Join PSP co-chief editor Keri Stephens as she sits down with Alexander Zuriarrain, MD, FACS, a board-certified plastic surgeon and owner of Miami-based Zuri Plastic Surgery, to delve into all things rhinoplasty.

 The conversation kicks off with the impact of the so-called “Zoom Boom” on the popularity of rhinoplasty. As people spend more time on video calls, they find themselves scrutinizing their own appearances, leading to a surge in interest for nasal corrections. Zuriarrain explains how the advent of remote work has contributed to this phenomenon, with individuals seeking rhinoplasty to address nasal deformities and enhance their facial features.

Zuriarrain then discusses the evolution of rhinoplasty techniques and outcomes over the past few decades. From traditional methods involving chisels and hammers to modern innovations like ultrasonic rhinoplasty, the field has seen remarkable advancements, Zuriarrain explains. The use of sophisticated technologies, such as 3D imaging and computer-assisted surgery, has also made a significant impact. However, Zuriarrain cautions against relying solely on 3D imaging due to potential discrepancies between the generated images and the actual surgical results.

The podcast moves on to discuss patient selection, emphasizing the importance of identifying individuals who are genuinely good candidates for rhinoplasty. Zuriarrain shares his selective approach, highlighting specific patient populations, such as those exhibiting body dysmorphia or unrealistic expectations, who may not be suitable candidates. He further emphasizes the importance of ethnic considerations, as different geographic backgrounds have unique nasal anatomies that require specialized approaches.

 Complications associated with rhinoplasty are also addressed in the podcast. Zuriarrain explains that swelling is a common concern, with patients often underestimating the recovery time needed for optimal results. He discusses potential complications, including “whistleblower” deformities, collapse of the tip, and issues with the nostril base, highlighting the need for skilled surgical techniques and patient education to minimize risks.

 The episode concludes with a discussion on how surgeons balance patient desires for specific nose shapes with overall facial features and aesthetic goals. PSP

 

 

 

Podcast Transcript

Alison Werner:

Hello, and welcome to the Plastic Surgery Practice podcast on the MEDQOR Podcast Network. I am Alison Werner and I’m joined by Keri Stephens. We are the co-chief editors of PSP. Today, we’re going to be talking to Dr. Jordan Plews, founder and CEO of ELEVAI Labs. For those of you who don’t know, ELEVAI is a biotechnology company developing regenerative skincare applications and has developed a line of physician dispensed exome solutions. This all stems from Dr. Plews’s work on next generation topical stem cell based skincare solutions. Dr. Plews, thank you for joining us.

Dr. Jordan Plews:

Yeah, thank you for having me. Great to be here.

Alison Werner:

Great. Well, let’s get started. Can you talk about how you made your way into the skincare space and how ELEVAI got started?

Dr. Jordan Plews:

Yeah, sure. So my background is in biochemical engineering. I started as a biochemical engineer. I’m from Northern California, but actually did my studies over in the UK. So I was based in University College London doing that, then got the opportunity to work at Pfizer as part of their bioprocess development group. And initially I was thinking, “Okay, it’d be great to create drugs and things that are going to help people.” I got a little bit jaded, honestly, with the healthcare system and seeing that so many drugs are going after the symptoms and not the core of the problem. So after my undergrad, I ended up getting the opportunity to go back for my doctorate in stem cell research, also in the UK, and so I lived in the UK a little over eight years. I was really kind of combining what I learned from biochemical engineering with stem cell research at a really pivotal time when I think a lot of the work here in the United States was blocked or banned under Bush.

And then I managed to go from there back home to California where I did my postdoc at Stanford, really focusing on utilizing stem cells for translational medicine purposes, regenerative medicine purposes. And we looked at a lot of different things. I was mainly in a cardiology radiology lab, so things to do with the heart, also looked at diabetes quite a bit. And that’s really kind of where my first exposure to exosomes and extracellular vesicles came into play. And it was something that we were actually looking at causing heart attacks in pigs, because they have a similar size heart to humans, and then found that there was something being excreted by stem cells that were being injected next to the infarction and they were helping to ameliorate the issues of the heart. And at that time it wasn’t clear that it was exosomes, but over time that has become more clear.

And I actually was pulled more into aesthetics later on after I was giving a lecture and a couple of MBA guys originally reached out to me wanting to work together. And it was really out of their interest in aesthetics that pulled me over to it. And since then, I’ve been in aesthetics now for about eight years, making different products, also working in a few different biotech companies and developing products for biotech companies.

