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March 13, 2024

Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...

Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.

Transcript

















Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California





























































































































































































































March 13, 2024



Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

























Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...































Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.













Transcript


















Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California





























































































































































































































March 13, 2024



Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

























Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...































Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.













Transcript


















Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California





























































































































































































































March 13, 2024



Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

























Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...































Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.













Transcript






















Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California





























































































































































































































March 13, 2024



Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

























Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...































Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.













Transcript






















Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California





























































































































































































































March 13, 2024



Corey Maas, MD - Facial Plastic Surgeon in San Francisco, California

























Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma...































Facial plastic surgeon Dr. Corey Maas has always been fascinated by the complex anatomy of the head and neck.

With experience helping patients not only through aesthetic surgery, but also through head and neck cancer reconstruction, facial trauma surgery, and sleep surgery, he has a rich knowledge of everything above the collarbone.

When he’s not helping patients love what they see in the mirror with their results, Dr. Maas devotes his energy to research and clinical trials for non-surgical treatments to help push the specialty of medical aesthetics forward.

To learn more about Dr. Corey Maas


Follow Dr. Maas on Instagram

ABOUT MEET THE DOCTOR

The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you’re making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be.

When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you’re interested in. There’s no substitute for an in-person appointment, but we hope this comes close.

Meet The Doctor is a production of The Axis.
Made with love in Austin, Texas.

Are you a doctor or do you know a doctor who’d like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.













Transcript

Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host Eva Sheie, and you're listening to Meet the Doctor. You're listening to Meet the Doctor and Corey Maas is a facial plastic surgeon who is my guest today. He's in San Francisco, California. Welcome to the podcast.


Dr. Maas (00:41):
Well, thank you very much for having me. It's a pleasure to be here.


Eva Sheie (00:45):
Tell us a little bit about who you are and what your practice looks like in 2024.


Dr. Maas (00:51):
I am a board certified facial plastic surgeon. I'm also board in head neck surgery. Haven't practiced that for many years. I trained in Florida in med school and undergraduate and then went to, followed the wagon trains west, went to St. Louis, did general surgery and had neck surgery residency and finished. Came out to California and did my fellowship at UCSF in facial plastic surgery and they asked me to stay on the faculty when I finished and I stayed at UC for about 12 years and did my thing. My practice evolved from doing a variety of bigger reconstructive things, facial nerve and all that, but it really narrowed down ultimately to doing aesthetic surgery and I still am a clinical professor at UCSF and participate in the training of residents and fellows. Now in particular, I have a fellow that spends a year with me each year and I strictly limit it to facial plastic surgery and we do skin on the whole body. We do a lot of minimally invasive things at the mosque clinic, which was established in 2002 through all the way through 2024 and the pandemic era and all that sort of thing. We've been around.


Eva Sheie (02:10):
When you were studying head and neck surgery, what kinds of patients are coming to you and what kinds of cases do you see early on in this progression? Where did you start?


Dr. Maas (02:21):
Yeah, well that's a good question because I started because the complex anatomy of the head and neck really was interesting to me and I was always a kind of anatomist at heart and spent many, many hours in anatomy labs and things like that. And I think that led me ultimately to surgery. Head neck surgery is really a big combination of the critical functions of which overlaps with hearing and vision and eyes and things like that. Ophthalmology, it's its own specialty now. And now so is otology, which is the years itself at my institution and this is now med school. I'm about, there was a lot of head and neck cancer surgery and when I interviewed for fellowships and actually even before that residency training, I was attracted to St. Louis University where the chair there had five facial plastic surgeons on the faculty and we were doing lots of facial trauma but also doing a fair share of aesthetic surgery.


(03:23):
And we did other things, head and neck cancer and reconstruction was a big part of it. We did a lot of sleep surgery. That was the early years of doing sleep surgery. You call it UP3 Uvulopalatopharyngoplasty for snoring and sleep. But ultimately the things that I liked the most it turned out was really more putting people back together rather than taking out the cancers and things like that. So that led me to fellowship in San Francisco with a purely aesthetic facial surgeon, Dr. Shane Rock, who was my fellowship director, which is really, fellowship is like your most advanced year of training because you're pretty much one-on-one with a mentor that has a broad scope of knowledge and you're just living and breathing aesthetic facial surgery during that year.


