hair. [00:20:00] My reasoning is, unlike say the O-
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Section 3 of 5 [00:20:00 – 00:30:04](NOTE: speaker names may be different in each section)
Charles Runels: My reasoning is, unlike, say, the [O shots 00:20:04], where you need the material to stay within a few millimeters of where it’s injected, because you want it close to the urethra, with the scalp, that’s sort of the exact opposite. You’d like it to spread diffusely, so you don’t have to do as many injection points. As a matter of fact, if you inject too much when you do the hair, you can cause it to hydrodissect down, and the eyes can be swollen shut the next morning. Of course, it goes away eventually, [00:20:30] and everybody’s happy, but I’d hear of that happening.
So, that’s my reasoning. I don’t think it’s needed. We have a lot of people doing amazing work, and lots of good, raving reviews, who do not use the calcium. So, I would stick to when you do the O shot, the P shot, and when you do loss of sensation of the nipple, all for the same reasons. You want it to stay where you put it, and it’s more therapeutic versus [00:21:00] cosmetic. Again, part of the danger of teaching, if you start to believe everything you say, so let’s do the research, and help me figure it out. Someone should do that study.
Okay, next question. Let’s see. I think that was all on the Vampire site that was not … That was on the P shot site. Okay, so here’s one, okay. Dr. Gaskill. Let’s look at this. Give [00:21:30] some guidance how to know where there are active hair follicles. Is it necessary to do the microneedling?
So, you don’t really know, but as a general guideline, you can see where the hair used to be, and if someone’s just bald as a cue ball, [00:22:00] I’m probably not going to do it. Usually there’s a receding hairline, and some thinning. What I usually do is just go ahead and treat everywhere there used to be hair. I don’t try to delineate exactly where the living versus all-the-way-gone hair follicles, where that borderline is. That’s the way I handle it.
It’s because I have seen some people where I just don’t think there was no way something was going to come back [00:22:30] there, and it did. Even some of our providers. Then, on the other hand, you have people where you just think it’s going to be the bomb, and nothing happens. I’ve seen a couple people lecture. One guy, out of NYU, he wrote a textbook on hair. Saw him lecture out at Denison, and he said after years of doing this, he still has no way of predicting. No blood tests, nothing. He just treats people, series of three, but after the second treatment, a month after treatment number two, if he sees no [00:23:00] results, he stops. But, he doesn’t really know until he tries.
Of course, it doesn’t mean because there is that unknown, you check thyroid, and you think about … I do. I think about IGF-1, and nutrition, and all that, but even with checking all that, you still can’t predict many of those who will fail.
Okay. Let’s see what other questions there are on the facelift website. [00:23:30] Anybody want to add to that? Let’s see. Here’s one. Where can I get more info on amnion and the hand lift? So, the amnion, to actually see where we have it, talk about it in particular, if you go to … Let’s see if I can show this for you. If you go on the [00:24:00] member site, and then you scroll up here to where the blogs are … Right there it says Hand Lift with Amnion. I think a lot of people just haven’t done a good job of showing people where that lives. So, if you want to know what’s recent, then look under Recent Posts.
You can also see who’s commented last. There’s [00:24:30] about how to do it, and I had some questions about Amnion, so I answered that there. There’s a little seven minute video. Then, you can purchase it there too. The prices there will be shocking compared to what you’re used to seeing from the number one providers. Wherever you’ve been buying it, we’re most likely getting it from whoever’s supplying that … from the person that’s supplying them. I think that answers that question.
[00:25:00] Let’s see what other question there was. This page. Oh, this is back on Priapus Shot. Going to shut that one down. There wasn’t no more questions. Then, on the facelift, I think there was one other question. [00:25:30] Recently purchased the pure spin system … There’s two more questions. One about cannulas, and one about PRP systems. Recently purchased a pure spin. Been training with Dr. Runels online. The direct injection of the PRP into the dermis is extremely painful. Mix with bicarb. It’s on back order. Okay.
[00:26:00] Yeah, isn’t it crazy that our laws … Every time I get one of these questions, it makes me sad that our laws are such that … Realize this is salt water, basically. Bicarb, calcium chloride. These are not narcotic, addictive things. These are not difficult to make in a sterile way. But, because of the rules with the compounding pharmacies, this makes salt water hard to find. It’s actually heartbreaking, to me. The place [00:26:30] that I go to that seems to be always, either they have it, or they can get it quickly, is … [inaudible 00:26:39] if you go back to our how to do it page, you go to the dashboard, and then you go … Scroll down to where I buy everything. Then, right here, it has all of it. It has my source, and it has [inaudible 00:26:57] phone number in there. So, that’s [00:27:00] where I would go.
After that, I really don’t have a good answer. Now, for the calcium chloride, you can also go to mrcrashcart.com, or whoever’s stocking your crash cart, and use those ampules, because that’s also 10% calcium chloride.
Let’s see. Think there was another question. Oh, it was about cannulas. Let’s see what the question was on cannulas. [00:27:30] I get that a lot. I can just start ranting about it, but I want to make sure that we answer this particular question. The general principle that applies to this, I think, and I see our expert injectors are divided about half and half, is that when you use a cannula, if you think about it, you have to make a small puncture [00:28:00] wound to put the canula through.
When I first started using PRP, I tried to use it like Juvederm, where I tried to lay down retrograde, or a line, do linear lines, or I would do little fans, like you do with a [hyaluronic acid filler 00:28:21]. Imagine if you had a bucket of water, and you’re trying to cover the floor with it. You wouldn’t feel inclined, or need to do that at all. You just pour it, and it would spread. I [00:28:30] found that that’s really what you can do with PRP. Instead of having to retrograde a line of hyaluronic acid filler, for example. Through the tear trough, you can just make a little puncture wound, and my needle doesn’t pass any further than it needs to go to put the lumen all the way through the dermis.
Then, I inject and it hydrodissects everywhere it needs to go, which is what you would have to do. You would have to make that same hole to put a cannula through, so there becomes no need for the cannula, which is why I don’t use [00:29:00] them for PRP.
Let’s read this question. Two questions. What are your thoughts for using cannulas for PRP. That’s it. When I talked about hyaluronic acids, I realize there’s a different reason for using them, and what I see there is our providers are probably divided in half. About half use them and half don’t. I usually don’t, just because I trained without them, and usually do not bruise people, or worry about necrosis, [00:29:30] because I’ve trained learning how to do it with a regular needle. But, I don’t have any problem at all with using them. I think that people who like using them should keep using them.
