All Things Scars w/ Dr. Christopher Zoumalan

This audio podcast has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

Intro:

The following podcast is a discussion between two experts in their fields of beauty and not meant to be taken as medical advice. Be sure to consult with your doctor if you have any medical inquiries.

Dr. Anil Shah:

So I’m super excited about, uh, this podcast, which is gonna talk about all things scars, and it’s gonna be through the lens of perhaps one of the leading experts and scars and research. And that’s Dr. Christopher, Zoumalan Dr. Christopher Zoumalan, who I’ve had the pleasure of meeting and knowing for, uh, a few years now is one of the top oculoplastic surgeons in the world. Uh, you think of any A-listers who are out there, who, who you don’t know have had worked on. And it’s probably Dr. Zoumalan because he is super stealth with his techniques, um, and just really creates natural results. One of his secrets has been, uh, the use of this scar gel, which is called, uh, Skinuva. And what we’re gonna find out is, uh, some background on scar, some backgrounds in how the best management of scars, when to use the scar gel, just scars in general, where is the worst area for scars?

Dr. Anil Shah:

We’re gonna talk all things scars and how to manage scars. Dr. Zoumalan is making an interesting journey. He’s a Stanford graduate. He did some fellowship out at NYU. That’s where I met him. And then he’s established himself as one of the leading doctors in, in the realm of plastic surgery and specifically OAL plastic surgery out in Beverly Hills. It’s interesting. His background in skin is interesting because his dad is a scientist. So he had this passion for science and medicine, all kind of derived into his own skincare brand, which has developed with a few interesting products, including skin Uber. So guys, I am super pleased to be speaking today with a worldwide expert in so many different fields. And, uh, that’s gonna include aside from oculoplastics, it’s gonna be scars and skincare. Dr. Zoumalan is super talented. He is out in Beverly Hills. Um, he’s been trained throughout the world and that includes NYU.

Dr. Anil Shah:

So he is been in, uh, New York, Beverly Hills all over. And he’s kind of not just your regular doctor who just sort of does what everyone else does. He looks at problems and he, you know, kind of figures out solutions for that. So I always like doctors who think outside the box and come up with solutions that so many of us have been plagued with and can kind of look at that. And one of the products we’re gonna talk about is he’s the innovator CEO of skin, Uber scar, and skin, Uber bright, both of these are not just things he’s developed. He’s actually studied them and found out that they have worked in, you know, studies to show to be significantly better. So we’re gonna pick his mind. We have a chance to dive into it. We’re gonna get in the nuances of first GU scars, all these things. And these are just for patients, surgeons, anyone involved who can find out about Skinuva. So my first question for you, and do you want me to tell you, I, I know, uh, Dr. Zoumalan and off things, I’m gonna call you Dr. Chris Zoumalan if that’s okay.

Dr. Christopher Zoumalan:

Whatever you’re comfortable with Dr. Shah,

Speaker 4:

You can. Okay.

Dr. Anil Shah:

Okay. So Dr. Zoumalan

Dr. Christopher Zoumalan:

Still so professional. You can call me Chris, you can call me, uh, whatever your Chris does, you know me.

Dr. Anil Shah:

Okay. Yeah. Yeah. Okay. So I’ll go with Chris. That’s that’s all I know. Otherwise feel like a little too formal. Okay. So first of all, let’s talk about schoo. You know, it’s, it’s a product I use in my practice. It’s a game changer, you know, for my patients, but how did you come up with scan? What new made you formulate this product?

Dr. Christopher Zoumalan:

First of all, thank you for inviting me on your podcast. You know, I don’t get to see it often, but I do follow you on Instagram and the work you do, and, and just very impressed with the talent that you bring out to Chicago. And it’s an honor to be here and just kind of talking about, uh, what I love, you know, besides surgery, developing products and products that can help us help our, of patients. Um, I, uh, initially thought about Skiva when I was during my fellowship at New York, which is kind of where you and I got to know each other. You know, we met, uh, through my brother, who’s a T resident, and they’re going into facial plastics. And, uh, during my time at NYU is where I started, uh, hearing about silicone cream for post CARSs. And you, I was, I was intrigued and I started using it for some of my sty procedures and my other procedures I was doing on the face at that time during my training. And I saw that the benefits of silicone was there and that there was the evidence to back it up. And I, and I went back to, uh, back home. I, I I’m from Los Angeles and I ended up going back home to, to start my own private practice in OAL plastics. In Beverly Hills. I figured there was a shortage of plastic surgeons in Beverly Hills, and that’s where I

Speaker 4:

Ended up starting my practice.

Dr. Christopher Zoumalan:

I figured it’s late in the day to make a joke, but I think I had to, uh, I wanted to, I wanted to be the best OAL plastic surgeon. And I, uh, knew my home was back in

Dr. Anil Shah:

Beverly Hills. And I’m gonna, I’m gonna raise my hand and say that, um, you are probably the best oculoplastic. I mean, I know I’ve sent a few patients your way, who’ve gone across the country to see you and, and see your talent. And, uh, I mean, nothing, but, uh, thank you probably the most amazing work I’ve ever seen for oculoplastics.

Dr. Christopher Zoumalan:

I, I appreciate it. You know, I, I, I learn, I learn every day. I’m, I’m always learning, you know, I want, I’m strive to be the best. It’s, it’s a, it’s a, it’s a hunger for desire we have. And, and while I was establishing myself and, and, and, you know, and, and becoming more familiar with running a practice and seeing patients and, and kind of growing that, that practice, I started to think of ways that I can help improve my patient care. And, and I, I started purchasing one of the medical grade, uh, silicone cream back then, and I realized it was so expensive to buy like a one ounce. And it was just essentially, you know, I had another, uh, rep that was knocking on my door for a competitor to have me try out their silicone cream. And it was essentially, they were just fighting over, uh, a treatment that was using the same basis, Silicon cream and I, a light bulb went off and, you know, I was trained at Stanford and as a resident, uh, my department always teach us and encouraged the evidence to think outside the box.

Dr. Christopher Zoumalan:

You know, how can you make, uh, this product, this device, this people modality better? What can you offer your patients? That’s better than the current market. And, uh, and that’s where light bulb went off and said, and, and being that I’ve done research just like you have, and we have that interest in research, and you appreciate that as you’re like that too intuitive. And you think outside the box, I, I realize that there’s other ingredients in addition to silicone cream, that could potentially work. You know, I remember when I was a kid and I got sunburn, my mother literally had an H there, a plant broken and half said, Hey, why don’t you apply it on your skin? And lo and behold, it helped my burn. So there’s evidence a lot of ingredients besides Silicon cream that can help improve scarring out was just, I don’t know.

Dr. Christopher Zoumalan:

I was like curious and also like dumbfounded as why these ingredients weren’t really integrated into, um, a scar cream. And I was surprised. So I looked more into it and I started developing a list of about 20 or so ingredients that could work, help improve wounds. Um, uh, scars, one of ’em was for sure, Silicon cream, Silicon cream is a very, very effective, uh, um, ingredients that helps hydrate the wound. You wanna keep that scar moist hydrated, uh, you want keep kind of barricaded from the air, so it doesn’t dry out. Um, and you also, uh, the, these other ingredients that I, I started stumbling upon and, and some of ’em were also growth factors, but there’s these synthetic or whatever based growth factors you have that play role in, in scarring. I was very curious and I started looking into these ingredients and I began to formulate my earlier versions of a product, uh, with Alovera sent AA, which is an Asian herbal product from an Asian continent, which has been profound evidence to show that helps improve scars and burns and open like non-healing ulcers, um, vitamin C, which is a powerful ingredient.

Dr. Christopher Zoumalan:

And, and I was just curious why vitamin C wasn’t included in a scar cream product before. And, and the reason to it is it’s very unstable, very difficult to work with. It’s, um, there’s so many different forms, and it’s just hard to blend it in with these other ingredients that I’m mentioning to you to keep it stable. And that was a challenge with vitamin C, uh, hyaluronic acid, which is just really a lot of ample evidence of how it helps like silicone keep that scar moist. And, um, in addition to it, art, these, these growth factors. And so I started diving deep, deeper into developing this product. I realized that, you know, making a product based product with growth factors, new that ingredients is not easy, so much instability. There’s so much difficulty acquiring these ingredients. So that was in 2015 and 16, and it took me a couple years to really formulate this product and really integrate these ingredients.

Dr. Christopher Zoumalan:

I felt were really important in managing scars and really helping improve a scar. And each ingredient has a purpose. Every ingredient I’ve included has a purpose. They’re all backed by medical data and medical literature, but I, for cherry picked these ingredients, uh, these synthetic growth factors, I didn’t want to incorporate human growth factors. I felt that there was some controversy with human baseball factors. I wanted to integrate a product that had safe, uh, controversial free products, uh, backed by data. That growth factors were the type of growth factors I wanted to use. So, um, that’s the impetus of how I, and why I developed SBA. And I wanted to back it by data, develop this product, do some ample data studies to show that safe and effective and, and really market it to my colleagues at a price that’s very, uh, competitive, reasonable, affordable, whatever the word is. That makes sense. That makes sense by providing them the most advanced clinically proven product for their patients. And so, uh, we’re now almost our third three and a half years, and it’s been an amazing ride company’s growing, and it’s really exciting to see this product take off and now we’re developing other products.