Eva Sheie (04:16):
When you're the fellow, are you seeing all the patients? Are you shadowing the surgeon that you're working with? Are you seeing your own patients? When do they let you loose?


Dr. Maas (04:28):
Yeah, that's a good question. All fellowships are different. I mean there are some fellowships within the scope of the American Academy of Facial Plastic and Reconstructive Surgery that just do c craniofacial surgery for example, which is things like cleft lip and palate and facial deformities. And there are other fellowships and the vast majority of ours or facial aesthetic surgery, many like mine, you get to run your own clinics at uc and see patients and train residents and you're the attending in charge of doing the cases and you're helping the residents learn what you know. And when you're working with your fellowship director. Like with my fellowship, my fellow is my first assistant, so rather than having a high school educated, really good surgery tech, which is fine, I have a medical student graduate finished residency and internship and all that as my first assistant. So I get a little more advanced challenging during the procedures where they're asking lots of questions, but they serve as a first assistant and then have the opportunity if they want to see and take care of their own patients as they graduate.


(05:43):
In terms of skills and knowledge and experience, for most of the fellows who have really put a lot of work in the first six months, they can do a lot of things on their own and some patients can't have a budget that doesn't meet with our fees and the fellows is a very good option for 'em. I'll be around, I don't do the case if it's the fellows case, but I can be around to assist if they need it. I think all of them are a little different, but in general, my patients are my patients and they know that and they help me mostly with the pre and postoperative care of my patients and then they have time to do their own patients if they so desire, they want to do some of their own things.


Eva Sheie (06:27):
Since you started doing this work, nonsurgical aesthetics have also really, they were probably introduced about the time you started and then have grown and changed and evolved over the course of your career. Is that a fair statement?


Dr. Maas (06:43):
Very fair. So my early work in research when I was at UC, I gained a lot of interest. I did implant research in medical school even and published some papers with a newer, at the time, a newer type of material called bioglass, which has not been used much in aesthetics. And it led us to do comparative analysis and different models where we were studying their effects and animals and ultimately humans. And that continued really when I came over to UC, I looked at E-P-T-F-E or Gore-Tex would be the common name for that, but the medical uses of it for blood vessel replacement and sutures and things, and then the applications as an implantable material. And so those early years when we were developing all these non-invasive, especially with the injectables were things of interest to me. We were looking at other injectable filler materials. The only one that was available when I finished was collagen, which was human derived.


(07:49):
But there were many other biomaterials that now were available the ha's and whatnot. But the first one and the one that we got most excited about was in 91 and two where Alan Scott, who was an ophthalmologist, he passed away about a year and a half ago. He didn't discover Botox because it's a naturally occurring protein that was described in the 18 hundreds and sequenced later on. But the Botox knowledge that was passed on by him, he was really just doing people that were sort of cross-eyed to have strabismus and those were largely kids and treatment at that time was to cut the muscles that were too strong or working to not have conjugate gaze where the eyes move together in sequence or in parallel. So he was mentioning to me, and it was working the same well, I noticed when I treat blepharospasm where you get a twitchy eye that the wrinkles go away.


(08:45):
So it was interesting that wrinkles went away and one of his fellows was a woman, Dr. Jean Caruthers, who many people had known and have heard of is one of the people that started the real clinical use of botulinum toxin for wrinkles and fine lines. We did our own studies with that. I was my first patient in 1992, and at that time it was really a little known product. They probably sold 20, 30 million Allergan did at that time. Now we know it's a multi-billion dollar drug, but those led us to studies looking at serotype b myo block, and then we got into doing scales and other research for that. And so those were days of what I would call the pioneering days of minimally invasive because Botox led to the adoption of many other injectable fillers. And then the lasers that came out in the early nineties led to a lot more options than just doing sanding other dermabrasion of the skin.