Next question. As well, I have a patient with very mild acne pitting, with slightly darker skin. Do I set my speed faster and depth deeper with microneedling? How many treatments, and expectations?
So, I talked with a guy who actually invented one of [00:30:00] the pens, one of the major name brands. He said that-
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Section 4 of 5 [00:30:00 – 00:40:04](NOTE: speaker names may be different in each section)
Charles Runels: The pens, one of the major names brands. And he said that they found that more holes is always better. And the only reasons they put three speeds on the pen is because they knew if they only put one speed, that others would brag about how they had a three speed pen and his company only had a one speed pen.
To me, it’s similar to your blender. You know, there’s a frappe and a whoope and a soupe and I don’t even know. Those 16 button blenders, is there really a difference between [00:30:30] button 10 and button 12? I just don’t have one, I have a blender that has one switch, on and off, and it’s got a steel bar that connects to the whirling blades. I think you could grind nails with it. When I turn it on it’s just wide open or it’s off. Maybe, it has a low, I don’t know, but it’s just one switch.
That’s the way I would think about your microneedling device. Just, turn it as fast as it will go [00:31:00] and as far as the depth goes, I don’t think it relates so much to the color of the skin. As a matter of fact, one of our providers, Dr. Lubin, up in New York, is treating and has some really beautiful pictures where she’s treating keloid in dark skin, with microneedling. I don’t think that really matters. I think that what matters is that you look at what you’re doing and you vary the depth, such that you’re getting [inaudible 00:31:29] hemorrhaging [00:31:30] as in going all the way through the dermis.
As far as expectations and how many treatments for someone with acne, I would plan on doing a series of three, about four to six weeks apart. The other little pearl of this is that, I would go ahead, even though it may not be part of what they came for and even though it may be a younger person, consider adding some volume to the cheeks and wherever it might need it using Juvederm or hyaluronic acid filler because adding [00:32:00] volume before you even treat the pit, pitting acne, is going to make those pits more shallow, just like if you blew up a basketball, the little holes are going to become more shallow because of inflation. Before you even directly treat the acne scars, they become more shallow, just because you add volume. And the expectations would be, I never tell anybody that things will go away but just that they will be improved and you can promise them, that they will be improved. They will like it and it will be softer [00:32:30] and less noticeable after you are finished.
All right, I think let me slow down here, because we’ve got some people commenting. I’ll start at the top and we’ll start with Dr. Kelly. I think I’m just going to unmute, Dr. Kelly, if you don’t mind. Let’s just let you ask your question to the group in a second if I can get this done. Here we go.
So Dr. Kelly is gynecologist out of the Atlanta area. She one of the, way back in the day came to see me [00:33:00] early on and trusted me. Has been doing the procedures for quite a while. I’m glad you’re able to log in. Tell us how it’s going and what’s the question.
Linda Kelly: Things are going well. Thank you very much. Can you hear me?
Charles Runels: Very well.
Linda Kelly: Okay. I had a question about whether or not anyone has used PRP in other areas of the body such as in the buttocks or a lift in that area, along with sort of like a vampire butt lift. Used it for cellulite [00:33:30] or anything. I just wanted to hear from the other doctors.
Charles Runels: I’ll see if anyone raises their hand and I’ll post this on to the websites. As you might know, we’ve talked about this before and I’m glad you brought it up so we can see what other people say about it. But, I normally will treat the lower part of the buttocks, that will roll right above the leg, like a Vampire breast lift and try to put at least 10 or 15 ccs preferably 15 mls of [00:34:00] PRP on each side and that fluffs that out where it’s rounder and I’ve treated quite a few people who’ve had divots in their buttocks from a cortisone injection and I don’t even mean Juvederm. If you just put 5 ccs of PRP in that, somehow it just knows to fill in and it won’t overfill and it looks beautiful and it’s permanent. I have people that, one of the first things I ever did with PRP, on the very first day, someone came. I put it in, not knowing if it would work, it worked great. There’s a lady on my staff, that’s been with me for several [00:34:30] years, same thing, just injected PRP in that area so the fat in the buttocks, just like in the breast, goes crazy with PRP. But somehow, it knows what level to go to genetically and it doesn’t overfill or underfill.
But, I don’t see anybody else raising their hand. I’ll post this to the website, Linda and see if anybody else comments on it. I know for the, I’ve had quite a few people, I don’t think any of us are doing this yet, but I’ve had quite a [00:35:00] few people tell me and they always just start ranting about the results from microneedling in post partum stretch marks on the abdomen. I know being a gynecologist, you probably have a few of those ladies around and they just rant over and over again about how wonderful that works, microneedling with PRP for stretch marks.
I’m just going to leave you unmuted, because I know you’ve been doing this for a while and might help us with some of these other questions. Would you have any, if someone was [00:35:30] just starting out, when you started out, our marketing, we didn’t have this much attention, nothing like this much attention when you first come to see me down in Fair Hope, so any tips you would give them as far as what you did right in marketing and maybe where things didn’t work so well. I’ve never even asked you this question before, but I was [inaudible 00:35:53] anything that you would say about what work well for you, what maybe did not work so well with you work.
Linda Kelly: I [00:36:00] really do think, with someone who is a celebrity, has had an experience with the procedure that piggy backing off of that, it makes a huge difference. People were interested in that and it, there were people who did not like the name Vampire Face Lift, here in Georgia, but there are people who loved it, so it’s kind of a different clientele that we were attracted to the practice because of adding that. Everyone loves the microneedling with PRP, I [00:36:30] mean, it’s really just, it’s been amazing and it’s one of the most popular procedures at my office, now.
Charles Runels: Beautiful. It’s interesting, it’s become accepted but you’ve been with me long enough to remember, when we first started using that name, and you don’t hear it so much now, now we spend lawyer money trying to shut down the people who are stealing it from us, but eight years ago when we first started using that name, we got a lot of criticism about how gross it was, it wasn’t really a face life, [00:37:00] but of course it is a face lift, in some ways more true than a surgical face lift, in that we are lifting the skin away from the skull and recreating that younger, full shape.
Of course, I’m all for surgery, I have great, we have amazing plastic surgeons at our groups. I want to make sure I say, someone goes through a windshield, we can put their face back together, that’s wizardry. We have amazing plastic surgeons. But there is this war for what [00:37:30] a word means, right? Like what does vas rejuvenation mean, some people want that to mean just surgery, and some people don’t want us to use it at all. There was this war, they thought the vampire name was gross and they thought we didn’t deserve to be able to use the face lift name, so you had enough courage to come on early and I’m grateful for that.
