Episode #29: Junera Laser

0:00Hello, Kane. How are you doing? Fantastic. Thank you very much. Welcome, everyone, to Jess laser and all things cosmetic. And today, Kane, I have to say, I'm going to give a shout out to somebody today, just their first name, because we had a couple people in clinic this past week, and one young lady in particular kept saying, when are you going to do another podcast episode, which I felt embarrassed that I need to do another podcast. It's been a little while, hasn't it? Actually, I felt, I felt inspired. I shouldn't say embarrassed. But anyway, so this is a shout out to Jess. Well, it's nice to know that, you know, people will actually look forward to it. Well, that's true. So this is a shout out to Jessica. Thank you for getting us back on and doing another episode. Yes. Thank you, Jessica, because this is my favorite thing to do. Well, today, we're going to talk about something

1:01pretty exciting. I know I always say that, but I'm really excited. Kane, I've been at this what now for 20 years. I did my fellowship with Dr. Goldman in laser science and dermatologic cosmetic surgery back in 2007. And since that time, we have always been looking for the holy grail to try to get our skin in better shape. One step closer to surgical outcomes. You've heard me say this multiple times. Yeah. And we get closer and closer and closer and closer. So what you're saying right now needs leads me to believe that we're even closer. Now still, nothing will compare to surgery. And I think that's really important because there are some patients who come in for consultation. And they might have a lot of neck laxity. And when I always ask them, what would you like to see? And if they're truly really pulling it back, I tell them, you know what? That's that is surgery. And there's some talented surgeons around us here in Charlotte, North Carolina that I refer them to. But what I imagine there's

2:03a lot of people that are hesitant for that kind of step, right? I would raise my hand and be one of them. Sure. There are some people that are hesitant or there are people that aren't quite ready for surgery. They're just maybe there is a laxity, but not quite as much. And so that's where this laser called Junera is something to consider. And I just want to introduce Junera. Junera's new to our practice as well. And what it is. Can I stop for a second? Sure. It's a different name. So it's J-U-N-E-R-A. Correct. Junera. Junera. But what this laser is, it is a subdermal type of laser. Do you know what I mean by that cane? Subdermal would be under the skin. You got it. So it's a laser that's delivered with an optical fiber that's delivered underneath the skin. And whenever I start to talk to patients about this, they think that I'm talking about threads. They think that I'm putting it under the skin and I'm leaving it. No. The optical fiber is

3:06there to deliver the laser energy under the skin. But it's a similar concept in terms of just in that little bit of a, I guess, that that layer of skin that you would be running the fiber in would be similar to like a thread. It's kind of a treasured maybe just a little deeper. It's a similar layer of where I put hyperdolute radius right underneath the skin. So it's very, very superficial. Correct. It's just right under the skin. And so the wave that it's performed in, and let me tell you a little bit about what Junera is. It's comprised of two wavelengths. It has a 1470 nanometer wavelength and a 980 nanometer wavelength. Now why I tell you this is because both of those are really important. The 980 nanometer is good for regulation of vessel. So it minimizes the bruising while you're doing the treatment. It also has a propensity for water, but not quite like the 1470. So it's there. What do you mean when you say propensity for water? Well, so when we say propensity for water, that means it's going to heat the water, the dermal water and sub-dermal

4:09water in this case to create heat. So it's your primary tissue contractor. Okay. But with the 980, it still has that, but still your 1470 is really going to be your primary tissue contractor. The 980 is just wonderful there as. It's an add-on bonus. It's an add-on bonus to kind of pre-heat the tissues and get the tissues prepared for the 1470. So the two wavelengths are really key to have. You can deliver them simultaneously or you can deliver them on their own, each individually. And the way that this procedure is done, Kane, and it's about a two hour procedure, two to two and a half hour procedure when we're talking about the face and the neck area. But it's done by first numbing the patient up and we numbed the patient up by kind of the same way that we num with threats. We take a cannula and we just go under the skin and we start to numb the tissue up. And it is not bad. You know how- This isn't a topical numbing. This is something that you inject a little bit.