(09:48):
And the nineties was where that curve was steep. And I ran a minimally invasive aesthetic surgery course in the late nineties here in San Francisco that seven, seven or 800 people attended because I think everybody was recognizing that this was going to be very important in the aesthetic world. The big step that happened in the nineties was that we moved from in the early two thousands was we moved from it being an enormous step from going to a dermatologist and getting some skin treatments to going to a surgeon where you cross the threshold and there was a scalpel involved and big surgery, to where surgeons and dermatologists and people inside were doing smaller procedures that had huge impacts and huge impacts in things that were typically only surgically treated. And that's where we are now. The growth of these noninvasive or minimally invasive technologies and the improvements in them over the last decade or two has been tremendous. So that's an evolution that's really happened in this century where it's become quite refined. So it's pretty new. The one hand on a big scale, it's pretty new. It happened in my lifetime, but its changes are so dramatic even year to year that if you're not on top of the minimally invasive things, then this is true of all. A lot of the surgeons were late adopters. They were, oh, that's just for dermatologists. If you're not doing this stuff, you're missing the boat because there's really so much there.


Eva Sheie (11:25):
I don't think it's optional. Can you think of any things in the graveyard, things that came along that we all thought were going to be great that didn't make it, that were a big flop?


Dr. Maas (11:36):
Oh yeah. The number of machines that coat hangers or would be if we still had them are probably too numerous to count. I still have a couple of 'em and then I won't name out or call 'em out, but there were a number of different, and there were some recent ones. There's a good example, which is an interesting enzyme still used and still commercially available for a condition called Peyronie's disease where the penis is sort of bent due to scar tissue and it's available for that and it works pretty well for that quo is what it was called. It's Clostridium, Clostridium histoliticum. It's an enzyme made by a bacteria that breaks down protein basically. And that disease protein plaques that they think cause this bending, which causes dyspareunia and a lot of emotional problems in men and women, frankly, sexual dysfunction. But that's one that was recent, but you can go farther back.


(12:35):
There were flops with myo block, which was the type B serotype, B botulinum toxin. It's really stung. It was a liquid formulation. We did dose response curves on that, and this is all published, but it worked, but it hurt so much and it didn't last very long. And then when you did get a really good effect, you were so smooth that you couldn't even move. So that wasn't a good look. And there's even some that I was involved in the development of a product that's called Softform and a lot like Quo, it hit the graveyard, not because it was pulled, there were any big side effects from it. Quo had bruising, but I mean it's still approved and it works, but they just didn't sell enough of 'em. And one of the soft form product which was used for lip enhancement that was spawned from my research with Gore-Tex was a way of placing very small tubes or different size tubes below the skin subcutaneous tissues. And I still have many patients that had the soft form lip implant that love it. I mean it works great. And it just got kind of sold by different companies and then it disappeared just by attrition, by these acquisitions and companies that wanted the patent technology, but not necessarily to be in aesthetics.


Eva Sheie (13:52):
That lip implant, it was like it just disappeared one day.


Dr. Maas (13:55):
Yes, and there's a silicone lip implant that's still around and they've had those for years. And I'm not talking about injectable silicone now, which I think is dangerous. You can't remove it, but the preform silastic, so silicone implants are still around. A soft form implant should be back around. It really was a great tool for if it was used correctly. The early version of it, the wall was a little, it's like a tube, but the wall was a little thick. So when the ingrowth happened through the lumen or the hole in that tube, it would contract a little bit. That got solved a little later by just making the wall a little thinner. But by the time it was purchased and sold by half a dozen different companies, there was just attrition. But there are a lot of cool devices that are I think still could and should be used. They just need someone following the technology and really pursuing them. Hopefully a lot of these things come back. I mean, I think there's a value to 'em.


Eva Sheie (14:52):
What about the opposite? Can you think of anything that came along that you thought was going to be terrible that ended up being amazing?