Dr. Anil Shah:

So, so, so you mentioned a product earlier. I wanna dive into the weeds a little bit here, so just cuz it’s, there’s some things that, you know, kind of, we’re gonna jump into things. What was the name of the Asian skincare product? Um, you, you, you investigat the beginning. What was that called?

Dr. Christopher Zoumalan:

Sent AA?

Dr. Anil Shah:

I have not heard of that

Dr. Christopher Zoumalan:

Sent, sent ACA is also also known as go to Cola, G O T U uh, K O L a. It’s an herbal it’s herbal ingredient. It’s it’s, it’s, it’s, it’s derived from the sent ACO plant and it’s origin. Origin is an Asian continent and pub you’ll see how much data there is on this ingredient that it helps in diabetic, um, foot wounds, um, sunburns scarring and, uh, it’s, it’s well documented as an ingredient. And so

Dr. Anil Shah:

Do you know, ingredient how that works, uh, that product off the top of, I, I don’t, I have no idea. I’ve never heard of this product, so

Dr. Christopher Zoumalan:

It’s not a product, it’s an ingredient

Dr. Anil Shah:

Ingredient. Yeah, it’s

Dr. Christopher Zoumalan:

A, it’s an ingredient. So the way multifold, uh, sent ASCA worked through multifold, it helps reduce vascularity of a scar, helps her improve the redness with scar. It helps in some, some, some direct and indirect ways of restructuring collagen as well. Uh, it’s also helps in promoting, um, uh, proper uh neogenesis as well and, and Regener, and, and, uh, regression of vascularity. And so allowing for wound to heal and then also to appropriately regress it’s arguably like works too well. So you gotta make sure that you using the right concentrations. Um, and, uh, but it’s, it’s, it’s a wonderful ingredient that I, I, I definitely was my top, top, top five ingredients that I wanted include skinny

Dr. Anil Shah:

Ball. That’s interesting. Cuz, so you mentioned one of the things that I, I see in scars, if I look at scars that I don’t like, um, one component I’ll note and we’ll kind of talk about what makes a scar favorable, not favorable and things of that nature. One of the things I’ll notice is that sometimes around the scar you’ll see that redness along it you’ll see those extra blood vessels. What are the things you’re looking for a scar are like when you look at a scar and just in general, this doesn’t have to involve Skinuva, but just what makes a scar, um, as a surgeon, like as favorable as possible for, for those viewers out there,

Dr. Christopher Zoumalan:

That’s a great question. I mean, everyone heals differently. First of all, everyone heals differently when it comes to postoperatively. And you mentioned something about redness vascularity. So initially, uh, when you see an incision and I will see, you know, you know, five to 10 patients a week that I, you know, just be something operated on, I’m looking at their incision and they’re all different patients at different age. Patients have different ethnicities. Patients have different lifestyle, all have different characteristics of how scar should heal. But in general, the scar has some degree, whether it’s mild or moderate, uh, findings of vascularity, where it’s red, where there’s a lot of blood flow going in all scars incisions will have Neo angiogenesis, they’ll have new, uh, blood supply going into the wound. Why well, your own body, uh, those blood vessels are essentially the new highway system for all your own cytokine growth factors that will be sending messengers to your new incision to heal.

Dr. Christopher Zoumalan:

So some people have a more robust response with these, uh, new blood vessels. They just proliferate more than others and it could be their age. Younger people tend to have more of that response than the older people. Younger people tend to respond more to such stimuli for instance. And so certain ethnicities can be more prone to increased vascular response or people that are more out in the sun could be more responding to this. There’s so many different characteristics, but essentially though scars also have this redness to some degree, they also have pigmentation. Some people tend to have, uh, a pretty, um, mild hyperpigmentation response, but others have more of a prominent hyperpigmentation, which we call post-inflammatory hyperpigmentation or PIH that that is fairly present in myself. Like if I get any sort of incision made or any procedure, even a pimple, I will hyper pigment tremendously and it will eventually calm down, but that’s, that’s, that’s characteristic for a lot of people with darker skin.

Dr. Christopher Zoumalan:

Um, and also people with Asian descents can tend to hyper pigment more. So those are two things that I see in scars to some degree, um, thickness the thickness of a scar is also important. You know, like how raised it is. And this, this certainly depends on the location. Scars on the face may not be as thicken as the chest, but scars on the nose will thicken more than scars on the eyelid, just because the tissue’s thicker. And also the liability is how, when you feel a scar. So you mentioned redness. Well, you can, you can have a fairly prominent vascular response of the incision scar is very flat. So the sickness is not an issue or it can be vice versa where scar is very thick in, it’s almost becoming a little bit, um, hypertrophic and the vascular response is minimal. So it doesn’t have to be all or not.

Dr. Christopher Zoumalan:

They’re all very different variability characteristic findings. What I just describe to you are four things, vascularity, hyper segmentation, the thickness of a scar and its liability that those are the characteristics that we grade using the Vancouver scar study scale. So it’s a fairly well documented scar study scale. And that’s what I use in my studies when comes evaluating scar and you have a grading scale and a lot of these can be done through digitally and remotely. When I do a lot of my studies, all independent evaluators, review them and grade ’em obviously you can’t grade one of the four variables, which is the feel the scar that has to be done in person, but the other three you can’t. So then just to briefly summarize, I mean, I, as the scar heals, you should have that redness go away. You know, it, it’s essentially a regression of the vascular vasculature that should regress what time that scar should, uh, have that redness essentially regress, but not all due. And some people may have that vascularity for months given years afterward and that that’s persistent. And that that’s one of the reasons why I included a lot of my ingredients to help with the regression of these blood supply, this, this, this blood, this, this vascularity that you don’t need anymore because the skin is healed incisions healed. So, so the short,

Dr. Anil Shah:

Yeah, so, so that’s, uh, you know, that, and, and for the viewers listeners out there, it’s, it’s the, a first phase of scar healing, which is the inflammatory phase, which normal, uh, but when it goes beyond normal, that’s when you’re gonna have that, uh, that hyper normal response. I always tell my patients it’s, um, it, it’s kind of counterintuitive. Who do you think would heal better granddaughter, you know, daughter or grandmother and surprisingly it’s grandmother, I think heals better than the granddaughter, cuz they’re gonna have that hyper hyper response. Is that right?

Dr. Christopher Zoumalan:

Yeah. It’s, it’s studies have supported that, you know, that, that, that, uh, younger, younger people will heal more aggressively. So maybe the impact structure of the collagen, the college of structure may be a lot better aligned in a, in a younger person, long term, but they, they may have a more profound hypertrophic response earlier on someone that’s much older may not have as strong of a collagen type one type three response as a younger person, but they will not have that profound hypertrophic response that incision or that scar just heals better. But in terms of strength and rigidity, I’m sure the younger person’s incision will have a much more normal looking structure like histologically, but on the surface it may be a lot more of a aggressive response.

Dr. Anil Shah:

So kind of to recap over here, we have the three phases of scar healing. We have the inflammation, proliferation remodeling and your product, um, skin UVA, which you developed. It’s, it’s controlling that over vigorous inflammatory response, which is what a lot of people will see with their scars. And that’s gonna be one of the products you mentioned earlier, which is I, I can’t even say it, so you’ll have to do that for me because I, I’m not familiar. It’s a sciatic. It’s a, what is it

Dr. Christopher Zoumalan:

Sent? Has the Attica.

Dr. Anil Shah:

Okay. I have to see it. I’m like my auditory knowledge. If you’re tell me something, I can’t pick it up, but if you, uh, if I see it, I can remember it. That’s just what kind of the way I, how I, my, my brain works, which, which is good but, or bad. So, um, um, so that’s gonna be one of those key inflammatory,

Dr. Christopher Zoumalan:

If you have my, yeah, it’s right there in the

Dr. Anil Shah:

Third. Oh, I see it now.

Dr. Christopher Zoumalan:

Third line on the left. There you

Dr. Anil Shah:

Go. I got it. Thank you so much. Okay. So that’s gonna be one of those ingredients and, um, that’s gonna be, um, huge for the scar for that red spot. And that’s why I’m gonna show you a case example where I’ve used your product and, um, I wanna see your reaction to this. So this is gonna be super fun, but, um, right. And where I’ve struggled before I’ve used scan. So this is kind of, um, uh, perhaps that’s been one of the areas I’ve, I’ve been missing. I think so with the inflammatory response, any other ingredients in the inflammatory response we should, we should talk about before we move on to the other phases of scar hu.

