She Got 3rd° Burns: How Illegal Devices End Up in Legit Spas | EP 91

0:00Have you ever assumed a treatment was safe just because a friend recommended it? Sarah Kabalka is a nurse practitioner with 13 years in medical aesthetics. She thought she was getting a legitimate RF microneedling treatment from someone she had known and worked with for years. Instead, she developed injuries she is still living with the consequences two and a half years later. We go deeper than the one bad treatment, breaking down how a non FDA approved device can end up in a treatment room that looks completely legitimate and how trust can override critical questions and why having a medical director does not always mean real oversight. Sarah also shares the exact transparency step she now takes with every single patient before she ever picks up a needle. And stay till the end because the most shocking part of her story has nothing to do with the device. If you get aesthetic treatments or thinking about it,

1:01you need to hear this. Hi, I'm Dr. Kate D. And I'm speaking today with a nurse practitioner, Sarah Kabalka, Sarah. Thanks for being here today. Thank you, thank you for having me. You know, I had worked with this person for about seven years and I trusted her and she said that she had gotten our radio frequency microneedling machine and this was two and a half years ago. So it was relatively new technology and I had worked with somebody who had had it done and said it was the most painful thing that he had ever gone through. But it was kind of torn up the next day but nothing like I was. And she and a client and sort of friend that you'd work with who is an esthetician? She was an esthetician, she's a master esthetician. In Washington state, there are not very many states that have this but we do have a certification for master estheticians that are actually allowed to do lasers and other medical things within their scope under a doctor. So in Washington, that's legal.

2:01It is and she had taken further education at the Laser Institute in Arizona. So I had no reason to believe that she didn't have a medical director. She said she was getting really good results from patients and I had wanted to try it because it was sort of, we all do in this industry, the newest, whatever. What I didn't know is that it was bought offline probably from like Alibaba or one of those companies. And so she didn't have an NPI or a national certification person and advanced practice person or an MD to back her up to buy these devices. Basically, you have to be a medical like a doctor to buy one of these things. So if you're an esthetician and you don't have a medical director, then only thing you do is buy a cheap illegal wine often. And that's what happened. Yeah, because you didn't know it was at that time. No, I didn't.

3:01And nor did I know she was calling me her medical director. Yeah, wait. So she was actually using you as her medical director and you didn't know it? No. Wow, okay. Okay, sorry. Yeah, it was a question I asked later is if I'm your medical director, why would you not inform me? And how did you get it? Because you don't have a medical license and she said she didn't need it. So you don't know any of this at this point. You are your long time colleague got a new device. He thought it was legit. You showed up in her office presumably, right? Right. And then what happened? So she numbed me because I wanted to try it. And she used the wrong cartridge, unfortunately. So it started out at one. And I mean, again, the needle tip that, or what? Yes, the depth. So I don't know what the energy was,

4:02but she started the depth at one. And I didn't feel anything. And a friend of mine again said, it was the most painful thing he had gone through. And so I said, what happens if we go up? And she said, do you want to? She said, yeah, we can, but I didn't know she was going to go to one, to a hundred. You know, one, two, I think it was 3.5 millimeter depth. So we're getting into subcutaneous tissue and the heat that was produced, the energy that was produced by those needles at that depth went straight into subcutaneous tissue. So the, the dermis is where you really want to insult this at energy. And so you really want a depth. And of course you need insulated needles and you want a depth of, you know, between one and 1.5 millimeters usually, right? Maybe up to two if you have thick skin, or you're in the body that has thick skin. So she's going all the way up to 3.5.

