Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Today I have a really fun topic to explore. It's about threads and thread lifts and how we can use threads in lots of different places in the body to lift and, you know, create more collagen. So I have Khanh Nguyen with us today. Welcome, Khanh.

Khanh (00:38):
Hey, good to see you Monique.

Monique Ramsey (00:40):
Good to see you. Better known as Dr. Khanh <laugh>. Everybody's like, oh, Dr. Khanh. I love Dr. Khan. So Khanh is the thread doctor, the thread specialist in the office. And you know, you're widely known, comfort doing all kinds of great things with injectables and lasers, but I think you're the king of thread lifts. Would you allow us to grant you that title?

Khanh (01:06):
Sure, I'll let you say, I'll just say I've been doing it the longest. So the senior citizen of threads. How about that?

Monique Ramsey (01:11):
Oh <laugh>, senior citizen. So let's talk about what a thread lift is and what makes the procedure special. Tell me a little bit about threads. What can we like picture as what they look like?

Khanh (01:25):
Yeah, so threads for me, I think it builds a bridge between a medical spa and then a surgical center. So not many things outside of surgery will help lift skin. Now, in med spa arena, we have Botox for wrinkles. We have fillers for volume and highly debated subject do fillers lift, which we can talk about another time. But at a certain point you'll have too much fillers in your face, or you are just the type of person who doesn't want fillers in your face. But you still need to reverse the signs of aging. Aging is going forward, aging is falling down. So now we can take threads and actually physically lift your face, physically lift your body, physically lift your neck, different areas of the body. So that's why I believe it's that bridge between a medical spa arena and a surgical, because not that many, many things lift. And that's where threads are mostly used for is lifting of the skin and like you said, really building collagen.

Monique Ramsey (02:18):
So how do you know when you've reached the point? Like let's say you're using fillers and don't know if you're reaching the point where fillers just aren't doing the trick anymore. Like, you know, is the threads gonna come in after fillers or in conjunction with, and then how would I know when it might be time for a facelift?

Khanh (02:37):
Sure, great question. And I might be divulging a bunch of secrets here, but when you see me in office, or even when we do Zoom consultations, my hands represent fillers. My hands represent threads. So I can actually physically show you one side of your face, what it'll look like with fillers, the other side of your face, what it'll look like with threads. Oh, so with fillers you're replacing volume. So as we age, we lose bone fat, collagen and muscle. So we're losing a bunch of volume systems in our face. The only thing that we replace volume is volume. So fillers. But let's just say you're at an age where your skin is very thin, and if you don't like fillers or you're already volumized to the point where you're happy, but now how do we lift the rest, rest of that skin? That's where PDO threads comes in. Now we all do this trick at home in the mirror. When we look at ourselves in the bathroom, what do we do? We take our face, we put our finger on our skin and we do this.

Monique Ramsey (03:33):
Yeah, <laugh> all the time. <laugh>.

Khanh (03:35):
So I'm like, one day it just, it came to me. I'm like, this is how I'll represent threads to people. If you take your finger one solo finger and you put anywhere on your body, eyebrows, cheek, jawline, and you give yourself a nice little one finger lift without causing any amount of the skin bulging in the back of your finger, that's how you'll look with PDO threads. So if that makes you happy, PDO threads is a great option. Now if you have to take your whole hand, you have to take multiple fingers. Or if you're pushing so hard that you have a mound of skin behind your hands, that's when you go see a surgery center. That's a quick way to represent PDO threads versus your surgical result.

Monique Ramsey (04:12):
Okay, and filler. How do you figure out what filler might look like before you have the filler?

Khanh (04:20):
Yeah, similar situation. Let's just say we have generally three hollows in our face. We have temple hollows, we have midface hollow, and we have lower face hollow. So when we start hollowing, that's when skin begins to sag descend, and we look a little bit older. So how do I represent volume? So if you take your temples, if I had a hollow temple right here, take your hands now instead of lifting, you want to pinch that skin to create a mound. Oh, that's replacing volume. Let's pretend that you had this tear trough, this midface hollow. If you push the skin on your cheek up to create this volume, that's how you represent fillers.

Monique Ramsey (05:01):
Got it.

Khanh (05:02):
So that's how I generally represent fillers versus lifting with threads to patients.

Monique Ramsey (05:07):
Perfect. That was, that was so educational. Thank you. <laugh>. I'm now gonna be after this thing. I'm gonna be like, all of us are gonna be <laugh> using our fingers and figuring out like what we need. You said PDO threads. So what does that mean? What is PDO?

