Dr. Kay Durairaj 0:06
Well, hello, hello guys. You're listening to Beauty Bites with Dr. K, Secrets of a Plastic Surgeon. And today on the podcast, I am thrilled to be interviewing Ariel Kushbein. He is CEO and founder of the brand new Fusion Labs, but you know him, he is a former CEO of Prellenium, and has brought products like Versa and Versa Lips to the marketplace, and has been thriving and successful. He's coming to us all the way from Canada. Welcome to the podcast, Ariel.

Speaker 1 0:35
Thank you so much for having me. It's an honor to be with you.

Dr. Kay Durairaj 0:38
I'm so thrilled to have you, and we, our connection goes way back, I think, back in the very beginning of when esthetics was kind of just blossoming, and I've been so thrilled to see how, how far and fast you went, how far and wide and fast you went with Versa and Prellenium products, and the company accumulated all those beautiful cars behind, I

Speaker 1 1:04
spent all my money on cars.

Dr. Kay Durairaj 1:09
That's called Fusion Labs. After 25 years in esthetics, you really, really know this industry, but it's a whole new class of products that you bring to market. These are enzymatic bioremodelers. Yes,

Speaker 1 1:24
yeah. Is

Dr. Kay Durairaj 1:25
that.. let's dive deep.

Speaker 1 1:28
Well, you know, it was.. I think all of all of us kind of know this space enzymes from hyaluronidase. I mean, any injector that uses HA fillers really knows about hyaluronidase, and that's kind of like the first enzyme that I heard of, and personally, for me, I, you know, enzymes were interesting because I was taking digestive enzymes for a long time, because my family has a history of, like, gallbladder issues, and you know, so when I first actually heard about these, I had a limited knowledge of them, and what really kind of changed the way I viewed them was the way they work in regenerative medicine, so I think one of the things that we've done in esthetics over the last 25 years has been that, or 30 years, or 50 years, or even, is that we've looked for almost band-aid type approaches to issues, more, more of a symptomology, so for example, if you had a, if you had a wrinkle, you would fill it up with, you know, a filler, but we wouldn't really solve the issue of why, you know, the wrinkle was happening, or use a neurotoxin to stop that from happening, but we wouldn't really actually solve the issue, it was more of a symptom management approach, which is kind of in all of medicine over the last century. So, when I first started looking into this, I realized that your body has a lot of the abilities to actually regenerate and fix your skin, and that's why a lot of people, they look great when they're in their 80s, 70s, and 80s, and some people don't. It's because they're able to act, manage, you know, good genetics, but also they're able to use their body's power to kind of heal, and these enzymes are kind of that type of an approach, because what happens is, when we're younger, our skin is constantly turning over, like our collagen is turning over, our hyaluronic acid is turning over all the time. Anybody who knows about HA, we talk about this all the time in the HA industries. We say that, you know, HA has a half life of 48 hours in the skin. So, I think when, when you, when I first started learning about hyaluronic acid, you know, one of the enzymes is hyaluronidase, and everybody has to have it in their office, because there's always a risk of occlusions and those things, so you need to have it around, and we've all been told that HA in the body, natural HA turns over every couple days, so that ability, you know, as we age, kind of slows down, and that's just generally the as your body ages, the regenerative ability slows down, and the enzymes that your body's creating, like hyaluronidase, are naturally occurring. They're in your system, it produces hyaluronic acid, and then it breaks down that hyaluronic acid and does that whole thing all over again. So, when I first learned about it, I immediately started thinking about that, because we've been told that you know if you use too much hyaluronidase, it can deplete your body's own hyaluronic acid, of course, that's true, but just the right amount will actually just regenerate your body to produce more of it, so the other enzymes, when I started reading about them, like collagenase and lipase and different lyases, these are all enzymes that are naturally occurring inside the body, and you're, and when you're younger, they're in abundance, so that's why your, your wounds heal faster, they don't look as bad when you're younger, scars don't happen as easily when you're younger, and so the more I started reading about it, and the more I started looking.

Speaker 1 4:59
The research I realized that this is like true regenerative medicine, because it gives the skin the ability to regenerate collagen, elastin, hyaluronic acid in a way that the body understands, because you're just simply communicating with the body's regenerative ability, and that's what really caught my interest in it, because I think for a lot of what we've been doing in esthetics is again treating symptoms, so we tend to stretch the skin when there's wrinkles with filler, or we try to get an immune response from, you know, biovitalization products like sculpture or radius, but really what we're generating is a scar tissue response, so why not try to generate a natural regenerative cascade with enzymes that your body recognizes and understands. So, for me, it just made complete sense, and it was really easy to understand, and that's what kind of made me fall in love with

Dr. Kay Durairaj 6:00
it. That's such a unique way of looking at things. I mean, as a surgeon, we use hyaluronidase in the operating room when we want to improve vascular permeability, like if I'm doing a blepharoplasty, I might inject lidocaine, but I'll mix some hyaluronidase in there, and it'll just kind of diffuse all that numbing through the tissues really beautiful, and so it does have that tissue permeability aspect to it. It's not just for dissolving inflation and stuff like that. I have, I have three different boxes here that you sent over. Or am I allowed to show this?

Speaker 1 6:35
Absolutely, yeah, absolutely.

Dr. Kay Durairaj 6:37
So, so excited to try all of them. So, they're from those of you in the audience, okay, maybe you can see them there. There is restore, and then we have rebalance, and then we have refine refine. So, can you kind of get into what each one does? And absolutely, how clinicians should even start thinking about using this in the setting of all they've ever done is hyaluronic fillers and toxins.

