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.

(00:32):
Welcome back to Meet the Doctor. My guest today is dermatologic surgeon Ron Shelton, who is in practice in New York City and he's an expert or has deep expertise in lasers. Welcome to the podcast.

Dr. Shelton (00:46):
Thank you, Eva. It's a pleasure to be here.

Eva Sheie (00:48):
Thank you for taking time on a Saturday to come sit in a dark room with me. <laugh>. It's beautiful day.

Dr. Shelton (00:54):
It is a beautiful day, finally, but it's very nice to be here.

Eva Sheie (00:57):
Now are you a longtime New Yorker before you were even a doctor, were you here?

Dr. Shelton (01:01):
I am. I was born in New York City in Manhattan.

Eva Sheie (01:05):
Mm-hmm. <affirmative>. So I bet you probably couldn't imagine living anywhere else but here.

Dr. Shelton (01:09):
Well, I have, and it would be very interesting to live in other areas. I've lived in San Francisco and Los Angeles and San Antonio and Virginia all for training as well as serving the US Air Force as a physician. And many of the places that I lived I really enjoyed. But once we decided to bring up family, it was nice to come back to home and be with our families.

Eva Sheie (01:40):
You said Air Force and San Antonio almost in the same sentences. Are those two connected? Is that why you were in San Antonio?

Dr. Shelton (01:46):
I was, yes. Yeah.

Eva Sheie (01:48):
So you were stationed at the base there?

Dr. Shelton (01:49):
Correct.

Eva Sheie (01:50):
How long were you there?

Dr. Shelton (01:52):
San Antonio was three years. Yeah. And Virginia two. And Los Angeles two.

Eva Sheie (02:01):
So how long were you in the Air Force?

Dr. Shelton (02:04):
 seven years.

Eva Sheie (02:05):
When you were at the beginning of your career?

Dr. Shelton (02:07):
It involved scholarship from medical school. Mm-hmm. <affirmative>. I didn't want my parents to be feeling like they had to watch their expenses. And three years was residency while I was in the Air Force. Yes.

Eva Sheie (02:23):
What is dermatology like in the Air Force?

Dr. Shelton (02:26):
The same as the civilian sector. I was very fortunate where I was, because we had a superb faculty. We had five hours of homework per se each evening. And you know, some of our faculty went on to Harvard. One of my passions is most surgery, I had the fortune of studying under Dr. Stuart Salasche, one of the nation's best Mohs surgeons, unfortunately has passed away recently. And I was able to have my office and exam room for three years and saw the same patients. Unlike many hospital programs in the civilian sector where residents are forced to go to multiple different hospitals through the week. Any surgery I did, those patients were coming back to me for follow-up. So I really got a very good education as to how wounds heal, what complications look like, and I was able to help my patients through it rather than having a colleague help them. And I found that very beneficial throughout my entire career.

Eva Sheie (03:34):
I'm a little surprised that that's not the normal way that doctors are trained and I can see how that would be an advantage.

Dr. Shelton (03:42):
Yeah. And the other thing with the Air Force is, you know, you get to treat the active duty, so the age ranges, you know, from the twenties until seventies, but you treat their dependents and the retirees and there's a very big pool of retirees in San Antonio. So there was nothing we didn't see. We had an incredible burn center on the army post where I actually learned dermatology.

Eva Sheie (04:07):
And the patients were all either in the military or related to someone in the military. Yes. It's a little bit curious when you say there were lots of burn patients, but were they being burned at work or just by accident?

Dr. Shelton (04:24):
No, no, these were trauma cases. San Antonio had a very, at Brooke Army Medical Center, a very big burn center. So there was a young boy in a field struck by lightning and I heard it on the radio. And that morning at five I before work went to see him and examine him and learn what those injuries were. And the nurses taught me a lot. So it's, it was for civilians as well.

Eva Sheie (04:49):
That's really interesting.

Dr. Shelton (04:51):
It is. But it, it really, the traveling you were asking about New York is my home and it's great to be back and we see so many different patients in our practice because so many people do travel here.

Eva Sheie (05:07):
San Antonio and New York City are pretty different. Sure. But people are the same, you know, patients don't tend to change too much from place to place.

Dr. Shelton (05:18):
No, absolutely.

Eva Sheie (05:20):
So you were in the Air Force and then eventually as most people do, it's time to be out of the Air Force. Right. So what did that transition look like for you?

Dr. Shelton (05:32):
Well, already in the Air Force, I knew that I wanted to study dermatologic surgery. And so I applied and was accepted into a very prestigious fellowship in University of California San Francisco, where I learned laser dermatology and Mohs micrographic surgery for skin cancer and reconstruction. It was one of my best academic years of my life. Plus my daughter was born that year in San Francisco. And then we moved back to New York because I had a position that I was hired by the Mount Sinai Medical Center to start their Mohs surgery unit upon my graduation. That was in 1993. You weren't even born <laugh>.