Dr. Christopher Zoumalan:

Yeah. I, I think that we haven’t really touched a lot upon the growth factors and, and that’s like a really, really cool part of Canva and that that’s, I think what kind of put, put us on that map as a reputable company where we actually are, I’d say one of the only ones that I’m aware of that, uh, specifically we selected, uh, synthetic growth factors that play a role in, um, the solu the problem that we’re trying to help improve. Right. So it’s a solution based formulation and, uh, in, in skin scar we’ve, uh, I’ve, I’ve identified three, three growth factors that play a role in the wound modulation process, meaning that, uh, I didn’t, did you do any rotations in med school? Uh, or I don’t know, an intern where you were, um, when you did, uh, uh, pediatric, uh, surgery or intrauterine surgery, the, the fertility rotation or in the pediatric surgery, we actually did like spin bifida work. Um, I didn’t, but did you have any exposure to

Dr. Anil Shah:

That? Uh, no. I, I, I did a pediatric T, but not necessarily like the spin bifida aspect of that.

Dr. Christopher Zoumalan:

Yeah. I didn’t either. And, and I, and so going into my research first, getting a scar and using, trying to identify ingredients, I was really curious about growth factors in their role and then, uh, fetus don’t, uh, scar. Okay. So, uh, essentially if you, uh, see a spin, a bifida incision years out from tus had a procedure done in Ute that incision barely perceptible because the type of response the scars have, or the incision has in the womb is much different than outside the womb. And the reason is that the, the cellular response, the response has in Ute, it elicits a very different array of growth factors than we do. And one of ’em is transforming growth factor data, three to subhuman, and that is found in very high concentrations in fetal scar tissue. Whereas in, in scar tissue, in adult, you don’t see that or anyone outside of Ute that it’s the complete opposite.

Dr. Christopher Zoumalan:

It’s a very low response of TF beta three and a very of its counter subunit TGF beta one. Whereas Fetra uterine scar tissue has a very high B3, has a low B one, but adult scar tissue has a very high B one and a very high B3 and a very high B one and a very low B3. So it’s the difference. So playing on that more, I, I identified a couple other ingredients that are proprietary growth factors. Um, we’re happy as a company exposed P data three, because I think the story is beautiful. There’s a reason why we included that there’s a couple other growth factors that have a similar sort of, um, uh, rationale why we included it. And, and, and these, these three growth factors helped improve of inflammation. They help improve redness. They help improve pigmentation. They help improve better causes structure as well.

Dr. Christopher Zoumalan:

And, and they help improve the thickness of the scar and allow from the healing to be more optimal. So that’s the reason why they include these, uh, synthetic growth factors. Again, they work on the skin. These don’t go into your cellular structure is device or a medical drug. It’s a topical skincare product, but we wanted to integrate these sort of ingredients along the skin surface to see if it would, these ingredients would actually work better in Silicon cream. And we’ve done data that we did a large multicentered trial. We actually show that our product looks better in Silicon cream. So something is working, whether it’s the growth factor, whether it’s the Senta, whether the, all I won’t be able to tell you which one it is, or the vitamin C, but I’m very confident that all of these play a little bit of a nice role in kind of getting what we have as a result of this product.

Dr. Anil Shah:

So do you think, um, on those three phases of growth factors that we talked about as wound healing, sorry about inflammation, proliferation, and ma maturation or remodeling, do you think, think the growth factors are working? It sounds like a little bit on the inflammatory response and changing or modulating that way that’s gonna work with the TGF beta three, but you think it’s also on the proliferation of maturation, or you think it’s a little bit on all three layers or just on

Speaker 5:

Three phases or

Dr. Christopher Zoumalan:

All right. So we’re gonna really break it down from, in a scientific, uh, way without kind of throwing, losing your readers on this. Uh, so we generally recommend using skin a scar about, uh, I generally recommend using it about, uh, a week after the sutures are removed, right? So it’s about two weeks up. Some people use it earlier, some people you, but I, for the purposes of where we, uh, like to use this product, it’s best to use it about a week after the sutures are removed. So technically in that timeframe, you’re in the ended, the proliferative phase, beginning of maturation, right? So the inflammatory phase actually is kind of done, right? The inflammatory phase has already been done. It’s been the first few days you got the S scab. Now you got the bleeding stop hemostasis now. So, so technically our product starts to cause I don’t, I don’t want, I feel like our body needs its time to heal.

Dr. Christopher Zoumalan:

I think it needs its own way to heal. You don’t want to be putting in these other, you know, ingredients, uh, in the beginning besides just keeping that area of moist, but also, uh, have an topical antibiotic. So I recommend like mized appointment for like 10 days or 14 days, and then take, you know, then start skin Nuva. So it’s actually more the, I think it helps in the proliferative phase where sometimes you’re proliferating too much is you’re, you’re potentially, uh, having too much of a vascular sort of response. It starts to help, you know, improve that and try to help and improve the appearance of the redness. And I think that helps in the, in the pro phase and the maturation is where you start getting that, um, uh, contraction, sometimes dryness, sometimes pain, you know, from a, from an incision as it heals and hydration, hydration, hydration is so key, right?

Dr. Christopher Zoumalan:

You want to keep it hydrated. But also during that phases where you get that persistent redness to get that persistent segmentation, but you also start getting that potential contractors that can occur, not contractual persist. Uh, that’s where the hypertrophy response happens. The maximum scar tissue is what was, what were we taught about two weeks out? Yeah. You start to see the maximum scar tissue occur. So that’s where I really want to do on how the patient start massaging it to help, help improve that maximum scar tissue and try to help improve that, try to help decrease that, help decrease that hypertrophic response. It’s normal to have a T response it’s normal for a start to be a little bit red, normal for be to it, but you don’t want to be painful and tight and, and raise normally that’s where starts to become hypertrophic. Let’s control that. And that’s in the, at proliferative to maturation phase that you start to really see the benefit of a, of a scar.

Speaker 5:

So, so we talked about the phases of wound healing. Let’s talk about this a little bit in detail. Uh, so there’s three phases of wound healing that are generally accepted that all scars and wounds need to undergo. The first phase is called the inflammatory phase. And as doctors, Jim Jamal indicated this phase begins when the wound develops and it lasts about four to six days. It’s normal during this process to have redness, erythema inflammation. And he recommends that this process go uninhibited. The second phase of wound healing is called the proliferative phase and this lasts for the first four to 24 days. And that’s where granulation tissue’s gonna fill in, uh, the wound or help the scar heal. And this is where little cells call fibroblast lay in the collagen. And then the final phase of healing is called a maturation phase. And this can last anywhere from 21 days to, to about a year to two years. Uh, it’s generally accepted that scars are completely healed at around one year. Uh, although, uh, it may take longer in some cases

Dr. Anil Shah:

For the TGF beta three. Um, what, what creating specifically, did you, uh, incorporate that to kind of, um, what growth factors did you put in there to kind create that response? The TGF ATA three response?

Dr. Christopher Zoumalan:

Well, the, the TGF beta three is one of the growth factors.

Dr. Anil Shah:

So you actually have that physically in the product. Yes. Oh, wow. That’s amazing. Cuz that’s yes. So he’s like, did you not listen to the beginning part of this hole in the no, no. I, I thought you had a product that would stimulate that in your body, but you actually put TGF ATA three. What? Wow.

Dr. Christopher Zoumalan:

It’s, it’s, it’s a growth factor. It’s a synthetic growth factor that we were able to work with our, our company and, uh, we, we basically utilize it and we incorporated into our

Dr. Anil Shah:

Product. That’s amazing. Actually, I, I did not know. I thought you, you listed that response. Okay. So, so that’s, that’s cool. So like that’s the whole product. No, I knew there was growth. I didn’t realize, I thought you was kind of like your body would make the growth factors response to it, but I didn’t realize you actually put the growth factors in there, so that’s wow. Well,

Dr. Christopher Zoumalan:

Alright, so, so that’s, you know, that’s something we haven’t Studi is whether our TF beta three would actually stimulate your own TGF beta three. Um, we haven’t really studied that, you know, but certainly I’ll tell you though, I’ll play something really cool is that we did a pilot study where we included five patients that had tummy tucks all seen a month out from their tummy tuck. And what we’d ended up doing is an IRB approved study, where we ended up, uh, having them use skin scar on a third of their tummy, tuck a third of their tummy tuck. We provided them a regular silicone cream to home. And the other third we, we said, do not use anything and come back and see us in a month. So low and mold. They came back in a month. Uh, we already knew that data would show from our previous experience that that side treated with will look a lot better than the other two.

Dr. Christopher Zoumalan:

And what we ended up doing was we actually did, uh, skin punch biopsies. We two, two millimeters skin skin punch biopsies of those three areas, one treated with Skiva, one with regular silicone cream, one with nothing. And then we did a foresight just near the tummy to right below the incision. So an area that’s not affected by surgery. And, and this is published. There is published in a scars, burns and healing. Uh, years ago we published this data and what we were able to see from these five patients in our, in our pilot study, that was really fascinating that their, their mRNA expression, it actually differ between all three. And that the mRNA that was expressed in that punch biopsy showed a more favorable call type one type three response, more favorable, um, fibroblast response, basically all the key factors that you want in a good healing scar was hit it with SNU a scar.