Speaker 1 7:05
Yeah, so I mean, I'll give you, I think the easiest way for me to explain this is kind of just tell you this couple stories about what I saw and how with how the products used. So when I, in January of this year, I was for the first time in a long time, I was like, you know, I'm going to go to Imcas in Paris, because for the past 20 years I've been going to this show, but like I've been stuck at the booth, and I haven't really had a chance to mingle and see what's going on, so this is the first year that I really want to go and learn, so I got there, and on the first night I got invited to a dinner, and I didn't want to go, because I was, I was exhausted, but I'm like, you know what, my mom told me that I should always go if somebody invites me. So I went to the dinner, and they sat me at a table with some of the distributors for this product that was hosting the dinner, and I was complaining to them about the fact that I didn't feel like there was anything really new in esthetics for a long time, and they all, they were all younger, they kind of reminded me of myself when I first started, like in their, you know, late 20s, early 30s, and they told me, "Well, look, you know, we've been selling this stuff and it's become our number one product, and I was embarrassed because I had never heard of

Dr. Kay Durairaj 8:21
it. Wow,

Speaker 1 8:22
and so I started asking questions, and then by the morning I had just.. I spent.. I was up till like two, three in the morning, because I was jetlagged, and I was just.. I went down this rabbit hole of researching this stuff, and by the morning I was convinced that I had fallen upon the next thing that I wanted to do in esthetics, because it just was so refreshing, and it made so much sense to me. So, I, the next day, I went to, they were doing a training event in Paris, and I went there, and I, you know, I tracked down the CEO, and kind of forced them to sit with me, and I told them what I wanted to do, and, you know, we kind of were discussed, and I ended up going to Spain to visit the factory and learning more about the product, but the way that they explained it to me, that was so easy to understand, which I always think of a five year old can understand it, you know, is that there's so many people that are walking around with a lot of junk in their face, not just old filler and old product, but you know, years of treatments with energy-based devices, there's so much scar tissue, there's so much old product, there's so much collagen in this, in the spit, in the face that becomes denatured or fragmented as we age, and this is what causes the laxity that people get in their skin, so like, for example, if you know someone, as they ages, are getting a little bit of fat accumulation in their nasolabials or in their jowls, what we would do in the filler space is we would put some filler in their jaw to kind of stretch out that laxity, and we would try to mask the wrinkle here by putting a little bit of filler, or a little bit of filler up here. And in essence, what happens over a couple decades is that patient just keeps getting their head just keeps getting bigger and bigger and bigger, really, or their skin just keeps getting thicker and thicker, because we've used so much, you know, PLLA or calcium hydroxylaptide or other products that are, you're getting a scar tissue response from it, so what these guys, their approach is like, look, this is like you've, you've renovated your house and you've got all this stuff in it, and all this furniture, and now it's been 20 years, and you don't really, it doesn't really look good anymore, it's worn, you're not going to go and, you know, put a set of cabinetry on top of it, or add more to it, what you really want to do is you want to gut the place before you renovate

Dr. Kay Durairaj 10:45
it, so

Speaker 1 10:46
you want to, you want to do remodeling, but in order to start that whole remodeling process, you need to remove all the junk out of there, and then once you do that, then you can decide what the patient needs in terms of filler or toxin or whatever, but the problem I see now, just being in the space for a while, is you got people that they're going back to their doctors because they're not happy with how they look, and the only tools that we have are making the problem worse, and not for everybody, but for a majority of people, and that's one of the things that has led to this, this pushback against filler in the globally has in this thing we call filler fatigue syndrome, really now is that we are not, we haven't been using fillers the right way, and

Dr. Kay Durairaj 11:34
yeah,

Speaker 1 11:34
this resonated with me, because I've been saying that for a while, like you know, these classes that people have been giving, saying you should put 40 syringes in someone's face, and without any real idea what that means long term, and thinking that these products go away in six months, which they don't. So you have a lot of patients that are walking around with 20 year filler or all this stuff in their face, and this is a way to clean the slate, and this is not only a way to clean the slate, it's a way to actually tackle the problem, which is you have all this old collagen, this old ha, and all this stuff, and you want your body to regenerate new type one long strands of collagen, and how do you do that? How do you really improve skin quality? This is treating the actual problem as opposed to the symptom, so bioremodeling is pushing your skin to create new collagen, new elastin, so it's really what we've been trying to do with skin boosters for the past four or five years now, is give the body what it needs to do what it's best at, which is regenerate,

Dr. Kay Durairaj 12:37
so the idea being that these enzyme remodelers are going to dissolve and remove some of the old product that's there, these are made from recombinant hallleronidase. Right,

Speaker 1 12:51
absolutely, absolutely. So,

Dr. Kay Durairaj 12:52
and then collagenase, and then it has collagenase. There's

Speaker 1 12:58
different types of all these enzyme classes that were naturally occurring, hyaluronidase, collagenase, lipase, lyase, different proteases, and these are all abundant in the body from a young age, and they start to dwindle as we get older, so your collagen, for example, you know, if you're getting laxity in the skin, it's not just a loss of volume, it's also the quality of the collagen, the quality of the skin is getting worse with age. So, what this is doing is it's restoring the skin quality, and one thing that I've seen with hyaluronic acid and other products on the market is that they don't really help with skin quality, they help with volume loss contouring, but they in hydration, but they don't really help fix the problem with the skin, which is, you know, skin quality. So I think these products address that.

