Skincare for Your Practice: Defenage

Alison Werner 0:10
Hello and welcome to the plastic surgery practice podcast. I’m your host Alison Werner. In our continuing series looking at retail skincare products you can incorporate into your plastic surgery practice. My co host Keri Stephens and I look at Defenage a beauty brand that offers a range of anti aging skincare products that incorporate defensins a patent pending technology that is exclusive to the company’s products. And joining us to learn more about this product in this episode is Dr. Gregory Keller, a Board Certified facial plastic surgeon who has offices in Beverly Hills in Santa Barbara, California. Dr. Keller is a full clinical professor at UCLA, where he is also the co director of the facial plastic surgery fellowship and on the medical staff. Here’s our conversation. Dr. Keller, thank you for joining us.

Dr Gregory Keller 0:50
It’s my pleasure. Thank you for inviting me.

Alison Werner 0:53
Great. Well, to get started, can you tell us about your focus in facial plastic surgery and about your work at UCLA?

Dr Gregory Keller 0:59
Yes, my primary facial plastic surgery practice is in facial rejuvenation. And I have been doing this exclusively for some years. As you mentioned, essentially, I’m a clinical professor there on on staff still and run the facial plastic surgery fellowship at UCLA. My work has been primarily in working with stem cell technologies. For one thing, we used to have labs at UCLA to do this and also in developing Facial Plastic procedures. We were one of the early people in endoscopic facial plastic surgery.

Alison Werner 1:37
So as I mentioned, you’re in private practice as well. But what are the key trends or demographics you’re seeing amongst your patients?

Dr Gregory Keller 1:45
Well, it’s very interesting. I’m seeing in addition to the usual facial plastic surgery, rejuvenation, practice, I’m seeing older and younger people as well. And all of these people want to change, they want to change in their skin. They want to restoration, some things and the younger people want to prevent problems that they see occurring to people older than them.

Keri Stephens 2:09
When it comes to talking to patients about their skincare routines. What does that conversation look like?

Dr Gregory Keller 2:15
Well, basically, they want to know that they’ve gotten more technical, because the web is out there and they’ve researched a lot of things. So they want to want to know what we’re doing and how we’re doing it. And what’s unique about products that that do this particular work. We’ve had retinols for many years that stimulate the basal cell, which is a stem cell that grows older with you, and undergoes maturation, and mutations can form skin cancer. So they’re looking at other things, what’s out there that can really make a difference for them reliably without too much inflammation or problems.

Alison Werner 2:51
You offer Defenage products in your practice and your practice centers, what role does retail skincare play in your business,

Dr Gregory Keller 2:59
it has a lot of role in my practice, actually, one of the things that we’ve wanted to do is retain patients and to do that, we have to give them a service that really makes sense to them. And that they come back for over several times. So we do offer medi spa type of services. And in addition to those skincare products are really natural, and also things that help healing and things that we can do preoperatively to them to help healing and postoperatively to them to encourage healing to occur. It’s unique, not too complicated, and also doesn’t involve a lot of what we call SKU numbers, we don’t want to sell a lot of different products for very little profit, what we’d like to do is give someone an overall skincare type of solution that will help them preoperatively, postoperatively, pre laser work, pre non-invasive work and just help them alone with a high incidence of satisfaction. So we have a significant skincare sales that keeps multiplying. The thing about skincare is if someone’s really happy with their skincare, and keep reordering that it’s a geometric increase. Because if they tell somebody and we get a new patient, we still retain the old patient ordering things. So it’s a geometric effect on our practice.

Alison Werner 4:25
Building out on what you just said, How long have you been? How long has retail been in your practice? And have you seen a shift in recent years? Because there’s a lot of talk about how people are spending a lot more on skincare after the pandemic. Have you seen a shift in your practice in the last few years.

Dr Gregory Keller 4:40
We’ve been doing retail for some time. And what we’re finding is that people since the pandemic really picked it up because now they’re looking at themselves in zoom such as we’re looking at ourselves while doing this podcast and picking ourselves apart. So definitely skincare sales have gone up. We’ve also wanted to simplify that because people get all over the place. We’d like to have a product that people keep ordering two thirds of the time.

Alison Werner 5:09
So that kind of ties into my next question, which is kind of what is your decision making process when deciding on what products to offer in your office? And you said there, you’re looking for those products that people are going to repeat buy? But is there anything else that goes into your decision making? When you’re What are you looking at in terms of the products? Then what are you looking at in terms of like company support or that relationship?