Dr. Christopher Zoumalan:

Okay. More so than Silicon cream, more so Silicon cream, but, but the one that was not treated all the way down and then just to be a control, the mRNA in the, in that fourth specimen that had no incision had zero response to all these markers that you’ve seen of scar. So it was legit. Now it’s only five patients, you know, you can argue and say a pilot. I mean, but it’s a pilot study and we were able to clinic show it. The clinical indicators were very strong to support that from a deep cellular level that the scar was healing better. Yeah.

Dr. Anil Shah:

Um, this is one of the coolest things. So yeah, I think the product, it seems like it’s, um, the thing I’m get most excited about is the long term, especially management, we’re seeing so many patients virtually and in different areas. And what I used to do with my patients is I would have them come back and we’ll talk about some of these different technique used to use with them. Um, and um, I used to talk about derating them or needling them or lasering them. And, um, I don’t know. I mean, what, what are your thoughts on those as a treatment versus, um, not necessarily versus, cause I think as, as an adjunct to skin, do you, do you like that with it or you feel like it’s not, uh, not your favorite shape. So any adjuncts you’d recommend with Nova to other surgeons who are using it?

Dr. Christopher Zoumalan:

I, I think you hit on a nail. I mean, you, the scar look at the end of the day, a scar cream is not an all end for all scars, right? So I generally will have patients use Canva, all my patients. It’s part of the package. You’re getting it, you know, thank you for trusting me as your doctor. I’m, I’m gonna give you my product, but also happens to be the most advanced scar cream. In my opinion, the market, based on the data, you’re gonna use that twice a day for a minimum of three, six months. So it doesn’t with, by integrating SVA in my patients, I found out that I’ve had to cut the need for doing additional treatment by half. So I used to my needle, a lot of my scars, I used to inject five U catalog in a lot of my patients.

Dr. Christopher Zoumalan:

A lot of my colleagues say, you’re crazy. Why are you injecting so many? And, and ultimately it, it, when you run a cosmetic practice, the incision is what patients see and they complain about. And they’re when they’re flying to see you, you know what I you’re nodding your head. You see that because they were, when they’re coming in, see you, they want that their inci to heal as best as possible and modulating the wound who works tremendously well. But having schoo on board has cut that need by half. I don’t need to inject as many people. I don’t need to micro needle as much people anymore. Uh, I still do, uh, but not as much. So it’s reduced the need for me to do additional treatments because scar heals so much better.

Dr. Anil Shah:

You know, I, I noticed it for, for me. Um, one of the areas of tension I put is on a face lift behind the ear. And I wouldn’t see a hypertrophic response there right away, but typically, um, it’s around the four week to six week mark, where, um, I notice that if they’re treated again, this is, this is me speaking anecdotally, not with sort, sort of study like that, but I know if they’re treated there, they tend to have, again, behind the ear, they tend to get red without treatment. They tend to scar tend to get thicker. Again, it starts having that abnormal response. Again, there’s gonna be some tension there. Um, uh, just in general. And then when they’re treated there, when they, with the scan, it’s less interventions, less injections, less pain, less discomfort. It’s more of a normal thing. And then that, that fourth characteristic that we, we kind of hinted on, but didn’t really go into the pliability. That’s kind of one of those things I don’t wanna underestimate because it’s such a big difference when you can feel a scar versus when it feels like your normal tissue. Yeah. Patients, it’s so big, at least in this, this facelift scars. I’m not sure O other areas of course too, but it’s such a big thing.

Dr. Christopher Zoumalan:

Absolutely. And that’s one of the, you know, when we were doing our clinical trial, we noticed that that redness was a really interesting thing in patients that had facelifts. And then you can see that sort of redness bit prominent behind the ear go away so much quicker than just to use a regular Silicon cream. But yeah, I mean, that’s one of the first things I noticed and segmentation, our product actually has vitamin C and along with growth factors that really help with pigmentation, which, which is a big issue with scarring. So, you know, it’s, it’s great to have that these products on board, but, you know, everyone has, every ingredient has its own reason, its own story. Why we included

Dr. Anil Shah:

It now I, I, I think it’s important for everyone to know that Geneva is not a substitute for a good surgeon. Like, you know, it’s part of it is like, you know, we kind of talking about earlier, like the qualities of a scar. So if you’re someone you’re advising a young surgeon and you have surgeons observe you from all over the world, um, what would you advise a surgeon say, Hey, I wanna make the best scar possible. I wanna make this scar on the middle of the face. Uh, that we’re both, that’s our area that we’re comfortable with. Um, what would you advise this surgeon? How, how should they close this scar? What should they do to kind of minimize the scar? Because if you make a poor scar, it’s gonna be way harder to treat after I think,

Dr. Christopher Zoumalan:

Yeah. I think there’s a lot of factors. One is, you know, making sure that you’re, you’re a surgeon that has experience doing this procedure, right? So you have adequate training or adequate experience and you feel comfortable repairing the, whether it’s, uh, uh, a blepharoplasty incision or facelift or Mo reconstruction. Ultimately you wanna make sure the wound is clean, that the edges are, uh, adequately aligned without any the minimal tension. And you have decide whether you’re gonna be closing just with a superficial skin closure or if you’re gonna be doing, uh, layered closure, you want to make sure the tension is reduced. So if you have a forehead laceration, uh, which I had many years ago from surfing, I, I, I had a surf work at my forehead and

Dr. Anil Shah:

That’s a California problem.

Dr. Christopher Zoumalan:

Yeah. One of my buddies helped me out. He was, he was a resident and I called him, nobody else was sticking up their phone. So he, he came over and uh, and then he irrigated the wound. There was no was minimal tension because I wasn’t missing any skin. All right. But, uh, uh, you know, dermo closures were done to minimize tension with an absorbable suture, I believe was a, probably a five O PS and then skin skin closure was done with, with a very clean inner suture, like a six oh proline, I believe. And so those stayed in place for a week. So, uh, wound closure, the type of sutures you, you, you choose. So if let’s say we didn’t do DMO closure was just skin closure that would probably lead to more, but the hissin a wide in scar. Right? So that we saw that too, the type of a suture, um, you know, PDs can be inflammatory.

Dr. Christopher Zoumalan:

I did have some inflammatory nodule, which I had to put steroids in. When my colleagues put afterward, that’s fairly normal. Patients have to be aware about that. Um, that didn’t spit out three is, uh, remove dissolvable versus non dissolvable sutures. You know, I, I, I rarely use dissolvable sutures because they, I, lot of inflammation, a lot of redness in that area and prolonged healing. Sometimes you have no choice and you have to use those sutures. So I try to, my blessed always, I use removable sutures because you wanna minimize inflammation. You wanna minimize that redness. You wanna minimize those, uh, those, uh, sort of like, uh, uh, penetration, but you’ll see,

Dr. Anil Shah:

Even Subary blasts, I’m sorry. Even Subi Subi. So below lower bluff, you’ll use observable. Um, nonabsorbable sutures,

Dr. Christopher Zoumalan:

Uh, Subi. I use a six O Prolene. Really. I’ll just take it out. Yeah. But sometimes I’ll do a six O fast as the patient’s very difficult for me to work with. And I’ll just take it out in like six days and that it doesn’t really have a lot of inflammation cuz I take it out quick. Yeah.

Dr. Anil Shah:

Um, what

Dr. Christopher Zoumalan:

Do you use for Subhi?

Dr. Anil Shah:

Uh, I use six so fast, but again, I, I do get a little inflammation on, on the, on the corners sometimes and

Dr. Christopher Zoumalan:

Normal, normal, and that’s because it fights some inflammation. Most I’m like 50 50 when it comes to the lowers, but it’s hard, you know, by still take them out. So even if I do six so fast, Neil, I will take them out under his foot length because I don’t want to keep them in there. So I’ll pull ’em out.

Speaker 5:

So we mentioned absorbable versus non-absorbable also known as permanent versus temporary sutures. So let’s talk about those, a permanent stitch, which is also non-absorbable has to be one of the benefits of this type of stitch is that it creates less inflammation, an absorbable stitch or a temporary stitch. Um, your body will absorb it. The problem is as your body’s absorbing the stitch, in some cases it can create inflammation. So in some cases it’s more beneficial to have an absorbable stitch. In some cases it’s bone benefit to have a nonabsorbable stitch

Dr. Anil Shah:

I’m, I’m gonna mention something controversial, you know, the deep layer stitches. I find that they can create a lot of inflammation personally, that, that part. And I know it’s important to put them, but I’ve been going a little further away from the PDs stitches because I think that, you know, it’s, it’s a tough stitch that it seems to work it’s way out, especially along the nose and deeper through here. So I do it as a deep stitch, but like near the dermis, sometimes I’ll go with something like either a monocle or a Viro, just because I’ve had maybe it’s bad luck or bad patient things. But, um, that’s been my, my take on that. Your thoughts.