Khanh (05:23):
Yeah, so a low history behind it. So PDO stands for Polydoxin. That's just the chemical makeup of the thread. Now, much like fillers where you have brands like Juvederm and Restylane, they all make HA fillers. So think of PDO as equivalent to saying a hyaluronic acid filler. Now here at La Jolla, we specifically use Nova Threads and maybe a couple other threads if I need something specifically. But the history behind that is surgical sutures. Your whole family is um, surgeons. What happens in the 1970s for cardiothoracic and um, orthopedic surgeons, they needed a suture where if they sewed up a patient, it would dissolve over time because you don't want any foreign implants on the body that may cause issues. So now in the late nineties, early two thousands we're like, Hey, can we use this dissolvable suture to actually lift skin? There's a little bit more history behind that, but the medical history behind it has been around since the 1970s. But now we can take that dissolvable suture and lift skin, more importantly, build that collagen that we've lost over time.

Monique Ramsey (06:23):
So because you can get a little bit of lift, could it postpone the need for a facelift? Does it help make it be like, oh, that's five years down the line now because I had threads? Or is it more of a temporary fix?

Khanh (06:40):
It can do a lot of things. Let's just take the patient who isn't medically qualified for surgery, isn't financially ready for surgery or they don't feel like surgery is, they don't need that much of a lift yet they're in that middle ground. So PDO threads is again that great bridge to give you that one finger gentle lift because it builds collagen because it's also improving your skin and quality over time. Can it postpone surgery? Absolutely. But it can also prep you for better surgery in the future because if you have better skin, better tissue quality, the surgeon can potentially pull tighter, lift harder, things like that.

Monique Ramsey (07:19):
Oh, I like that. I didn't know about that. And then for somebody who's already had, like me, I had a facelift a long time ago and I've had threads. I mean to me it's kind of a wonderful adjunct after when you're like, okay, I have some laxity again, and how do I take care of that without another surgery?

Khanh (07:40):
Bingo. So threads can be the ultimate fix. However, it can also fine tune. So some of the surgeons who have actually done the surgeries and let's just say they're, they were unable to grab everything that the patient needed due to a multitude of issues, right? Let's just say we weren't able to grab all the jowl, all the nasolabial or the smile line. After the patient is fully recovered, the surgeon will actually send them up to me and be like, Hey, can we grab the rest of this jowl? Can we grab the rest of this smile line? Because the last thing a surgeon wants to do is put a patient under anesthesia again, just to fine tune these little things. So now this is where threads comes in. I can actually physically grab that area where we wanna lift, lift it up, and now hopefully the patient's at a hundred percent improvement now even after surgery.

Monique Ramsey (08:20):
That's wonderful because I think that's the one thing with facelifts that people really are scared of, is that looking too tight, too pulled. And you're right, if they're, if they pull a little bit more, it could end up looking unnatural. Whereas wait and see how everything settles and then maybe fine tune with the threads. That's a, that's really a, I never knew that you, you know, I knew I did it after having a facelift l much later. It's been a long time. I was 37 <laugh> when I did it. Yeah. And I'm 55, so you know, it's been a long time, almost 20 years. But would you wait, let's say the patient would be how far post-op from a facelift to be able to have you fine tune?

Khanh (09:02):
I leave that up to personally your surgeon. That's always the most important thing. If you aren't not part of our surgery center, then I always say, Hey, go to your surgeon, make sure you're qualified and then we can address it as well. Actually, this brings up a a good point. I had a patient in their mid thirties who had a facelift and it was I think within six to 12 months, I can't remember. But the first thing I said is, Hey, go to your surgeon, make sure you're qualified for threats. Because the last thing I want to do is make any damage that's long lasting, right? So speak to your surgeon, make sure it's okay. And then we can do threats anytime that I give that clearance. I think our surgery center, I think it's usually after like three to six months. And that's usually my personal rule is three to six months outside of surgery just to make sure you're fully healed. That hey, maybe in six months everything that you thought you needed to correct will correct itself.

Monique Ramsey (09:45):
That's true, that's true. A lot of things do resolve on their own and you know you have swelling even if you don't even really realize it, I think over time. Now, speaking of swelling, so is that something that when you're doing, let's say we're doing threads in the face, does that cause trauma or swelling or what's sort of the, do you have to worry about if they went out to dinner that night or the next day? What are your tips for managing your post-op?

Khanh (10:13):
Yeah, so I know threads are relatively new to the San Diego area, especially when I brought a hair four or five years ago. Everyone was like, you wanna put a string in my face? <laugh>? So I wanna break this down as easily as possible for people. Everything that you associate with fillers, you can associate with threads. If I'm doing a filler, I'm taking a needle and I'm putting in a filler with threads, I'm taking a needle and I'm putting in a thread. So every single thing that you associate with post-care or pre-care, things like that with fillers and threads analogous with each other. Now with threads, can you get swelling? Yes you can. With fillers, is there a downtime? Absolutely. If I bruise and swelling you, it would just be normal downtime. But fortunately at La Jolla we have a laser that gets rid of bruising and swelling.