5:04And she gets you into the subcutaneous fat, which is not where you want to be, but okay. They created little white dots. They were sticking to my skin. And I didn't know it, but my son was in the room. And he knew something was wrong because the needles are supposed to just go in and out. And they just kept pulling on my skin. I guess she kept ripping off the tip. And she didn't stop. So if she had the skin was dating to the needles, basically. It was because she was using non-insulated needles also and the wrong tips. So these are 10 linear needles. They're non-insulated. They're going way past the smears where you really want to be for that college and production into the subcutaneous fat. Right. And so, and I know we've covered RF microneedling a couple of podcasts before, but if people are listening or watching and they don't know. So the reason I've come out super duper strong on this podcast about being against anything with uninsulated needles, because the damage they do is really, really huge.

6:06And you can get a lot of complications from that scarring and hyper and hyperpigmentation. It's the equivalent of doing a very uncontrolled ablative laser, it's very dangerous. And so what you're describing is she's doing exactly that and too deep. It's sticking to you and she's pulling it out and bits of your skin are basically coming with it. I guess I was, I didn't know it was happening because I didn't feel it. Well, that's good now being here. So I didn't know and then I looked in the mirror and because she said I don't know what this is and it was the first one. She just sort of stopped. I would be, I'd only have a couple. But then I don't know because I'm not a laser tech. And so when I used to work family practice, I had anesthesiologist, I had family medicine, I had internal medicine docs. It doesn't matter at that point, they're my patient, right? They're sitting at my table. I'm a patient.

7:06I am not a laser expert. I don't know what these dots mean. I know that I've seen it with some like radio frequency hypercation, I've seen it with some of those machines but I don't know what it is. And I said, is it like frosting? And she said, you know what? I have seen it and it is frosting and she just continued. And so then after that, it continued all the way down into here, through here, here. And yes, into my subcutaneous tissue here, here, here. And I was at 13 years of working in this industry and I still had, I mean, there's no other word for it. It's botched. I'll never have, I can't get rid of these scars. They're third degree. They eventually started to split open and then you could see straight down into the fat. Once they started healing, they started healing wide.

8:06And that's when I contacted a friend of mine that I used to work with in Albuquerque. He's a double board certified plastic surgeon and ENT doc and I said, what do I do now? Should I suture him shut? And he said, you have to debris them. And I said, okay, so they were infected. They were, well, one was infected. We got that infection under control. I was on high dose steroids. I did hyperbaric oxygen therapy. I did PRP. I did multi-vitamin IVs. I did everything I could do while I was in the healing process but they just kept breaking open. The fluid behind them, I was so swollen. They just kept popping open. So you talked to your mentor who's the plastic surgeon. You tried all these different things over the last but two and a half years. And so it really has left you with some permanent scarring. It has left me with a lot of permanent scarring and it's never going away. I mean, it's, and because it was 10 insulated needles,

9:08a lot of people online didn't believe it. They said that I was doing it because it was AI or it was self-harm, which I took huge offense to because that's scary because it went viral so quickly. And so I don't want people to believe that that is a form of self-harm and sometimes it's just the lighting on no harm. They're implying that you went to this person on purpose that she would work. They think you saw I didn't miss out home and it wasn't an idea. Well, we know it was another person. We're not going to say who this person was or where this is hard. I think the important thing is to recognize that there are many, many, many people who are buying devices on the internet that are not FDA-approved and then they're literally practicing medicine without a license and it's very risky, right? Right, and so that's the thing. How do you keep yourself safe?

10:09How do you know that these people are legit or how do you know that the device that they're going to use is an FDA-approved device and that they have adequate training. They have a medical director behind them and what do you do when adverse events happen? I mean, these are all questions that people need to ask and I didn't ask them. Yeah, and because of trust. Yes, and that's the thing, right? Is for whatever reason, if you trust that person for whatever reason and you don't ask that question, right? I have had patients who are lawyers who, you know, they went to a place that was illegal and they didn't ask the question either, but that's because their friend went there and they just trusted them because they assumed that it was legit. And I think there's this assumption, I had another guest on the show that said, like, look, when you walk into a restaurant, you assume they're getting inspections and you're not asking, you know,