Dr. Christopher Zoumalan:

Well, I, I, I cannot argue with you at all, man. Actually, when I do my brow lifts, I use pretty much monochro because I, I have less issues of, of that. So I’m, I was just kind of saying PDFs. So kind of like a, a monofil that’s dissolvable. I prefer monochro uh, if I want more tension go deeper with a PDF PDF. I do have, I, if I do PDF, uh, deep thermal, it has to be deep thermal. It won’t, it won’t be rubbing close to the skin. Do you, so

Dr. Anil Shah:

Do you think, um, and we’re just talking, do you think it matters if you do, um, you know, vertical mattress versus this, or just kind of, it’s all kind of avoiding tension. It’s the same physiologic response that, uh, you know, some patients will do, you know, subcuticular versus vertical mattress versus, you know, locking suture. I think to me it doesn’t really matter. This is my take on this. It doesn’t really matter what you do. As long as you don’t put tension, you squeeze on the oxygen supply, you sort of avoid that tension it’s but your thoughts on that, do you think there’s a one type of suturing technique?

Dr. Christopher Zoumalan:

There’s no study that supports, uh, for instance, uh, upper for less there’s no study. Well, there’s actually one fairly, fairly acceptable study with the ENT literature that actually showed that the best wound that, uh, were the ones that were done with the running and with interrupted immediately and laterally there’s a running the subcuticular you figure would be best if not. And, and I actually, my practice user running most of the time with interrupted based on that study and my experience, I, I, the subcuticular initially looked better, but long term, I find that the running heal better. So, uh, vertical, I used to do verticals more so horizontal with my direct lateral brows, especially horizontal running horizontal running mattress. I, I, I haven’t really, you know, I went back to running. I find that adequately good closure, you know, not too much of a super high tension, like you mentioned, but beautiful closure with sparsity interrupted immediately, centrally and laterally be.

Dr. Anil Shah:

And, and one thing it’s interesting about the mechanics of a scar and, and the suture that you use. If you look at a shirt, you rarely see a shirt with interrupted sutures, you know what I mean? Usually it’s a running stitch and there’s something about the, the physics and the integrity. When you have one suture, that’s kind of holding things together. Um, I, I think it does per provide some sort of, uh, a physical mechanical advantage versus single sutures. Maybe I’m wrong on that, but that’s, that’s kind of one of those observations I made.

Dr. Christopher Zoumalan:

I think you’re on it. So distributing that tension, it’s kind of like this sort of workhorse that’s distributing it it’s throughout that whole area. Right. Rather than interrupted, it’s kind of a single horse doing its own thing. It’s like you have a team now that’s working together along that decision. I agree. I, I like running for that reason.

Dr. Anil Shah:

Um, skin UVA around the eyes. Can you put it on upper bluff scars? So let’s talk about that.

Dr. Christopher Zoumalan:

Yeah, absolutely. It’s it’s, it’s ophthalmic tested. We did a, a special test to do for skin care products and it’s safe with really, I mean, it’s, there’s no issues. You may have a little bit irritation, just some artificial tears and just take it out. If it goes in your eyes. I have used Skiva scar, probably just my own, uh, 1500 patients. Oh my gosh. Zero issues. You know, I mean, uh, I just, I’m gently put on the upper lid, close your eyes and they’re good. And gently massage. Don’t put a huge amount, put a small light amount and it’s very tolerable. And again, it builds in your eyes. It may be a little irritated, just like any other moisturizer gets in your eyes. It’s not worse.

Dr. Anil Shah:

Uh, that’s amazing. And it’s, it’s good to know that your oculoplastic, I’m gonna emphasize the Olo background here. I mean, if you say it’s safe, I mean, um, that that’s basically gonna be Trump, anyone else out there, right?

Dr. Christopher Zoumalan:

No, it worked out great. It works great. I mean, I, I, it’s a dream to develop a product like this and have your patients use it honestly. And, and then have colleagues like you use it and invite me to talk about it. It’s it’s, it’s it’s it’s awesome.

Dr. Anil Shah:

So, so let’s talk about the best way to apply it. So someone has their incision. Do they apply this with, it sounds like a basic question. Do they apply it with a tube? Do they apply it with a Q-tip? Do they apply it with their finger? Um, what’s your, what’s your recommended way? Do they apply it after they moisture? After they, it shower before they shower, before they wash their face? Like, what’s your, your best way of applying this? And if you had the best patient out there, what would they, and how long do they use it for? If someone said, I want the best scar possible, I’m gonna first pick the best surgeon possible. After I see this doctor, we’ll call this doctor Dr. Z or Dr. S

Dr. Anil Shah:

I’m just trying and then, uh, why

Dr. Christopher Zoumalan:

Not? Why not?

Dr. Anil Shah:

Okay. And then after they see them, when, when do they start? How often do they use it? How do they apply?

Dr. Christopher Zoumalan:

Yeah, I think, you know, the goal is to design a product that lasts like 12 hours, right. To some sort of barrier effect. And so that’s beauty of silicone. It gives you that, that, that ability to do that. So a light pump, uh, for that, that you’re willing to have it done. So I will show you here for lucky day. We have some,

Dr. Christopher Zoumalan:

So generally the YouTube. Okay. So this is a pretty big airless pump, but you can actually get an appreciate a lot can come out with one small I, a third of a pump. So this is more than enough for one eyelid. This could be for the back of an ear. Okay. Uh, this, this would be for back of the ear. You probably want something like this, like almost a half a pump. That’s a good amount. All right. So you’ll put it. Let’s just say I’m now at the back of the ear and the way you don’t want to super high, like this, be one of the nice gentle massage. And in the beginning, I tell my patients don’t go too hard, but don’t tap it. Don’t use a, Q-tip wash your hands with soap and water, wash the area, tap it dry with a towel, use some soaps to clean off the area.

Dr. Christopher Zoumalan:

No problem. Don’t be too aggressive and scrubbing initially. Cause it’s tender. It hurts. You just want to gently put it on, but you don’t want to dab it like this. You want to massage it, gently get that product into the incision around it. And I’ll just do visualize as kind of like a barrier effect. And you may want to go side to side up and down and even circular later on, as you get more comfortable with it. I generally see my patients two, three weeks after the, their initial postop week one visit. And then I will look at them generally, if they need any steroids at that time, that is where I will inject steroids. That point of maximal contract, right? Two to three weeks after surgery, they don’t need it. Then they’re pretty much good, but that’s why will encourage them to start massaging a little bit harder because their incision is healed better.

Dr. Christopher Zoumalan:

It’s less tender and you can increase the F not frequency, but the, the, the pressure at that time and that’ll help soften the incision as well. So I feel that the, the, the workhorse of a scar dream is two horse. One is the, the massaging effect helps break up scar tissue stream. There’s evidence to not support that. There’s a lot of evidence that does not support that, but I think anecdotally it does. But again, research does not support that researchers support that to fill and their ingredients help hydrate the wound and allow for that wound to be barricaded from the air. So it’s dry out, but I believe that’s twofold personally. Um, and that’s not why it works.

Dr. Anil Shah:

So when you’re applying the product, um, should you see the product when you’re done or should it just sort of like, it should not be visible after you’re done applying it. It’s

Dr. Christopher Zoumalan:

Not a bit, check it out next time you try it on in your office, you know, have a patient bring you with them, but it’s not visible. It’s clear.

Dr. Anil Shah:

Okay. But they shouldn’t have it layered on. So it’s actually sticking out. They should rub it all through. Okay. The second question is, can you put makeup over it?

Dr. Christopher Zoumalan:

Yes, you can. You can it’s that it, you, you wanna let it dry after like an minute two with makeup on

Dr. Anil Shah:

Unscreen. Any issues with that, is there a sort of, uh,

Dr. Christopher Zoumalan:

Hundred percent to put sunscreen, know no problem. We can bar layer it on top

Dr. Anil Shah:

Again. If you had the model patient, how long do they use this product for, you know, based on the science based, based on cuz we have those three phases, it says it takes a scar. At least I tell everyone it takes a year for a scar to fully heal. Should they use it for that full year? Again, imagine if this patient I want the best car possible. I don’t want to take any chances. Dr. Zalman what would you say? Six months? A year, year and a half, two years would

Dr. Christopher Zoumalan:

Say, I would say minimum of six months to really get that optimal result. And generally speaking, you can help determine whether wound is heal at six months. How do you know it’s when wound is completely mature, that the redness is gone, the pigmentation is gone. It’s flat and it’s white, that’s it it’s healed. And I have patients at six months, they’ll come further, follow up. Do I still need to use it? I’ll look at them. And they meet all those characteristics. I’ll say, no, you’re good. But if there’s still a little bit thickness, there’s still that redness, I’ll say, keep on using it. It’s heading the right direction, but do it for another six months. So total one year.

Dr. Anil Shah:

Okay. So let’s say someone comes and sees me and says, you know what? I had this scar. It was 10 years ago, you know, I was surfing and I was next to this crazy OCUL plastic doctor and he cut me off and he and I fell down and hurt myself. Um, what would you will schoo work for them 10 years later.