5:14Correct. It's an injection numbing that goes right under the skin. Quick and relatively painless though. Well, the numbing part takes a little time. It takes about 30 to 40 minutes to do. It's not super quick to numb. But it is relatively painless. It's just numb gently as we go along. In fact, you know how I'm such a wimp when it comes to these type of things. And I had zero pain. I had mine done last week, actually. And I had zero pain. Yes, you might feel a little pinch here and there as you're being numbed. But during the procedure, it was it was really quite comfortable. But so you're numbed up in that fashion. So it's important to note that could bruising occur. Absolutely. It could occur. It's primarily from the numbing, but it could a little bit be from the laser as well. So the first step is again the numbing. Then what we do is we take the laser and you know we look at the different areas that we're doing. And the laser, what's important to know, the optical fiber cane for the face and for the neck area is about the size of a almost a 25 gauge needle, which is tiny. It's it's not

6:22large at all. In fact, back in the day, we did a procedure that was subdermal called precision. And that was a laser that we went under the skin of the neck area. And it was popular back in its time, but it was a larger fiber in a cannula. And so you'd have to really numb the heck out of patients. It was like bullfrog numbing. So it kind of fell out of favor because it was such an involved procedure. But we used to always say, is there any way we can get just the smaller, smaller optical fiber so that we can go into the face. And that's where generic has come in. Okay. I'm going to pause you for a minute because you kind of dove right into the actual kind of application of generic. I want to pause for a moment and say, okay, let's very simply what are you trying to achieve? Are you trying to tighten? Are you trying to lift? Are you trying to, like what is it that you're trying to do with this particular procedure? All of the above. We're trying to tighten the tissue from going underneath and it does lift the tissue. So you see a nice lifting of the gel area in the neck area. And again, remember that 980 can like fat. So if you

7:27can if you dial the energy settings up, you can target specific little pockets of fat. So if there are some areas of jowling, you can you can take care of it or right under the neck area, you could also minimize that as well. So it basically can reshape the face, but more importantly, the primary use is to tighten the tissue and to lift the tissue. Okay. Yeah. Those are like the words, like I remember word. So it's like it's lifting, it's tightening and in some aspects, it can even do some sculpting if you target fat. Correct. If you're wanting to target fat, but then you specifically have to dial those settings in. So I don't want people to think that, oh my gosh, I'm going to lose my fat if I do this. No, no, no, that's not the settings that are utilized, but if there are specific areas, you really want to study the face and then target those zones. Now you've also talked a little bit about doing the face and the neck. Are there like particular areas that you could just target if they bothered you? For instance, for me, you know, my jowls bother me a little bit. Is that like a particular area that you could target or is that more like, we kind of have to do the whole face and neck for that. You know, you kind of do have to do the

8:30face because chances are when there's jowling present, there's a laxity above. So really to get more because remember, we're not cutting out tissue, you really want to be able to target the face. I would consider that more of a face area with special attention to the jowls from a fat perspective. And then I'm going to talk to you about one more thing about this procedure. Well, I wasn't done that. Okay. Okay. Sure. Sure. And then I'm thinking like, okay, if I'm a patient and I'm listening to this, are there any like signs other than what we just talked about? Like, yeah, I need to lift up, sagging here and there. But is there a particular patient that, yeah, this would be really good for you. And is there a particular patient that you would say, you know what, this, this wouldn't be? That maybe is a too broad of a question, but you know, I think it is a more sophisticated type of procedure in the sense that there is some commitment from the patient itself. So for example, if someone does not want to have a downtime, hardly at all, then maybe this is not the procedure because there is a little bit of a downtime.

9:32And we'll talk about that next or if they're just new to lasers and they say, hey, you know what, it's just my, my blood vessels or my pigment. Okay, then that's an IPL or that might be a little fractional laser or something different than this. But if they're truly, this is kind of the patient that wants to get a little more than just surface, you know, just, just resurfacing, they really want to get a little more of a lift and a, and a targeted tissue area, then I would go to this device for sure. But again, where I like what Holly Coco in Denver, Colorado says and she says, with big results come big responsibility. And that's really important when you're talking about genera or ability meaning by the patient, by the patient, by the provider, two I suppose, but in this case, I'm referring to the patient. And I suppose that really refers to any type of procedure. But when you're doing this type of procedure, we are placing that energy under the tissue and we want to regenerate that tissue. So it's so important not to have anti-inflammatories,