(10:56)
But then lastly, a lot of the swelling that you actually get from threads is not from the thread procedure itself, it's from the lidocaine I put in. So I can make you as comfortable as possible where you feel absolutely nothing or you're like, Hey, I have to be somewhere in 24, 48 hours. I don't wanna be swollen. So we can limit how much lidocane we put in you. So it's actually not the procedure that that makes you swollen. Unlike fillers. Fillers naturally makes you swollen by nature, but threads doesn't, it doesn't pull in water. So a lot of the swelling that you do get, it's just from the lidocaine itself.

Monique Ramsey (11:25):
Interesting. So now of these threads, I've seen you hold them and there's different kinds. So you're talking about it being suture, but kind of if you could walk us through what are the different types of threads and what you use them for?

Khanh (11:41):
Yeah. In America we have three different type of chemical makeup. When it comes to threads, we have PDO, we have PCL, and we have P L L A. PCL and P L L A produce more collagen, they're more biostimulators. They're similar to what sculptura is. Now, PDO is more dissolvable over four to six months. So because it doesn't last as long, I like it because there's less complications. Something that lasts longer in your body. Granted we want longevity, but anything that lasts longer, the complications last longer. So if you create a lump bump, you're gonna create a longer lump bump. And then PDOs for me, I think are stronger. So that's why I use PDO threads. They less complications and they're stronger by nature. Now, within PDO threads, this will distinguish coming to me, coming to La Jolla versus coming to other places. I use all different types of threads I want to lift you.

(12:31)
So these are the barbs, also known as molded, also known as cogs, multiple terminology for it. But what they are is they're little porcupine tails, thin threads. And I can actually physically lift your face. So that's that one finger. Anywhere where we wanna lift skin, that's where we're using the barbs. Now we have two other types of threads. We have smooths, which look like little pieces of dental floss. And then we have twists that look like little slinkies. Now I'm probably aging myself by saying Slinkies, <laugh>, but, but, but this is how we complete the treatment for you. We don't want to just lift you because this is what happens. I lift you, you look great. Two months down the line, you're like, where did all my results go? So I want to make sure I stimulate enough collagen so your body looks better, better and better. All the way up to the six month mark, you will look a certain way When we first treat you, you will look your absolute best in six months because you're stimulating more collagen, you're lifting and you're more tightening. So that's how we treat it here. We use barbs, we use smooths, and we use twists to complete the full treatment when it comes to your face and neck body.

Monique Ramsey (13:33):
And do you think that that could be why, like I've gone to different websites and sometimes people are like, I got threads and they didn't do anything. Do you think that's kind of why maybe that the approach isn't a full treatment?

Khanh (13:47):
Absolutely. Just like fillers, just like Botox, just like, well any anything in surgery and medicine, right? If you don't choose the right treatment and you don't choose the right dosing, you don't get the complete treatment. So if you do surgery and you need a full face and neck, but all you paid for was lower face of neck, you're not getting the full treatment with PDO threads, I am more of the Asian and European style of treatment where my treatment entails a lot of threads and a multitude of treatments. When I go train other facilities, I'll ask 'em, how do you treat a patient? Or I'll see how people get treated. And um, I'll also ask 'em how many threads they use. Cuz most people don't just lift you and then they'll send you on your way. Well, lifting only fixes the issue in the moment and within a couple months after the threads dissolved, if I haven't stimulated that collagen, nothing has happened. You're not getting better, you're not looking better. You're not stimulating that tight skin. One of the analogies I commonly mentioned is as I go into the gym, right? You may have the trainer who trains you for that one day, you feel absolutely great, but if you don't constantly train, train, train, train, train, you're not gonna look better. You're not gonna feel better, you're not gonna be healthier. That's why it's the, not just the threads, but how many we use and how we place it. That makes the biggest difference.

Monique Ramsey (15:04):
So during the procedure, you talked about having lidocaine, which is to numb the face, right? So what do most people feel during the treatment?

Khanh (15:16):
If you can get through Botox, you can get through threads. If you can get through fillers, you can get through threads. But now it'll harken back to who is your provider. For anyone who's got Botox from multiple providers, for anyone who's got filler for multiple providers, you'll know that provider makes the difference on how much pain tolerance you need to deal with. Now with threads, and this is actually funny that you asked me this week, cuz last week on Thursday in Carlsbad had two patients back to back, brand new thread patients and they were told this is gonna be the worst pain you've ever had in their life. Even from her provider friend who does all her treatments for her, she's like, this is gonna be pretty unbearable for you. And I love hearing that. Like I honestly love hearing that cuz there's just an utter shock when we finish the procedure.

