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 is 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. Welcome back to Meet the Doctor. Today I have a special guest, someone that I remember vividly from speaking almost 10 years ago about what patients really want. And so I'm very excited to introduce you to Dr. Monte Eaves. He's a board certified plastic surgeon in, where are you in Georgia?

Dr. Eaves (00:49):
I'm in Atlanta.

Eva Sheie (00:51):
In the Atlanta area.

Dr. Eaves (00:52):
Yeah.

Eva Sheie (00:52):
Okay, so let's start with the tough question. Just tell us about yourself.

Dr. Eaves (00:59):
That is a tough one. Next question. No, yeah, so I'm a plastic surgeon. I grew up in Tennessee. Went to medical school there and ended up training in Dallas, Texas in general surgery was the pathline for most people back then, and then came to Emory in Atlanta for plastics. And while I was there, I hadn't really expected to embark on an academic kind of pathway, but at that time, endoscopic surgery was really new and my chair kind of encouraged me to go and play with it in the lab. And I ended up inventing some equipment and then inventing with people at Johnson & Johnson, the first vein harvest system with small incisions, endoscopic, so they didn't have to have a big huge scar up and down their leg. And that really gave me the bug. So ever since I've been doing that, and that's happened as I transitioned to private practice for 15 years. And then I came back to Emory, full-time academics, and then now I'm kind of on the entrepreneur route of the world.

Eva Sheie (02:11):
I needed to go back to the lab for a second because you said they told you to go play with it, and I need to know what that means in the lab. What are you playing with?

Dr. Eaves (02:21):
So I think there are different types of research that you do. Sometimes it's very structured and you know exactly the answer you want to do, and there's certain really set ways of measuring that answer or testing that hypothesis, and it's very structured. Sometimes when you're talking about something totally new, you have to go in and just try different things and see what works. So in this case, we went into an anatomical laboratory and would try a piece of equipment, then I would go back and have it modified, then try another one. Does this allow us to see? And once we got so we could see how do we dissect? So it's kind of an iterative process and I really kind of like that. There's different ways people will try to create something new. One is it's, and I'll use the term me too, not meaning necessarily the me too movement type thing, but me too in the sense of it's a copycat product.

(03:18):
It has a very defined market, everybody knows how to use it. It's maybe just a better mousetrap. And then there's another type, you're trying to figure out a totally different way to do something. And that's where I get real excited and have a lot of fun. If it's some copying, some making some little small iterative improvement, it's not particularly super exciting. Some of the best days I've ever had at work were we're sitting with engineers in the lab and trying to figure out a problem to change the way we take care of patients. I love taking care of patients and I love translating that and then using that for the patients. But I think to sit there and figure out a new way that maybe a hundred thousand doctors can use or people can do around the world that can affect people in a very positive way.

Eva Sheie (04:06):
Have you ever reflected on things that you did when you were younger or even when you were a kid that were similar or the same to this sort of process you did in school of figuring these things out? Did you have to figure everything out when you were little too?

Dr. Eaves (04:24):
Well, I think probably the most obvious perspective on that for me is when I was growing up, my best friend was my dad. And he was a built furniture, reproduction furniture. And so we would spend all this time in the shop doing different things or building something for the house and so forth. And he was an engineer and he thought very much like an engineer. And he'd often say, Monte, how do you think we should do this? And he wouldn't tell me what we needed to do, he obviously already knew. And I would come up with an idea and he said, well, why would you do it that way? What would happen if you did it this other way? What do you think? And then the great thing was if it was, he said, I might've done that a different way. That's a pretty good idea. Let's do it that way. Let's try it. So I always felt kind of empowered to try something a little bit different.

Eva Sheie (05:18):
Did he ever let you build anything yourself and see if it worked?

Dr. Eaves (05:21):
Oh yeah. I managed to cut off the tip of my finger once and then some other things, a little shop accidents that do happen. But no, I ended up, and I'm actually sitting at a desk now that I built. He's 91 and a half now, and this was a few years ago, and he would sit in the chair and kibbitz a little bit and tell me things that I should do. But it's something that I've really enjoyed. I don't have as much time to do now is I would love, but it's one of those places you get in your zone. And I think the other type of problem solving we're talking about is that same way for me. It's that kind of happy place.

Eva Sheie (06:02):
Did they sew your fingertip back on?

Dr. Eaves (06:04):
Oh yeah. Barely see it right there.

Eva Sheie (06:08):
Oh yeah.

Dr. Eaves (06:08):
See the little cut.

Eva Sheie (06:10):
Yep. I stuck mine in my grandpa's car probably in the 19 early 1980s. I stuck it in the cigarette lighter after the orange was gone and it went back to silver. I went, oh, it must be cool. And I still have a scar.

Dr. Eaves (06:24):
Anything but cool, right?