Dr. Kay Durairaj 13:56
Interesting, when you think about aging at the tissue level, do you think that the primary driver of aging is going to be collagen degradation, or is it the extracellular matrix getting disorganization? Is it cell signals changing? What do you think it is? I think

Speaker 1 14:13
it's a combination of really all those things. So, I mean, we, for example, I'll give you an example with, with joints, you know, from the moment we're, we're born, really, there's this inflammatory cascade that's happening. It's inflammation is the driver that pushes us towards death, really, at the end of the day. And, but your immune system is, is battling that inflammation, and you know, it gets tired as you get older.

Dr. Kay Durairaj 14:39
Yeah,

Speaker 1 14:39
so you need to support your immune system, whether that's through diet, exercise, or, you know, supplementation, nutrition, or whatever you're doing, but, like, for example, the joints, for a long time, we thought that people had joint pain because there was loss of synovial fluid in the joint. It's right, and in fact, what we've been finding lately is that no, it's actually more inflammatory, it's an inflammation in the joints that's happening, and there's various theories around what happens and why, but our understanding of this degradation of this inflammation is changing now. So, before HA was injected into the joints to supplement the synovial fluid, but in fact it doesn't do that. In fact, the most effective hyaluronic acids for the joint are those that are anti-inflammatory, so it's more of a, it lowers inflammation, so you get less inflammation, less scar tissue in the joint. So now our understanding has changed, and we thought something 2530 years ago, which now is, we don't think it anymore at all. And now that there's even, there's even papers that I've read on back pain and joint pain that talk about bacteria and viruses hiding in areas with low blood flow, and that's causing the inflammation. So, so the all these.. so pretty much what I'm trying to say is, like, we're dying from the moment we're born. This thing is starting, and as we get older, that ability to fight that really slows down. So, anti-aging now, the treatments are really about how do we support the body in fighting that, and previously all of the tech that we've had in anti-aging has been more of a band-aid symptomology type solution, as opposed to really treating the problem

Dr. Kay Durairaj 16:28
interesting. So, if I'm seeing a patient and I wanted to adjust their products, I would use these three in combination, or just use one by itself.

Speaker 1 16:39
So, the interesting thing about this line from Proteus, which is the Spanish company that I'm working with, is that they've actually done there's over 300 studies that they've done on this stuff, and from a variety of areas, for wound healing, scars, post-surgical fibrosis, bioremodeling, and the general theme is that if you, these enzymes in the body, they work together, so they're not just happening individually, you know. So, for example, as you mentioned earlier, hyaluronidase is improves tissue permeability and can spread and breaks down the HA, so it allows fluid to move around the tissue. Lipase is cleaning up and shrinking fat cells, collagenase is breaking down that old collagen and allowing the body to refresh it with new collagen, and they work together. So, the line that they've recently released is actually combination enzymes in different quantities. So, if you, if you've seen the product Quo, for example, there's.. there was a product called Quo on the market a couple years ago, which was taken off the market, and when I first heard of this stuff, I was like, oh wait a minute, there was a product like this on the market that didn't do very well, why? And the answer to that is really that, first of all, it was a single enzyme, and second of all, it was in a very, very high concentration, which was not naturally occurring in the skin, and so therefore would cause almost like a shock to the system, and damage, really, was it was like a bullet wound that your immune system had to come and, you know, repair. So these guys have a very different approach, which I'm in line with, because they're much more the concentrations of the enzymes are more in line with what your body would actually produce, so you don't disturb that equilibrium that is already in the skin. So I personally now tried it a few times, I went to Spain, and I'll give you my own experience with it, because for me, if I don't believe in something, I can't, you know, promote it, and so for me, the first thing I did was I had myself treated with it, and it was interesting, because I had in my, in my forehead, for example, just from years of getting injections, botox, or whatever, I actually had so much fibrosis in my face, and I didn't even know, and when I went to get treated, it within five minutes my fibrosis went away.

Dr. Kay Durairaj 19:11
Yeah,

Speaker 1 19:12
and I said, okay, this is this is different, because nothing's ever worked that quickly for me when I've been treating myself, so then I started treating the rest of my face.

Dr. Kay Durairaj 19:25
Did you feel like your movement was better? Yeah, like, like, first

Speaker 1 19:28
of all, I couldn't even get.. I don't even think neurotoxins worked on me for that. I thought I was immune to neurotoxins, but I think it was just because I had so much scar tissue in my glabella area that they were.. it was just trapped in there, and so then I started treating my, my nasolabial area with it, and then I did my kind of jaw and jowl area, and what I found was that it shrunk, like it reduced the volume of my nasolabial by 6050, 60% Yeah,

Speaker 1 19:55
and for me, and like that's interesting, because normally what you would do is you go to the doctor and say. Don't like my nasolabial, and they put some filler here and some filler here, but then you look weird a little bit, you know? If you don't do it right, but this, this is actually kind of, I think, taking me back a little bit in time when my nasolabials weren't as big, and it's removed, it's kind of smoothed out my jowls and my jaw without having to do filler, and I think if you still need filler, then you're in a place again with this whole bio remodeling idea. Now you've removed all the junk, and if you still need to put some volume or augmentation, that's fine, because I'm not saying you don't - filler has no place, and I'm not saying sculpture has no place, I'm just saying that because we didn't have a lot of tools and esthetics, you know, everything was, we had a hammer and everything was a nail, pretty much. So this gives us another tool. I mean, the way that I was looking at it is, as a physician, you're like an artist, you're a sculptor, and your neurotoxin was like your sandpaper to smooth out filler, was like your plaster, but really, what was the chisel? We didn't really have a lot of good tools that were chisels, and

Dr. Kay Durairaj 21:05
such analogy. Yeah,

Speaker 1 21:07
so I feel like this is giving that tool. So I think it's the next frontier in esthetics, because everything's moving towards regenerative medicine. And for example, one of the products I was working on at Prellenium was Vamp, which you know we use polynucleotides and PDRN, and that's another form of giving the immune system what it needs, giving the body what it needs to repair. So that's kind of the direction I think a lot of things are going in.