(15:58)
They're like, you're done <laugh>. That was it. It's no big deal because it's how I numb you. It's how I know how to do it. So here, here's the thing with threads, if I'm in the wrong place, it's gonna hurt. If it hurts, you're not supposed to bear through any pain. You're supposed to tell me, Hey, that's a little uncomfortable Khanh. At that point I need to decide, does this patient just need more numbing because they just are have issue with pain or am I in the wrong place? If I'm in the wrong place, I need to adjust just like fillers, just like Botox, things like that. So your body always reflects if I'm doing the procedure correctly, but no, it should not be painful.

Monique Ramsey (16:35):
Okay, that's good to know. <laugh>, now we've been talking about the face, but you and I talked on a a podcast way back when we, I think we were talking about cellulite and we were talking about how threads can sometimes help in other places the body. So tell me where else you like to use threads.

Khanh (16:57):
I've used threads from hairline all the way down to kneecaps because unlike the face where you can put in Botox, fillers, lasers, do a bunch of procedures to help improve that area. From the neck down, I consider the body and from the neck down, you don't have much. All you have is collagen. So unless you have a ton of laxity and you go to a surgical center to have surgery, there's not many procedures that are, one gonna lift the area. Two, stimulate collagen and three, improve the texture. So again, if you take that one finger and you put it anywhere on your body, common places is the neck, the back of the arms where our skin falls on our elbows. So if you lift your skin back there, if you give that one finger lift and it makes you happy, PDO threads, laxity on the chest.

(17:41)
Now I'll never do it a breast lift because most people don't qualify because if your breasts are too big and they're heavy threads can never pick 'em up. Now if you're looking for a breast lift because you have a smaller sized breast and you're looking for a perk, again that's, that's not what it's meant to do. But if you have wrinkles, if you have general laxity, we can pick that up with PDO threads. Abdomen is another big one. So if you've lost a ton of weight, um, you have laxity over time and people always say, I work out 24 hours a day and I'm not improving my stomach. Well yeah, it's not a muscle thing, right? It's a laxity thing. It's a collagen thing. Yeah. And we said not many things pick up other than surgery and threads. Not many things stimulate collagen. And yes I can use injectables, but for the body it's too mobile in the skin's a little bit different for me to use injectables to the area. So that's where again, p threads really bridges that gap and gives me a tool that I can actually fix or not fix. Improve laxity and lifting of the body.

Monique Ramsey (18:39):
Mm-hmm <affirmative>. Now you were mentioning earlier that how your results, you see an immediate lift, but then that collagen building happens over time and that by six months is a, is that about no matter where you're putting them, is that sort of the time where you would say, okay, here's my peak result?

Khanh (19:00):
Yeah, so as long as the threads are in your body, so on average it lasts about four to six months. As long as they're still sitting there, your body's gonna wrap neogenesis around it, create pseudo scar tissue, good scar tissue. But what you're doing is you're just creating that lattice. And if you look at some of the research that's come outta Korea, I think there's a couple research articles out of Europe as well, but most of 'em are from Korea. Cuz Korea's done them the longest. What they'll do is they'll do a cross section of tissue, oh they'll put in threads, take out a cross section, six months, you'll see a little hole there where the thread used to be. But now you have this bright ring of new collagen right around where that thread used to be. And that's what we're trying to stimulate.

(19:38)
Cuz fillers puts in volume but it does nothing for collagen. We want to thicken that upper layer. So when, if you remember, when you pinch a baby's cheek, right, it bounces right back. That's why they look so young and youthful. You pinch the skin of like a 60, 70, 80 year old person, that skin just sits there, it tenses, it stays in place. We're trying to create that bounceback effect and that's what collagen really is. And that's I think one of the common missing keys when it comes to aesthetics. We always wanna fill, we always wanna fix wrinkles, but we never wanna fix that elasticity of the skin. And as long as the threads are sitting there four to six months, you're gonna continue to improve over that time frame.

Monique Ramsey (20:16):
So you're gonna improve over time. How long can people expect to see their result last for?

Khanh (20:25):
Yeah, most people, if you treat it appropriately and you're happy in that timeframe, I usually don't treat it within a year, year and a half. Okay. Normally my follow-up time, I time it with your Botox cuz everyone comes sees me for Botox every three or four months. So we do the threads. If everything goes well, no complications, no issues. I want you to see me in three months because if you see me anytime sooner than that, you haven't given your body the chance to develop collagen. You haven't developed the chance to stimulate, lift and tighten more. So come back, see me in three months for Botox. At that point we'll take pictures, we'll evaluate, you'll tell me if we need to do anything further. But let's assume you are absolutely happy. Most people don't treat it within a year and a half.