Eva Sheie (06:26):
Exactly. When did you know that you wanted to be a doctor?

Dr. Eaves (06:34):
When I was at the end of junior high school, beginning of high school, I don't know why. I was pretty anxious about what to do in life. My parents were looking at me, why are you worried about it now? You got plenty of time. But I was, and so dad said, well, I got a lot of friends who do different things. What kind of things you interested in? I said, well, I don't know, engineering, maybe architecture, maybe medicine, and a couple other things. So he made a few phone calls and then we were working in the shop and one of his friends was a plastic surgeon and he gets a phone call and he said, somebody has amputated their thumb in a garage door. I'm going to go replant. You want to go watch? It was like, sure, yeah, why not? And that was back in a different time where the head nurse made sure I was appropriate and didn't touch anything, but you could go observe.

(07:23):
And I watched it and go, this is just amazing. You get to take care of people, you're very connected, you're not, but at the same time, it's very scientific and it's technical and you can use your hands. And that was it. And it was like that day it was like, this is easy. This is what I need to be doing. And I thought about some other, I thought about pediatric surgery quite a bit. I thought about orthopedics quite a bit, but I ended up with that man who was my mentor working for him in the summer sometimes in their group. So I had the bug.

Eva Sheie (07:59):
So that day when they let you come in to the OR were you actually standing at the table?

Dr. Eaves (08:05):
Well, you have to stand back to maintain sterility, and they were making sure that I was appropriate and wouldn't do anything to the patient, but I could see what they were doing. And then they got on their operating microscope to reconnect the arteries and veins and nerves, and you can see that on the TV screen. So that was never having been, and this is in the late seventies, so this is not like you can go watch all this stuff on the internet. This was eye opening to me.

Eva Sheie (08:37):
They had a TV screen. I mean that was probably a very high tech OR.

Dr. Eaves (08:41):
That's right.

Eva Sheie (08:43):
Was it even a color TV?

Dr. Eaves (08:45):
I don't remember that. I just remember there was a little monitor I could watch and see, but I don't remember exactly what it was. It was small.

Eva Sheie (08:53):
It's pretty vivid though. Do you feel like this just happened? It wasn't that long ago.

Dr. Eaves (09:00):
No, it was only 40 something years ago. Not long at all.

Eva Sheie (09:06):
Yeah, you've seen a lot since then. So you first went to general surgery, you were trained as a general surgeon, and then you went to plastic at Emory.

Dr. Eaves (09:19):
That's right. That was the pathway most commonly back then. Now it's a bit different. I was the first six years I was a director of the American Board of Plastic Surgery and we kind of look over how these training pathways have changed over time. So now many people go directly from medical school into plastics residency. When I went through the vast majority, I'm going to say probably over 90%, the general surgery became board eligible and general surgery and then plastics.

Eva Sheie (09:49):
The training at Emory, I feel like is pretty well known as one of the strongest places you can go. And I think a lot of the people who are there have been there for a really long time. They stick around. There must be something really good about Emory.

Dr. Eaves (10:07):
Yeah, I think it was a great place to train. I think it was open-minded. Every program has its personality and I think this was a really good fit for me. You had leeway to do things like go to the lab and do those things and that kind of encouragement. And it wasn't a super strictly hierarchical sort of thing. So I have some people that became very dear friends that are still active there, either full-time on the faculty, or they are now transitioned into a private practice but are still carrying the banner of Emory everywhere they go.

Eva Sheie (10:50):
You also mentioned that you were the director of the American Board of Plastic Surgery for six years and

Dr. Eaves (10:56):
Yeah I was a director. Yes, there's like 16.

Eva Sheie (10:58):
It's like a board?

Dr. Eaves (11:01):
Yeah, it's a board. And then we administrate board certification. So our early goal is to make sure that everybody's out there that is board certified as competent as ethical, well-trained and can take the right kind of care of patients.

Eva Sheie (11:21):
Have you always, well, what were your motivations for wanting to be of service in that space that doesn't come up every day with doctors.

Dr. Eaves (11:35):
I think one, I think for a long time quality and healthcare delivery was an area of interest for me in patient safety. But then I started giving the board exams. So when you take your boards and plastics, you take written exams and if you pass the written exams and you get to sit for the oral exams, and when I started giving those, it was extremely fulfilling because you saw these amazingly bright young people come through that were just well-trained and you had the opportunity to really validate what they're doing and it was great camaraderie to meet with all the leaders. I've been involved in the Aesthetic Society, as you know, and have been president of that, and I love that. What was really different about the board is you're meeting with a hand surgeon, a craniofacial surgeon or a lower extremity reconstructive surgeon, something that's very different than what you do every day. And you find these kind of common threads that bind us and you become kind of part of something a little different, a little broader.

