How Cancer Survivors Can Reclaim Facial Volume Via Injectables

Alison Werner:
Hello and welcome to the Plastic Surgery Practice Podcast on the MEDQOR Podcast Network. I am Alison Werner and I am joined today by my co-host Keri Stephens. We are the co-chief editors of Plastic Surgery Practice. As this is Breast Cancer Awareness Month, we want to focus in on topics related to that patient group. So today we’re going to talk about non-surgical services plastic surgeons can offer in their practices to breast cancer survivors, specifically services that can support them post chemotherapy or post radiation. And joining us to talk about this is Kim Welch. Kim is a licensed RN and degreed aesthetic specialist with over 15 years of experience focused on aesthetic injectables. After getting her start in aesthetics at a Dallas based dermatology practice, Kim went on to open her own aesthetic wellness practice in 2016. In addition to all this, Kim is one of the most requested national injectable trainers for Galderma. Kim, thank you for joining us.

Kim Welch:
Thank you so much, Alison. I’m so happy to be here with you.

Alison Werner:
Kim, let’s get started. Can you tell us a little bit about your aesthetic practice and what you are focused on?

Kim Welch:
In my aesthetic practice?

Alison Werner:
Yeah.

Kim Welch:
We believe wholeheartedly in just bringing patients to their best self, whether that is their new self or restoring their old self, whatever that looks like, whatever’s best for them. That looks different for everybody, but that is our main goal. Not necessarily looking younger, but just looking like who they are and their most natural self, but the best that they can be.

Keri Stephens:
Well, let’s dive into our topic. Can you explain the impact chemotherapy and radiation could have on breast cancer survivors, especially with regard to the face?

Kim Welch:
Absolutely. Being a recent survivor myself, it is just unbelievable what you have just endured and survived. Every breast cancer patient’s journey is going to look a little bit different, but if you’re in the typical patient population of having to choose between chemotherapy, lumpectomy radiation or mastectomy radiation, chemotherapy, like lots of different little cocktails there, but whatever the choices that you’re making, it is physical deterioration, as well as mental and emotional. All of those things are such a challenge that you have to be ready to go through. So just by mere survival of that journey makes you a different person from when you started.

Kim Welch:
So chemotherapy and radiation can absolutely affect facial atrophy, accelerated facial aging. The skin loses its elasticity. I mean, we’re already losing elasticity. By the time we’re 25 to 30, we start producing collagenase. So when you are on a program, especially including chemotherapy where it’s meant to kill just about every cell in your body, the good ones and the bad ones, then of course the face is going to have some effect with that as well. So what we might see with a typical breast cancer survival in accelerated facial aging might be thin skin, the loss of elasticity, facial atrophy. For me personally, I lost every hair on my body. My skin dried out completely. My very oily skin dried out completely. But because I had to take so many steroids to fight the body’s response to not reject the chemotherapy basically, my face blew up like a balloon. So you’re going to have lots of different survivors and how they experienced this process may be different.

Kim Welch:
So for me, I gained a lot of weight. My face swelled up, so I just would look in the mirror with no hair, no eyebrows, no lashes, and think, what has happened? Who is this person in the mirror? Those are very significant physical changes that your face will experience, but the emotional part that you really have to be prepared for is something that you have to grab strength from, and people in your life will need to be partners with you. You really dig down deep and say, “Maybe it’s not all about your hair and your lashes, but I’m still Kim Welch.” So we figure out who we really are without some of those things too.

Alison Werner:
As our audience’s plastic surgery practices, what type of services could their med spa component, what should they be looking to offer to help survivors with loss of facial volume?

Kim Welch:
Absolutely. I think the first thing is just being aware that you can help this group of people. As a non survivor, as of three years ago when I wasn’t a survivor, because now I am, just two years in survivorship, I would even have patients come in because I’ve been injecting for 16 years. When a chemotherapy or a cancer patient, post any kind of disease like that, just the word cancer scares me as a provider. So for a plastic surgery office, I think the number one thing is to embrace their survivorship, congratulate them that they have survived, and that they are willing to take the next step to becoming their best self. So just the congratulations is a great place to start.