Monique Ramsey (21:04):
That's good. Now I'm assuming there are times where you're gonna maybe recommend threads plus something like you said maybe Botox for the dynamic wrinkles or you know, what are kind of some common adjunct procedures that you might recommend to a patient?

Khanh (21:27):
Yeah, there's a lot of stuff that we can do, right? Lasers, Botox, surgeries, all kinds of, all kinds of injectables. Even within injectables you have hyaluronic acid fillers, you have Bell fill, which is um, bio stimulant, you have Colp sculpture. It was also a bio stimulant. I try to break it down easily in these three steps. Two, reduce aging to look better, to look more youthful. What are we gonna do? We're gonna reduce, so I have three Rs, reduce, replace, rejuvenate. So what are we gonna do? We're gonna reduce wrinkles with Botox. We're gonna reduce pigment with lasers. Now what are we gonna replace? We're gonna replace the volume that A has taken away from us. We're gonna replace with cheek fillers, temple fillers, lift fillers. And lastly that last R for me is rejuvenate. This is where threads comes in. We're gonna rejuvenate by lifting, we're gonna rejuvenate by building that collagen. So if you think of those three Rs, those are the three things that you want to correct to make you look better and more youthful, reduce, replace, rejuvenate. And then from there we can pick any numerous procedures from Botox all the way up to lasers, all the way up to surgery. We can help you out with that. But if you think of those three things that will help.

Monique Ramsey (22:39):
That's so interesting because really I know one thing can really do everything right? Yeah. Or at least for most of us <laugh>. Yeah. We're trying to tackle a bunch of different things that maybe we wanna replace, like you say the the hollow areas and also get a little lift and some tightening and maybe like you say the texture or age spots or sun spots. So that, that makes a lot of sense. Now can you have some of those treatments at the same time or do you stage them?

Khanh (23:10):
I time it all based on the patient. One of the big questions I ask patients is what's your timeline? What's your goal? So if you're like, Hey, I'm new to aesthetics, I really just want to dabble in a couple things, then sure we're gonna build this journey together. I wanna see you every couple months for the next 12 to 24 months. But if you have this 60th birthday, and I say this because I have this patient who has their 60th birthday coming up in June, she's like, I want to crank out everything cuz I wanna look my absolute best by June for my 60th birthday. So we can do fillers, Botox, and threads all in one sitting. So we're doing all three Rs at one time, but then if we need to do lasers to reduce pigment wrinkles, things like that, we can tack that on as well. So I base all my timeline on you. You tell me how fast you want to go, how slow you want to go, and if there's anything special or the reasons or the motivations behind this that will all play a role in how fast we do something.

Monique Ramsey (24:04):
That makes sense. So one of the things that we are, I guess, addicted to at <laugh> at La Jolla Cosmetic is reviews. And we've got thousands, we've got over 8,000 now five star reviews. And so I found a review from one of your thread lift patients con and they said Khanh was very patient, informative and realistic about what I wanted and likely results to help me decide what I wanted to do during procedure. He made me feel very comfortable, moved with my speed and took great care to reduce discomfort. He followed up after with an email and also a phone call to make sure I was healing correctly and happy with the treatments. So that's a nice, a nice little bit of feedback, but I think what it really shows is that your care for your patients is going beyond that treatment day. That it's, you know, you're, you're checking in with them and making sure things are going according to plan.

Khanh (25:05):
Yeah. Cuz no matter how easily I explained something, no matter how long a procedure's been around, it has to make sense to you. So I can say it's been around since 1970, but to you, you just heard about it on Netflix two weeks ago. <laugh>, I can say I've been doing this for five years, but to you it's a brand new procedure. So comfort is key. Having you feel safe is key and then going at your speed is key because if I just go in there and hammer it out, you may look fantastic, but you may not be comfortable in that setting as well. So it's all about comfort and safety. I think that harks down all the way down to our original CWO Marie where she always mentioned that comfort and safety are like two of her biggest words.

Monique Ramsey (25:43):
Right? Right. Because I think that is true. It's like you've done it time and time again. Some of us are sitting in that chair for the very first time and we're not sure what to expect and is it gonna hurt? And you have all this stuff in your head. So, and I I think it's nice when you know you're, and really all of our providers are so good at kind of explaining what's happening as you're doing it. Because that, at least for me as a patient, that makes me feel better. It's just like, okay, that's what's happening now. And um, I think you're really, really great at that and that helps with that feeling of comfort and safety. So I know that I, I took your picture a few years ago, some awards from your thread lifting skills. What was that all about? I don't remember.