Dr. Christopher Zoumalan:

Great question. Uh, so if this scar is still, uh, having characteristics that we described as being red, hyperpigmented tender, then it’s worth trying the chances of it. Getting a significant improvement are very low, but the chances of it having some improvement is fairly high because they’re still finding that that scar is not completely healed the way it should be. You know, most scars mature at one year, but not always. I’ve had patients that come, come to the, in two, three years out and have used not 10 years, but two, three years out and have still some findings that are consistent with a scar, not well heels they’ll use scar. Now it gets much better. Now if somebody presents to you and it’s an old scar, that’s flat, it’s only thing that is, uh, has, has characteristics of not a well little scars that it’s hyper pigmented, but just hyperpigmented, but flat, you could try scar, but you can also try ski bright or some other skin writing product because that, that fills some remnants of post-inflammatory hypermutation, that’s persistent. And that is evidence of some inflammation. That’s still there.

Dr. Anil Shah:

Have you noticed any docs using this as an adjunct to kilos? You know, sometimes we’ll see OIDs in the ear, they’ll inject them and put this on top of that. Any, any, any evidence of that?

Dr. Christopher Zoumalan:

No, I, in short, no, I, I wouldn’t use this for kilos as the sole treatment, nor do we have data to support it as one that’s used post, like, uh,

Dr. Anil Shah:

Injection catalog. I have a

Dr. Christopher Zoumalan:

Few, yeah. Can analog or radiation. I don’t suspect it will hurt. I just, uh, you know, I can, we don’t have data to support that would make a tremendous improvement, but it’s not going to hurt. And if it were me, I had a key, I was going through treatment. I would use product. I do. I like to have data to back up my statement, but I don’t. And uh, so any scar claim that says it works for OIDs, it’s, that’s a very challenging, um, uh, issue, especially severe OIDs, but if it’s a minimal OID that’s, someone’s receiving treatment for, I, I don’t, there’s no downside of using a scar, but there’s no data that support it. If they’re willing to try it, try it and please let me know.

Dr. Anil Shah:

Yeah, it’s interesting because that’s, it’s such a tough thing. And, um, and some people think there’s some benefit with silicone and silicone cheating around it. So to me it makes sense. Why would you not want to have the, um, improved growth factor? It’s essentially, it’s an abnormal, uh, wound healing response. And if you can influence the wound healing response with growth factors, I mean, um, and ity, but yeah, that’s, that’s an interesting thing that can pregnant women use it and can, uh, breastfeeding women use it. Is there anyone who can’t use it?

Dr. Christopher Zoumalan:

Yeah, there’s, there’s the all, although this has not been studied in pregnant or breastfeeding women, none of the ingredients have been shown to be concerning thy or harmful to pregnant women, uh, breastfeeding women and children. These are all safe ingredients. So in, in summary, yes, it is absolutely safe to be used in breastfeeding, uh, women, pregnant women and children.

Dr. Anil Shah:

How, how about with post laser patients? Have you noticed, um, you know, someone essentially you’re taking a controlled trauma, what’s been your feedback on that?

Dr. Christopher Zoumalan:

We have dated a supported safety and efficacy in post CO2 of post ablated. Um, I’ve probably done about a thousand CO2 lasers, uh, and about maybe thousand chemical peels and all my patients after procedure will I put ’em on skin of a scar. And I, I find that the redness gets better quicker that Herce gets quick and better quicker. I use a fractioned CO2 laser in my office. I use a PCA 30% in my office when I use my fractured CO2. I don’t go super heavy. I, my settings are mild to moderate. There’s no exudation or pus, you know, from the room, it’s a very light laser they’ll scab for sure. They’ll scab. Uh, and I haven’t, I personally haven’t start using it immediately. You know, I’ll put ’em off before the first, like, you know, few hours, they start getting home. I have them use this product.

Dr. Christopher Zoumalan:

There’s less irritation. I’ve had less had reaction, but I’ve actually really Haven had any issues with skin scar, but Aqua floor. I have every so often I have a patient call me and say, I reaction dermatitis and skin scar. I have it. So it’s, it’s safe to use. Poste two laser it’s. It’s not considered an open wound. Um, it’s an, a braided wound. So certainly once the doctor come switching to Mon scar, it’s, it’s a great product and it’s got great healing properties, the same ingredients that help with, uh, scars help with burns Alovera Centa same growth factors. Uh, hyaluronic acid helps moisturize. Silicon helps, helps keep that wound, uh, hydrated, uh, vitamin C helps with hyperpigmentation and collage restructuring, you know, erythema. These are all fascinating, how it all kind of, uh, plays a role and, and, and, and burns as well.

Dr. Anil Shah:

So I, I, I’m gonna show you some, I’m gonna share this kind of crudely with you, Chris. So tell me if you can see this, but this is a patient, uh, dear patient of mind. So I’m, I’m gonna show you pictures. Uh, she had, uh, essentially a full thickness, um, accident to her, her chin, and this is her.

Dr. Christopher Zoumalan:

Oh gosh. Wow.

Dr. Anil Shah:

And that is immediately after, um, a lot of patients after, uh, COVID they kind of resume normal activity and sort of stuff like this. And I’m gonna pause this a little bit. We’re gonna look along the way. Um, and this is about a week after this is a week out after scan UVA, and it takes a while this was a full thickness. I did not think she was gonna get a full recovery. This is her a month after. And hold on, this is, I’m gonna pause it. This is, it’s a little hard to see on here, but you can’t really see anything on there. Um, so that is about, um, eight weeks after. So I, I kind of used it similar to how you talk about using it post laser, um, you know, talk, I looked at the ingredients, looked like, you know, I talked to you before at a conference about, you know, safety in the eye.

Dr. Anil Shah:

And I, I assumed that, uh, this was, again, we talked about, you know, laser wound, not necessarily being a, a true surgical wound. And essentially I thought I’d have to laser this patient, deride this patient, do all this. All I did for this patient was have her use skin UVA. She’s still using skin UVA. And every time I see her, I say, Hey, you know what, we’re gonna have to laser your, your, your, your wound, your area. But every time I look at her, she looks a little bit better. I’m like, oh my God, well, let’s hold off till next visit. And then I see her again. I’m like, we’re gonna have to laser. I’m like, you know what? It looks even better. Let’s hold off. Let’s keep so, um, amazing.

Dr. Christopher Zoumalan:

How far out was she that last picture from

Dr. Anil Shah:

The, uh, the last picture she is about? That was over the summer. So she’s about three months out. Um, so she’s still using skin. Um, and, um, I, you have these, these moments and I think it’s, it’s hard for a patient. I mean, to kind of, I mean, she’s super thankful. She’s like, oh my gosh. Um, so if, if you ever say, have a random person just go up to you and just start, um, hugging you and kissing you. Don’t first of all, record that and tell your wife, but they’re probably like, thank you for saving me for, um, you know, with this scar, because it is Joe us, I mean, talk about saving someone’s life. And it is so distressful for a patient to have a scar. And it, it’s easy for us to talk about scars as some sort of thing that exists in space, but when you pinpoint it to someone it’s on someone’s face and you feel the emotion that, that person’s feeling of how this scar, not all of them are from surgery, some of them are from accidents and other sort of traumas. And if you can help improve this in erase this from a person, oh my God, how powerful is that?

Dr. Christopher Zoumalan:

Yeah. I love these stories. These are amazing. And, and thank you for sharing that. And that’s, that’s why I started considering using it for a blade of treatments and microneedling too. We haven’t talked at microneedling, but I use it in all my post micron patients. I used to do a lot of PRP and I, and you know, it became a little more a challenge for us to draw the blood, spin it down and apply it. What was the reason why I was having PRP involved in microneedling was to help the skin heal better. And I really believed in its recovery process, the PRP, I didn’t feel it for my practice. PRP had a long term effect. Now that’s just my experience. Some people argue with me,

Dr. Anil Shah:

It

Dr. Christopher Zoumalan:

Hurts. I felt that it hurts. Yeah, but the microneedling is, is the, is the mechanism action where you’re creating, you know, these micro punctures, you’re stimulating collagen, thickening, and a P P essentially aids in recovery, or maybe temporarily or whatever it is, gets into fours and channels. And these growth factors, again, help improve that sort of skin problem. Fair enough. But it’s just a one time thing. I think that the longevity of PRP is minimized compared to microneedling, but I started using schul scar post microneedling, and I noticed recovery was as similar to the PRP treatment in terms of the redness getting better, Emmic getting better. And so I, now you do micro kneeling with PRP, uh, with micro kneeling, with skin, with scar. And the rationale is still the same. If it’s a great product to help improve the skin from a recent injury. And, uh, again, we have data with it. It’s safe, it’s affected. And so, you know, it just,

Dr. Anil Shah:

Do you have a name for that because, uh, there’s, there’s a trademark. So microneedling with PRP there, there’s a name for that. There’s a facial that if you say the word it’s, uh, you know, I I’ll say the, without saying it because there’s a trademark on that name. Um oh, right. But I’ll say, uh, I’ll say the father of the dry cool facial, not the full version. Um, right, right, right, right. And so with this, um, is there a name for the needling with schoo?