Alison Werner:

Can you talk about how exosomes, given that our audience is plastic surgeons, what role do they play for plastic surgery patients and aesthetic procedures? How is this connection and how did ELEVAI kind of get into that?

Dr. Jordan Plews:

Yeah, so a lot of my initial research was about cell signaling, right? So my doctorate work was all about converting fully differentiated somatic cells back into a stem cell state, and so you end up learning a lot about biochemistry and biosignaling. And as we learn more and more about stem cells and the way they differentiate and the way that they control or modulate inflammation and healing, it became apparent that they are releasing these powerful factors that are catalyzing healing and that, through further studies, we’ve learned this is to do with the exosomes.

So the exosomes are like little pieces of mail that one cell is sending to another cell. And it just so happens that, out of all the cells in the body, stem cells are sort of privileged in the fact that they have a larger repertoire of cell signals that they can send. I usually liken it to a general of an army, right? So the general of the army can command every troop in the army. Whereas if you’re at the bottom of the totem pole, like a fibroblast, you’re maybe more like a private, you’re more or less taking orders, not really giving them.

And so when we have the opportunity to work with stem cells and kind of modulate what they’re producing, it became clear, you can more or less take these signals that they’re sending and concentrate those and use those for a variety of applications. And I think the aha moment for me was that early on people had said, “Why don’t you put stem cells in or on the body? Why don’t you inject them?” And I had to explain, “You can’t grow stem cells in a bottle. You can’t keep them on the shelf. They’re not going to last.” But the real innovation of exosomes is that you’re getting all of the best stem cells produce concentrated in something that can go into a bottle, if it’s packaged correctly of course.

Alison Werner:

Okay. So what do the exosomes do for the skin? So specifically plastic surgeons are our audience, if they wanted to understand, these exosomes, what part are they taking, why are they helpful in any kind of skincare product that their patients might be using?

Dr. Jordan Plews:

Right. So in aesthetics, most of the time procedures are causing a little bit of damage, sometimes a lot of damage, in order to catalyze healing, and the goal being that you heal up better and more youthful than you started. I think the exosome component here is we’re hijacking what nature does best. And so in a normal situation where, say, you’re causing a bit of damage in your own system, your own stem cells is meant to kick into gear and then heal you up, we know that over time that doesn’t work out as well, right? We scar more easily. We don’t heal as quickly. So the idea here is, what if we could take the healing capacity of some age zero stem cells, take those messages, and give them to the cells where damage has occurred to really turbocharge their ability to heal and replenish?

That’s probably the simplest way I can put it, but to dig a little deeper, essentially, this is growth factors, this is cytokines, there’s mRNA and microRNA that is carried by exosomes. To me, it’s like if you imagine a building that is on fire, right? And the firefighters come in; they put out the fire. You’re giving them the ability to put out the fire, but you’re also giving them building blocks. You’re giving them the repair pieces, the wood, the bolts, the steel, to rebuild. And the skin, of course, it’s elastin, it’s collagen, it’s fibronectin, it’s modulating factors for inflammation, like interleukins.

But essentially, if we can treat the stem cells in the right way, they’ll produce the right factors and triggers to help ameliorate the skin after injury, and arguably do it better and faster than a patient’s own system would, especially if they’re of an advanced age or have any kind of issues, like they’re a smoker, or, for whatever reason, their health is not what it used to be.

Alison Werner:

Okay. So ELEVAI has two products featuring exosome technology, they’re specifically intended for post procedure skin support, ELEVAI Empower, and ELEVAI Enfinity. So after what types of procedures are these two products ideal for use?

Dr. Jordan Plews:

Yeah, so I designed this system in a way that you can use it with almost any device, but particularly things like energy devices, everything from as mild as microneedling up to a laser resurfacing of the skin. We also work well with devices like the Tixel, anything where, again, you’re causing a low level of damage and you want to give the patient something that’s going to really supercharge their recovery.

And as you mentioned, those two products are part of what we call the E-Series. The Empower product is a concentrated 5 ml in-office product. So it’s not something that you buy as a patient and take home, it’s something that’s applied in the office, it’s part of a treatment protocol. And then you’d send them home with a bottle of Enfinity. And, of course, some of these treatments that are going on today are so aggressive you may need multiple vials of the Empower, but for most, you’re using one application of the Empower, just concentrated but gentle exosomes, and then you’re sent home with the bottle of Enfinity, which is meant to last you about four to six weeks.