Khanh (26:28):
Uh, we've had it for a couple years now. So 2020, um, La Jolla was awarded number one Nova Thread practice in San Diego. Um, I was awarded that as well as a personal provider, 21 and 22, same thing. Um, La Jolla was awarded number one Nova Threads in San Diego. And then, uh, for myself, uh, I've had a couple other awards, but I'll just leave that private button for San Diego and La Jolla 20 21, 22. So three years running, we're the number one practice for Nova Threads.

Monique Ramsey (26:57):
That's awesome. And I think we're all so addicted to these threads because they work so well. If you ask any staff member who's had them, I think all of us are just like giddy because you can see how they work right away and you can see how it gets better over time. And so, and I think part of what you're talking about is sort of the ability for them to go into lots of different places and solve a lot of issues that maybe you didn't even know was solvable. So now you're also a national trainer for Nova Threads, is that right? And like tell everybody a little bit about what you do when you're doing that.

Khanh (27:33):
Yeah, so that's actually one of my passions. I love teaching. Um, I love traveling and just speaking about threads because it's re, I don't wanna say new, but relatively new to most people's practices. So I love hearing people's feedback. I learn just as much from these procedures cuz every time I start my procedure I say I want it to be fun, comfortable, and safe. Just like I'm speaking to patients. I want to be fun, comfortable, and safe. So if during these sessions, if a provider says, Hey I've seen it this way, why don't you do it this way? I have to be able to articulate that and then if they give me feedback they're like, Hey, wouldn't this be a better solution? I learned just as much. So that's why teaching is a passion for me. But then also just learning as well during all these procedures.

Monique Ramsey (28:12):
Now if you could ballpark it, could you estimate how many thread lifts you've done?

Khanh (28:18):
If we were to average, let's just say three a week, which is on the low end times 52 weeks times five years. So five, 50 times three is 150 times five years, 1500, 2000 maybe I'm just making up numbers based on math. But <laugh> that's, that's not including trainings.

Monique Ramsey (28:39):
And if people are thinking about, you know, let's say we're doing a little mini facelift with threads, is that like three threads, five threads, 20? Like what is the, or does it depend on where you're using them or the person?

Khanh (28:54):
Exactly. All those plays a role in a, if we go back to that thought process of fillers, right? Are you a person who needs one filler, two fillers, three fillers, four fillers, so on and so forth. If you are young 20 something and you just need me to lift some heaviness out of the way, then I'll just use a bunch of barbs to lift your skin, approximate skin or give you a certain trend that you're looking to do. It's not just the eyebrows, like the eyebrow trend that has recently come through the past couple years. Now if you are a 60 year old patient, I don't want to just lift you, I want to stimulate collagen to make your thin skin much like that 20 year old skin, that means I need to put in a whole lot more threads. And that's the common question people always ask me is how many threads am I putting in? And I always respond, well if you have a fear, do you really wanna know how many threads I'm putting in?

Monique Ramsey (29:47):
<laugh>

Khanh (29:49):
But it's always a common question. And if I were to put a number, let's just put an arbitrary number cuz we say 10 units of Botox for every decade of life, right? I would say it may be close to that. So 10 threads for every decade of life. Might be a reasonable number.

Monique Ramsey (30:08):
Got it. So you're telling me I'm 90 in my Botox years <laugh>

Khanh (30:13):
<laugh>,

Monique Ramsey (30:14):
We just did a whole bunch recently and it was like yay, how many did we do? And she's like, I think 90 or something. But we did this area for the first time. I'd never had the little, you know, neck cords done. So it was like, how did I get from in the seventies to the nineties? Well we added a whole nother area and I love it. So that's, but I'd never heard that. That's really cool.

Khanh (30:37):
Yeah, I've never used that analogy either. But if I were to just make up a number for you, it's actually pretty close.

Monique Ramsey (30:42):
Interesting, interesting. Well I think we could talk about threads all day, honestly, <laugh>. But one of the big questions people have is how much does it cost and could you kind of approximate that for us? I'm sure it's super dependent on how many you're using cuz every little thread costs a certain amount of money, right? But is there a ballpark range that you sort of work with?