Dr. Christopher Zoumalan:

Uh, we call it Ooba needling, but you know, we haven’t really, you know, it’s, it’s one

Dr. Anil Shah:

Of those, it’s Halloween, Chris, we need a name here, so we need to come up with something, you gonna call it the,

Dr. Christopher Zoumalan:

You look, your, like you got, these are ideas that we’re, you know, we’re considering and, you know, but yes, needling and we’ve, we’ve, we’ve thought about

Dr. Anil Shah:

A play on it’s all about the scary, it’s all about the scary name. That’s what people, that’s what gets people in the doors.

Dr. Christopher Zoumalan:

But yeah, I mean, this is where we’re at in terms of our product and, you know, safely launching it and like we’ve had, and kind of now expanding and branching out into these treatment, um, uh, options for solution, uh, for microneedling and lasers and chemical peels. And, and we find out it works really well for them.

Dr. Anil Shah:

Uh, okay. So let’s talk about a couple other skincare products. I, I don’t wanna bash any products, but we’ll talk about some things that patients always talk that they’re gonna use and talk about. Let’s talk about the literature, cause I know you’re well versed in, so I’m gonna first start off with another one, onion, neck, extract the name of this product that’s out there. I don’t want any trademarks out there. It starts with an M um, onion, neck extract. Uh, what, what does the literature show on onion, neck extract for scars?

Dr. Christopher Zoumalan:

I, I, there’s a lot of literature that supports onion, neck extract, onion extract is actually, uh, one of the ingredients I wanted to put in skid of a scar. But if you really want to use true onion extract, it smells and it’s very unstable and it doesn’t work well with the greens we had. There’s other companies out there that use onion extract, but it’s not the same type of extract it’s been kind of processed in a different fashion. So it’s lost potency hence of the smell, uh, and in though there’s data to support that, those products that actually use on an extract, the data wasn’t there. In other words, the data is not supported helping scars. So I think it’s not a fact that money extract being issued. It’s the, but maybe the ingredients weren’t adequate or wasn’t adequate enough money extract, you know, you have to have a right percentage of it and the right type of money extract, but UN extract actually has been shown to improve scars. Uh, okay. But it wasn’t. Yeah, it wasn’t one that I,

Dr. Anil Shah:

It’s not on the market right now. If you’re getting onion extract, it’s not clinically available on the market, would you agree?

Dr. Christopher Zoumalan:

It’s not clinically the only market, right.

Dr. Anil Shah:

And the one onion extract that’s out there is, uh, not effective in studies. I would say

Dr. Christopher Zoumalan:

It’s not effective. Hasn’t been shown to be effective.

Dr. Anil Shah:

I, I’ve not seen it effective in my patients not to cut you off, but I have not seen it to be effective my patients. And usually it makes redness this scar, I think, prolonged redness and that those patients,

Dr. Christopher Zoumalan:

Yeah, it’s, uh, I believe the ingredient is UR it’s, uh, it’s the, the true, uh, chemical name for the onion extract, uh, uh, ingredient. That is what makes the product, what makes makes that makes onion extract work. And it has, again, when you’re developing a product, say, I, I have sent, sent in my product, but do you have the right form? Do you have the form that’s stable? Do you have the form, the right percentage that’s been backed by data in your product and has that been, has been shown to be stable? So one thing, when it comes developing skincare products is doing it the right way, backing it by data. And that’s what sets us apart from other companies is that we, we look at the, we look at medical literature, we make sure we work with a reputable team of chemists, you know, and, and we get the right suppliers of this ingredient, the right percentage, and then make sure it’s stable.

Dr. Anil Shah:

Yeah. Sourcing a product so important because if it’s not sourced well, a lot of the products, um, especially a lot of the products you get online, Amazon products. I mean, they’re, cross-contaminated what, what about, um, uh, cocoa butter thoughts on COA butter for scars? I hear patients talking about that.

Dr. Christopher Zoumalan:

I don’t think there’s a lot of evidence to support cocoa butter itself works. You know, I, I have to look up the latest literature. I haven’t looked cocoa butter up particularly, but, um, you know, there are products, like, are you talking about like bio oil?

Dr. Anil Shah:

No, I’m actually talking about pure Coca butter. Not nothing patients talk about that as, as a treatment for their scars. I’m not sure if you get that much in California. We definitely get that in Chicago a little bit. And

Dr. Christopher Zoumalan:

I don’t think there’s a lot of evidence to support that, but I need to look more into that. Get back to, and honestly, it’s not, it’s, it’s not within the lines of a true well-documented scientific improve an ingredient. But

Dr. Anil Shah:

What about that? What about vitamin E

Dr. Christopher Zoumalan:

Vitamin E is interesting? You know, it’s, it’s, it’s a long, long battle that people that have scar creams with vitamin E will try to say it works, but really the evidence does not support vitamin E helps. In fact, it can actually help mitigate it. Worse hyperpigmentation, actually there’s data support that it does not approve scars. Some data shows that it actually makes scars worse. Uh, the only time the vitamin E may work is if you include it with vitamin C, cuz it helps stabilize it. But for those reasons we did not include vitamins.

Dr. Anil Shah:

Yeah. I, I did the little, I know again, you’re a thousand times an expert me on this area, but I, the little I know is I’ve heard it does not help. What about tape? I mean, I know that tape is gonna be super inconvenient if you have a scar somewhere, does, does tape work. Um, and I mean, how long can someone possibly tape an area for

Dr. Christopher Zoumalan:

Like a paper tape?

Dr. Anil Shah:

Yeah. Paper tape, uh, paper tape.

Dr. Christopher Zoumalan:

So the whole reason that people want to use tape is the reason why we, we have silicone to begin with. So silicone brief history of, of, of scar management in 1960s and on silicone became available as a strict. And so people were applying a silicone silicone strip, like a bandaid over the wound over and, and they were doctors were seeing an improvement in scars, in a diabetic wound ulcers to apply a occlusive barrier. And so I still believe that silicone strips are a great option for those that wanna use it in parts of the body, such as the breast or tummy tucks that really have a lot of tension that they’re challenging areas to heal. It’s just a lot of, lot of patients don’t wanna spend the money on silicone strips. A lot of patients don’t really comply with strips because they’re itchy half the year, especially in human environment, they can’t use it the whole day because they’re skin breaks out. They’re sweating that area. Uh,

Dr. Anil Shah:

They fall off creams. Uh, here’s been our issues with silicone. So they, they tend to fall off. And then the other issue that we have with our patients is sometimes some of the strips have an adhesive with it. So is it, it’s a, it’s a, it’s a product that’s between the silicone and the, um, and the body. And then the third issue we have with it, they have to put tape around it to hold it on. And sometimes they’ll put, and the tape for a lot of patients, we have about 10 to 15% of patients who have some tape sort of crazy reactions to tape. And you wouldn’t think so. So, um, for me, it’s not that it may or may not work, but it’s the fact that it, um, it’s so inconvenient to use. Uh, but if you’re looking into the part of this, it seems like you’re not gonna get this. You might get the initial part with this, but you’re not gonna get the long term, you know, TGF beta three response with, with silicone.

Dr. Christopher Zoumalan:

No, exactly not. And so, uh, I think that’s the reason why people scar cream came about is because people tolerated scar dreams better with silicone. There was data to support in 1990, the Silicon cream as good as affected as Silicon strip. Fine. So now people are using tape. Well, it’s going back to using some CLU device, but tape is not anywhere near the efficacy of a silicone based product, whether it’s a cream or a strip, there’s no way in fact your, um, let me take that back. So I know surgeons use tape, post surgery, not patients, I meant patients using tape or doctors use tape. So I know there’s doctors that actually use tape post surgery. They’ll like really put on some tape. Sure. And get on for a couple weeks. I think there’s a role for that because you’re, you’re keeping that area completely barricaded.

Dr. Christopher Zoumalan:

And, and um, you know, you apply some ointment tape, mask salt, keep that on for a couple weeks. There’s some reasoning to that because you’re really keeping that area occluded as a barrier. It’s, it’s a moist environment, but you can’t take that off, you know, but you’re you’re until the doctor sees you in a couple weeks it’s so of doctors do not all, but some do, but a plastic surgeon, uh, but people can develop a rash, a reaction to the tape and that’s the problem. A lot of people can develop a reaction. And so it’s, it’s not a, it’s not a solution that is reusable. So if you were, for instance, I, when I do, when I used to do more eye would reconstructive surgeries, I used to apply a pressure tape along the area that I reconstructed for 24 hours. And I apply massive fall tape. And, and some do, you know, the tape would be around the area and it, it includes the area apply. Some pressure helps minimize bleeding and, uh, but it’s not a, a treatment that you can be doing every day for like extended periods of time. The skin’s gonna break down, you’re gonna have an abrasion. You’re gonna have Mara rated skin. It’s not good.