11:10do you have a license to sell me the burger, right? And so when you walk into a place that looks legit, people are not used to asking those questions, you know, do you have a license to do this procedure on me? Right. And what I think a lot of people don't realize is that our legal system depends on this reliance on the professional, which is just, it's the doctor, okay, it's the doctor's license that they get and you have to, you know, there's a whole lot of standards that we have to comply with. And it's our license on the line. So if we do something dangerous, we could lose our license and our livelihood and we'll never be able to practice medicine again. But so the law relies on that check, right? But now we have in the last, especially last 10 years, an economy where people can purchase illegal medical devices online just delivered to their home or their spa and just do this and there's no check,

12:11there's no balance, nobody's looking. And if you don't ask that question, there's always the possibility that this person's completely illegal and there is no medical director, there is no doctor. So, no, that's why I always, that's like the number one question you should ask before you go to any provider. Okay, is not just what's your license but who's your medical director and look them up? What device are you using? Look it up. Yes, I mean, that's the problem. But at least if there's a medical director, that person is responsible for making sure that that device is legal and you're trained on it and it's safe, the medical director is there to make sure that it's safe. So the idea of having a medical director who doesn't know anything about the device or what you're doing or aesthetics in general, that's really not okay. And then also the idea of having somebody who doesn't even know that they are the medical director. Now, you're not the first person I've talked to

13:15who was being used as a medical director and they didn't even know it. I've talked to one other person in the past where when they tried to get their own contract with one of the, you know, talks and providers, they couldn't because that company said, well, you're already the medical director over here, you already have an account and that person had no idea. So yeah, I had no idea until she said that and I said, if I had been your medical director, I would never have approved or signed off on anything like this. You have to talk to me before you buy anything that's invasive or that needs, I mean, that's something that you do training on, right? You buy a device that is FDA approved. That company comes in and hands on trains, you and your staff and everybody else including the medical director. And so I would never have signed off on something like this, especially because it wasn't FDA approved but also because I wasn't told about it

14:16or I wasn't trained on it. So those are things because if I have a, if she has a complication, say this was not my face with somebody else's face that she did this to and she calls me as her medical director, I'm in huge trouble, right? So I would never ever sign off on anything like this. The Med Spa Board certifies Med Spa's that prove they're doing things right. Legitimate supply chains, proper licensing, real medical oversight. It's the difference between guessing and knowing you're safe. If you're looking for treatments, go to MedSpaBord.com to find certified Med Spa's near you. And if you already have a Med Spa you love and they're not certified, send them our link. And if you're a Med Spa owner doing things right, get certified and show your patients you're not cutting corners. Did she tell you you were her medical director

15:16just for that moment? Or... No, it was after the fact. Or literally are you on all her accounts? I have no idea. I've called most of what I know she has to make sure I'm not on any of her accounts. Okay, wow, okay. So the crazy thing is that if you go online there are esthetician spa, source websites, tons and tons of them, where estheticians can buy all kinds of devices that they can use in their spas. And the crazy thing is there's this giant overlap in actual what they're allowed to do and then all these illegal devices. It's really remarkable actually. I just was looking up a device the other day because someone told me that they got treated with a device I'd never heard of and I had to look it up. And actually it was taken off that company's website because probably because of something like this.

16:17So what I'm just curious though, so when this was happening and your skin was sticking to the needles and she was pulling out and it was getting stuck, she just kept going and doing the whole face. So the first one again was up here. That's when she turned the energy or the depth up which I'm sure the machine just sort of, I don't know if she changed the energy. It probably changed on its own based on depth and then she kept going. And as soon as she kept going, it came all from here to here. So it's kind of like if you look at me on this side, those are where all the scars are. And then on this side, I got away with one or two. Wow. And did she recognize the damage that was done? Did she do anything to treat it? Did she see you back in any kind of follow up? Or are you just too as special as to like take care of the burns? No, she just said that she would pray for me.