Dr. Maas (15:00):
Well, I think Botox is probably the best example of something that everybody perceived. And I'm telling you in the early nineties when I was doing it, this came directly from patients saying, yeah, Dr. X sent me to you, cuz you're the crazy guy injecting the poison. So it is a poison, but as I tell every patient, every medicine we use is a poison in the wrong dose. But in the case of Botox, it was good. I mean that's probably the best example because it got labeled a poison. There are some that are on the cusp now. I'll give you a good example, which is the deoxycholic acid molecule, which is kind of a bile salt in the body. Deoxycholic acid is called Kybella. Allergan bought that. We were involved in the clinical trials with a company called Kythera that developed this bile salt and isolated, made sure it was pure and all that.


(15:54):
And we did the clinical trials in the neck area, the submandibular below the chin area. It was a multicenter trial and it did work. You did it every month or so, probably better to wait a little longer. As we've looked back at it, and it should have been great, they spent 2.1 billion on the product, but there's a lot of good options to do the neck. It was a good way of proving that it worked on the neck, but it sort of fell flat. I mean, they still have good sales of it. I think people not great though it's not anywhere close to a $2 billion product.


Eva Sheie (16:30):
I think for a while, especially when it was new, you could get lipo to your neck for the same price pretty much.


Dr. Maas (16:36):
Exactly. And I think lipo, CoolSculpting and Kybella are all, when you add 'em together between the five or six treatments you need with Kybella or the charges, especially with the cost of goods relative to the CoolSculpting, the freezing the fat thing, when you have to do more than one hand piece to typically get a good neck result or doing supplemental lipo, we just did this. We just did a submental liposuction case a few minutes ago. I mean the difference between those, the three or you can group them. CoolSculpting and Kybella are both destroying the fat inside you in the body. So the body has to handle all of the cellular debris that's left behind and that takes time and it can be a little bumpy and lumpy, and there's this condition where the inflammation continues and it creates more thickening. They're calling that PAH or paradoxical adipose hypertrophy. I really think it's more commonly just fibrosis, the thickening of the tissues. It's very rare with CoolSculpting. It happens with Kybella too, where you get little nodules, you can treat 'em with a corticosteroid injection, but still it seems logical. And I think most people just, if you're really thinking about it objectively sucking the fat out with a small cannula takes 30 minutes and you're done.


Eva Sheie (17:59):
Very predictable.


Dr. Maas (18:00):
Yeah. And you don't have any real downtime and tiny little incisions. It makes more sense. But there are people who are afraid of surgery. So to have these other options are great. And I do think we've done some recent studies with Kybella and cellulite and other small fatty deformities that are not the neck, and I think it will still have a role. So it started off as something that was thought to be really great and then it sort of hit a lull or a Nader, and I think it'll probably be on the climb as some of these publications start coming out about its use in other areas that's on the horizon.


Eva Sheie (18:43):
I heard it described recently by two surgeons talking to each other that one of the other most amazing breakthroughs kind of in the last 20 years was Fractionating energy devices when they went from just obliterating all the skin to fractionally treating skin. That was a major advancement. And I wonder if you saw the same thing happen or think about that the same way.


Dr. Maas (19:09):
Absolutely. Fractionated, now we're getting beyond just lasers too because they're fractionating in energy in general with microneedling, it's fractionated RF or electricity basically where you're the resistor in a circuit and everybody knows when energy passes through a circuit and goes through a resistor, it builds up heat. So basically


Eva Sheie (19:31):
Does everybody know that?


Dr. Maas (19:32):
Oh, maybe not. But that's really how all the RF works. So they're introducing a current and the current, your body is a good resistor. There's lots of fat, so it slows the flow of electricity. And so as a resistor in a circuit slows the flow that creates heat. And that's how all of the RF technologies, radio frequency is sort of a euphemism for electricity, but they're used in cautery and all that sort of thing. That's really all the same technology. The point I'm making though, it started with the lasers. The Fraxel was the first version of it. It was an Erbium laser which was so efficient in vaporizing cells that you really had no zone of thermal injury. See, you'd make these little tiny holes and you just didn't see a whole lot of improvement. It's a little bit like microneedling without the RF in it.