Kim Welch:
But of course we have facial injectables, like in the Galderma portfolio specifically, you have products, dermal fillers like Restylane Lyft that can build back zygomatic arch, facial cheek volume loss, products like Restylane Contour. And then you also have a neuromodulator like Dysport that helps relax forehead lines, glabellar lines. And then they also have a product called Sculptra, which is a collagen stimulant. That product is unbelievable in restoring because what it does … What’s happened to us not only as we’re aging, but accelerated aging with the cancer diagnosis, is we’re tearing down our own collagen. Galderma has a product called Sculptra that is a collagen stimulant. Who wouldn’t want that? People ask me all the time, who’s a Sculptra candidate? And I say, “Anybody who’s lost collagen.” So pretty much anybody over the age of 30 is a great Sculptra candidate.

Kim Welch:
And then you compound that with maybe a 40 year old like myself, almost 50, that’s had accelerated aging in the last couple years. So I really truly need some collagen remodeling and rebuilding back. You can get that from lasers, obviously facial injectables and even skincare products like Galderma’s Elastin products that have that TriHex technology, and then that helps rebuild collagen from the outside in. So there’s a lot of amazing opportunities that plastic surgeons and med spas can utilize to help this patient population.

Kim Welch:
I want to just make sure that they understand their number one goal should just be embrace the patient, embrace the patient and where they are, and be so excited to take them on this journey. Of course, we want those survivors to be cleared by their oncologist and make sure they’re a good candidate for these treatments, depending on the part of the journey that they’re in. We always want to make sure that the oncologist has put them in the clear because your white blood cell count goes down, so your risk of infection goes up. So making sure that they’re always a good candidate, but if that’s been determined, then please embrace the journey with them, cheer them on, be excited that they’re excited to be their next best self.

Keri Stephens:
No, that’s great. So as an injector yourself, what aesthetic products do you work with when treating survivors?

Kim Welch:
I think it’s really important to choose products that are safe, effective, and predictable. Those are my three words that I measure all things that I bring into my practice, safe, effective, and predictable. I would encourage all plastic surgery offices to let that be a guideline for them. So for me personally, Galderma’s portfolio, a huge dermatology company that’s not new to the market, their products have been around for many, many years, clinically studied, hundreds of clinical studies, lots and lots of clinical data that show those three things, safe, effective and predictable. Especially their hyaluronic acid is all 20 milligrams of HA, so it’s most like your own body’s. So if we are going to choose a product maybe for a potentially immunocompromised patient, would we rather have a product that’s most like their own body’s that they’re not going to fight against? Those are the things that you need to be considering when choosing a product for rejuvenation for all patients, but especially our surviving patients.

Alison Werner:
Can you talk a little bit about the injection process?

Kim Welch:
Sure. For me personally, I like to have every patient come in and I obviously will hand them a mirror and say, “What brings you in today?” But then I turn that conversation into, “Would it be okay with you if I share with you what I know about facial aging?” Just embracing that question has changed my practice. It has changed my practice from selling you something to let me share with you what I have researched and experienced for the last 16 years of my life. And of course the majority of the answers, I don’t know if I’ve ever had a no, but is, “Absolutely. Share with me what you know about facial aging.” It’s their time and my time and it’s a gift that I get to share with them what I know about facial aging.

Kim Welch:
So that opens the opportunity for me to talk to them not only about skin, or not only about what they see, but what’s objectively happening to them as we age. We used to talk about, bring me a picture of you 20 years ago or 10 years ago, and let’s see if we can get back there. We don’t have those conversations anymore. We say, “Bring me a picture of your mom,” because that’s where we’re going and what do we need to do to not go there if that’s not where we want to go? Or what did your mom do that worked out really, really well? Let’s go there. Let’s do this thing. So that’s my new consultation and way that we talk about facial aging in my practice.

Alison Werner:
Do you have any tips or advice for injectors when working with breast cancer survivors?