Dr. Kay Durairaj 21:32
It's so interesting. I already am imagining a ton of uses for this, like treating malar edema, or like when we're subsidizing acne scars, and we want to smooth out textural problems, or it's incredible for scarring.

Speaker 1 21:45
Yeah, incredible, like

Dr. Kay Durairaj 21:47
deep-seated marionettes or creases, where it's almost like there's so much muscle memory in the tissue that it starts to fibrose at the ligament lines. Absolutely,

Speaker 1 21:57
and you know, because I early on I worked on sodium deoxycollate with phosphatidylcholine, like way back, you know, from it was I was bringing it in from Brazil, I was interested in it, and that's again one of those things that it's more of an indiscriminate detergent, like it just eats everything, and that's that causes laxity in the skin because you're getting rid of the foundation and the skin is just kind of like all the stuff that was holding it up is gone, so this is a different approach, because these enzymes only work when they cleave on to what they're looking for, and that way you get tightening in the area, as opposed to just getting rid of, and you know, you can even kind of harm the platysmal blends bands when you're using the oxycholic acid and those things, so this was like, oh, this is interesting, because this is actually a solution, it doesn't cause more problems, which is the last thing I think any esthetic practitioner wants, is you know, a patient calling them after they've had a treatment done with all kinds of issues, so

Dr. Kay Durairaj 22:56
there's been so much talk in the industry about using collagen biostimulators like calcium hydroxyapatite or PLA, and do they cause fibrosis to the point where it affects, you know, dissection and surgery, or the face in general? Are these products that could then be used to modify that type of fibrotic tissue that can.. that's a great question.

Speaker 1 23:19
That's a.. that's a wonderful use. Your brain thinks like me, so yes,

Dr. Kay Durairaj 23:24
that only happens when it's incorrectly injected or placed in raw planes. But

Speaker 1 23:30
right, well, I think my opinion is that in the next 10 years there's going to be a, there's going to be a bit of a backlash against the use of those types of products, because they're being used in the wrong way, so if you talk, I mean, plus your, you mean, you know this better than anybody, like, you try to cut, if a patient has sculpture for 20 years, and you try to, like, give them a facelift, I mean, you're, it's sometimes it's impossible to cut through it, so when we, when I first started in the, in, in the industry 25 years ago, there was a, the product was called New Phil, it wasn't even called Sculptra, and there was people in Canada that were injecting it, mostly for patients with HIV-related lipo atrophy, you know, yeah, and then again, it's this thing, we don't have a lot of tools in esthetics, so people tend to use what's there, and they use it for all kinds of different things and discover things with it. So, I do think it has uses, but again, if you abuse it, which I think sometimes people are doing now, you can end up with a lot of fibrosis in the skin. Your skin gets heavy, and that's not what you want either, because collagen, you have type one, type three, and all these collagen in the skin when you're young. When you're young, you, you still have type three. It's not like you want to get rid of all type three, but it's the balance of it that's important. And sculpture tends to promote more of a, there is type one, but there's also more of the type three, which makes the skin a little bit denser.

Dr. Kay Durairaj 24:59
Mm.

Speaker 1 25:00
And that's not what you want for anti-aging, you want more, a balance, but a little bit more of the longer type one collagen strands, and that's not what you're getting with sculpture, so yes, you can actually use these types of enzymes to break down that fibrosis, also with any type of AES related to sculpture, where you get a capsule where there's a scar collagen, like a capsule of scar tissue around it. You can actually break that down. You couldn't do that before with hyaluronidase alone. What would happen was, you would, it would look okay for a couple days, and then it would fill up again, you know. And that capsule was still there. So this allows you to kind of break down those capsules too, which is very interesting. And the other, the other area

Dr. Kay Durairaj 25:43
looking at treating delayed nodules, or you know, or refractory nodules. So, this products have been helpful to remodel nodules.

Speaker 1 25:51
Yes, and I would actually.. what I'm looking at doing now is one of the first things I want to do is do a study on, on a, on AES. I don't want to do. sorry, excuse me. I don't want to do.. I mean, I think one of the most important uses of this is to actually first start and treat, you know, adverse reactions. So, like, even for HA, I'll give you an example. For years, and I'm sure you're familiar with this, people who've had HA in their under eyes, meet myself included, it was so hard to get rid of it, and why nobody, I could never figure out why is it so hard to get rid of HA in the under eyes. There's all these theories around it, and I think one of the things is obviously that around the eyes it's just your lymph systems there and moving fluid in and out, so you have more chance of getting fluid build up, but also the fat pad in the under eye, if you get filler in the fat pad, one thing that I learned is that filler is a tissue expander, depending on, like, if you've, if you've had patients that have had filler in their lips, for example, after a few treatments of filler in lips, they, they never really go back to baseline, and it's the same thing with if you get it in the fat pads, in the under eyes, you can actually expand the fat pad, and what do you do in that scenario? When you expand the fat pad, you can keep hyaluronic, hyaluronidas, and it to death, and it looks good for a couple days, and then it fills up again, and you just got to hit the area so many times, but like it doesn't really solve the issue. So I think with products like enzymes like lipase and collagenase, you can actually tighten the skin, like us. I had a family friend that had, you know, residual filler in her under eye for 20 years, couldn't get rid of it, and then when she did get rid of it, well, she thought she got rid of it, there was like her fat pads and this crepey skin, and the only thing that we, that solved it was enzymes, so I think it's going to open up the doors to treating a lot of people that have been misinjected by unqualified injectors and people that have given filler a bad name. I think this is actually the best thing to happen to filler, to be honest with you. So,