(20:24):
You can make little holes, but it heals so quickly you don't see a lot of benefit from it. They're very popular in Asia, by the way, these rollers where you just roll needles over the skin frequently and it pokes a little holes in the skin, but you really don't see a lot of improvement. You need some energy, you need some amount, and it's got to be controlled of thermal injury to really stimulate wound healing and the repair mechanisms that the skin has naturally to see the best benefit. And this is always how much of that is delivered and how close together or how spaced these little microthermal injuries are really critical factors. And if you get into non-ablative, it even gets a little more complicated because non-ablative means there's no wound, but they're fractional, meaning there are little dots of thermal energy if you will, below the skin surface devices like clear and brilliant, there's a half a dozen of 'em.


(21:26):
I'll name all of them, but the bottom line is you don't have much downtime. On the flip side, there is a curve, the less energy delivered and the less density, if you will, of these little dots of thermal injury, whether it's at the skin surface or below or both, the less improvements you get. So the most improvement is if you do fully ablative fractional laser and then use the CO2 laser, which was where the company that made Fraxel finally came around and developed their own CO2 version. And the CO2 has it more of a layer of thermal injury that the Erbium does not have. And so that's where we see better improvement. We're able to control how close together those little dots of thermal injury are and then the fluence or the power you use. And in general, what I tell patients about this, this is a long answer to your question, but the more energy that you deliver, in other words, the deeper you go and then the closer together, the little dots of energy or the little columns of energy that are delivered, the better the outcome up to a point.


(22:37):
And then if you get past that point, you start getting into problems with damaging the pigment producing cells or even having scarring. And none of us want that. If somebody's coming in and just has wrinkles, you don't want to end up with scars or lighter skin,hypopigmentation. You can get relatively lighter skin because you have a lot of other sun damage, but that's all treatable. But true hypopigmentation where the skin cells are not producing the melanin anymore is an unwanted side effect with too much energy or too close together of the spacing of the energy delivered.


Eva Sheie (23:13):
We are certainly in the weeds, and I love the weeds. I don't usually have someone in front of me who's been in the catbird seat for as long as you have. So thank you for going so deep on so many of those answers. The new one that came to mind when you were talking about holes is now Ellacor, which has no energy at all. So what's going on there and why does that seem to be, I don't want to bias anybody's, but I've heard people personally that I know are getting good results, especially around the mouth and very happy with it. Lots of surgeons talking about it seems to be coming on strong as something that people are adding to their practice and it has no energy in it at all. It's just removing tissue and sort of fractionally, do I have it right?


Dr. Maas (24:10):
Yeah, you do. Well, there is energy in the removal of the tissue. So they for the most part are using some type of mechanical energy to if you will, core out or make little holes in the skin. There's more than one device. And some of the early ones made holes that were quite large actually, that were scary looking and they did get good results. But you do get scarring and scarring is something you have to accept with 'em with the smaller the hole you can make just like a punch biopsy if you're down at the millimeter or less size with the holes, that really is hard for the eye to detect when they heal and it heals by secondary intention. And then the spacing of course is important too because if they're really, really close, it's functionally one wound, but there's no question that it works because it's removing excess tissue just like we do on a facelift or a neck lift.


(25:09):
The difference is that in a face or neck lift, we're generally pulling the skin and repositioning it back to where it used to be and then taking the excess out where we can hide those scars versus the Ellacor or the other devices that are doing core technology or taking that excess skin out at the point where you see it. And for the most part, if you're older especially and you have kind of wrinkly skin, you're probably never going to see those little scars. If you're younger, it's a little more marginal, you might see them. And then the skin types are important. Darker skin types are more likely to have a little bit more noticeable areas of healing because each of them, all those small, especially like I said, if you get down to one or two millimeters in sub diameter like doing, we do biopsies in the skin to test for cancer and things like that, it's really hard to see the scar when it heals by what we call secondary intention means there's no stitches that just lets it heal. And so I think the technology's interesting. I don't know that it's better than doing fractional resurfacing. It's just where there's no heat, but it is a way of getting rid of the excess tissue that we're doing traditionally. And like I said, with lifting techniques where you hide the incisions.