Eva Sheie (12:47):
I may not have the order entirely correct, but at some point, and most recently you were in private practice for 15 years, so how did you end up going out on your own and what inspired you to do that?

Dr. Eaves (13:02):
Actually, I was 15 years in Charlotte, a great group called Charlotte Plastic Surgery. It's one of the oldest plastic surgery groups in the country, and there was just some great people there and I think an opportunity to really continue to do some academic things as I went through practice, but also have that different kind of environment from a private practice standpoint. And then in 2013 I returned to Emory and was there until 2020. And then now my name is anomaly on the door with my wife who's a plastic surgeon in Atlanta. She's the one carrying the ball of clinical practice while I'm working on my other stuff.

Eva Sheie (13:49):
Did you have a specific procedure focus or body area focus or patient focus while you were still doing aesthetic surgery?

Dr. Eaves (14:01):
Absolutely. So I started, one of the really core areas of Emory is in breast reconstruction. So when I started very new to practice, that was probably the bulk of what I did was breast reconstruction, both with implants and autologous tissue. And then I had begun getting involved in the Aesthetic Society through the stuff I did with endoscopic surgery. That was an area that just kind of naturally fell into aesthetics, but in parallel for that, and about 1998 or 1999 was when we started to see a lot of patients with massive weight loss after gastric bypass. And within our group it's like we're starting to see these patients. Does anybody want to take this on as an area of focus? And I said, I'll do it. I love the breast reconstruction, but this was a group of patients that, again, it was new. These are operations you were figuring out because it's not like there were 20 years of publications and things you had to use that innovation in the way that you approached it. So I did that for a number of years and then kind of evolved toward the end of my career. I was doing about half facial aesthetics and about half breast and body aesthetics.

Eva Sheie (15:22):
There's that thread again of you figuring stuff out, being the first one to figure something out.

Dr. Eaves (15:27):
Yeah, some people are the perfectionist. I'm really proud of my wife, she's one of those, if she's at 97%, she's going to get to 99.9% and I get to 80%, it's like we really learned, let's pass that torch to somebody else to carry that ball. I want to go work on the next thing to figure out.

Eva Sheie (15:47):
Yeah, that's a good balance. The weight loss thing is coming around again, and I think there's probably many, and even going to be even many more weight loss, post weight loss patients heading into the future.

Dr. Eaves (16:05):
I think with effective medications, we're seeing a whole new surge of this and I think there's going to be many, many positive things out of it, and there's going to be some unknown things like you hear sometimes some people have GI, chronic GI problems and so forth, but for the most part right now it seems like there's a lot of positive both for overall health and for improvement of quality of life with the weight loss.

Eva Sheie (16:34):
Yeah, it's a big deal. I think watching where it's going to take aesthetics is do you ever feel like things don't change? For a long time we sort of reach a plateau and everything seems like it's going to stabilize, it's going to be normal for a while and then something comes along and you have a few more decades than I do of watching, but I've never seen anything this big. Have you?

Dr. Eaves (17:04):
Mean as weight loss within?

Eva Sheie (17:05):
Yeah.

Dr. Eaves (17:05):
I would actually say in a certain sense, yes. I have seen, so before I got involved, for instance when plastic microsurgery came on the scene. So if you sit there and you look at what we could do, there were times when you could have nothing but an amputation of your leg. And now with microsurgery you could have that done, totally changed the world of reconstruction and things like that. I think when endoscopic surgery came on that made some significant contributions and then we see these various things. What happens though is sometimes described as when these things are new, there's this wave of enthusiasm that people try to use it for everything, and it's the answer to everything. It's like people hear laser and they think, oh, this is the answer to everything I have. And what you find is over time those things settle and they find their place.

(18:06):
Some things fade away, some things continue to grow, sometimes it fades for a while and then a new improvement happens. I mean, think of breast reconstruction with implants and now that we have the various meshes and dermal matrix and stuff that's totally turned around again in a different way and take it to new heights of outcomes. Or you take autologous breast reconstruction where we used to do tram flaps and we were taking huge chunks of patient's abdominal muscles, and now we do these perforator flaps where they're so relatively little morbidity, it's unbelievable. So these things cycle and have a ways of coming back. So you're right, they don't really settle, but it's kind of like you go back to the restaurant and you see people that used to be there and they're back again.

Eva Sheie (18:56):
Yeah, I've been hearing that ultrasound is making inroads in new places recently, so that started to come up again. I was speaking to a reconstructive surgeon last week who was using it. My memory's not as good as it used to be since I had kids. They've kind of ruined, my laser sharp memory is not quite there anymore. But

Dr. Eaves (19:23):
Yeah, so I mean ultrasound's kind of interesting because for several reasons. I mean there's obviously ultrasonic liposuction and so forth for many years. And there can be other sorts of ablations and things that are done in care of cancer patients and so forth. But one of the really big things lately has been using ultrasound as a tool, as a diagnostic tool or as a visual. So you can visualize the anatomy. You can, for instance, if you want to put a block of pain anesthetic to make recovery better, if you can visualize the area, make sure you get right around the nerves or so forth. Or say for safety, if you're doing fat grafts to the buttocks, you can now visualize and make sure you're in the correct plane and you don't have anywhere near the risk of any complications that you might do it blindly.