Let me see who else is on the call. Here’s a question from Rob Hamilton. If you don’t mind, [00:38:00] I gonna unmute you, too, Rob and see hold on a second and see if you can just ask the question. Go for it. Can you hear me, Rob? Are you there? There you are, now we can hear you. Go ahead and ask your question.
Speaker 3: Did you want some coffee or anything?
Charles Runels: Are [00:38:30] you there?
Speaker 4: Is there any way around here to get a bowl of soup?
Charles Runels: Okay, I’m just going to mute him. He must not be able to hear me. Okay here’s his question. He says I’ve done two hair restorations procedures and the patient said the intradermal injections both the vitamin and the PRP were very painful. I tried scalp blocks but didn’t have much success. We had tried putting the cream on also, again still painful. [00:39:00] Any hint, tips, experience for better pain control during this procedure. Sorry, I may not be able to stay on the line, okay.
So yes, I get that a lot that the hair is painful and so I’ve seen many ways, at least half a dozen ways to block the scalp and I’m overdue to do that. I’m just gonna promise you I will do that. I teach it in my hands on classes. [00:39:30] The method I have found works the best for me, at least in my hands and the short description would be though is I’d take 10 millimeters of 2% lidocaine and I usually just use it without epinephrin and I make little blebs just below the hair line as though I were making a line across the forehead, like you had a headband on. I do that across the front and then I do two injections in the back [00:40:00] that I’ll demonstrate on video, each of them two and a half ccs.
Section 4 of 5 [00:30:00 – 00:40:04]
Section 5 of 5 [00:40:00 – 00:50:55](NOTE: speaker names may be different in each section)
Speaker 1: And i”ll demonstrate on video each of them two and a half CC’s a piece and that gives me good pain control. That’s the first thing. And it usually gives me wonderful pain control but hardly ever perfect.
Then the second thing I do is I divide the PRP into one CC syringes with a Luer Lock. One CC syringes with a Luer Lock and I put 30 gauge half inch needles on there. The significance of that is that the 30 gauge needle doesn’t hurt much, but [00:40:30] if you put that 30 gauge half inch on a five of a 10 CC syringe, it takes forever to push the PRP out because the hydraulics all off. But if you it in a one CC syringe without a Luer Lock you just blow the needle off the end of it and you just give the person a PRP shower.
So it has to be a Luer Locked, one CC syringe and then the hydraulics are that you can push that very, very quickly. And so you can do the scalp literally [00:41:00] in about a minute or less. Where … So even if you have, say you have three out of 10 pain, if it takes you forever to do it, after you’ve done a bunch of injections, they’re not liking it. But you can get a six out 10 pain and if you can be done in 30 seconds, 45 seconds, they’ll still think it was pretty good because you’re just over before they have the time to complain much.
So those two things, the block combined with using that setup allows me go very quickly and so I owe you a good video to show [00:41:30] you how I do my block. And again, I have the great privilege, I think, to have taught these classes now for eight years and seeing how the people who come to me to learn the face, who are already making a fortune doing hair, see how they do the block. People come to me who are a very expert and every class I teach I try to learn something. So, it puts me in a very, I think … I’m just very blessed to be able to learn from you guys. So I’ll take [00:42:00] my combination best block and put a video up. But swap to the one CC syringes with a half inch 30 gauge.
Okay. So here’s another one from Dr. Newbanks. That’s a good tip. So I’m gonna let you tell them that. I’m gonna see if you can … Hopefully I can get you on here. Dr. Newbanks has been with us awhile. Let’s see if I can get you on.
[00:42:30] You there, Desmond?
Yeah. There you are. Beautiful. So give us your pearl about hair. Nice to hear from you.
Desmond: Oh. Yeah. Good to hear from you.
Well, what i do with hair, I have a little magnifier, dermatoscope, that attaches to my iPhone and so I can look under pretty high magnification of the scalp and there are areas that look full but they’re actually very wispy hair. And that helps me to be a little more precise with my injections. [00:43:00] And I combine PRP with an amnion called BioDRestore and get really good results. And the results tend to last … Oh, a year and a half.
Speaker 1: Beautiful. So you’re … Appreciate that tip. So where did you get the magnifier that’s attached to your iPhone?
Desmond: Well, it’s made by a company called Canfield. And it’s the brand is B-E-O-S H-D-2.
Speaker 1: [00:43:30] B-E-O-S H … as in hat, D as in dog, 2?
Speaker 1: Okay. I’m gonna put that in the chat box. Thank you for that top. Let’s see.
Speaker 1: B-E-O-S H-D-2. And it’s called Canfield with a C right?
Desmond: Canfield with a C is the manufacturer.
Speaker 1: Okay. Great tip. Okay.
And then, there was something else I was gonna … Oh. For your [00:44:00] amnion, I’m pretty sure the BioD people get their amnion from our new supplier so you might wanna look at the price on the website. If you go … I think I just showed you where to get to it. If you go to the Vampire Face website or member website. And then you click over to the Vampire … Look under the recent posts under Vampire Hand Lift and then you scroll down. That’s it. That’s the telogen. [inaudible 00:44:28] supplies. [00:44:30] Excuse me. Telogen, you can see it there in my little video, supplies entheogen or the amnion entheogen plus this is the amnion. And we’re getting 25 milligrams for a price that’s probably about a third … I bet it’s no more than a half of what you’re paying to the BioD. So hopefully that’ll help you.
And by the way, that price is only on our membership site. It was part of the deal I cut with them. I don’t have it out there. It’s only for our members. They just figured they [inaudible 00:45:00] [00:45:00] for it with volume because our people are, or they knew how to market and how to take care of people. So, might check it out.
But that’s a good tip. So, did you try it? Did you do the scalp without the amnion and swap over. What caused you to swap to the amnion? What happened there?
Desmond: Well, I just started using the amnion. The guys that I’m training with down in Boca Raton used the BioDRestore. And that’s why I used the BioDRestore. I started using that. [crosstalk 00:45:29]
Speaker 1: And [00:45:30] you saw a difference in your success rate?
Desmond: No. Again, it’s based on his experience. That prior to him using it, his results were not as good and were not as long lived but after the BioDRestore, there was a substantial difference, or the amnion.