Eva Sheie (26:29):
What a time to be alive.


Dr. Maas (26:30):
Yeah.


Eva Sheie (26:31):
So where do you think we're headed? Is there anything that you're excited about that's coming?


Dr. Maas (26:36):
Well, yeah, there's a lot of things to be excited about for everyone. We see it all around us. The semaglutides are making a big impact in getting this epidemic of obesity under control. They've been around for decades. By the way, this is by no means a new technology and the semaglutides are like ozempic and we talk about ozempic and these drugs have been around for decades and used for people with type two diabetes and obesity and not just a couple of comments about that. I mean, you can still eat through them. I mean literally people who have obsessive eating disorders or satiation genes that are not functioning correctly, but they're helping a lot of people. And I think some people are going way too far. If your BMI is less than 20, you don't need to be skinnier. You need to work out or treat the fat little, if you have a little fat pocket, go get CoolSculpting or lipo or something.


(27:30):
But it's helping a lot of people to feel and get more fit and size. And I think that this combination of using various supplements and some of these drugs that are traditionally haven't been used in ordinary people. And when I say that, I mean people with no diagnosed illness other than obesity or overweight. And we know overweight is a problem and obesity, it's a huge problem in this country. It's a huge problem around the world in developed countries and some worse than others obviously. But that I think is exciting because it gives us opportunities even with people that are really fat to get them back to normal and get them feeling better about themselves. And that sort of ties in very closely with our practices as do some of these other medicines that can like bioidentical hormone replacement. We're learning a lot of things and those are so closely integrated with appearance care and your self-confidence, self-image and all those sort of things.


(28:33):
And whether you're working with someone that does it or bring it into your practice, to me that's exciting because it gets people a head start. The technology side, I really think we are getting, especially with the anesthetic techniques we're getting now, where people can really just be lightly sleeping. You don't need to be intubated and on a respirator for hours and hours to do these things. You can be breathing on your own with a newer device called an LMA, which protects your airway, but doesn't have to require you to be paralyzed. And that means lower levels of anesthesia, fewer side effects, and more safety. And so these advances along with a lot of the advent of having available outpatient, really accredited surgical facilities that make it more private and more personalized for the patient that are very safe, are really much more widespread now, big advances.


Eva Sheie (29:32):
Are you still involved in research in any way?


Dr. Maas (29:36):
Yes, we do clinical trials. So I have a clinical research center and we discuss a spectrum. The clinical research center goes from anything that has to do with skin to, I've even looked at doing some urinary tract studies, but at the end, most of our stuff is about skin and aging and aesthetics, and that's still important to challenge the industry has is if they go to these institutions, the typical academic institutions, there's so much paperwork and they want their own institutional, their ethics board to review the study and then they want to change it. If you do a multicenter study, you can't have one center doing one thing and another doing a different thing. So the private centers that are doing research, there's probably a hundred or more, maybe a couple hundred now in the country that are doing really quality clinical research. I don't really do much in the basic science world anymore. It's just too much work and labs are needed and all that sort of thing. But yeah, very interested in research.


Eva Sheie (30:37):
Can people volunteer to help with that research? Is that something you make available to your patients?


Dr. Maas (30:43):
Oh, absolutely. Yeah. So when we're starting a study on long-term satisfaction with one of the botulinum toxins, actually we're going to start this week or last week, so it's going to probably be this weekend. And for the companies that are, I would just say that the companies that are investing in research and even things that we know a fair amount about the botulinum toxins, they're the ones that are going to lead the way to the next gen of these things, and they're supporting what are called an investigator initiated trial. So the investigator is the person who puts forward a program, a protocol that wants to ask some questions. It's a lot like what the Food and Drug Administration calls an IDE investigational device or drug exemption where you want to look at something and they encourage these. I think the FDA in some ways is arcane, but in these areas they've given physicians that have an interest in advancing technology, the opportunity to look at it, and patients who are obviously have to be properly informed and all that kind of thing. So the more people that do it, the better we get. I mean, there's really cool ideas. I hear every meeting I go to.