Dr Gregory Keller 5:28
Well, that’s a good question. You know, one of the things that we’re looking to do is simplify. Most plastic and facial plastic surgeons don’t want to sell 50 products for $5 profit apiece, what we’d like to do is find something that reliably reliably works for people and that they can simply use and that we’re sure will work in a unique type of way. So that’s why I choose to use primarily Defenage, we do have another sunscreen type of product that we use. But Defenage really can answer most of the questions because it has some unique scientific technology that specifically influences the skin, the pores, the pigmentation, the skin tension, wrinkles, and most of all, healing. Defenage is your natural way of healing, when we can use that pre-, post-op. And for skincare maintenance, we have one set of products not too complex that we can sell as a unit. And for the practice, it’s great, because we’re not selling a million different products for $5. We’re selling one product that just that the profit on which justifies the staffs time and explaining everything.

Keri Stephens 6:44
Right. So as a clinical professor, can you explain with the defensins molecules are and how they work?

Dr Gregory Keller 6:51
Yeah, defensins are actually a peptide that has a unique type of use. Defensins stimulate our what’s called our LGR6 stem cell which is at the top of the hair bones, so we can get it to penetrate the skin deeply enough to stimulate that. If you have a burn, most products stimulate the basal cell, and that’s between the epidermis and dermis. So that those cells grow old with us, they mature, they can mutate and form skin cancers. So we want we want to establish cells that can regenerate our skin, start new keratinocytes forming, and the way that naturally happens is that when we cut ourselves or injure ourselves, burn ourselves for instance, then what happens is that defensives are secreted by neutrophils, and these defenses stimulate the LTR6 stem cell, which is a stem cell that’s gone into hibernation after it forms all of our skin, when it goes into hibernation. It stays young, essentially. So when it’s brought out and stimulated by the defensins, since it forms new basal cells that can form new young skin. So really what we’re doing is youthening the skin in a natural healing matter. It’s a unique peptide that has a single use. So we’re not worried about cancer formation or other bad side effects. It also does it without inflammation. So your skin isn’t getting red and irritated like it can with other products. If there’s any irritation, it’s just your new skin turning over quick enough very quickly.

Alison Werner 8:31
So there have been a number of clinical studies looking at Defenage products, and they’re defensins. What findings stand out to you?

Dr Gregory Keller 8:40
Well, I think the one that was most interesting, and it was the first one ever to do a double blind, randomized clinical trial, and look at everything, pore size, skin tension in an objective 3d manner with a quantified care setup, so that you can actually see the difference. And it’s a very impressive type of article that clearly showed all of the benefits of defensins that really don’t occur with anything else. So I think that article is the single most impressive one. There are other articles that I also find interesting, such as the ones that show micro needling, putting Defenage on right afterwards and seeing the incredible results that you get with just plain micro needling and defensins, which testifies to the healing properties that it has. There are other studies but those two I find most impressive.

Alison Werner 9:34
You’ve talked about what defensins do now when you put them in incorporate them into the skincare product formulations for Defenage, what can users expect or what even you know, what do plastic surgeons need to know about what those formulations can do?

Dr Gregory Keller 9:49
Well basically what defensins The other thing I like about defensins is patients can see a result very quickly if they use the first thing that I usually put people on the first thing they’re usually interested in is the product of the face and I’m a facial plastic surgeon. So that’s what I see even though there are uses for the body and the hands and the eyes and everything else my most and hair, I also do hair, but usually we start people on products for the face. And when we do that, what we use is a scrub that has a sugar scrub in it, that makes a difference in sets the skin up, and then there’s a serum that helps actually there’s a cream that we use next, which actually helps the serum which has a higher amount of defensins than a cream and usually what we see is that within a week, people start to see a difference. And by six weeks, they see a real difference in their skin that pigmentation gets better, the pores get better, the skin gets more tension. And for physicians, Defenage has a different pro-line that actually is more effective than the regular defensins are. So most people will switch onto that even after buying Defenage maybe online or something like that, they’ll start to ask their physician and he can tell them that they have a pro-line, that works better. And with the pro-line, we really five or six weeks they really have a definite change to the skin particularly. I’m in California and so we have a lot of sun damage people you know of all ethnic backgrounds, we’re very diverse. And it causes that without any inflammation which is very important for people because we don’t want to do we don’t want people to get reactive hyperpigmentation and such. And the defensins actually diminish that pigmentation, those age spots the sunspots, wrinkles, pores and such.