Khanh (31:06):
Yeah, it just depends on the area. And again, it really depends on the provider. So when you tried as a consumer, as a customer, let's just say you, I'm the fifth person in line in that's giving you a consult. That question of how many threads I use will play a huge role in that because those four other providers that you had consults with in, in San Diego, let's just use the normal 40 year old person. I guarantee you they probably told you four to six threads and you got a certain price, you come to me, you got a price probably higher than all those other consultations. But I'm probably using three to four times that amount of threads. So it's one part of it is actually the material of it, how much I'm doing. But more importantly I'm doing that because I want to give you the best result possible also is the person who's doing it just got trained by me last week or have them been doing it for five years.

(31:56)
And this goes back to that client or one of those clients who I had last week. She said she had a consultation, it's actually on the review I think, I think it's on Yelp or Google. She wrote on the review, had a consultation, but the provider canceled for one reason or another. But that gave her time to research. When that patient researched it and found out this provider's only been doing it for a couple weeks, she's like, eh, maybe I don't want to go forward with someone who is new to this. Came to us, realized I was a national trainer, been doing this for five years and they're all of our rewards. It makes a little more sense. I will never speak to costs when it comes to procedures because money is very important. We work hard for our money, but then also we have one face, one neck, one life. We don't wanna risk it. There's so many things that can go wrong and for the most part it should be safe and comfortable. But finances plays a role in that.

Monique Ramsey (32:46):
It does. And I think we just did a, a financing episode with Janelle, our COO and she talks about, you know how in the med spa we use cherry for financing And that really helps bridge that gap cuz you might think, well I had 2,500 budgeted, but you know, cons may be telling me I need $3,500 worth of threads to really get to my goal or 4,000. Then that helps bridge that gap and it can make a really affordable monthly payment just like you make for your car or anything else that you're able to sort of get the best result, you know, by using the right amount. But you alluded to something of, you know, what could go wrong And I, we never like to think about what could go wrong, but with threads, you know, why is having an expert person who like yourself, who's done thousands of them and you know, does it every day because what, what are the things that could go wrong if it's they're put in by somebody who just doesn't have the experience?

Khanh (33:48):
Anyone can do a procedure. Can you troubleshoot the procedure? So if something goes wrong, do you know how to fix it? Something goes wrong. Do you know how to backtrack? And I'll give uh, two examples of this patient went to somewhere else, got threads, had a miserable experience, but it was all based on finances. It was probably half if not a third cheaper than what we are. But what happens, she got an infection, the provider did not know how to treat what was actually happening. And then after that did a treatment on top of that to try to fix that issue and made it worse. So the patient ended up with a huge infection, going to urgent care, going to the hospital on six weeks of antibiotics. So you can imagine all that money you saved, all went towards urgent care, all went towards this huge infection only in the end for her to come to us to try to figure out what was going on.

(34:42)
Number two, this was another situation. I'll get these emails all the time because providers will know how to approve procedure. But if something goes wrong, if you don't have the expertise, if you haven't had the training for, if you never encountered it, just because it's a numbers game, the more things you do, the more times you get to practice something. Someone had PDO threads in their nose, the coordinator sent me the picture and said, hey, the client knows that they probably can't do anything but they want to get your feedback and it, and from a liability standpoint, we just have to make sure I'm like, hey, this isn't a consult because I'm not seeing you in person. I can say, hey, this potentially is a situation but you need to go back to your, your provider to figure out what's going on. So PDO threads likely two issues.

(35:21)
One, it was infected and then two is was a migration of the thread. And with the migration of the thread, it could be any number of issues. But if that's the case, then generally you have to go in there and try to take it out. But if your provider doesn't have experience and doesn't know how to or even have the, let's just say the, the, the team to help them out, right? Let's just say if I can't personally do something, at least I can call any six surgeons that we have downstairs and be like, Hey, I can't get this thread. Do you guys think you can get it? Or is this an infection? Do you guys think it's an infection? So that's the, the kind of the team effort we have at La Jolla as well. One we all national trainers to try to troubleshoot something but then if we don't know how to do something, we can rely on our fellow colleagues to help us out.

Monique Ramsey (36:03):
I think that's a huge, huge point is that whether the complication is starting to happen or that the issue is starting to happen as that provider is delivering that service, like something that's in the wrong plane or get stuck somewhere or you know, or after do you have the knowledge and expertise and or the people around you to fix it. And you know, I think that's something that when I read things on real self or you read different articles or you see things on social media, you know, you could hear of course the most extreme of the stories. But you know, would you say, have you ever seen a complication that you yourself produced and and were you able to fix it in a way that everybody was happy in the end?