Eva Sheie (06:18):
Sadly you're wrong. <laugh>. I was almost in college by that point.

Dr. Shelton (06:24):
All right.

Eva Sheie (06:26):
But I, I'm going to take that as a compliment to my dermatologist. So thank you.

Dr. Shelton (06:30):
Yes. You're welcome. Well deserved <laugh>.

Eva Sheie (06:33):
So Mohs surgery, I think it's unusual to hear that someone is passionate about Mohs surgery except for maybe, you know, one reason is it's so life-changing for people to be able to help them with that. Right?

Dr. Shelton (06:48):
It is, it's very important. Skin cancer abounds. Most of us are better these days to use our sunscreen and know to not abuse our sun without protection. Midday summer sun. But the damage was done 30, 40 years ago and our immune system can't keep up with that, especially with all the current stresses the immune system goes through, including current sun, other illnesses, mental stress, god forbid, someone smoking, et cetera, et cetera. And so skin cancer is so prevalent and when someone has it on their nose or their eyelid or their lip or their ear, they are very concerned. And I get to see people coming into me who obviously are very anxious and they leave with a big smile on their face, often feeling that, you know, this was incredible and they don't even know how to verbalize that. It was an enjoyable day.

(07:43):
We have incredible staff. I refer to my nurses as angels and we get them through it. And most people, I'm talking about 95 plus percent deal with a really good result. And that to me is the most rewarding thing to see an anxious person get through it and move on with their life. And cosmetically, we do a lot of things for our patients that are interested in improving photo damage from the sun and and the aging process. And what's been great to learn that discipline in fellowship and continue through my career is I've been able to apply that to my Mohs surgical patients as well. So we're not talking about injecting filler in the lips for a Mohs patient, but we can do lots of different lasers on scars to improve them at the right time while they're healing.

Eva Sheie (08:39):
It sounds like you're suggesting that there may have been a less aesthetic component to Mohs maybe in the past.

Dr. Shelton (08:47):
That is an understatement. <laugh>, what Dr. Mohs deserves is just a little background. He was a general surgeon in Wisconsin. He was researching how to cure cancer and was using a paste that was applied to the skin to kill the cancer. It also killed the living skin around it. So when the cancer was creating like this ulceration or hole from the paste and would create this significant defect, patients were just allowed to heal on their own. The wounds would heal.

Eva Sheie (09:26):
Sorry about the hole.

Dr. Shelton (09:27):
The wounds would heal. Yeah. But then, you know, with World War II, there was a lot of development of plastic surgery for reconstruction and suddenly that took off like wildfire. So yes, in the mid seventies is when most surgery really got reinvented with what we call the fresh tissue technique. And the turnaround time for the laboratory is not as long and the reconstruction can be done immediately, but when you have this hole from the paste, you had to let the rest of the skin kind of ulcerate and heal before you could touch it surgically.

Eva Sheie (10:08):
When did they stop using the paste?

Dr. Shelton (10:11):
Not sure. I mean, even in the seventies and eighties, maybe some more senior physicians were still using it. But I would say sixties, seventies.

Eva Sheie (10:21):
And what do they use now?

Dr. Shelton (10:22):
It's fresh surgery. There's no paste. We are just numbing with a little local anesthetic and removing it surgically as it would be removed conventionally. But it's how it's processed in the laboratory cuz we look at a hundred percent of the margin.

Eva Sheie (10:36):
So the surgery isn't done under a microscope itself, is

Dr. Shelton (10:38):
It? No, it's the tissue that's analyzed under the microscope by the surgeon later after it's processed in that next hour.

Eva Sheie (10:45):
So pretty, pretty close to real time.

Dr. Shelton (10:48):
Pretty close, but not intraoperatively.

Eva Sheie (10:51):
And are you looking under the microscope or somebody

Dr. Shelton (10:53):
Else? Yes. The most surgeon must be the pathologist. Mm-hmm. <affirmative>.

Eva Sheie (10:56):
Oh, interesting.

Dr. Shelton (10:57):
It's fascinating.

Eva Sheie (10:59):
It is fascinating. I don't want to get stuck there for too long. Okay. I've always wondered about this because you know, I've been looking at the internet mm-hmm. <affirmative> in aesthetics for over 20 years and I remember seeing the photos of the people with the holes. Yes. So it really hasn't been that long since this has improved and gotten better.

Dr. Shelton (11:20):
Correct. Correct.

Eva Sheie (11:22):
Is that, do you think, because there's a much heavier focus on aesthetics in our culture today?