Keri Stephens 11:45
So when we talk about anti aging products, what are some of the user concerns Defenage products can tackle?

Dr Gregory Keller 11:52
Well, basically again, I think the most common thing in my practice is sun damage and just plain aging wrinkles, brown spots, you know coarse skin, they’re not retaining water and it’s drying out transepidermal water loss moisturization so what we want to do is turn over the skin and the epidermis quickly and thicken it so that their skin looks better and younger people with poor skin often look tired to add and that type of thing. So definitely just really can make a difference.

Keri Stephens 12:23
So I want to get into get into the Defenage pro-line. What are your go to products that you typically recommend to patients

Dr Gregory Keller 12:29
Basically, the trio kit is what I start out with particularly preoperatively. I want their skin to heal wall and react. Well. defensins oddly enough are used for for burns in Europe. An interesting point, if you have a sunburn and put the serum on, your sunburn will go away very quickly. So that’s sort of fascinating if you’re in Hawaii or somewhere like that, Florida. So those are the go to products is the trio kit. A lot of women like the neck cream, because necks often sag. And that’s definitely a favorite. The eye cream really can moisturize and make the eyes look good and it feels good as well. Again, I’m a facial plastic surgeon, body cream is great. I have people who almost bathe their bodies. But I’d say that for me as the facial plastic surgeon, the trio would be the go to.

Alison Werner 13:19
And that’s the that’s the pro-line correct was that the consumer line?

Dr Gregory Keller 13:22
The pro-line, yes. Most of the often the consumer line is great. And there’s a lot of publicity out about that and in a way that drives people into the office to ask their doctors this stuff any good. And interestingly, on the consumer line, they found that there’s a 66% reorder rate which is amazing for skincare products in that the normal reorder rates 14 or 15%. So the pro-line has a higher and higher concentration of defensins in it. And that that really helps it to work work a little bit better. And most of my patients have switched over to the pro-line

Keri Stephens 13:59
Defenage has recently released its 150k hair follicles serum, which also incorporates these age repair defensins and also a skincare line for men. Can you talk about these products bring to the table.

Dr Gregory Keller 14:13
It’s interesting, and that’s based on a 2013 study that studied burns basically. And they did a double blind study where they applied off defensins to people with burns and did used so you know, a sulfa cream for the other ones, the standard treatment. And they found that not only did the skin get better, and grow better with the defensins, but hair also grew back on the people that were used in defensins. And they assumed that that was a WNT1 pathway that did that. And they did some RNA messenger RNA work, which was fascinating. But the very fact that the hair grew back was quite interesting. So that was sort of the basis for getting involved with the hair, hair work. And people that followed with a study by an independent lab, it’s entirely independent to look at, because hair goes through several cycles, anagen and telogen. And as as we get older if we’ve had thyroid problems, if we’ve reached menopause, if we just have the genetic tendency, we start to get thinning women particularly get thinning first, down the part line Ludwigs, one, two, and three are well known. So they did studies with hair pulls and biopsies. And you can tell if a hair is in the telogen stage, which is the resting stage, or the anagen stage, which is the active growth stage, people who have hair that stays in the anagen phase longer, the hair gets longer as time goes on. And it’s growing. So people with hair down to their knees have what’s called an angora disorder, like an angora sheep, it just stays an anagen. But if your hair is in telogen, like many women around menopause, then you know, your hair will fall out before it can really get long and thick. It’ll stay a sapling rather than a tree type of thing. So what they found was that Defenage reversed that tendency. And rather than 80% of the hairs in sort of a telogen, makeup, and 20%, anagen that reversed to 80% and anagen and 20% telogen. So that was good news. So people have done done very well with it, there are a couple ongoing studies with it that so far, so good. Most of the patients that I treat, are happy with it.

Alison Werner 16:45
Keri also asked about the product line for men, how how much of a proportion of men are in your practice. And you know, what do you think about that line?