Khanh (36:53):
Yeah. There's always gonna be issues, there's always gonna be side effects because one, this is the practice of medicine, again, a quote taken by Marie, our former CEO, it's not the perfection of medicine, it's not doing medicine, it's the practice of medicine because everyone is an individual. Your face is different from my face or it's different from someone else's face and then it's fixing it in the appropriate way, right? Sometimes what a patient perceives as an issue they want to fix in the moment might cause more harm to them. So as a provider myself, I have to say, Hey I hear you, I understand this is the issue, but if I try to fix it in the moment, these are the potential outcomes that make and make it worse and may not even fix what you're trying to fix. Sometimes time is the best healer of everything.

(37:43)
So you have to make sure, am I doing something that's appropriate for the patient when it comes to fixing something? But I've never had an issue where it was catastrophic. Let's just say that. Knock on wood, I've never had any issues because I'm very strict when it comes to my treatments, anatomy and respecting what the patient is, I'll never gungho something be maverick about it. And although threads are new to San Diego, threads are newer to a lot of the people that I treated on, it's been around forever. And I never touched threads until there was enough research behind it, until I learned enough about it before I would ever do it on a patient. I'm rarely the type of person that says, Hey, this is a brand new treatment. I want to be the first one to do it because I don't wanna be trendy. I want to keep my patients safe. I have a name behind myself and more importantly, I have a name behind La Jolla that I need to respect and work behind just because something's new. Just because something's trendy doesn't mean I need to be the first to do it. So that's where I'm coming from when it comes to procedures.

Monique Ramsey (38:40):
I think that's a really good approach because in the long term as we're coming up in our 35th anniversary, that's really been kind of the, the modus operandi of like, how do we practice? Practice medicine is in a really safe way and you don't have to be cutting edge on everything cuz it might not be something that is really ultimately beneficial to the patients. You know, there's a lot of technology that we've looked at in the past or other fillers or other, you know, technologies that it's like there's a new machine out every five weeks, you know, it's like, oh, there's this and you can, but that doesn't mean it's appropriate and doesn't mean it's gonna help you as a patient and we could sell you anything, but that doesn't mean it's gonna, it's gonna work. And ultimately, you know, to have the reputation we have over so many years that I think it's better too. Like you say, not be a maverick <laugh> and just kind of, let's just make sure that this is gonna be something that you're gonna like and bring you benefit. So have we kind of covered the spectrum of threads? Do we miss anything before we wrap up?

Khanh (39:47):
One of the things I want to address is reading stuff on Google, reading stuff on RealSelf. This is where a lot of the negative press comes in and if it bleeds it leads, right? So you will only read negative press when it comes to any procedure. Even if Botox fillers, most of the stuff you'll read is all negative. It's just been around for so long that we're more comfortable with it. Now, if a practice promises don't go under the knife when you can get a thread lift, likely you should not be going there. If they're promising you surgical results for a thread lift, not accurate. If they're telling you it's completely safe and no harm will come about it, likely you shouldn't go there. Your provider has to be able to explain beginning to end what they're doing. Answer all your questions and be completely honest with you. If it sounds too good to be true like it is, if you're paying for two units of Botox worth of threads and La Jolla's charging you a hundred thousand dollars, likely there's something going on there <laugh>. So <laugh> sometimes too good to be true, but don't let the fear get in the way of appropriate and safe treatments.

Monique Ramsey (40:49):
That's a, that's a golden nugget right there for sure. And I think the thing is you are so accessible and all of our providers are so accessible and very down to earth and you know, if you have a question you're not sure, we don't want you going forward with something if you're still 80% sure but not a hundred and you know, you guys are so responsive. I think, you know, phone call, email, a second Zoom consult, I mean to feel that, you know, you're going forward and it's gonna be a positive, a positive thing. And I think that accessibility is really important for patients.

Khanh (41:29):
Yeah, yeah, absolutely. You can fool a patient once into paying for something, but in the age of media, Yelp and everything else, it's gonna get out really quickly if we do bad things.

Monique Ramsey (41:37):
Yeah. Yeah. Well thank you Khanh. This was really fun. I've learned a whole bunch of things that I didn't know before, even though you and I have spoken in the past way back, we did a quarantine with LJC way back during Covid. We talked about threads and this was like what, three years ago? Yeah. So it's been fun to kind of reconnect on this topic because we do them so much and you do so many threads in the practice and, um, so it was nice to be able to connect with you and go diving into this topic and I look forward to seeing you again soon. And then if you're in our audience and you're listening and you, you know, have a question, put it in the comments. We'll have all the links of things we talked about in the comments section and you know, if you love our podcast, give us a review. We would love it. You know, I'd already told you we're we're, um, review Junkies <laugh>. So with that it counts for our co podcast as well. So we'd love to have you give us a review on Apple Podcasts or Spotify or Good pods or wherever you listen. So thanks everybody and we'll see you next time.

Speaker 1 (42:48):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis ,t h e a x i s.io.