Dr. Anil Shah:

Yeah. Yeah. So that seems like it’s not a, uh, a long term solution and it may have a mixed result and very little sign to back that up. It’s kind of just random facts about scars. If you had to pick the worst area to have a scar for a patient, I know my area, I would never want to have a scar on, but if someone said Dr. Zu, Zul, I want you to treat this scar area with his knife. You’re gonna cut it out physically and put a scar somewhere where would be your worst area to put a scar on? I think I may have showed you where I, my worst area was

Dr. Christopher Zoumalan:

Well, definitely anywhere with the highest amount of tension. Right. And will. So somewhere that has a lot of tension and mobility, somewhere that you’re moving around, right. Would be an area that really would have the most difficulty in healing. I had one, I had a, a benign cyst taken from my thigh. I mean, it took months to heal and Skiva was amazing in terms of how honestly helping with the tend and whatnot. But the first two weeks I, it opened, it was because it was such a high tensile area. So it opened up because I was moving around too much. I couldn I was operating, I was think so it was like eight, eight sutures. But, you know, I was told not to do anything for two weeks. And obviously I did my best not to, but it still open up, but it healed fine. It took time to, it was dehi for a while. Then it granulated in, it’s a widen scar somewhere, not visible. So it’s fine. But I would say that anywhere that is highly mobile, highly Tenile.

Dr. Anil Shah:

So you’re gonna pick orthopedic then anything orthopedic involving a joint. And so I’m gonna pick a different subspecialty. I’m gonna pick a CV, the sternum, because it seems like those scars are always nasty. Like if someone says, can you please pretty please revise the scar for me? It’s right here in the middle of my chest. I’m like, no way am I touching that? I, I may, you know, at word inject something there, but for the most part that’s, I’m not touching that because that’s shoulder.

Dr. Christopher Zoumalan:

Yeah, yeah. Mine, the shoulder, mine, the shoulder elbow, you know, I mean, those are areas are so hard to heal and treat again or Revis

Speaker 5:

A little background on closure techniques. We mentioned simple interrupted closure, which means a single stitch, which is approximating the woo wound, uh, running closure, which means one suture goes back and forth almost like a sea, uh, to spread tension across the entire incision line mattress sutures, which essentially means you’re gonna have an outer and an inner layer. That goal of the outer layer is to provide extra, um, support so that the inner layer can actually reach itself and become more averted or lifted or raised, which is a common concept and desirable thing in scars.

Dr. Anil Shah:

Um, so okay, there we go. So we got a couple different areas there. Do you think sunlight affects scars in a negative or positive way?

Dr. Christopher Zoumalan:

I would say sunlight definitely affects them negatively. I mean, the sunlight is, is it’s it a UV it’s, it’s providing photo radiation inflammation, uh, and essentially you are, you’re promoting a, you know, uh, free radicals and, you know, all these sort of, uh, you know, reactive species, oxidative species that are hitting the scar, it’s becoming, uh, red AEM. It’s becoming inflammatory with hyperpigmentation. It can, um, limit the appropriate collagen structure. So that’s one of the reasons why, you know, we encourage patients to put on thumb block after applying Canva scar. Um, we have ingredients in there that are photo for such as vitamin C our growth factors. And, but yeah, you, you should not be out in the sun after with a scar for at least several months, I would say until it’s mature,

Dr. Anil Shah:

Random question schoo, how did it get its name?

Dr. Christopher Zoumalan:

That’s a good question. Uh, you know, one of the, the most exciting, but like challenging parts to naming a company, to, to starting company a name. And I think you and I, you know, I use, I use my name in my practices, but I Dr. Christopher Al, so there wasn’t much creativity there. And I think I had to really put all that creativity in a product name that was different. That was medical oriented that encompass, like what we’re trying to get here as a solution based company, a solution based skincare company skin was a name that I wanted to integrate somehow with D or skin der Nova skin Nova. I like Neo. I like Genesis. I liked something with new in it Nova kind of, uh, encompassed like Neva is, uh, actually comes from a Hindu word for, uh, gods of light of, of life. And so, uh, or could be like a rebirth of life. And that’s where I found that name. And, you know, it’s quite challenging to find an name that wasn’t trademark that wasn’t used in other companies, uh, that was unique. And so putting skin and Nuva was literally when I put those two together, it was exactly what I was looking for.

Dr. Anil Shah:

So technically the correct pronunciation, I I’m only happy. I’m not full Indian here, Chris. So if you had to say the full name, it would be skin Nova is the full name, but it’s abbreviated to scan UVA or am I I’m making that up

Dr. Christopher Zoumalan:

Kava,

Dr. Anil Shah:

But U Nova is the actual, the derivation, right? The N O N UVA. A right

Dr. Christopher Zoumalan:

Nuova. Yeah. Hindu. I think it’s Nuova.

Dr. Anil Shah:

Nuova. Yeah. You may have Trump, my Inova Nuova. So that’s interest. Well, I did not know that. And then, um, wow, cool. Um, alright. So I think I have,

Dr. Christopher Zoumalan:

I, I I’m full of surprises today. Neil, You, you wouldn’t know that. I, I, I, I tell you some Hindus as well today, right?

Dr. Anil Shah:

Um, yeah. I mean, I actually, I don’t even speak a, a word of it other than the swears. So, so had you named it, uh, skin F word in hi in Hindu? I would’ve been like all over it. I would’ve been like, yeah, this it’s

Dr. Christopher Zoumalan:

Okay.

Dr. Anil Shah:

Okay. So, um, don’t think that would work. No, that wouldn’t work for selling either. Um, so yeah, so I think, um, one of the go-to products of, um, you know, I’ll so of the go-to products, I think if you are a plastic surgeon, you’re a patient, who’s getting something in the aesthetic world. Or even if you’re just getting surgery in general and you care about your scar, um, not just how it looks, but how it feels. Um, and you want a go-to product. I actually think this is the, the product that you would. I, I think you’d be Remis to find and other product that has enough literature. That’s gonna support it like this. They have so many things on it, the science behind it, the thoughtfulness behind it. And I think the multi-leveled approach that you, you took in this and seeing that, Hey, GU, this is not just, let’s just kind of reproduce everything that else is out there.

Dr. Anil Shah:

Let’s look at all these other facets of what’s going on. Let’s kind of, um, create a product that’s gonna be practical. You usable. And I’ll say this affordable, because at the end of the day, I actually think your product is a premium product. And sometimes patients like, think that if they spend more on a product they’re gonna get, I don’t think there’s actually necessarily a more expensive a product out there, but it it’s just like, it’s, it’s just an overall practical, great product to use. And there’s pretty much no downside to use seen it that I can think of.

Dr. Christopher Zoumalan:

Oh, thank you. You know, this is just an honest, uh, testimonial from you. You know, when I developed this Neil, I wanna develop this product, you know, essentially buy a doctor for doctors. You know, that’s, that’s the reason why I developed this. I wanted develop the best product on the market, backed by literature effectively studied and priced affordably. You know, there’s just, uh, that’s what we’re, we’re standing for here.

Dr. Anil Shah:

Um, I didn’t get a chance to talk about your trial. No, I, I was wanted to talk about skin. I have to talk about your childhood. I also wanted to talk about the challenge here, Chris, that, uh, there’s a rumor that the zoom all and brothers did, you know that there’s another set of brothers in, uh, the world of medicine, the Shaw brothers. So, um, the next time the zoom all and brothers are in Chicago. Um, we may have to challenge the zoom all and brothers to a, uh, a sporting event.

Dr. Christopher Zoumalan:

I, what are we gonna do?

Dr. Anil Shah:

Uh, event. It’s not tennis. Cause I know both of you are like, like

Dr. Christopher Zoumalan:

We’re not that good at tennis. What are you talking about? We’re terrible.

Dr. Anil Shah:

Yeah. You guys are tennis, Devon didn’t you guys both play like division one level and all this kind of crew crazy Southern CA like that’s not gonna, um, so we’re, We’ll pick at something that’s, uh, I can think of things that I would be good at. That would be like sports wise is ESE sport.

Dr. Christopher Zoumalan:

Yeah, we can do not fencing out fencing.

Dr. Anil Shah:

My little guy will have to represent me. My, uh, my nine year old. He’s a, uh, he’s a fencer. So

Dr. Christopher Zoumalan:

Really? Oh, that’s amazing. That’s a great sport.

Dr. Anil Shah:

That’s, that’s a little too much contact for me. So when he pokes me and now I know what to put on afterwards, it’s it’s just throw a little oo, on these little, these open wounds from this guy.

Dr. Christopher Zoumalan:

I love it.

Dr. Anil Shah:

Hey Chris, thanks so much for spending so much time. I know you’re super busy,

Dr. Christopher Zoumalan:

Dude. Honestly, I enjoy, I enjoy chatting with you, man.