And that gives you not only the exosomes, but I’ve tried to pack it with as many ingredients as possible that really support skin health. Everything that we know is clinically proven to work. So this is various levels or molecular weights of hyaluronic acid as a main driver. This is ceramides, so they kind of serve as a biological bandaid for the skin if you have barrier repair issues. There’s a selection of peptides in there. There’s some that are Botox-like peptides. Also, copper peptides are very powerful and help to signal to your own stem cells to come and recruit to the area where you’re applying this. We’ve got four different forms of Vitamin C that are highly bioavailable to help boost with collagen production. Glutathione, which helps to recycle Vitamin C and Vitamin E.

So we really kind of packed this with a lot of different ingredients. And arguably, these on their own, individually, would be quite expensive individual products. And we tried to simplify the whole thing, making it kind of a really eight-in-one sort of product for an at-home product. Does that make sense?

Alison Werner:

It does. And ELEVAI Enfinity is an at-home daily use serum. What can patients expect with this take-home product?

Dr. Jordan Plews:

Yeah. So I think what people have become accustomed to are these exosomes that are in-office and they have a short duration of treatment. And we provide that as well, where maybe you’ve just had a radiofrequency microneedling, for example, you’re all red, and you apply our Empower exosome serum and within a few hours that redness subsides significantly. And the thing is, that’s really not where it ends in my mind. You really want to continue to nudge the skin in the right direction, and that’s where the Enfinity comes in. So if you’re dealing with persistent inflammation, or signs of inflammation, like redness, I should say, things where you have uneven tone or texture, this is going to help overall improve your skin in a very visible and noticeable way.

I think a lot of folks are accustomed to creams and serums not really doing anything, especially my colleagues in the plastic surgery arena. I’ve talked to many that are just convinced there’s nothing you can really do topically that makes a difference, but I think we’re finally entering an era of applying the science in a way where topicals really can move the needle for patients. I don’t know if you had a chance to review some of our results on our website, but these are not like before and afters where you’re kind of going, “Hmm, does it work?” It’s very clear that there’s an improvement.

And, of course, we really try to apply quantitative techniques whenever possible, using things like the Canfield VISIA system or other quantified photo systems, to really show that we are seeing an improvement and we’re not just taking pictures from funny angles or something like that, this is a real quantifiable difference. And usually, you can see that within four to eight weeks; whereas more persistent issues, like hyperpigmentation related things, sometimes take longer, around 12+ weeks.

Alison Werner:

Well, it sounds like Enfinity can really be a long-term aid for patients. So these products are only available for sale from authorized providers, for instance, physicians and their trained staff, so why is it important for ELEVAI to work with doctors and staff like this?

Dr. Jordan Plews:

Yeah. For us, we understand this is not a low education product. This is something that we really want to talk to practitioners about because we know that when it comes to who you trust with your skin, you really want to talk to an expert. You really want to go to your derm or your plastic where other aesthetic procedures are getting done. And we really want to make sure that we’re associating ourselves in the high science that we’re trying to provide with the top practitioners. And we understand that when they relay this message to their patients, that they’re going to come back more and more for this.

We’re trying to really create a bit of a virtuous loop in the same way that I think Botox has done for a lot of practices, where you’re kind of coming in on a regular three to four-month basis. And those are providing opportunities for the clinicians to upsell them on other treatments and other modalities, right? And so we really want to benefit the practitioner by providing a product that you can only get through these aesthetic professionals and something that’s going to keep customers coming back into your office to ask for the next round essentially.

Alison Werner:

Okay, so what should plastic surgeons looking to incorporate ELEVAI products in their retail offerings know about ELEVAI Labs?

Dr. Jordan Plews:

Yeah, so I’ve already touched on my background in biochemical engineering and stem cell research, but I really feel like that is a standout difference between us and a lot of others in this space. Biochemical engineering is really all about scaling up of bioprocesses; whereas stem cell research usually is something, when you’re taught to grow stem cells or to do anything with them, you’re taught to do it in very small portions, like well plates or small T-flasks, and it’s a very expensive endeavor.

So scaling up is really the skillset of the biochemical engineer that I don’t think the two have come together very often. So we have really developed a process, and, basically, we’ve got a sort of trademarked technology name around what we do. But we believe that it’s not just about having the best source, which is very important, right? You have to have the right source cells, but it’s about how you treat those cells in the laboratory, it’s about the research that’s done, it’s about having the right people involved in it.