Speaker 1: Beautiful.
Do you know what milligram it is that you buy? I know that the product come in …
Desmond: It comes in a one milligram vials. But these are [crosstalk 00:45:59] [inaudible 00:45:59].
Speaker 1: Oh. [00:46:00] It’s a one milligram vial?
Desmond: It’s a one milligram vial. And it’s frozen. So you gotta have a freezer that can keep it at -30 degrees.
Speaker 1: Not sure what happened. Yeah. Ours is a 25 milligram vial. So, even if … I’m not sure what happened there with your sound. Check … ‘Cause it comes as a powder and it comes reconstituted with a powder and a [00:46:30] sterile saline. And no matter what the volume is, look at the milligrams because we’re getting a 25 milligram and one CC. And we have half of that, we have 12 and a half milligrams and a half CC. And it could be that what we have is quite a bit more for a lot less to help us stay profitable.
So thank you for those. Those are good pearls.
Speaker 1: Let’s see if we have other questions.
I’m not sure what happened with our sound there, Dr. Newbanks. Hope you forgive me for that.
Desmond: [00:47:00] No worries.
Speaker 1: Okay. So, here’s one from Dr. Pickens. I’m gonna unmute you, Leslie, so you can … Oh, he fell off the call somehow. Okay.
I’m gonna unmute you, Dr. Pickens because it sounds like you might have had some things go wrong. Let’s talk. I mean, nothing serious, but let’s figure this out.
You there, Leslie?
Can you hear me?
[00:47:30] I’m not sure what happened. Can you guys here me?
So, I’m just gonna read this question. I’m not sure how we got disconnected.
Oh. Okay. So Leslie’s still there, but her sound is off.
Okay. So I’m gonna read your question, Leslie. It says, “I’ve done the ‘Vampire Breast Lift’ in patients with small breasts or long pendulous breasts. [00:48:00] You see little change. I’ve even used radioshurperapies. Anyone gotten success with patients with small breasts? If this is to [inaudible 00:48:08] aspects of the breasts with large?”
You know, that is a … That’s tricky. So, heres the thing. With the long pendulous breasts, say where it’s just almost flat and long pendulous, they … It doesn’t work as well. And I often will just, will not do it. I’ll tell them that probably they need [00:48:30] an implant, and I’m just not gonna be able to do much. When I’m talking almost flat, very long pendulous.
For the smaller breasts, I sometimes do get good results, but I have to let them know what’s going to happen. That you’re going to be perkier. So with this, they’ll be fuller, but it’s not going to be necessary cleavage that’s meeting in the center. It’s just going to be perkier like they had the bra on. And this … So this in a smaller [00:49:00] breasted woman who’s 20, may not do so much because they’re already perky. But let’s say she’s 30, and she’s breast fed her baby, then even though I’m still not going to have the breast … The cleavage meeting in the center and maybe not even enough coming towards the center to where she thinks it was a dramatic change. Because her breasts are not as perky perhaps as they were before she breastfed, she’s likely to [00:49:30] still like what I did if I tell her that’s what the goal will be and she’s, knows that up front.
And using that strategy, I do have a lot of ladies who had smaller breasts are happy, but not so much with the long pendulous breasts. So hopefully that answers that question.
So, I think maybe that’s enough. That’s 15 minutes. And I think we covered most of the questions. We did some marketing. Does anybody have anything they wanna add that’s … [00:50:00] Before we close this down because I know there’s some people on the call that are very experienced.
I hope to have some new tips. I’m spending three days and a bunch of money out here in Santa Barbara learning from the best. I’m surrounded not by doctors but by marketing people and programmers. So hopefully we’ll, I’ll have some new tips for you guys that I didn’t have even yesterday by the end of this week that I can put out there.
I continue to be honored. I don’t see anybody raising their hands. So you guys have a good day and [00:50:30] I’ll post this recording. Go check out the amnion and be sure and put up lots of stuff about Vampires this month because … Even if you’re just doing [inaudible 00:50:41] you can say, “Like the Vampire works, here’s how the [inaudible 00:50:46] works.” Use that Vampire word and you’ll be tapping into the flow. You guys have a wonderful day. Bye. Bye.
Cellular Medicine Association
- Google Click ads, small budget, geographical settings (click)
- O-Shot for lichen presented in Argentina by Dr. Posey (click)
- Vulvodynia (click)
- More about amnion (source, use, storage) (click)
- Pain control when treating lichen sclerosus
- Varying the O-Shot® in relation to pain/itching/symptoms (remember, don’t treat what’s not been diagnosed…biopsies sometimes needed).
Transcript of Video/Webinar
Charles Runels: Okay, let’s get started. The first question, we’re on the Vampire Breast Lift website, is actually a comment from Wendy Hurn.
Vampire Breast Lift® Questions…
She says, “I have performed several of these procedures to date and have amazing results around six weeks. My own, which is performed nine weeks ago, was amazing. Fullness and firmness with cleavage area many have commented upon. After breastfeeding in the past, I am delighted, so can pass this on to my patients with confidence.”
Thank you very much for writing Wendy.
This is one of those things where it almost seems too good to be true. I’m always grateful when our providers encourage each other. One thing about this when you do these procedures, just be sure you realize there’s a correlation and there’s causation and if you hand out 1,000 Tootsie Rolls to women who walk down the sidewalk, there will be some of them who get breast cancer. If you called it a Breast Lift Tootsie Roll, they might blame it on your Tootsie Roll. I think you can make a very strong argument that PRP is perhaps protective against cancer. We also have the strong research that if you look at the research part of the vampirebreastlift.com.
If you look at the Research tab, you’ll see there’s very good, very strong, research showing that when you mix PRP with fat and transfer it to the breast, there is a trend towards less cancer and there has been two really strong studies showing no increased risk of biopsy or recurrence rate in people who have had breast cancer and then being reconstructed, so it appears to be a very safe thing, but I would still do the same things that you would do for documentation if you were transferring fat to the breast. Most people know you transfer fat to mix it with PRP, so do those same protocols, just make sure the woman has been two things. Make sure seems been recently screened and that whoever keeps track of her breasts says that she’s good to go and number two, make sure you get a good consent form.
Second thing, but hopefully one of you guys will eventually do the research. I think that if you did, if you look at this trend towards less cancer, I think if you did a study where you injected the left breast of a thousand women, you would see a higher rate of breast cancer in the right breast. We don’t know that yet, but that’s what I suspect.