Eva Sheie (20:11):
And that my impression of that use in BBL is it went from being a nice to have, to an absolute requirement very quickly.

Dr. Eaves (20:19):
Yeah, yeah. I think the Aesthetic Society in general and the ASPS as well really stepped forward when this started to be identified as a potential patient issue. They really put effort and people behind getting some research, and I think Pat Pazmino and some others down in Miami really stepped up to the plate to really define this and then make this so that this is something that you can feel real confident can be done safely.

Eva Sheie (20:50):
I think really as an outside observer, watching the surgeons get together and solve big problems outside of the society, like something like the BBL and the ultrasound and those standards, the data was really scary and then the surgeons got together. I'm oversimplifying, but you all made a plan together and then put it into action and the data immediately changed for the better and saved a lot of lives.

Dr. Eaves (21:19):
No, absolutely. Absolutely. And I think there was some other examples to that. I think there was a period of time when very large volume liposuction was being promoted. People were taking 20 or 30 liters and there were some of these patients that were dying, they were losing too much blood, they were basically being bled out or things like that. And I mean, it was done with good intentions to give the patients what they wanted, but it was not a safe way to do it. And then the societies put their heads together and said, until we get more data, we are going to say, do not do more than 5,000 ccs without admitting the patient to the hospital and creating these safety. And it just stopped overnight when it was identified. So I think as a specialty, the ethical surgeons put their heads together to try to really refine and define what's best for their patients.

Eva Sheie (22:15):
It always comes back to patient safety when you're on the right side of it. And I think we all fight in our own ways. I fight with information and I try to get, every day I go to work to try to get the right information out to people from the right kinds of doctors. There's a bug flying right in front of me. I'm trying to be serious.

Dr. Eaves (22:38):
No, I think you're right. There's an old saying that there's no softer pillow than a good conscience or clear conscience. And so I think when we do those things, when we strive to always be as transparent and ethical and honest to ourselves as well as to other people in those endeavors, then I think good things coming up

Eva Sheie (23:02):
As well said. Well, let's get to, I think you said this almost at the very beginning that now you're an entrepreneur. We haven't even touched that yet. There's probably 50 other things you've done that I would love to hear about, but this is kind of the most exciting. I heard about your invention probably two years ago, maybe a little less. And I kind of fear everything, and so when something new comes along, I really do pay attention because, it's also the reason I love this work because it changes all the time. It keeps getting better and more interesting, there's always something happening. And so a surgeon said to me, and then I used the Brijjit, and this is what happens when I put the Brijjit on and I said, what in the world are you talking about? What's a Brijjit?

Dr. Eaves (23:58):
Is that a question?

Eva Sheie (23:59):
Is it, what do you want to say? What is the Brijjit? Let's go.

Dr. Eaves (24:03):
So if I was talking kind of in all encompassing terms, maybe a little bit technical, it's a noninvasive wound closure and wound support device that offloads tension to improve blood supply and decreased complications such as open wound infection and to reduce scars. So we're just really trying to get one of those fundamental things is that we know that tension on wounds is really a driver of a lot of problems and wound healing. It's kind of like the weather to a certain extent throughout history. People like the saying, you can talk about the weather, but nobody does anything about it. We wanted to do something about tension.

Eva Sheie (24:51):
And it's because people's wounds are unpredictable? You don't know if they're going to heal well or quickly or. So what was the lightning bolt that led you to create this magical device?

Dr. Eaves (25:08):
So there is a story to that. I think part of the thing was understanding that tension is this underlying kind of enemy to good healing. And I had been thinking about this for a few years and one night, I'm really congested, I'm snoring. My wife says, go take some nasal spray and put on a Breathe Right strip. So I'm lying there. And of course at this point I'm wide awake thinking about this, trying to figure out this wounds, how we do this differently. And I said, okay, I got to think out of the box. And I said to myself, well, what is the box? What box have I created? The sense of constraints for this idea? And as I thought about it, I had created this box. I said, you either have to be flat on the surface or you have to be under the surface of the wound to close it.

(26:02):
I said, okay, if that's the box, then I'd go out of the box, I go up, out of the plane of the tissue. And once I did that, I was wearing this Breathe Right strip and then it just kind of hit a Breathe Right strip or similar, they come flat, you put it on your nose and then it wants to snap back. So what if you do the opposite of that? You have a device that's curved, you flatten it out and you put it down. Will it pull things together and create that rotation and project that tension reduction not only at the skin level but below to do that. And that was it. And so I had several other ideas I looked at, but it was the one that just kept working and kept kind of moving forward. And that's the one that we're our first one to market. We have other ideas we're working on, but this is the one right now that we're really trying to get out there and make available for many people as possible.