17:19Okay, that's helpful. So was she concerned? No, not concerned at all. Thought I was just not concerned at all. She kept asking me what it was. Okay, this kind of reminds me of when the plasma pens first came out, just been many years now. And there's various devices that you can just lump into that category where it's basically, you know, a caudry in a robot and you press down on the skin. And if you touch the skin very lightly, you'll just get the epidermis, and you probably won't do too much harm. But the more you press the farther down, you cauterize the more and more damage you can cause. And it's not controlled in any way. It's literally your hand, like, you know, putting this thing on this skin. And the first time I saw this demo, I'm like, this isn't safe. Like how could this be? This cannot be approved. This is crazy. And that was being offered by a statisticians all over the place.

18:19I mean, doctors would never use that, but it was just a totally normal, like, you know, a statisticians thought nothing of it because it wasn't regulated, right? Like, it just, you could just buy it and use it and all, it's the next best thing. You know, I've just completely, I still can't believe those are in use anywhere. So if you're, if you're trying to avoid something besides uninsulated RF micronealing, avoid plasma pens, anything they call fiberblast, which is a ridiculous name because fiberblast is the name of yourself by your dermis that make collagen. Love fiberblast. You're cute, they're adorable. They make collagen, we love them. But they call that treatment fiberblast. I'm the first time I heard it. I was like, what are you talking about? But anyway, very dangerous. So let's, let's not worry, totally agree. Okay, well, so it's been, it's been two and a half years. We're not, we're not naming names here, but is there, how has this affected your practices? Are anything that you do now that you realize

19:23you should have been doing before? I just, has it changed your clinical practice? So, I mean, it's changed everything. When I first came back to work, because I couldn't, obviously I couldn't work for a while. I had three patients that I had known for a really long time and they came and, and they started crying. I mean, they didn't even know what happened, but they just burst into tears. And then I explained what happened and they were appalled. And I, I guess I was in sort of denial. It will, it will heal, it will heal, it will heal. And then I flew down for my first treatment and it, it turned out it was third degree. So it's not going to heal. That's the unfortunate fact between third degree and second degree. You get 50, 50, at second, you get 100%, 100% scarring at third, right? Yeah. So I've gone through five CO2s, I've gone through all sorts of things since then. But I have to explain it to every new patient. I've had patients just one, just one the other day

20:24who is saying, I was totally afraid of you when I first met you because of the scars. I've had patients walk out because they don't want to look like me. Wow. And I can't blame them. I mean, in the beginning, especially, I didn't want to look like me and I still don't, but it's, it, that doesn't mean it doesn't hurt. Do you know what I mean? I know, I mean myself. Absolutely, especially, you know, in this industry, it can be very, very harsh, right? Yeah. And, and also because you're offering skin treatments, it's, it's helpful to have, you know, good skin. You know, I mean, it's like going to a plastic surgeon who's definitely so good. It's like early, you know, it's like, well, like what are you, what are you doing? Or somebody who's totally over-injected. There, I ran across an Instagram real the other day and I was though, it was a split of two, two injectors and one of them was completely over-injected and the other looked pretty normal, which would you choose?

21:25And it was, I mean, everybody said the same thing. You want somebody that looks normal. You want somebody who looks good. They don't want to look 52, but what have you been doing to your skin? And so that was the question I got all the time. What do you do to your skin? What do you do to your skin? What do you do to your skin? Yeah. And I don't get that anymore. Yeah. Well, you know, just to reassure people watching. So, I mean, RF miconadeling is actually a fantastic treatment in the right hands. Obviously, the right device in the right hands. And there was recently this FDA warning about RF miconadeling and I think that that's all about the device and who's doing it. I personally have had so many RF miconadeling treatments since I turned 50, I'm 58 now. That I don't even know how many, probably in the high teens. But yeah, I mean, I did five that year and then I've done one every six months since. So it's been a long time. And so it's not a disaster at all.