As you start to see technologies like exosomes become more and more popular, you also see more and more misinformation unfortunately. I know a few years ago when I was first kind of traveling around speaking on exosomes at various conferences, number of exosomes was one of the things that came up a lot. People say, “Well, how many exosomes? How many exosomes?” But I had to really call that out right away and say, “This is not what we should be focusing on, guys. The exosomes are an envelope that are carrying this great growth factor and a mixture of factors in them. And you don’t care about how many envelopes you’ve got, you care about how many growth factors and the types of growth factors that are inside there, and any other kind of signaling molecules, and how much they’re going to have an impact.” And so I think the field, in general, is still sort of struggling to properly quantify this, because there are others that are saying they’re getting exosomes from other cell types that are non-stem cell types, and I think it’s further confused how difficult it is.

But suffice it to say, I’ve applied all my background to really try to make the very best product we can. Obviously, if you see our product, if you’ve handled our product, you know right away that it’s top quality. And we’re not doing the typical hero ingredient model, just throwing some peptides in there and telling you that they give you the world. We’re not trying to give you the minimum amount of actives. We’re really trying to maximize the results for patients and to provide this only to the top quality skincare professionals so that when you’re buying and using our products, you know you’re really working with something special that moves the needle.

Alison Werner:

Okay. So what’s next for ELEVAI?

Dr. Jordan Plews:

Right now, we really want to be the dominant topical exosome company and we’re working hard to do that. Beyond that, I think there’s going to be different variations on exosomes in the future, different flavors of exosomes, if you will. We’re looking at different ways to apply them. You’ve probably seen there’s some already branching into the hair area, trying to use exosomes for hair, and that’s something that we’re looking at as well.

I think that the real magic, again, is something that happens in the laboratory and what you’ve packaged in those exosomes. So I expect that we’re going be launching different, quote, unquote, “flavors” of exosomes for different purposes. And also, we’re partnering with other high tech folks to try to bring additional technology into this. We really want to be known as the company that’s bringing the highest skincare technology to the practitioners, like plastic surgeons and derms. And that’s really the space we want to dominate.

We’re probably not going to be, for example, making a ton of different cleansers and basic moisturizing creams. We really just want to make an impact in specific verticals where I think technology matters and can really move the needle in a way that previous technologies have not.

Alison Werner:

Great. Well, what excites you about the future of skincare or biotechnology in the skincare space?

Dr. Jordan Plews:

I think it’s sort of funny that the tip of the spear scientifically is often in the aesthetics arena. You have people who are willing to do what it takes to maintain their youthfulness, and it’s forced the industry forward. And I think before, it was like you had these two parallels. You had the kind of cosmetic parallel with the pharma; and now, I see more of a convergence happening. And there’s good things and bad things about it.

I think on some regard there’s a lot of cowboys out there that are doing some crazy stuff. I mean, the FDA has been very clear that you should not be injecting exosomes at this time. We’ve specifically targeted the topical area because we do not want to be involved in anything that’s over that line, injection, but there’s a lot of docs who say, “Whatever, I’m going to do what I want to do.”

And what we’re seeing is that there is this convergence happening, where I think the latest in biotechnology is more quickly and more rapidly making it to aesthetics, which is really exciting. And I think we’re quickly approaching a point where we’re probably going to have to pump the brakes a few times on some of this stuff. I can see stuff coming down the pipeline right now that’s super exciting, but there’s a few things that worry me.

I can tell you there’s some topical gene therapy stuff that’s coming out, right? And topical gene therapy for serious skin diseases, like epidermolysis bullosa, that is amazing and it’s exactly what we should be doing; but topical gene therapy for just the purposes of aesthetics, I’m not sure if we’re ready for that yet. I’m not sure if that’s something that’s ready for primetime, but I do see evidence of private companies going towards some of these endpoints in the near future.

But all around, I think we’re quickly and rapidly approaching a future in which we’re going to be able to reverse the signs of aging as fast as they happen. And I always like to give the analogy of aging is like a boat with a hole in it. You can bucket the water out, but you can’t stop the water from coming in entirely. And I think we’re just getting better and better at bucketing that water out. And I wouldn’t be surprised if the first person to live to 150 and beyond has already been born. So I see this really cool future of aesthetics and biohacking all kind of coming together with pharmaceutical and biotech grade science.

Alison Werner:

Great. Well, Dr. Plews, thank you so much for speaking with us today. If plastic surgeons or their staff are interested in learning about more about ELEVAI and including these products in their office, how should they get in contact?

Dr. Jordan Plews:

Yeah. Our website is always a great start. It’s E-L-E-V-A-I-Skincare.com. You can also reach out to us at [email protected] That’s [email protected]

Alison Werner:

Great. Well, to our listeners, thanks for joining us. Be sure to subscribe to the MEDQOR Podcast Network for the latest Plastic Surgery Practice podcast, and remember to visit plasticsurgerypractice.com for the latest industry news. Until next time, take care.