Eva Sheie (26:59):
What did you do next after you thought of it?

Dr. Eaves (27:03):
Well, the next morning I go and I raid my closet and I had some collar ties I took out of my dress shirts. And I found boiling water and I boiled and I tried to create different shapes and use double side tape. And played with that until I said, wait a minute, I can get this to do what I want. And that was it. That was the next morning. And then I started writing it up. Because I had done some other things and I'd written some patents and done some stuff in the past, I had some idea how to get started. But this was new because this was something that I was interested in doing myself rather than just trying to shop to somebody to get, I wanted to figure it out.

Eva Sheie (27:50):
Who did you call first and say, I have an idea. Your wife or somebody?

Dr. Eaves (27:54):
Yeah.

Eva Sheie (27:55):
Yeah.

Dr. Eaves (27:55):
Oh yeah.

Eva Sheie (27:56):
What did she say?

Dr. Eaves (27:58):
No, she was super supportive and she always is. I think she is the perfectionist. She takes an idea, something, she grows, she nurtures it. That's her thing. And this kind of of the box, brainstorming stuff is I think she appreciates it and so forth, but it's not her happy place. It is mine. So she was always there to listen, but I played with this and then the kitchen counter was taken over for a while. Then I got kicked out of there and then it was the coffee table, and then I finally ended up in a closet in a guest bedroom. Eventually when we moved to our current house, had a basement. It's one of those things that it took a lot longer to evolve than I ever would've imagined.

Eva Sheie (28:46):
Was the name Brijjit something that came to you easily or did that take some time too?

Dr. Eaves (28:54):
I definitely thought about it. I think names are important, and I think especially when it's the first of the new kind of thing, you want it to be something that kind of stays in people's minds that is easy to communicate and so forth. And the technical name and all the patent filings is force modulating tissue bridge. It takes the force, adjusts the tissues, it modulates that and it bridges over the tissue. That's the part that goes up. But obviously that's not a great moniker for a brand. So we actually took it and I've been playing with different ways of bridge and different spellings, and one of the things that I had been made aware of years before is that spellings make trademarks easier to enforce. And you see this now with some of these crazy pharmaceutical names. You look at it and you go, came up with that, but there's no confusing it. So it did that, and then actually my wife really kind of contributed and pulled it all together. I was looking at bridge and then different kind of things, and we played around. Then it kind of stuck. So the company is Brij Medical and the device, our first device is the Brijjit.

Eva Sheie (30:13):
B-R-I-J-J-I-T, which it took me a minute of Googling when I heard the word. I didn't see the word first. I heard the word first and then I had to figure it out and it didn't take very long. I got there. This morning, I was thinking about it when patients start to demand it, when patients start to say, I need you to use this, then you're really up to the next level. And I wonder if you've started to hear patients doing that and telling doctors why aren't you using this yet?

Dr. Eaves (30:48):
We have a few examples. I mean, we're small. We're a startup, we're scrappy. And so a lot of our outreach has been to physicians through social media, but that then sometimes goes down to their patients as well. So we're starting to see more of that, absolutely, for sure. We sometimes have patients that will call us directly and said, my doctor's not yet familiar with this, and would you reach out or could you sell it to me directly so I can use it to improve my scars and things like that. So we deal with that certainly. Yeah, at first it's like, what's that? And then the next year it's like, well, I've kind of heard of that, I'm waiting and seeing. And then the next year it's like, I really need to do that. And then it starts moving. So that's in plastics and that's where we started, cuz that's my home.

(31:42):
But now just in the last several months, just since maybe March, April, we're starting to really look at orthopedic surgery because this is an area we think we can have potentially a lot of impact. But there's other areas as well. Doesn't require anesthesia, so this can be used for lacerations in the emergency room to give you surgical plastic, surgical quality closure without stitches or shots of local anesthetic. It can be used in the field. We've seen it used for OB GYN for C-sections and so forth. So we think there's a lot of opportunities in multiple directions.

Eva Sheie (32:22):
Where do you see it most commonly used in plastic and then in ortho? What kinds of surgeries?

Dr. Eaves (32:28):
In plastics, I think it just kind of naturally fell into the vertical limb on breast lifts, breast reductions, breast reconstructions, because we have such a problem with those T junction breakdowns where the scar at the bottom and people just started saying those disappeared and it makes sense, right? Tension on the wound impacts the blood flow. You've got these little corners of tissues that are huffing and puffing, you offload the tension and that problem basically goes away. So we have two clinical trials, both of which showed a 90% reduction in those kind of wound complications. And one was a randomized trial where one side was done with sutures and the other side was done with Brijjit. And so we think that's incredibly powerful, especially if we can take that now to people that are at risk that have diabetes or other wound healing issues in say vascular surgery or other things where they're real risk of wound problems. So the scar is really important to us in plastics, but in a lot of these other specialties such as orthopedics, it's not having complications is super important.