22:27If you are very, very careful and it's done right, it can be fantastic, but it just, it's so hard because people are trying to cut corners on both sides, right? This person was clearly cutting corners, big, big corners, big legal corners. But then also like a lot of people are like, oh, that's so expensive. It is because it's an expensive device. It takes a long time to do. It takes a really skilled person to do it. So, you know, but you go to a place like my place and oh gosh, that's kind of pricey and you go find something cheaper. And the thing is the cheaper thing might be really super crazy dangerous. So, I mean, price is part of it, but there is that saying that cheap Botox isn't good Botox isn't cheap. You want to go to, you're not just paying for the product. You're paying for the person that is administering this treatment, whether or not it's seller or it's Botox or it's RF micro-needling, you're paying that person.

23:27So I can put on my waycode and bring in RF micro-needling and say, I know what I'm doing and I have no idea, but these people want that they want it and I'm doing it at a low price so they do it. And that was something that came up a lot on the forum when I started posting the photos was you did it because you're cheap. And it wasn't that. We trade treatments all the time in this industry. And so it invested her. Right, it was all about trust. It's somebody that I trusted that I had worked with and was friends with for seven years. So there was no reason for me really not to trust her. She has other FDA approved devices. I didn't think she would be so stupid. I'm kind of hoping she has a real medical director now though if she really does do that. Well, and that's a whole other topic. I actually dropped somebody as a medical director because they were doing things that were outside of their scope by a long shot. And now there are these companies where you can just

24:29like rent a medical director. And I don't even know if they're in the same state but they'd never even met you. And so how proficient are these medical directors and how much do they know? I mean, yes, our of micro-needling in the right hands can be great. For me, it's, I'm not doing it again. I don't blame you. I don't blame you. But I agree with you about the medical directors. So that's one of the things at the medspot board. We not only confirm that the medical director is licensed in the state, but also we interview the medical director to make sure they know about aesthetics, to make sure they know who they're, there's the make sure they are actually doing the job of a medical director. And then of course they have to sign an attestation saying, yep, everything I just told you is true. And I do think that that is so very important. So finding a place that's legit means having a real medical director, not just an absentee one

25:31and not just a rent a dock. And there's a company that I was starting to research and I won't name it because I don't know yet. But there's a company that literally their whole job is finding medical directors for people who need one. And I think that it's really important that we investigate that company. And find out like who are they actually finding for this? And do they have the skills to actually supervise the person? And are they there? I mean, there are laws being proposed right now in it's like four or five different states that require the medical director to actually be in house a certain percentage of the time. Right. And a lot of these places, the medical directors nowhere near the place. Like they're not in forever because they're not there. I did a previous episode about two medical directors in California, one of whom supervised 13 or 14 spas, all over the state and then one spot in Maine.

26:34And I was like, there's no way you are supervising all these places. And he had a full time job as a palliative care doctor in Napa. And I was like, there's no way he's traveling around and actually personally supervising anything, right? No, and when you get, so I was a medical director for a place in Seattle and they ended up going, it wasn't anything that happened between us. It's just they wanted somebody there full time and they were bringing on. She was in an ejector and she was a nurse practitioner. I think she was a DNP and so it was just, it was fine. It was, we were just flooding ways. And she's on, of course, there was sight. And you should always have the medical director on the website. But when I worked for, there was an adverse event and he was able to contact me to tell me about it and show me pictures and tell me what happened in blah, blah, blah. And I was able to tell him how to treat it and what to do because that is extremely important.