Kim Welch:
Absolutely. I think that we always want to clear them with their cancer providers, their cancer treatment. What are they currently doing? Is there anything that would be a contraindication to what we want to do for them? So establishing that right off the bat. Making sure they’re healthy enough to receive these injectables. But then again, let me reiterate, embracing the journey for this patient. Don’t be afraid. Know that these products, especially Galderma’s, are safe, effective, and predictable. And if you’re choosing another product, make sure you’ve done your research on those products. And then what is their goal and what objectively has happened to them? Have they had mid-face volume loss? Have they had temple volume loss? Have they frowned so much because of what they’ve been through, that now they have permanent frown lines or they feel like permanent frown lines? So what are the biggest things that we can do?

Kim Welch:
I’m going to write out, and I hope you guys do too as providers, an entire treatment plan that encompasses facial injectables, Dysport, dermal fillers, collagen, stimulant, as well as take home products like elastin. I teach my patients all the time, I’m like going to the dentist. I’m going to do the hard work, but you’ve got to go home and brush your teeth every day. So skincare at home and maybe during the treatment may look like Cetaphil or more sensitive skin type products. Then when your skin is coming back, you can move more towards elastin regenerating products and Retin-A and those kinds of products. But it’s a all in kind of thing.

Kim Welch:
Typically in facial aesthetics, we’re not a one and done either. So go ahead on that initial consultation, we’re doing objective assessment, but I really want you to go ahead and share with them what this is going to look like for the next year. We need you to go to the dentist twice a year. You get your haircut however often you get your haircut. This will be a maintenance thing. This is not a one and done. Now if you’re a surgical candidate, then that may be something that you need to consider. I do that in my own practice. I establish right from the beginning, if you’re a 50, 60 year old, are you interested in plastic surgery? Because that may have more permanent or long term results than what I can do as a nonsurgical provider. And if they are, great, we’re going to refer them to surgery, but then they’re still going to need the maintenance of dermal fillers, neuromodulators like Dysport, and obviously at home skin care. So, make a plan. That was a long answer to let you know that there needs to be a plan.

Keri Stephens:
As we mentioned earlier, you’re a trainer for Galderma. How long have you been working as a trainer, and how did you get involved with that?

Kim Welch:
It is such an honor for me to be a trainer for Galderma. I’ll get emotional about it because I know it’s silly, but I just love it that they’ve given me the opportunity, not only to educate me to be a better provider, but then to share what I know with other providers. I’ve always said we’re better together. There’s enough patients out there. There’s enough for everyone. I think there was a recent study that said 95% of patients who would be amenable and are ready for these types of treatments, 95% of them aren’t doing it. Why? And why are we worried about you taking my business? There’s just enough. We need to understand the why of where we’re missing it.

Kim Welch:
So I think that collaboration, and me as a game trainer, I get to share what you guys teach me. Every practice I go into, I learn something as well. And then I get to be the sewer of seeds and hopefully other people, their practice will be the harvester of those seeds. But it’s just been such an honor for me to be a trainer for Galderma. I’m so passionate about their products that are safe, effective, and predictable, and the results that we’re able to achieve with that portfolio change lives, ladies. These products change lives. And that’s the game I want to play, is to be a life changer for my patients.

Keri Stephens:
No, that’s wonderful. Can you also talk about your involvement with Galderma’s partnership with the National Breast Cancer Foundation?

Kim Welch:
Absolutely. What an honor it was for me to be approached. This actually happened. Galderma has always done, always is a generous word, but has for the last eight years, given over $450,000 to the National Breast Cancer Foundation. So they’ve always been a partner with them these last eight years. But what they did for me specifically, they knew that I had just finished my cancer treatment plan last August or September, and they wanted me to be a part of what was coming that Amy Baldwin had so beautifully planned with Plank for Pink. How exciting was that? But the great thing is Kerry Colgans, Amy Baldwin, they came to me and said, “We want to do breast cancer survivorship more than just, oh, here’s Kim Welch. She survived.”

Kim Welch:
So they literally worked with me, worked with other survivors, planned this month for a year to make it special, to make it impactful, and that meant so much to me. This isn’t going to be a flash in the pan Kim. This is going to be something that means something and will have an impact. So we’re going to spend a year working on it and make sure that it comes across the way we want it to come across.