Eva Sheie (33:39):
Are there photos of that side-by-side somewhere?

Dr. Eaves (33:45):
Yeah, it's actually open source, so anybody can go look at PubMed. So you can look at article. I just search up Brijjit Force modulating tissue bridge and Dr. Jeffrey Kinkle was the principal investigator on that. It's an aesthetic surgery journal. That's one of 'em. The other one was Dr. Holly Wall, and so they can get a sense of those. Jeff's has the side by side, so you can do that. And certainly it's available publicly online through PubMed.

Eva Sheie (34:23):
I'm just going to pull it up really quick since is that the photo?

Dr. Eaves (34:27):
That is a photo from the article. And then they will have also side-by-side showing open wound without, so if you open the whole thing, it's open source so anybody in the public can look at that. They don't have to have a subscription to the journal, so they can just go to the PDF of the entire article. And yeah, there's some other ones in there if you click down some other different patients. There's another example. You can see that big black area,

Eva Sheie (35:03):
This was

Dr. Eaves (35:04):
In the bottom

Eva Sheie (35:05):
Regular suture and this was the bridge?

Dr. Eaves (35:08):
Yeah. They'll have to look at, you can look at the labels. If you go on down, there's even, yep. So here on you can see the side, the second picture is the breakdown that you had that happened with the sutures. And then you can see there's none with the Brijjits.

Eva Sheie (35:31):
Oh, especially down here. This is the T that you're talking about down here at the bottom?

Dr. Eaves (35:36):
It looked like they may have had, if you look at number B, they probably had a little bit of breakdown at the top too, the upper T, you'll see that every once in a while you can see that white there.

Eva Sheie (35:47):
A lot of times I think consumers, prospective patients and the general audience who's looking for a surgeon, we're just used to seeing the prettiest before and after photos and not the ones that are in the journal. And I agree with you, it's amazing when you can actually read the full journal articles and most of those aren't accessible to us regular humans, unless we call somebody and say, I saw that you wrote, I did learn that if you saw that someone wrote an article, they are almost always willing to send it to you if you want to read it, if you just send them a nice note.

Dr. Eaves (36:24):
Yeah, no, absolutely. I think a little homework you can definitely do. I think caveat mTOR buyer beware a little bit. Things that are free online, I was going to say sometimes can be great, like The New England Journal of Medicine has a free section and things like that. There are a number of predatory kind of journals that are, we call basically fake journals as you can pay $3,500. A bunch of these are administrated overseas, they manage to get themselves indexed. They say they have peer review, but it's like basically pay to play. So if somebody wants to put something out there they can. So I think this is where it's really helpful, if you find something interesting, do some homework, but then confirm what the source is. That's like everything right now, right? With the internet and everything, how much fake whatever is there. And certainly we see poorly done studies, but we also see studies that are just basically marketing that has been framed as a clinical study.

Eva Sheie (37:33):
Is that, let me give you a good consumer analogy when you see, As seen in the New York Times, but they bought an ad in the New York Times and so then they say they were in the New York Times, like that?

Dr. Eaves (37:43):
Exactly.

Eva Sheie (37:44):
Yeah.

Dr. Eaves (37:45):
I think one of the things for me is, and I won't, our total team wants to generate as much clinical data. We don't only be putting out something there that's not doing what we want for patients and really fulfilling that dream. And really the way you support that and you get better and you bring it to more people is to create good data that takes time. You have to get a lot of people's hands, you have to have a lot of procedures done. Sometimes you have to fund studies to get that data. But for several years I was an evidence-based editor for the Aesthetic Surgery Journal. So it's an area to me that's just personally very important. You want to have this fun and create this thing, but then you want to back it up so that hopefully 20 years from now people will go, wow, that was really cool. And look at all now how much we know now.

Eva Sheie (38:42):
Do you have one there? Can you show us how it works? We've been talking about it for a while and I feel like the magic is like when you actually see it.

Dr. Eaves (38:51):
So the box, we're redesigning the box, but that's the current box you see in the back and you see it right here. It comes eight in a box and then it's a pack like this. And you open it up and it has an applicator and it has the devices. And nurse can just dump that on the surgical field. It's sterile. And this is our first model, it's the BP 75, the one we have the most experience in. Then we have our second model, I mean the BP 100, the BP 75, which is smaller and the ends are tapered to go around areas like the areola or in foot and ankle surgery when you're in tighter curves or more curved surfaces. So these are on their loading tray. This is by the way recyclable. That was one of our values. We wanted to do the applicator, this and the tray are all marked with our little recycling logo, which makes me feel good.