Dr. Kay Durairaj 27:55
I mean, there's definitely been a trend for people dissolving their full face and then getting it realizing that they like their volume and then getting it replaced more correctly or more conservatively, so this is definitely going to be a great tool in the armamentarium. How, how are you going to work on, I know you're doing some science and setting up clinical trials and protocols and things, but what do you think's the best way for people to learn about,

Speaker 2 28:22
well, we're,

Speaker 1 28:23
we're going to be doing a series, like we just actually last week, I just had an event here in Toronto, and we're going to be doing a series of events in the US in the fall, I think, in Los Angeles, probably in, actually want to talk to you about that, but we're hoping to do one in Los Angeles in September and in Miami in December, and the goal is just really to educate people on these products, and I think this, when I, when I look at this in this section of the industry, this whole regenerative section, it's really, we're really at the beginning, and so I'm finding that this is because when I was, when I was selling filler, you, when you were talking about filler people, kind of at the beginning, they still had an understanding of it, because it was collagen and other stuff. This is really brand new, you know. So everybody's just like trying to understand it. So I think right now educating people on what these enzymes do is kind of the goal of the company, and really starting to do more research around them, so that we can get labels on these products and start using them. That's my, my short-term goal. My long-term goal is to really create this as a whole new avenue in the industry, as a whole new section of the industry. The same way neurotoxins became a cornerstone of the industry, I think enzymes will one day, as well,

Dr. Kay Durairaj 29:42
I think it's really visionary. I mean, we've used collagen aces for wound healing, cleaning up wounds, and helping things to heal beautifully. And I'd say, I think it's very true. You're right, that the face does accumulate muscle tension, fibrosis, like even on a natural level. Even without having had fillers done, and things like the way you people repeatedly sleep on their face causes creases and anchoring of tissue in places where it's not supposed to be anchored, or facial asymmetries, like we've never been really able to treat facial asymmetry, but if we have a remodeling chiseling tool and a little conservative filler, maybe the rebalancing will be even more, you know. I agree, I agree.

Speaker 1 30:24
Yeah, I actually think you're, you know, your fat changes on your face too, right? Like, if you look at, you know, you get more fat accumulation here and here as you get older, and I think that has a lot to do with how you sleep too, because you're constantly like just pressing on one side or the other, so there's going to be so many uses for this. I actually think there's a million therapeutic uses for it too, because I think most of the time in injuries, for example, you're getting a lot of scar tissue accumulation. So one, I was talking to a surgeon in Latin America, because this product is approved as an injectable throughout Latin America, and he floods after every surgery, he floods the area with these enzymes, and he finds that the patients heal much faster with far less fibrosis when he does that, and it kind of makes sense, so like for joint, I think there's probably applications in joints, I think there's probably applications in dentistry, I think there's applications in sports injuries, you know, so there's there's many things. It's piqued my interest for sure, because I was hoping that a lot of these things would be true of hyaluronic acid when I was in the industry, and I think they can be true of non-crosslink hyaluronic acid, because that communicates with the body, but this, this is something that I think will create a whole new segment.

Dr. Kay Durairaj 31:51
Super interesting, I think you're for patients that have like fibrotic joints that have had two or three operations, this could be really game changing.

Speaker 1 32:00
Yeah, and one of the, one of the areas that I kind of saw miraculous results early on was for post-liposuction fibrosis, so we had there was because this product was the main approval in Latin America is for fibrosis, and for patients that have liposuction on their stomachs or whatever, where you know that skin is kind of stuck to their muscle, the end there, they can't, there's nothing they can really do about it, you know, and this within minutes it kind of opens that up, which is really interesting, so we had a patient that we, that we, a plastic surgeon friend of mine, she had this fibrosis that was bothering her, and she actually started crying when he was treating her, because she could feel, you know, she could feel that change right away, and to me that's like it's incredible, because you're really improving, you know, patients' lives with

Dr. Kay Durairaj 32:59
it. Yeah, well, you helped to bring revenues to 80 different countries all across the world. What is now going to be your biggest challenges? You try to scale, you're going to teach this, you're going to scale this new injectable globally. Is it going to be regulatory, manufacturing? Yeah, I mean,

Speaker 1 33:17
regulatory for me in North America is kind of, you know, for this line I've signed an agreement with them for North America, and regulatory and education really is going to be the next five years of my life with it, because you know, and I think this is another thing for young entrepreneurs, is like trying to do things overnight, it's never, it never really works like that, takes, it takes, you know, 20 years to be an overnight success, so my I want to take it. I'm not trying to, you know, build Rome overnight. I really wanted this. I want this to be something that I do for a long term, and I'm trying to build a business again, really. And that takes time, and those are baby steps, you know. You crawl before you can walk, and, and that's okay, because I enjoy it. I enjoy what I'm doing, and you know, I don't need to make a ton of money doing it. I just really love the industry, and I like the fact that I can help, you know, bring it forward. So that's kind of my goal.