Eva Sheie (31:59):
It seems like I've noticed a pattern in some of the things that we know and love, like your Botox example earlier was being used for something else and somebody said, I wonder if we can do this with it and then starts pulling on the string and can't stop because there just seems to be some doctors who have the personality to go figure it out instead of wait for someone else to figure it out.


Dr. Maas (32:22):
Yeah, absolutely. Yeah, that's right. Well, I think that's the beauty of having fellows too, the ones that are really engaged or asking questions that you go, that was a really good question. I wonder if we could figure out an answer to that. And as they start writing these papers, they are generating their own things, and I encourage all of our fellows, we have a research center to they get trained in it. There's a whole protocol for training people to do clinical research. It's not really easy. Lots of steps and lots of rules and all that sort of thing. On the one hand, it's not insurmountable. You can get through it. Once you have that system down to something that is manageable, it can just be treated like any other call center in your practice. Other examples that come to mind that are drugs are like the molecule, that's latisse that was used, latisse is bimatoprost, and it was used for glaucoma and all the patients that were getting treated with glaucoma, the nurses noticed that they were getting these big full eyelashes when they were using the drops in their eye.


(33:24):
And so they started putting it into their mascara. The nurses did literally, and the docs are going, what's happening to all our samples of bimatoprost? And the nurses would fess up and say, well, we're putting it in our mascara. It makes our lashes thicker. So that's how Latisse became a product. And it was the same thing. Just other examples that we'd all know it was with what we now know is Propecia, which is Finasteride and in a five milligram dose, which was used for prostatic enlargement, which happens in about 70% of males as you get older, the guys that were taking it were getting new hair growth and had better hair. And so everybody, so they studied it. Merck did it a one milligram dose, and sure enough they got really good hair, especially hair preservation, but hair regrowth in the top of your head, the crown area. So as long as you're thinking and observing and asking questions, I think the sky's the limit in terms of how far we go.


Eva Sheie (34:26):
It certainly is. It is. What do you do with yourself when you're not at work?


Dr. Maas (34:33):
Well, I've got a recent change because I've been married a long time and both my kids are gone now, but the last one was off to college in Florida. And so I've got my wife now working with us and we are playing golf. I like to play golf. We just got back from skiing this weekend. We had a big meeting in Tahoe, which we have annually. I'll put in a plug in for the California Society of Facial Plastic Surgery. The annual meeting in Lake Tahoe happens in February. And we had some phenomenal snow, but the weather got pretty severe. And I like to fly airplanes and play guitars and do things like that. So those are my hobbies, and if I could do 'em all at once, that's even better. Fly and go skiing and then fly and go play a round of golf, which you can do in California in the same weekend.


Eva Sheie (35:21):
This is true, especially if you have a plane and you could fly yourself to all the places. Your hobbies always have to be in service of your other hobbies.


Dr. Maas (35:33):
That's right.


Eva Sheie (35:35):
It's been really a pleasure to about your background and so much of the interesting work that you've done over the years. I wish we had more time. If someone's listening and they want to find out more about you, where would you like them to look?


Dr. Maas (35:50):
Yeah, so if really anybody has questions, patients or doctors or otherwise industry, my main website for the clinic is maas clinic.com. My video blog is dr maas.com, so either one of those maas clinic.com or dr maas.com. And they're linked so you can see us. You can find us on Instagram at Dr Corey Maas. And I think those are probably the easiest ways to get ahold of me. Happy to hear from anybody and start a dialogue.


Eva Sheie (36:18):
And I'll make sure I put those links in the show notes so they're easy to find. Thanks, Dr. Maas.


Dr. Maas (36:23):
It's an honor. Thank you for having me. I appreciate it very much.


Eva Sheie (36:29):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, T-H-E-A-X-I-S.io.