10:36no anti-histamines. You really want to minimize alcohol, definitely minimize sugar post-procedure. You want to be able to give yourselves the greatest ability to produce collagen. But probably the biggest commitment. And the one that I struggle with, but I did, was for three days straight, you have to wear a compression garment. So it's, it almost looks like, and I've put it on our Instagram, it's Lujelaiser MD to show what it looks like. It almost looks like a scarf. But there is a compression garment that must be worn for three days. And I'll be wearing it at night for an additional about three to four weeks. Yeah, it reminded me of kind of like the old school, like toothache in a cartoon where they have to wrap this thing around their head. It wasn't too bad, but you just had this thing wrapped around your head. I know my staff members were calling me a babushka. It's not uncomfortable, but it is something you have to wear and no exercise for one solid week as well. You can walk, you can do all of that, but no a vigorous exercise for

11:38that time period because you want to retrain your skin, essentially, to go upward. And anytime you do sub-darmal work like that, you don't want to have anything called a saroma, which is a pocket of fluid or for that matter of hematoma. And that would be really unusual for these small cannulas, but you still want to make sure that we don't chance those type of things and you wear the compression garment. Okay. So I'm just going to back up. So just real quickly. So a little bit of pinching when you're doing the numbing and that takes a little bit of time, but the actual procedure itself, not really painful. Not really painful long. It takes a long time. It's not really painful. And then you have, and then you have to wear this compression garment for a few days afterwards. Three days, and I'm solid. And then you're a little bit swollen. I mean, right now, I think today it's not hugely swollen and I barely bruised, but I have a little subtle bruise. It's interesting. The bruise kind of comes out more about day three or four, but I am, I'm not in pain or anything like that. I haven't been, but when I push down on my tissue, I can feel a little tenderness by my neck, nothing outrageous, but you can feel a little tenderness. So what I'm

12:43getting at is there's a lot of activity going on underneath my skin that is continuing, you know, the process is just beginning. And there are some patients where you can start to see that tissue tightening effect even at one week. You can start to see some initial results. And I put that on our Instagram, but it's really, really important to know that those are initial results. And in most patients, you're going to start to see your collagen effects starting at about six to eight weeks, and then certainly at three and six months. So that's something I think we need to highlight because it's expectations are so key. So yes, this procedure for what I'm hearing you say is you may start to see, let me stop for a minute. We talk about words like lifting and tightening and defining and sculpting. And in my mind, those are things I would hope to see right away. But this is a long, not long, but weeks, not days, type of thing, and even potentially months where you start to really see the results. So setting that

13:44expectation is really, really key. Correct. Because remember, we're not lifting and cutting. We're not removing tissue. We're putting the appropriate energy there so that your body can create that collagen elastin to create that lift. But it is fun to see some just beginning initial signs. And not everybody might show it at one week, but it is fun to see it when you do see it. So that's kind of the procedure in a nutshell. And again, it's called Junera, J-U-N-E-R-A. And there's some amazing, I mean, even their platform is supported by some really amazing digital work as well. If you go visit the NXMED website, UNYX-A-MED website, they really have some cool things on there as well to teach both the patient and the practitioner. So I just want to reiterate just real quickly. So kind of post procedure, right? So you wear a compression garment. You have some initial swelling. And it can be noticeable, right?

14:45It's swelling. Maybe a little bit of tenderness after even a week. And I'll go back, you know, when you wear the compression garment, it pushes everything up. So you almost look more swollen when you're really not as much. But I bring this up because a lot of people ask about what's the downtime. And the downtime is three days of a compression garment plus some swelling, maybe some light bruising. And that's really kind of sounds like it. I mean, maybe a little bit of tenderness a week or two out, but that's kind of it. And just minimize your exercise for sure. Like no pickleball, I couldn't play pickleball this weekend. So nothing real, real vigorous in terms of exercise. That's right. That's right. Okay. But I'm super excited about it. I think that this really will be something that I've been wishing to have in the practice to be able to help patients out. So I'm super excited. Good. I'm excited to see it as well. Well, that's it. That's all we got today. Okay. That seems pretty quick and easy for such a big topic. What do we talk more to?

15:45And certainly follow us on Instagram at salujalazrmd. You'll see a lot of different postings on it as well. And again, it's called generic and spelled J-U-N-E-R-A. You got it. All right. All right. Thanks so much. Bye-bye.