27:34I need to know what you're offering. So I know how to treat what you're showing me because those, if you want a reputable place, that's another thing that you need to do. As you need to go online and you need to see who that owner is and who their medical director is. I was never on her website as a medical director ever. So I was really shocking to hear that I was her medical director. So if you've been listening to the show, you know I've got stories for days about what goes on in Med Spas. I finally put them all in a book. It's called Med Spal, Mayhem. I wrote it because I got tired of hearing about people getting hurt by providers who have no business holding a syringe. You'll read about real patients, real nightmares. But more importantly, you'll know exactly what to look for when you walk into any Med Spal and what questions to ask. It's part expose, part survival, God. And it might just save your life. Med Spal mayhem will leave you informed, entertained, and a little shocked at what's really going on

28:36behind the business of the aesthetics industry. The link is in the episode description. Read it before you book your next appointment because beauty should never come at the cost of your safety. Wow, that's crazy. Well, is there anything else about your story that you wanted to share? I know that this has been just a really difficult journey. But I think it's been really, really helpful to be able to share with our audience, just especially to not feel bad when something happened to you. And you just, there are so many people who are victims of these illegal places that are just, they're blaming themselves. And I think you need to not ever blame yourself because you trusted this person. And it's that is so difficult to override that. Even if you're feeling a little like, in the moment, you trust that person and you don't say anything until you have a moment to process it like to her.

29:36So I've heard from some people anonymously now who they're telling me their stories, but they don't want to talk about, they don't want to be identified because they partly feel like it's their fault. And I just want that message to grant everyone that it is not your fault. That is absolutely still part of, and I have said it online. I mean, there have been a lot of people that said, it's your fault, it's your fault, it's your fault. And I have, and there's been, the medical community for the most part online have been a, I mean, in my corner, they have been, I will fly you out here and treat you. I will send you this to try on your skin. I will do, you know what I mean, they're just called and they have fought back for me. It is not her fault where I'm sitting here typing away saying, you're right. It is my fault because I trusted her. I didn't ask her any questions, which I always tell patients to do.

30:37I didn't ask for her license. I didn't ask where she bought the machine if it was FDA approved. I didn't do the things that I tell patients to because I did the exact thing I tell them not to do. I trusted her. And so there is a huge part of me that is still guilt-ridden. Well, don't be really. And I just, I really, really appreciate your willingness to share your story because I know how difficult that is. It's hard. I think that, you know, it is hard. Before I got down this road, I mean, when I first started in aesthetics, I really, I was very trusting and I just, I thought, well, this is medicine. So we're gonna, I really felt like I needed to learn as much as I possibly could and do it really right or I wouldn't feel comfortable. And I just- Well, that's everywhere. It's integrity and ethics. Well, and the problem is that everywhere I turned, there was someone doing it illegally and I was like, how are they getting away with that?

31:40Right? I don't know. I knew all along there were people who had been harmed, but it's like, it's so hard for people to speak up. And the problem just got harder and harder and worse and worse. That's why I ended up writing that book because I just needed to get it out of my system. I thought, okay, just write about it and people can read it or not. And then I, at least I've said my piece. But one thing has led to another and it turns out, you know, oh my gosh, it's even bigger than I ever imagined. Even worse. When I was first writing this, I thought, maybe it's a third of these places illegal. And then as we got farther along and the book was coming out, I'm like, it's probably at least half, given what I'm learning. And now with the studies recently coming out of New York and Florida, it's like 60%. And they're not even looking at C-POM law violations. So I think it's probably even more than 60%. But right now I'm saying that- The Florida has different laws like you can't see a physician's or something.

32:42So and that's a whole different topic because- For lots, it's a side. I'm just talking about who's complying with the law. And- Yeah, well that's true. There's just so many people who are just not. So- No. So I mean, and that's another thing. I tell people when I'm teaching them, when they first walk into my office and they've never met me, but they've been referred to by somebody because they don't advertise. So it's like somebody's referred or Google review or whatever. I always, especially if I'm opening a new bottle first of all, I never walked out of the room unless I'm getting silly because I don't have enough cabinet space to put everything. But I have a refrigerator in the room. So I always have my neural toxin in there. And if I'm opening a new bottle of Botox or Dispored or whatever, I don't use anything else. So I guess I'm not opening anything else. I show it to them. I take it out of the box and I say, this is it. Yeah. Can you see it? And they're like, it's empty. That's him left the key.