Dr. Kay Durairaj 34:11
So this is going to be the intro to extracellular matrix remodeling. Right? Yes,

Speaker 1 34:18
I think. I mean, I think so, because I think with skin quality, there's really no other way, you know, and I think for energy-based devices, for example, like I've had a number of treatments with RF microneedling, and I think this is a better, this is a better approach to it, not to say that you don't need those types of things, because I still believe in microneedling, and those things I think they're important, but this is a completely different angle on skin remodeling. So,

Dr. Kay Durairaj 34:49
and if you are going to continue to use fillers and practice, I guess there'll be a timeline of using enzymatic remodeling followed by conservative filler use. Followed by like reassessing in two three years after filler, how things are settling, so you'll kind of have to come up with those protocols and timelines for

Speaker 1 35:10
us. Yeah, absolutely. And we're, and I'm learning, you know, we're learning, I'm learning a lot about it as I go, and but one of the kind of factors that I see here is is adverse reaction management, you know, I used to, we used to get a lot of patients that we used to hear from a lot of doctors that were treating patients, and there was most of the time it was because product was put in the wrong spot or too much of it, you know, and I also think the companies had a little bit of responsibility, because we believe we truly believed early on that this stuff went away. We just started learning more and more about it. So, I think this is going to help us. This is going to help filler management. This is this is an adjunct to that. It really works hand in hand with

Dr. Kay Durairaj 36:00
it. Yeah, it's so important that the companies go back and invest more research into, I think, these products. When they launched, a lot of consideration that they were implant products, they were tested mainly in animals. Like, the true duration of products was not really evaluated, it was sort of just logarithmically calculated to assumed to be a certain degradation plot, and it really, what hasn't turned out that way, so

Speaker 1 36:24
yeah,

Dr. Kay Durairaj 36:25
so that's be really interesting to bring some new perspective in science to it. Yeah, absolutely. Where do you think we're headed in the next five years, in terms of I know we're going into a bioregenerative longevity marketplace now a how do you see yourself fitting into that?

Speaker 1 36:45
Well, since you, I mean, I think for what I've seen recently, I mean, with this whole, for example, peptides, I think patients are taking a lot more of their, their health into their own hands with the amount of information that they have now. So, you're, I mean, I'm sure you see patients coming into you that have already consulted Chat GPT for three days before they even come see you, and they know everything.

Dr. Kay Durairaj 37:08
They hand me the what to do chat,

Speaker 1 37:12
right? So it's like now, I mean, 20 years ago the patient would come in and say, what do you, what should I

Dr. Kay Durairaj 37:18
do? Yeah, and now

Speaker 1 37:18
they're like, okay, doc, here's what I want to do, and so there's a lot more customized approach to the treatment of the patient, because there's just so much more knowledgeable now in terms of what's out there. So I think information is right now information is easy to get and far easier to process, whereas 25 years ago information was harder to get, took longer to process, and now with all the tools that we have, patients are just smarter, and they know a lot more, and with all the rise in social media, they're they're watching these injections, and they're watching these treatments, they're almost coming into your office half knowing what they're gonna get already.

Dr. Kay Durairaj 37:59
Yeah,

Speaker 1 38:00
so I think we as companies, we have to, we have to help, we have to understand that number one is, we have to understand that information is power for these patients, and we have to promote that education side of it, not just before we were just kind of educating physicians and practitioners, but now we really have to educate consumers as well, because they want that information, they're asking for it, they're begging for it, and they're getting it, there's nothing we can do to stop

Dr. Kay Durairaj 38:23
it,

Speaker 1 38:23
so we can't really bullshit anymore. Number one, because there was a lot of bullshit, like when I first started in fillers, there was so much bs floating around that it was incredible to see what people were saying, and now you can't really get away with it anymore, which is good. It's

Dr. Kay Durairaj 38:40
become an information society, and yes, it's good, but people don't always know what to do with all the information, and they can't filter it,

Speaker 1 38:48
and that's why they need, and that's why they need you, they need experts to kind of help them, and I, but I think we, it's as companies now, where our approach to education is different, because you can, I mean, you could go on chat right now, and learn all about enzymes, and learn as like you become an expert in a couple of days, right? Whereas before, you'd have to go into a talk and sit there, and some guy would have to talk, and then maybe he was right, maybe he was wrong, and so now it's just the information and the knowledge is there, so we have to make sure that it's, you know, we're supporting that, whereas before we'd have to really write the content, come up with it, and make sure people are getting, but not people just get it on their own.

Dr. Kay Durairaj 39:30
Now, there is so much to learn in esthetics. If you are talking to the new brand new injector audience out there that's breaking into this, where, where do they even start? Should they focus on fillers? Should they focus on bioregeneration. What would you tell a new person entering into the esthetic industry?

Speaker 1 39:45
Well, I think so. This is the type of business advice I give to that's been really beneficial to me, and I think it's beneficial to esthetic practitioners, because you know that's kind of where I started, that's where I cut my teeth, really. I worked in my mom. Spa, and, and I think you've done such a wonderful job of this as well. When I watch, when I watch you on social media, the way that you treat your patients, you treat them as a whole, so they're not.. it's not just like, here's a Groupon ad coming to your lips for 300 bucks, or whatever, because they're, they're not, they're not coming to see you because they just want their lips done. They're coming to see you because they want to feel better about themselves.

Dr. Kay Durairaj 40:28
Yeah,

Speaker 1 40:28
and so you're the, you're guiding them in that journey of wellness. It's not just, you know, wellness in terms of like how they look, that's the big shift. The big shift is like I want to feel better about myself. I did all these treatments, I still don't feel better about myself. What else is it? And that's how I think we've been treating patients wrong, is like we're not treating them as a whole. So I think that movement is now happening. You see people with peptides, they want to feel better about themselves, like supplements and collagen, and what am I eating, and how much am I exercising? So we cannot put esthetics outside of that. It's a, it's a part of that now. You know, we're so holistically treating these patients is becoming more and more important. That whole wellness journey, which is about them feeling better about themselves, is not just going to happen because they got Botox and filler. We're selling confidence to these people, they want to feel confident about themselves, and that's more than just treating their face, it's also about treating their mind, really. So, like, when my mom had her place, people would come there just to kind of talk to her, and they would, it was like going to the hairdresser, you know, go to the hairdresser, and you talk about your life and your kids and everything that's happening, and that's what I think we've been missing a little bit of in the industry because people are kind of like it's become a bit of a assembly line,

Dr. Kay Durairaj 41:47
yeah.