(39:48):
And then it has this applicator and the applicator has these little pins and what you do is just slide it in, it clicks, you roll it off. And then this is special part of the innovation is these little flaps in the peel liner here that allow that to come up. They create a micro air bubble that then releases it from the plastic, otherwise you couldn't lift the thing off at all. And then to apply, think of it like loading it, you squeeze and now it's ready to go. And what you do is you would put it, and I'll use my hand as an example if I can and say the thing, going to go down, going to relax and now I'm going to release it. And you can see, I don't know if you can see now it's on my hand. Lemme do another one. I can put an area. It might be a little bit easier to see here. So again, I'm going to click, roll, lemme go where it's a little fleshier, maybe I can get a, here we go, I'm going to squeeze, press, let go. And it does, it'll pull that in. I'll get out of the shadow in a second, and now it's on. So if you look at it now, I think you might be able to see that the tension is off. You can see it averted and lifted up in the middle and that's it. It doesn't hurt if I do it this way, you can see it pressure. I can move, it moves with me, I can take a shower and so forth. So this can be used to close wounds. It can be used to support the scar.

Eva Sheie (41:25):
How long does it stay on? Does it fall off by itself?

Dr. Eaves (41:29):
It does. So you don't have to have it removed like sutures or staples or something like that. Typically it's going to stay on a minimum of 10 days. Usually it's more like two to three weeks. It depends on the area. If it's an area with a lot of movement, it's toward the lower end of that. On the breast we've had some people say it lasted longer than a month in certain situation. As long as it's well adhered, it's taking that tension off the skin. It's going to help create a healthy environment for wound healing and should help the scar improve.

Eva Sheie (42:01):
If the patient's Brijjits fall off too early, can they put them back on themselves or do

Dr. Eaves (42:07):
Yeah.

Eva Sheie (42:07):
They can?

Dr. Eaves (42:09):
They can. We haven't really been seeing that. If the surgeon prepares the site right to get it to stick, one of the big learnings was is that you would want to use an alcohol pad to decrease. So it's just a standard alcohol pad we would use in surgery and we would just go on either side and just basically you're exfoliating a little bit, you're rubbing off the oils. And when you do that, it usually sticks really well.

Eva Sheie (42:37):
That's really remarkable. And I think the magic is the simplicity. That there just are no barriers to using it, understanding it, talking about it, remembering it.

Dr. Eaves (42:53):
Yeah.

Eva Sheie (42:53):
I think there just is so many good things about how much thought you put into it.

Dr. Eaves (42:59):
Well when you look at it, on one hand it's so super simple,

Eva Sheie (43:02):
Yeah.

Dr. Eaves (43:03):
I had people say, what'd you, did you do that in your basement in a weekend? And I said, no. It took many millions of dollars more than a decade, bunch of engineers to get it to the point that you can manufacture it and you work out the kinks and it works over and over and you get the right adhesive, so there are no allergic reactions, and so it doesn't cost blisters or irritations or things. There's 10,000 things to work out. But when you look at it and you go, okay, it just rotates open, rotates back. These little struts are really important because they create this dual axis of rotation that when you let go, it's going to pull things together and push that tension reduction beneath the surface. And that's probably why we're seeing those decrease in wounds. It's taking the tension off not just on the skin but underneath as well.

Eva Sheie (43:57):
It's maybe too much of a marketing question, but I am a marketer, so I'm going to ask it anyway.

Dr. Eaves (44:03):
I'll do my best.

Eva Sheie (44:04):
Can you quantify the ROI for a patient on using or being the recipient of the Brijjit?

Dr. Eaves (44:15):
I think you can. I think that is some of that data that comes more and more of a time. So for instance, we believe this reduces the risk factors for surgical site infection. We know that foreign body by taking off that final layer of suture, by decreasing open wounds so that themselves can become infected and then advanced down by preventing necrosis. So those are the kind of things that, for instance, if you can one in a hundred patients decrease an open wound in a deep infection around a knee implant, you're talking around somewhere north of 65,000 and maybe well north of a hundred thousand dollars to treat that complications. Some they'll require repeat operations, more time away from work, potential for complications from that. So that's on one hand, if you look at somebody that doesn't get T junction breakdown and says for very little, I didn't have all that anxiety, what's my scar going to look like?

(45:14):
Am I going to have to go back, have a scar revision? I have to do dressings on this for six or eight or 10 or 12 weeks. I'm scared because I don't know what's going to happen. Is it going to infect my implant underneath and now I've got a problem? So I think those ROIs are different. And then for some patients it's like I had this huge surgery and if I get a terrible scar and I can't wear a bathing suit comfortably, what have I, have I really accomplished what I want? And if this can help them get there, that's big part of that ROI.