Next one is a question from Dr. Climikoski.
He says, “I have a patient who’s had breast implants and has loss of nipple sensitivity. Her primary concern is to regain the sensitivity back. She asked me, ‘What percentage of people that receive the Vampire Breast Lift do in fact have significant improvement in the sensitivity and are pleased with the results?’ If you provide me with an idea of this percentage, that would be helpful, as I’m a new provider for this procedure and don’t have my experience to draw from. Thank you.”
The answer to this one, I think, is … Again, we don’t have the research. In my practice, it is very near 100%. I’ve actually never had a failure when I was treated someone for loss of sensitivity after implants, but if they had extensive reconstruction, then all bets are off. When I talked to our providers, I hear everything from 50% are improved up to near 100%. I just wouldn’t promise this benefit if it’s for someone for extensive reconstruction, and with everything you do, I highly, highly, highly recommend that you offer a money back guarantee. When I treat this, usually it’s a woman who’s coming for improvement appearance and this is something she wants in addition to that. And so, she’s still happy if her sensitivity isn’t back like she thought it was, maybe, when she was 17. I’ve yet to have a woman tell me it did not make things better than before the procedure.
PRP Science-Techniques (what if the needle clogs?)
Next question is a woman who had … She just wrote this in to me. She says, “I had a 30-year-old,” this came an email but I thought we’d cover it here, she says, “I had a 30-year-old for her O-Shot. We used the Eclipse to spin the blood. My patients PRP was irregular in consistency and had clumps of what I thought had to be platelets. The 27 gauge needle and the syringe, for that matter, clogged a few times. I tried to force out the clumps from the syringe, but I’m wondering why this could’ve happened. Any comments appreciated in advance.”
There’s two things that could be causing clogging. I’ll tell you what they are and I’ll tell you how to deal with this because it can happen to everyone. First, it could be actually the platelet-rich fibrin matrix. I have seen clod up as quickly as two minutes out. This is why when I do this procedure, so in other words when the platelets are in the syringe, just sitting there, they can wait for about six hours in theory and still be okay to use, but once they’re activated; thereby, exposure to thrombin, calcium chloride, calcium gluconate, hyaluronic acid filler, or being excreted from the syringe back into the body exposed to collagen. All those things can cause the platelets to now degranulate, release the growth factors, and then the fluid of the plasma becomes congealed to hold the growth factors in place.
This is called platelet-rich fibrin matrix. It looks like goo inside your syringe. You may want to spend a syringe, activate it, and then just let it sit there and not use it so you can see what this looks like. It looks like little string or a little rubber band or something with a precipitate that forms in the syringe. It’s only probably 10%, 20% of the volume of the syringe will be clotted, but it makes a nice little linear precipitate in the syringe if you just let it sit and congeal. That’s what you’re making.
Now, if there’s turbulence and you’ve activated it can look clotted up in little clumps and that is what you’re seeing if there’s a delay. If you immediately take it out of the centrifuge and you see some little stringy things, maybe that’s platelet-rich fibrin matrix, but I’m not so convinced that sometimes it’s not some of the actual gel itself. I’m told that that’s not the case, but I’m not so clear that what that is and it could be the gel. In any case, I’ve never had it clog the syringe unless I’m slow about getting into the person’s body. When you’re drawing it out, use a … I use a 18-gauge needle to pull it out of the tube and then I have 25-gauge needles, literally within reach, so if I’m sitting there doing the O-Shot or whatever procedure have 25-gauge needles close by. If it starts to gel up and I can’t get it through the needle, then i just grab one of those and swap it out or sometimes you can just swap it before another 27 and whatever matrix is clogged the needle will be stuck in the needle, so when you get a new one, you can keep going. That’s the way to deal with that.
Try to have your patient all the way ready before you ever activate the platelet plasma when you do the O-Shot. Have 25-gauge needles within reach and fresh 27s and you should be okay. Oh, one other thing about the gel. We’ve had a few cases of urticaria. I’ve seen about, well, I’ve seen one myself in the face and I had another man who had some urticaria after Priapus Shot. In both cases, it went away with a Medrol Dose Pack. I’ve had two cases of urticaria reported to me by our providers. One after the face and one after an O-Shot where the woman got some urticaria of the inner thighs. All resolved without sequela using a Medrol Dose Pack.
If you look at the medical literature in some of the orthopedic literature, they talk about this happening and postulate that perhaps there’s a urticaria reaction that some people have to their platelets, but perhaps it’s from the gel itself. I just bring this up as a possibility. I don’t know why it happens, I just know it happens and that’s how you treat it. Maybe some of you guys can help us do that research.
Anything you would add to that Kathleen?
Kathleen Posey: No, but I actually think … I agree with the 25-gauge needle. I actually think I’ve used the 25-gauge needle more so than the 27 because the gel does really get thick and it makes it harder to push.
Charles Runels: So you use the … just routinely use the 25 for the anterior vaginal wall?
Kathleen Posey: Yes.
Charles Runels: While I’m here, just for those who may watch this video because this is all will be recorded and I’ll just post this to where people can see it. This gives a really nice simple diagram about where the material goes. I wonder sometimes if people are using enough. If you use the gel tube, I think you should probably spend three for each side of the breast. The price is set to where you can afford to do that. Basically, 15 milliliters of PRP for each side however you make your PRP. Some of the … I don’t know who knows, but I think some of the people who report not seeing much result are not using enough of this stuff. Let’s see. I think that’s all we had on the breast lift. Let’s look at some of the questions. By the way, anybody on the call who wants to ask a question, just click the raise your hand button and I’ll let you just say what it is you want to ask. Now, we’re on the O-Shot. That was the breast lift. Let’s go down the unanswered questions. By the way, if you ever want to ask a question, this is where to post it. Some of these have gone unanswered, but oftentimes our more experienced people will jump in there and answer a question. This is the way you get more than one opinion.
Priapus Shot® Questions…
Okay, so Dr. Ness has two questions. He uses the EPAT for erectile disfunction, along with PRP, after the fifth treatment and before the sixth. Should we inject PRP more often, say after every treatment? Also, has EPAT been used on women to augment the O-Shot? We’ll do this first question. I actually had an email from one of our urologists this morning. I’m seeing several variations, but most of the variations involve using PRP after the first treatment and after the last treatment, whatever your protocol is.