Speaker 1 41:48
And I think we need to go back to that a little bit.

Dr. Kay Durairaj 41:50
Very transactional, I think previously, and a lot of places still are very transactional and very cost per unit, and like I don't want, I want it to be like a, it should be such a great experience that you come into a place and you feel like you're part of a little mini community,

Speaker 1 42:06
they trust

Dr. Kay Durairaj 42:09
you, everyone knows you, and they greet you with a smile, and you feel like, oh, I'm here, I can relax, and they'll take good care of me, and then it's a full, it's a full body assessment, so often we're treating people who don't have a good internist, or like they don't realize their hormones are out of whack, and that's why they're feeling so crappy, and you can't fix that with a shot. You have to do talking, and some testing, and some.. you know, I agree. I think it's all the lifetime relationship. I'm definitely not happy getting the one to one of patients that just want a quick, quick check or a quick deal or set a lips, yeah, because they're never, and they're

Speaker 1 42:45
never happy, that's the problem, because they hop around and they're not really, they're not getting, they're not treating what they need to treat, which is, again, we're, I always, we're in the confidence business, you know, I remember one time, you know, I got, I'm a very outgoing person. I love speaking in public. I love meeting people, and I remember one time I got burnt. I did a laser treatment on my face, and I got a burn, and I had a really bad burn here. And I swear to God, I didn't want to talk to people, I didn't want to go anywhere, I didn't want to do anything, and that was the first time in my life where I actually realized what people went through when they felt like that, and it was actually such an eye-opening experience for me, because I was always like, why are you know, why can't they do this, and why can't you do that, and I realized how important it is just to feel comfortable in your own skin,

Dr. Kay Durairaj 43:34
which I always

Speaker 1 43:34
had, and then for, for like a period of my life, it was taken away from me, and I just was like this is the most interesting thing I've gone through, because I've learned empathy for people that didn't feel comfortable with themselves, and then I was like, well, what are we really selling? We're not really.. it's not about making their lips bigger and their cheeks bigger, it's about them wanting to feel good, and I think that's what it

Dr. Kay Durairaj 44:03
is, that's so true. Well, you started your business and prelonium at age 21 with $300 in your pocket. Thank goodness you interned with your mom, who set you on the right track of thinking about hard work and endurance and perseverance. What do you understand now about the esthetics market that other people have missed and that you see driving you forward.

Speaker 1 44:27
Well, you know, maybe I don't know if this is kind of the direct answer to your question, but I've one thing I realized after I got fired and I got pushed out of my company last year was you start to take it, you start to take it for granted a little bit, you know, this industry in general, because it's a great industry to work in, because you're able to really make a profound difference in people's lives, and I think I lost track of that the last few years of my career. And it just became, you know, business, business, business, and so when I, when I, when I got, when I left, I realized that this was a game that I loved playing, I loved being, I had made so many friendships, and so many like people like yourself that I love talking to, and all of a sudden you're just, you can't, you're out of it now, and you don't talk to anybody, and you're not really relevant anymore, and that was, that was the hardest thing for me, I think, was losing those relationships. So it's about playing the game, it's not about winning or losing, it's just about being able to play. So being in the game, yeah. So I

Dr. Kay Durairaj 45:39
don't think you've ever lost relevance, you never. Oh, I

Speaker 1 45:42
appreciate that, but I just missed everybody. I missed everything, and I missed everybody, and, and I felt like

Dr. Kay Durairaj 45:47
higher and higher and higher, like you were not like on the street level of seeing people going in their offices. I think you need that, you missed that.

Speaker 1 45:56
Yeah, no, this has been such a humbling experience for me, as I say that, with all my supercars behind me, but it's been humbling, because you know, one thing was, I, you know, you, when I started, when I was so young, that I was always kind of like a boss,

Dr. Kay Durairaj 46:10
he has like 20 Ferraris,

Speaker 1 46:14
I'm a Lambo guy now, too, though, so no, no, no, I was gonna say that I really missed people, and I missed being with people, and I missed, and when I was 21 when I started, and I was always a boss, so I thought everybody was so nice, and like, why is everybody? I was just like, this is great, everybody's so nice, I'm nice, they're nice, we're all nice, and then you know, when you're not a boss anymore, people aren't that nice to you. They kind of stop being nice to you, and so you kind of start reevaluating, you know, your friendships, and it's kind of a cleanse. And I'm 47 years old, and this was the first time, like, I was like, oh well, maybe I was wrong about human nature in some ways, and I hope I wasn't, but it's nice to start all over, because then you can kind of reevaluate those relationships and things you've been doing, and that's one thing that I enjoyed from this process has been the cleanse,

Dr. Kay Durairaj 47:11
the detox, and the cleanse.