Eva Sheie (45:48):
From the Marie Oleson side of things, I think she would say, and because she's my mentor and it's been drilled into me. And it is what I believe too because the data supports it, that when a patient's prepared for recovery and recovery goes well, they're twice as likely to refer you and recommend you to a friend. And so if having a smooth, easy recovery and incisions that heal beautifully and look great later, this is the purpose of aesthetic surgery is aesthetics, then it's easy calculation to see how it would turn out.

Dr. Eaves (46:25):
Yeah, I a hundred percent agree. And I think the other side of that as we get outside plastic surgery is potentially decreasing just the risk of significant problems that could impact a person's health or recovering in a very physical way. But that's why it's kind of exciting about it. There's the both sides of this. This is improving wound healing in terms of wound outcomes and preventing complications, but at the same time really trying to give people agency. For instance, if they want to reapply for scar therapy that they can have some control. We had just an amazing patient, a younger lady that it was a dental student and she had had a very large scar on her forehead from something that had to have an excision of that. And it kept widening. So she had a scar revision and widened again, had another scar revision widened.

(47:22):
So I have a lot of respect for the surgeon that took care of her. And he called me, he said, Monte, what do you think? Could this help? And I said, I think it's, it's absolutely worth a try. This young lady has this huge car on her forehead. I don't want to say it's debilitating, cuz she was very beautifully adjusted, confident young lady, but it was such a big thing in her life. And so not only did she wear these, but this became kind of her thing. And she wore it to class in dental school and she kept reapplying. And eventually I said, I think you've worn it long enough. I don't think you need to keep doing this. But it gave her a sense of agency that she had some control over how she's healing. And I think for us as physicians, we suture and do the best we can and we leave the OR and what can we do at that point? You hope for the best or you hope whatever your dressings or something complex like, closed incision, negative pressure wound therapy or things like that. But can we do some things that give us some control over this healing process? And that's, to me a big part of the excitement of doing this.

Eva Sheie (48:38):
Can you give us a little sneak preview into what's coming?

Dr. Eaves (48:43):
Well, I think, well for now, a big thing is looking at, on a couple of phases. One is really generating more data. We're going to be doing some data in orthopedics, especially things like total knee, total hip reconstruction, foot and ankle, very interested. We're doing some exciting research to quantify, hopefully improving blood supply at the incision to make a healthier environment for the wound using SPY and near infrared, I think that's be very exciting. And then I think we're going to be looking at new sizes to really help custom fit to certain areas and other specialties and other surgical procedures to bring that. We have other things in the pipeline that we'll start to bring forward later. I'd love to do some of these same things that we're doing on the surface for deeper tissues as well as an example. So that deep tissue healing while scar, visible scar may not be that important, last thing you want is deep tissues not to heal well.

Eva Sheie (49:50):
Where's my mind blown emoji? I just.

Dr. Eaves (49:52):
It's fun.

Eva Sheie (49:54):
That's incredible.

Dr. Eaves (49:56):
Yeah, you get going down this hole and it's fun.

Eva Sheie (49:58):
Yeah, it's, it's fun. So where can we find out more about the product and potentially try it? How would we go about, if I'm a doctor or someone who is interested in trying it?

Dr. Eaves (50:13):
They just go right to brijmedical.com, BRIJmedical.com and there they can get contact with the team, they can see some stuff. They'll have all the clinical data is posted there so that they can read about it. They have some tutorials for how to do. They can, through that, they can let people know that they're interested. We can connect them with either somebody in sales in their area. We can do online training. It's obviously simple to do. So there's multiple options we can do to fit their needs.

Eva Sheie (50:49):
Where will we see you in person at conferences coming up this fall?

Dr. Eaves (50:54):
Let's see. It's gotten pretty busy for me travel wise. So this coming week I'm at the Clinical Orthopedic Association meeting in Tampa. I come back for three days and I go to Vancouver for the foot and ankle orthopedic surgery meeting. I come back and then we have some more business related travel for really broadening exposure. And then we'll be at the plastic surgery, the meeting in San Diego, and then I get about a week off and then we do a whole nother round like that. So we'll be at several.

Eva Sheie (51:33):
Well, I will see you in San Diego.

Dr. Eaves (51:35):
We'll look forward to it very much.

Eva Sheie (51:37):
Thank you. Thank you so much Dr. Eaves. I want to talk to you for another hour, but we don't have another hour today, but we can come back.

Dr. Eaves (51:45):
We can always do another time if there's anybody interested.

Eva Sheie (51:47):
Yeah, I'm sure this is not the first time that we'll be hearing from you.

Dr. Eaves (51:51):
Well, thank you so much. I appreciate you and great questions. It was a real pleasure to talk with you.

Eva Sheie (51:57):
Thank you.

(52:01):
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 Meetthedoctorpodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.