Dr Gregory Keller 16:56
Well, I also do hair, so probably 30% of my practices men, they’ve been very happy with the product line, the ones that aren’t candidates for hair transplantation or don’t want to do it but still experiencing thinning hair will use that often needling and platelet rich plasma. And they seem as happy with the product is with the platelet rich plasma. But we’re still doing both to try and encourage hair growth both in men and women. And so it’s sort of a program that we do that with where we use of course all all of the usual things red light, propecia, if people will take it, the hard thing is getting guys to take them propecia you know in the many other medical kinds of treatments. But you know, the PRP has a lot of articles for it. And we’re finding just about as good a result with the hair product, which seems to be more the problem with a PRP as it takes painful injections, or painful micro needling. So people are much more accepting it first of the Defenage treatment.

Alison Werner 17:58
And then Defenage released a skincare line for men. Do you find that that’s resonating with some of your clients?

Dr Gregory Keller 18:08
I do. And as a matter of fact, my wife uses the women’s and doesn’t like the men and I like the men’s cream and don’t like the women’s. The men’s cream is a little thicker, and is more geared for male skin penetrates in a different manner. So it’s so that that may be testimony to it. So usually, if a man wants it will give him the men’s cream and the women. Likewise, the ladies cream.

Alison Werner 18:36
So we talked a little bit before about how consumer spending for skincare has definitely increased in recent years, especially with the pandemic. What does it mean to you as a business owner to capture some of that market and how patients buy their products through your practice?

Dr Gregory Keller 18:48
Well, again, if it’s just keeping contact with your patient and fulfilling their needs, and that’s the principle, essentially, we’re small businesses and sometimes even large businesses. But basically what you want to do is, is to have contact with that patient. And if you can do some good for them with their skin. Often, they’ll ask you about other things about your laser or your micro needling with radiofrequency or your micro needling or your facials. So it’s part of the overall picture that keeps that patient attached to you. And it does that without being too complicated when SKU numbers are numbers of products that you have to keep track of and all of that for my you know I’m in solo practice for me that’s really a pain in the tail. So it’s a simple method, we know we make a good profit for each set of products that we sell, we don’t have to sell 50 little SKU numbers, and the patients are happy as I say two thirds reorder almost. So that patient is coming in and out to either visit our practice or contact us about purchase. And when they do that out, they often ask other questions about other procedures and products and even surgery for that matter.

Keri Stephens 20:05
As a final question, we want to know, what excites you most for the future of facial plastic surgery?

Dr Gregory Keller 20:14
You know, a, there’s so much I need to say there is one thing unique about Defenage in that they do have a pro-line, that’s unique. So unlike some of the products, you can’t go online and order it, buy it first and then order it somewhere else. So it does keep patients within your practice. What excites me, a lot excites me. And you know, a lot of it, there are things in surgery that aren’t discovered and looked at even some of the anatomy parts that are only recently been looked at, we published one on a fascia that hadn’t been identified, you know, in conjunction with an international group, based in Italy, Cara Armadale, a plastic surgeon, in fact, and so there, there are lots of little things, even in our own field that are sitting right in front of us, you know, is for ptosis and Mueller rectomy better or a direct approach, because a lot of this has been each person’s experience. And I’ve really looked at studying, what really excites me are the advances in stem cell work. Exosomes, as you know, are one thing out there. There also have been very negative effects from them, and result in FDA black box ruling. So if you’re prescribing exosomes, and you tell your your malpractice insurance company about it, that your insurance will go up 10 times, almost guaranteed because it’s absolutely forbidden by the FDA. And a lot of places say that the exosomes are okay, and they don’t need FDA certification. That’s not true. The FDA has got definite statements about that. So, so I’m excited about all of the products, you know, and what what stem cells can do. I’ve been I’ve had stem cell labs for 22 years, started at UCLA, where we worked with fibroblasts and a few other simple things, and then graduated made liver cells and everything else. But you know, it’s just not there yet. The the Russian experience was pretty bad, and that stem cells injected into the vein, actually cause almost an 18 increase incidence of glioblastoma. So we have to know where we’re going with that and how to turn the switches on and off. And that really isn’t defined yet. So, but the prospect of it really excites me. CRISPR excites me a lot of those things that may happen in Japan or somewhere like that first, but those things excite me a lot. So that gamut goes from the day to day stuff that we do to what’s out there in the future.

Keri Stephens 22:54
As always, thank you for joining us and be sure to subscribe the plastic surgery practice podcast to keep up with the latest episodes. And also please check out plasticsurgerypractice.com for the latest industry news. Until next time, take care.