33:43You see this little white ring? That's it. And that's where people will over dilute Botox, right? And so I actually under dilute because there seems to be a correlation between the COVID vaccine and Botox longevity. I don't know if it's true or not, but it does seem to wear off faster since COVID vaccine came out. So I actually do 2.3. And I'd rather have happy people, but I never walk out of the room when I don't trust when an injector will walk out of the room to fill something. I do it unless they're really needle phobic and they cannot watch me do it. I will do everything if I'm doing a sculpture. I will start reconstituting sculpture right in front of them. Yeah. So they see every needle I pull it. They see everything I do. They see it step by step. And I educate the whole time I'm going through this. They probably might retain 10%. But you know, the 1% that they'll retain, they'll retain that I did it in front of them.

34:44Right, right. Because the next time they go someplace and that person walks out of the room, they're going to think. Well, so I have to say that like everyone's workflow is different. And we actually do it very similarly. We do our counter and our fridge and our sinker all in the same room. And we do draw up in front of the patient where the patient in the room. But not everybody has that set up. So I have another spot where there's four rooms in a row. And the prep area is outside that room in a separate space. And so all the Botox and all the supplies are in one place. Because we also have four rooms in my place. And now you've got to have like a separate fridge in every room, like a separate supply. Yeah. Where is it going? So it can be a very reasonable workflow to not be in the room. So I don't want people to go home and think red flags. But it's true. But the big reasoning is, yeah, is to absolutely

35:45know that they're using real product one way or another. And one way to prove that is they're doing that in front of you. But the cases last year of botulism from fake Botox, the one nurse practitioner who actually was reported, this was in Illinois. She had ordered fake Botox Alpha Ali Baba. And she thought it was real Botox or that's what she told authorities. And it was a spoofed box. Like the box was obviously fake if you dealt with real Botox in real life. You know, we told that one up and like, where did this come from? That looks weird. But she didn't know. And a patient would not know. You would see that. It would look like it was a Botox violin. It wasn't. So that's something also that can be very difficult, right? So I think the more important thing, rather than you, you can validate the vial. Because can I see the vial, please? That's totally reasonable. That can go get the vial. It is very unlikely. They've got a real vial of Botox,

36:46but they pulled it from a fake one. And they're giving you fake. And they're going to show you a different, but that's, I don't, I think that's very improbable. I think the most important thing, though, is to make sure that they are an actual licensed medical provider and that there's an actual medical director there. Those are the top two things. Because those people do not want to lose their license. And so they are much less likely to be doing something illegal. Because if they do, they'll lose their license. And whereas these unlicensed people, they've got no license to lose. They do whatever they want. And there's nobody coming after them. And, you know, I've had, you know, many cases reported to me where, you know, they report this nurse, so nurse lost their license doing illegal things. Okay, nurse doesn't have a license anymore. Still doing all the illegal things. And they get report to the nursing board. And the nursing board says, what more can we do? We already took our license away. And so, so, you know, the people with no license have gotten nothing to lose.

37:47And so you want to look that up and make sure it's valid. I hang everything on my wall. So there's no question. It should be on the wall too. Yeah, yeah. Well, Sarah, thank you so much for sharing your story. I really, really appreciate it. And I hope this has helped people feel okay. And if anybody has a story they want to share, you do not have to share it with your identity, but I really do want to hear from you. Yeah, I think it's really important that we put this out there. And that's, I finally got to a place where I felt like, okay, I can put it out there. There was a lot of lash back and that hurts. But at the end of the day, my priority is keeping people safe and knowing how to keep people safe because I don't want anybody to go through what I went through. If you found this helpful, do me a favor and share it with a friend who's considering any aesthetic treatments. Subscribe so you don't miss the next one. And drop a comment telling me your biggest takeaway.

38:47I actually read them all. Let's keep each other safe and elevate the standards in the men's fat industry.