There was another research paper came out this past July in the Journal of Sexual Medicine showing that this works, but there’s no one that has done, okay, this protocol versus that. We’re still trying to figure this out. There’s a research paper for someone. Obviously, there’s two variables there, how you inject the PRP, or where and when, and how you do whatever physical therapy you’re doing.
More O-Shot® Tips…
I don’t know if anybody has anything to add to that, but the bottom line is that do whatever your normal protocol is, and then do your PRP after the first one and after the last one. Same thing with any sort of these physical therapies, lasers. Whether it’s shockwave therapy or it’s … and your frequency. I know you have the Thermi-Va, Kathleen. When are you adding in Thermi-Va when you do O-Shots?
Kathleen Posey: Well, I add it when they want to have improvement in the labia majora or want to decrease the size of their vagina. What I have noticed consistently now, having done enough of them, I really think when you decrease that distance between the clitoris and the vagina and/or urethra, the orgasms get stronger. I think, I’ve done enough now to know. The patients are telling me now, the ones that have had the Thermi-Va with the O-Shot, that the orgasm has gotten even more intense than the O-Shot, so I think that’s an added bonus.
I wish somebody would do the research to prove that it’s that distance because there’s such a problem when somebody has a baby and things get stretched out AP-wise. What you’re really stretching out is that length between the vagina and the clitoris, and then you’re constantly, as a gynecologist, “I used to be able to have orgasms with penis in vagina. Since I’ve had children, I cannot have orgasms with a penis in vagina.”
I’ve even seen C-section patients that haven’t had a vaginal birth, they’re still stretching out. They still have [inaudible 00:13:19]. They’re still having problems. I think, basically, probably gravity, but they do over somebody’s lifetime take away from your ability to have different types of orgasms.
Charles Runels: When it comes to you, do you do Thermi-Va and then O-Shot immediately following on the first visit, or how do you do your series when you’re combining those two therapies?
Kathleen Posey: Most of the time, I do the O-Shot and the Thermi-Va at the first visit, but sometimes it just depends. If they come in there and just say, “I’m here for the O-Shot,” I do that, and then after I do my exam, and I find they’ve had three kids, and I feel like they could benefit from the Thermi-Va, I give them the pamphlet and talk to them about that. So I’ve done it different ways. I’m not real consistent on … because there’s usually three treatments of Thermi-Va, and I’m not real consistent when I do the O-Shot with it. It can be the third treatment.
Charles Runels: I recently talked to Dr. Alinsod about this too [he does something very similar] and I know, Dr. Posey, you’ve done a lot of these. How long have you been doing O-Shots now, three years?
Kathleen Posey: Four.
Charles Runels: Four, yeah, so you’ve had … and I think probably more than anybody on the planet, your experience with lichen sclerosus combined with PRP is you’ve probably seen more patients than anyone. I don’t say this is for gospel because no one’s done the research, but when I speak to other providers, including Dr. Alinsod, they will sometimes do Thermi-Va, then another Thermi-Va, and then the last one of Thermi-Va, they’ll do Thermi-Va followed by O-Shot, or they’ll do ThermiVa and O-Shot on the first one, and then another Thermi-Va, and then, if they’re doing well, on the last one they just do a Thermi-Va. If they’re not as where they want to be, they’ll add an O-Shot to that last Thermi-Va treatment.
As far as the business part of this goes, a lot of our providers, when they come in, they’ll offer the O-Shot at the regular price, and then if they want to add in the Thermi-Va, they’ll cut the price of the Thermi-Va treatments in half, and sell it all as a package. Anyway, that’s become extremely exciting what people are seeing combining those two.
The general principle though that you never break, I think, is that you don’t do a heat, energy type treatment immediately after the O-Shot or the heat denatures those amino acids, small peptide, chemotactic factors, so you can do them both in the same day, but if you do both, you always just do the O-Shot after the heat therapy. I know you know that Dr. Posey but some of the new people may not.
Kathleen Posey: I have one thing. Can I add one thing
Charles Runels: Yeah, sure. Please do.
HUGE TIP (Small Vagina & Thermi-Va)…
Kathleen Posey: I just treated a patient this week that the Thermi-Va people sent me: Had seen a plastic surgeon in New Orleans, decreased lubrication after chemotherapy for colon cancer. She was in her 40s. No exam. So she gets here, and she’d gone from having intercourse three times a week to barely being even one. It was very, very painful.
Her vagina was so small, and they had done the Thermi-Va, so they were making it smaller, so all her symptoms got worse after the Thermi-Va. Actually, a lot of her pain was in the posterior fourchette. I just treated her this week, but I gave her another shot because I said, “Look, I’m going to see,” but you really have to select the patients and do the exams. If the three of us says, “Okay, I’m going to increase lubrication and decrease pain,” well, if the problem is your vagina’s too small, you’re going to make her worse.
She was worse, so the plastic surgeon complained to Thermi-Va. Thermi-Va says, “Well, where’s her exam?” They go, “Well, I didn’t do one.” They lived in New Orleans, so the plastics doctor called me and said, “Well, will you see her?”
You just really have to take each case individually because she was crippled because of a really small vagina. I don’t know if the O-Shot helped her. I did the traditional O-Shot, and I treated her with pain. I just wanted to throw out all these pain symptoms. I did another one today, which was episiotomy pain, and it’s helped her. She’s a year out and this is her second time. I do do the O-Shot, as well as treat where the pain is.
Charles Runels: Yes, all those are good tips, excellent tips, actually. I’ll just add to that that there probably should be, and maybe you can help us think about this, a … What’s the right word? Sort of a chart where you can picture down the one side is all the therapies, and then across the top are all the different problems, and you pick which do you do? Do you do radiofrequency or laser or PRP or dilators or hormones or whatever? And you can picture a pretty extensive chart.
I agree, not everybody … I don’t even use the word “tight” or “loose” vagina. To me, it’s all about matching your lover, and not everybody needs a smaller vagina, and when it comes to pain, for some reason our O-Shot just seems to be amazing, even when the etiology isn’t always known. But I want to emphasize what you said, if they can put their finger where it hurts, always put a cc of PRP there, and then do the regular O-Shot in addition to that. For example, your lady that had the episiotomy scar. My experience has been that, after an episiotomy, they’re usually good to go. So she lasted a year, and now it’s come back and hurting her again?
Kathleen Posey: Yes, it lasted a year. What she had was an episiotomy scar, and then some scarring around her posterior fourchette as well. It hadn’t come back as bad, but she just said, “I don’t want to have painful intercourse. It worked so well before, just repeat it.” I looked, it was a year ago. That was her second shot.