Speaker 1 47:14
Yeah,

Dr. Kay Durairaj 47:15
I'm remodeling

Speaker 1 47:18
my career,

Dr. Kay Durairaj 47:20
you know, what it's the second stage of life, where you get to reinvent yourself. Yeah,

Speaker 1 47:26
yeah. So it's been great. It's been great, and I, and also I think it's, it's a bit, it's also freeing to stop something that you've been doing and take a step back and look at it in a different way, which is, which is what I was able to do with this, so

Dr. Kay Durairaj 47:43
what a gift you've, you've been given a gift of like a rebirth and a relaunch, and like honestly, I think this is a whole new class of product and a new paradigm shift in how to think about facial structure and giving us tools now, literally near surgical tools that you can modify and shape the face with, so it's going to be a very interesting product to try and sample. And thanks for sending. Oh, it's my, it's

Speaker 1 48:14
my pleasure. And again, your feedback is very important, because you know I respect you so much, and you know, love to hear what you think of it, but I'm super excited about it, and more than anything, I'm super, I'm excited about the direction that the industry is going, because I think

Dr. Kay Durairaj 48:31
that regenerative and longevity and skin maintenance, yeah, resilience, yes,

Speaker 1 48:36
because you know, I'm getting older and I need it, so I'm happy we're there, I'm happy I can be a participant as well,

Dr. Kay Durairaj 48:43
right now. Yeah, actually,

Speaker 1 48:47
you know, that's another thing I really want to learn about, because I don't - I'm trying to learn more about it. They're not as prevalent here in Canada as they're in the US. Yeah, I'd love to learn. I'd love to try it too. So,

Dr. Kay Durairaj 48:56
I think that's where we're headed, is performance optimization of our cellular systems, and you know it all starts at that molecular level. So, peptides stay at your 30 year old functionality and not have deterioration. Then

Speaker 1 49:13
sign me up, sign, sign me up before I'm 50. So,

Dr. Kay Durairaj 49:18
well, when people find these products in the United States, and how would they reach you or get more information if they're interested?

Speaker 1 49:27
So, we've actually, I've done something a little bit differently with this. Is one of the things I at Prellenium, when I was at Prellenium, I always wanted to have a digital platform because things are changing now, and I find a lot of practices are very busy, and they want to have access to their accounts online, and you know all this stuff. So, we, we've built out a really unique online tool that is going to be using artificial intelligence for skin analysis. So, what we've done is we partnered with a company that has 10s of 1000s. Tons of cases of skin analysis that they've done, and what they do is the patient can log in, or the doctor. We pretty much set up a patient management system for physicians on our platform that they can take pictures of their patients and have a skin analysis done, and that analysis will tell the patient how many units of neurotoxin they need, if they need filler, if they need laser, and the doctor can kind of customize it, and they can also use this platform to order product track their rewards, and so it's like a whole ecosystem that we've been building out, and you can actually access that by just going to Fusion Labs dot app and sign up for it, and you can order products and get more information on what we're doing there, as well,

Dr. Kay Durairaj 50:42
we should probably spell it for them. It's not regular fusion, it's p h i u s i o n. That's right,

Speaker 1 50:48
yeah, that's right. Yes, pH fusion labs dot app, and we're hoping to build that out into very much like almost like a repeat MD type system, but this this AI tool, I really love it, because it's validated over 10s of 1000s of patients of patient photos, and it uses the knowledge.

Dr. Kay Durairaj 51:10
What's the name of that AI?

Speaker 1 51:11
So, we've, we've been part.. we partnered with a company out of France called Universe Skin, that's actually a skincare company, and they've developed this AI model for their skincare, and when I, years ago, I saw it when I was in the industry, just because I love their products, because it's a physician-compounded skincare product, which I found to be really unique, and I think in the US it's sold under Alma, but this software they use in Europe quite a bit, and I was like, you know, patients would love this because they can actually at home sit there, take a picture, get a skin analysis done. It would go to their physician, and they would go to the physician, kind of already understanding the types of treatments they could have done to help themselves. So, it would, it would make the doctor's job a lot easier, you know, explaining these things. And then you can also, one of the things I remember from Prellenium, and being in the industry is people kind of forget what they look like, you know. They do these treatments, and then 510, years later, they go back and look a picture, and they're like, "Oh, I used to look like that. And so, you even if you've had great results, sometimes the doctor needs to convince you of it, because you forgot. So, this is a way to track your, your journey throughout esthetics, and all the treatments, and the progress you've made, and the AI tools actually help us analyze the skin, so that people can get a better idea of, you know, the progress.

Dr. Kay Durairaj 52:36
I think that's the wave of the future, so analyze and remodel, and you know, regenerate. This is, these are all things that we're doing every day in our practice, and I hope more of you guys in the audience will do that too. Ario, where can people find you directly if they want to reach out, or what are your social handles?

Speaker 1 52:54
Oh, I'm just.. I'm on social media, Ariel dot dot causpin. I try to answer everyone, and my LinkedIn, I think I remembered, but I'm on LinkedIn as well, and Fusion Labs is also on Instagram and Facebook and LinkedIn as well. So I'm easy to find because my name, there's not too many REO cautions in the world. So

Dr. Kay Durairaj 53:19
that's right. Well, it's been such a pleasure chatting with you, and I'm so excited for you to really remodel the industry. Oh, thank you, thank you so much.

Speaker 1 53:28
It's such an honor, such an honor to be in. I look forward to seeing you soon, hopefully. And thank you for having

Dr. Kay Durairaj 53:35
me. My pleasure. That's it for now, guys. Don't forget to find me on my Instagram, it's Beauty by Dr. K, that's D R K A Y, doing amazing things with people's faces, and our website is the same, it's Beauty by Dr. k.com that's where you can find our new peptide skincare launch, which is amazing skincare, different from your retina and vitamin C, this is actual G H K copper, glutathione, my own tripeptide complex. We have, yes, I'm going to send it to you. Mitochondrial boosters, everything to next level skin cellular performance. That's it for now, guys. Stay beautiful.

Transcribed by https://otter.ai