Kim Welch:
So with that money that Galderma has donated to the National Breast Cancer Foundation, they’ve provided take home kits. I don’t know if anyone is familiar with a patient navigation person, but they are the person … I had one. Those people cost money. The National Breast Cancer Foundation has provided financial help because of Galderma’s gift to them so that people like me can have a patient navigator that I can call and say, “I have so many doctors appointments. I have so many medications. I’m so overwhelmed right now. Where do I go?” You don’t really think about that when you’re just trying to survive breast cancer. You just want somebody to tell you what to do. You don’t want to think about it. So what the National Breast Cancer Foundation has given to us, with a gift of almost half a million dollars from Galderma, has been able to provide so many opportunities for survivors like myself.

Keri Stephens:
So this question’s going to really follow-up about what you just said, but can you share more about how Galderma and the National Breast Cancer Foundation’s resources benefit survivors potentially looking to embrace post-treatment care?

Kim Welch:
I love that, yes. Just this year, I had the opportunity to work with Galderma and inject some fellow survivors. I was such an emotional wreck that day, all day long. I was just so honored to be a part of something that they are embracing and that survivors didn’t just survive. We’re ready to thrive. We’re ready to be what’s next in our life. I had the opportunity of injecting some of those patients. And then Galderma did some follow-up video and footage and photography with that group of patients, and they were just shining like bright beacons in the night after those treatments. So what does that say to me as a provider, is again, embracing the survivorship. Don’t be afraid of these survivors. And then what a gift we have as aesthetic providers and a portfolio that’s safe, effective, and predictable.

Kim Welch:
I feel so good about what I have been able to help these survivors accomplish and just giving them that confidence back that has been so stripped. And not only that, but oftentimes survivors feel like, maybe this is vanity. Maybe I shouldn’t be doing these things. I’m just grateful to survive. And that’s a good place to be too. We are stripped of who we were. I was stripped of my lash extensions. I didn’t know what to do with myself. But I realized that I am not my lash extensions, but when I get them back, then you start to say, “Oh yeah, that’s who I was.” Whatever it is that you need to motivate you. I told a friend the other day, “If you put on a few pounds and you don’t want to buy yourself a pair of new jeans until you lose the weight, buy the jeans.” You need something that says, I want to be there. So what steps do I need to take to encourage myself and have the confidence that I can be there again?

Alison Werner:
Great. Well, as this is Breast Cancer Awareness Month, do you have any advice to plastic surgery practices on how they can communicate to survivors that services are available to help them with their aesthetic concerns?

Kim Welch:
How wonderful. What an amazing gift it is for a plastic surgery office to be able to do some kind of promotion, whether it is a social media response, to tag a friend who’s a survivor who you know would benefit from this pick me up. Tell your story, whatever it is. And then maybe one person wins that global treatment, but every survivor wins a $50 coupon. I mean, whatever it is that says this plastic surgery center, number one, I know it sounds silly, but they’re not afraid of survivors. We are confident in what we can do and the products we choose to help you. That’s the messaging that you want to get out to those survivors because we are looking for people to embrace what’s next. And again, I feel like there’s just a lot of fear, and the fear comes from knowledge, not knowing how we can help them.

Kim Welch:
So giving them those opportunities and maybe a gift set of elastin or Cetaphil that says, “We know your skin’s been through a lot and we want to bring it back for you.” Any encouragement that they can give, letting people tell their stories on your website or on your social media platforms, just encouraging that community and that you want to be a partner with them to get back to their best self or their new best self would mean so much as a plastic surgery practice, just to know that you have people out there embracing this new journey that you’re going to be on.

Alison Werner:
Well, Kim, this has been so informative, and we really appreciate you sharing your story with us. Thank you so much for joining us today to talk about your experience, how plastic surgeons can be there for survivors, and also the products that are available.

Kim Welch:
Thank you so much for this opportunity. I’m just so grateful to be able to share with you not only my passion for Galderma, of course, my passion for breast cancer patients and survivors, because we need each other. We need partners in this journey, and the team comes on. When you reach out and you know that there are resources available to you, people want to encourage and embrace your new best self. So thank you so much for allowing me to be a part of it.

Alison Werner:
Well, to our listeners, thank you for joining us as well. As always, be sure to subscribe to the MEDQOR Podcast Network to keep up with the latest Plastic Surgery Practice podcast episodes, and be sure to check out plasticsurgerypractice.com for the latest industry news. Until next time, take care.