Charles Runels: Beautiful. That’s encouraging. So it wasn’t all the way like it was, but it wasn’t-
Kathleen Posey: No.
Charles Runels: … it had started to come back. There’s that negative feedback loop that can just make anybody avoid sex, especially, I think, women who have pain, and so breaking that feedback loop is so important. Just anecdotally, another patient I heard about from one of our providers, who’s-
Charles Runels: Just anecdotally, another patient I heard about from one of our providers who stays here with, usually with O-shots, she said she had a lady who had an episiotomy scar that had, not only hurt, but would bleed and tear ’cause the skin was so thin. The tissue was so thin, for years. And, no creams and all sorts of things had been tried with no result. And in this case, it took three injections 8 weeks apart, before the bleeding and the pain was gone. So, 8 weeks, pain’s a little better but not gone. Another one. So a series of three O-shots. So, I’m thinking in some cases the tissue may need more than one procedure.
And then lastly, I know we don’t have it here yet, but I know in Europe they have HA that’s made for the vagina. And then I’m wondering in those cases, it might be helpful to do both. So, like we do with our vampire user HA posteriorly with pure AP on top of it to help build that tissue posteriorly when we have an episiotomy scar. All thought they should not be used anteriorly unless it’s under an IRB protocol because of the risk of granulomas. Okay, let’s do the next question. Anything else you could add to that, Kathleen?
Kathleen Posey: No, that’s fine, thank you.
Charles Runels: Okay, let’s see. So, Cindy Crosby says, “My first question is piggy-backing of a question I read in the previous post. If there are there any post-op instruction pamphlets for vampire clients, please email. Second, I had an O-shot and the client had two large babies with two episiotomies. The anatomies very difficult to maneuver. The urethra’s approximately four centimeters long, it’s in the middle of what appeared to be a build-up of scar tissue. Has anyone experienced this and what was the solution?”
I’m gonna turn this one to you Dr. Posey.
Episiotomy Scars & Pain…
Kathleen Posey: Well, I agree, these can be tough. I would put a red rubber catheter in there and find out exactly where her urethra is. And therefore you would know where to put the PRP. Those are hard because, she probably had a cystocele and if you’re not used to looking at them, you’re not gonna know your anatomy because, it gets very distorted. That’s-
Charles Runels: Mm-hmm (affirmative). So, I think you told me once about a lady who did not get benefit for incontinence and then you brought her back and put in a catheter and then things. Describe for them what you do.
Kathleen Posey: Right, I mean that lady had, I mean you don’t want to say a looser … We have a large vagina had cystocele rectocele I put it where I thought it should be the first time. And she just said it didn’t work and she got on the O-shot website, said my name … This is a long time ago.
Charles Runels: (laughs).
Kathleen Posey: Trust me, okay. She got on and said, “This is horrible.” And I think they gave her a discounted rate. So I brought her in, and I said, “Look, but it didn’t work, you’re going back on.” And she did.
Charles Runels: So you brought her back and repeated it, and she went, and she got better. And so, what you did was put in the catheter? Tell me exactly what you did.
Kathleen Posey: Yeah, I took a small red rubber catheter, you put the other end up on the abdomen, so you don’t get pee everywhere, and then you see exactly how distorted that urethra is, because the urethra is distorted in that patient. And it takes the vagina with it, okay. And so you have to see where to put it. And sometimes it can go off to the left or the right, it isn’t straight in the middle. And that was her problem, it had gone off to the side, and so I just put it in never never land.
Charles Runels: So, in the second procedure, your intention is to put the lumen of the needle in between where the catheter was and the outer service of the vaginal wall? Is that what you did?
Kathleen Posey: Yes, which was probably part of the cystocele and it’s gonna look like it’s scarring, it may not have a normal look by itself.
Charles Runels: Beautiful, very helpful.
Okay, let’s see. Dr. Tuttle, “Dear Dr. Runels I have a new person who wants an O-shot, so a daily load dose of methotrexate. Will O-shots still work? Will we get enough PRP, will it work in the presence of this suppressant drug?” She’s using the Emcyte machine.
Okay, so. The general rule I follow is: Would this person recover from surgery? Could you do surgery on them? And if the answer is yes, so can you do it with HIV? Yes. Could you do it with a profound thrombocytopenia? No, not a good idea. So, I don’t know … What’s your thoughts on this one, Kathleen?
Kathleen Posey: I don’t know, but the only P-shot that didn’t work at all was on an 82-year-old with a platelet count of 75,000, and I did two. But I don’t really, I don’t know. I would try it, it’s worth a try. I’d give them money back if it didn’t work.
Charles Runels: Yes, see that’s how I do it. And if you’re new to this, you’re listening to this talk, the first two months, I would just do the easy cases. And of course nothing’s 100% but you have a really high success rate. If not the first shot, the second shot, you’re gonna get it at least 80, 90% of your people well. If you’re treating incontinence with good pelvic floor integrity, dyspareunia, lichen sclerosis, those people are going to get better- people who can have an orgasm but it’s not as strong as it used to be.
If you’re treating someone who’s never had an orgasm in their life, that’s a hard case. Or something like this, where you’re not sure what’s going to happen. I agree, you’re not going to hurt her with this. She would heal, you could operate on her, but is it going to affect this procedure? I don’t know. So this would be a more uncertain case. I would be more hesitant to take these cases until I’ve been doing them. Otherwise, if you do something that’s hard and your first two don’t work, you lose confidence in what you’re doing.
But, on the other hand, I will often take someone who I don’t see any logical reason why I’m doing harm, and then I take them, exactly what you just heard Dr. Posey say, under the condition … I just tell them right off the bat that, “You know, I hope I can get you better. And I’m willing to try this. And if I don’t get you better, I won’t keep your money.” And worst case scenario, you lose a little money but you’ve learned, and you haven’t hurt them, and you’ve helped them find a solution, and you’re still profitable in the next procedure.
Let’s see, I think we just had a question typed in. Okay, yeah, so … Okay, here we go, thank you. So, Dr. Carp I’m gonna unmute your mic, Dr. Carp, so that you can talk with us. Hold on just a second.
Go for it, you there?
Dr. Carp: Yeah, can you hear me?
Charles Runels: Yes sir, perfectly.
Dr. Carp: Yeah, I do all kinds of surgeries on patients with methotrexate, you know, the significance. So I wouldn’t be concerned in the terms of a complication with injecting it. I don’t see how it should have any impact on the expected results with the PRP.
Charles Runels: Beautiful. Thank you for that. When you do your surgery, you don’t anticipate it affecting them healing. So I’m not doing operations every day, so I don’t know that. So, you wouldn’t expect it to have an effect on wound healing. So therefore, we’re both thinking that one variable should not change what the effect of the O-shot would be.
Anything else? Because I know you’ve been doing this awhile, too. Any comments on any of the other questions that we’ve fielded that you want to add to?
Dr. Carp: Not really. I think that, certainly as was pointed out, if they’ve had some uvula-related issues in the rectoceles, et cetera, it does make it more difficult anatomically.
Charles Runels: Mm-hmm (affirmative) yeah. I think it’s never an embarrassment to turf … I love that we have a gynecologists and a urologists as part of our group. And to those in our group who are not, if they see someone where the anatomy is not what you’re used to seeing, I would feel free to … You know, I’ve referred people to Dr. Posey, she’s about two and a half hours from me. And people that … For example, when the clitoris is phymosed down, that’s not something I should be tackling. And so, I send them her to a gynecologists.
And so I encourage those in our group to look at the others in the group that are close to you, so that we can work together.
Let’s see, there’s another. We’ve covered breast lift, the O-shot, there’s some questions that have accumulated about the priapus shot. Let’s go through some of these. Let’s see, okay.
“I was just wondering, can you freeze PRP and then thaw it later before activator procedure? We did a P-shot today, we used pure spin, which do about 20 CCs, and we used 10 of it, so we had some left over and didn’t want to throw it away.”
I know some of the ophthalmologists are putting in the fridge and using it for eyedrops for dry eyes, and using it for a couple weeks at a time. Maybe the answer to this is yes, but I wouldn’t want PRP that had been frozen … You know there’s enough profit built into our procedure that you could afford to spend a kit later. If you wanted, what I would say instead of this is that, there are those in our group that, when they use a priapus shot are using more material.
The only reason these volumes came about is back when I started doing these procedures, back in early 2010, so eight years ago, a one tube of Selphyl, which is what I was using at the time… so, my cost of goods was pretty high. So it was based on what I could find, the amount that could spread through a penis, and I found 10 was what it took to actually infiltrate the entire corpus cavernosoum of an average-sized man.
But others in our groups are using more, so I would say instead of wasting it, just double the volumes and use the whole 20 CCs if he’s average size or larger, and you should get a result. The only place I would say not do that, between the O-shot and the P-shot, is absolutely do not do that with the anterior vaginal wall because, I know of three cases now where our providers got a little overzealous and had an overflow obstruction. It went away and the person winded up doing well, and good results for their stress incontinence, but they went from stress incontinence to an overflow obstruction to wear a diaper for three or four days because of too much volume.
I think anything more than 4 or 5 CCs in the anterior vaginal wall is probably too much. But in the penis, go for it.
Anybody want to add something to that?
Lichen Sclerosus in the Penis…
Okay, so Dr. Leonardo says, “How do you treat lichen sclerosis on the glands? The video does not address this. Do you perform the same injections with the P-shot or would you micro-needle it?”
You know, Kathleen you’re treating a lot of lichen in the labia and around the clitoris, what’s your … This is just a larger clitoris, right? Or you could say clitoris is a smaller penis. What would you say? How would you answer this?
Kathleen Posey: I would inject it right in the areas of the lichen sclerosis, wherever they may be.
Charles Runels: Yep. I would too. I would feel … In a normal priapus shot, you would just kind of … I imagine the glands of the penis, literally like a sponge, and of course the underside of it that’s connected to it is the corpus spongiosum, so it does behave like a sponge.
But I agree with you, if there’s a sclerotic area that you can see or the patient can feel subjectively and put their finger on. I would go intradermally, as best you can, into the sclerotic area and treat it like you would sclerosis anywhere else.
I think, again, we just put out the first paper, I guess it was a couple years ago, and this last paper in the American Academy of Dermatology in January of this year. It’s not like we have some huge body of literature about the best way to do this. It’s part of the reason I like these calls because there’s smart people in this call, and you guys can help us figure out what the best way is. But that’s my best idea for now.
Anybody have anything else? Okay.
“I have a patient who has IPP. What is the injection recommendations, techniques, for lidocaine? PRP amounts of each … Locations along the shaft and the depth … In addition, has cold syndrome, for numerous reasons …” whatever.
Okay, so there’s a link here that takes you to a recording when it comes to the penile implants. That, when I interviewed Dr. Joe Banno, who’s one of the urologists in our group … And the biggest thing that I would say here is two things.
I would not use the vacuum pump, and I would not try to inject the shaft at all. And I would consider long and hard whether to even do it at all. Because if their implant fractures that night when they have sex, you could be blamed for it.
But if you do this, and Dr. Banno and I would do this, and most of our providers would do this … I would keep it just to the glands, and come in laterally like you do with the regular P-shot with just the bevel going into the carona of the glands. And just infiltrate the glands, and let that be it. Nothing else, or I think it’s too risky.
Anybody want to add anything to that?
Anyway, watch this video for more details. It’s only five minutes but you’ll get it straight from one of the urologists in our group who teaches. By the way, Dr. Banno teaches urologists how to do implants. It is his specialty. And he has told me that he started making the priapus shot as part of his pre-op before he does the implant because he’s getting more rapid healing and better results, as far as that sensation, and not having that cold feeling.
Any other questions? I think that might be the last one that was turned in. I know we’re only 38 minutes in, but I didn’t come here to try to teach anybody anything. I’m just trying to give us a forum. And our intention is to do this every week because the questions accumulate. And that way, someone other than myself can help think about them.
Anybody on the call have anything else to say or question to ask? Because now is the time and I’ll unmute you and we’ll have it out here for people to comment on.
And I’ll post this video, so who knows? Maybe some other people in our group … We’re pushing 2,000 members now in 40-something countries. We’ve got so many specialties and multiple medical schools, lot of smart people just like you guys are. So, maybe we can get other questions or other ideas.
But anybody have any other questions?
Okay, well I’m on stand-by and I hope this was helpful. And I’ll post the video, and we’ll try to do this every week. So if there’s something that comes in between, this will be the place to get it answered.
Honored to help out, and you guys have a good week. Bye-bye.
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