Dr. Shelton (11:28):
Absolutely. Yeah. In fact, I have to tell you, many years ago when I wanted to make it known that I'm doing cosmetic treatment and it's been 50% of my practice from day one, I never thought about posting Mohs reconstructive photos. And one day, and it wasn't that many years ago, the light bulb went off and I started posting on RealSelf as well as my website, reconstructive photos of my patients that I've done. And that gets an incredible draw. People come to me from by looking at those photos they on, unfortunately in today's time there are people who do not see their doctor because they know there's a problem, but they don't want to hear it because they know then that they're going to have surgery and they're going to be scarred or disfigured. So two, three years later when that skin cancer is actually evolved into an open hole in ulceration and they're forced to get treatment because of a quality of life, you can't put makeup on a bleeding ulcer. It's much more difficult to do reconstruction to make someone look excellent. So these pictures are bringing in patients at the earlier stage. They don't have to deny.

Eva Sheie (12:54):
There are probably a few other factors too. And maybe one might be that people don't know, they can choose who does their Mohs surgery. And we want to be able to choose that because we recognize, especially if it's on our face, that there's going to have to be an aesthetic component to that. Correct. And the other, I didn't realize until I spoke to a different, another one of your colleagues this morning who may, you may or may not know, but she said she needed to do Mohs surgery on somebody and their deductible was so high that they decided they weren't going to go forward with it because they couldn't afford the deductible.

Dr. Shelton (13:30):
It, it's one of the saddest things that we see.

Eva Sheie (13:33):
I'm sure.

Dr. Shelton (13:34):
Yes.

Eva Sheie (13:35):
So let's transition to cosmetic a little bit. Sure. And especially laser, because lasers are really exciting. There's so much that can be done now and you've kind of seen that whole progression from a handful of modalities to where we are today. So,

Dr. Shelton (13:52):
Oh, that's very well said. In the early nineties when I did establish the dermatologic surgery division at Mount Sinai Medical Center, I queried our voluntary faculty as to what need they would have in their patient population to treat unwanted redness of the face, port w stain birthmarks, red scars, as well as brown spots. And there was enough demand that I was able to acquire the Vbeam laser, which is a very common laser we use for rosacea. Port wine stains, red scars, and the ruby laser for sunspots liver spots, brown spots. This took off like wildfire and at that time there were only five dermatologic, most surgeons in the city and very few with lasers. Dr. Roy Geronemus had a very big laser practice and eventually I joined his practice. So we've seen now in our practice we have a hundred devices. Some of them are duplicate because they're in such constant demand.

(15:08):
And we do have 12 physicians that, and five floors that we have devices. Some of the similar ones on the, or the exact same ones on different floors. But you know, when someone comes with a tattoo, depending on the color, we can choose. And there really has been an incredible advance in laser tattoo removal technology with the shorter picosecond pulse duration lasers that cut down on the number of treatments. We have lasers for, as I said, unwanted brown spots, but also for melasma, the mask of pregnancy or hyperpigmentation, although that can be very difficult to treat wrinkles well. What kind of wrinkles? What kind of acne scars? Big part of my practice is acne scar treatment, microneedling with radio frequency. We have several lasers for resurfacing and including fractional carbon dioxide, fractional erbium, totally abl of erbium. What does all this mean? It means that we don't just to have to use our hammer, the one hammer we have and everything looks like a nail. We get to look at the patient, different parts of the face or arms or legs and determine what's the be best wavelength, what's the best laser. And often we're using multiple devices on the same patient.

Eva Sheie (16:34):
I visualize your office like the FAO Schwarz of lasers and energy devices. Like there's multiple floors and there's so many.

Dr. Shelton (16:43):
Yeah, we just don't have big teddy bears.

Eva Sheie (16:45):
No teddy bears.

Dr. Shelton (16:45):
Well actually one physician <laugh>

Eva Sheie (16:48):
The, the physician is the teddy bear, right?

Dr. Shelton (16:50):
<laugh>, is it you? No. <laugh>? No, I'm not big <laugh>.

Eva Sheie (16:54):
Which one's the teddy bear?

Dr. Shelton (16:55):
Oh, I can't say.

Eva Sheie (16:56):
Okay. Well if you are, if he's listening mm-hmm. <affirmative>, he knows who he is, right?

Dr. Shelton (17:00):
I would think

Eva Sheie (17:01):
So. Okay, good. <laugh>, how has this broad view, I think you're probably the only practice in the nation to have that many devices. Is that

Dr. Shelton (17:12):
Fair? No, there No, it's not fair. There are a few, A handful. There's a handful. Yes. Absolutely. And are

Eva Sheie (17:16):
You all collegial with each other? Do you talk to each

Dr. Shelton (17:19):
Other? Oh, absolutely. This is, you know, it's not just how we learn from each other, but as you're embarking upon a newer device, it's really nice to reach out to colleagues who might have used that more than you. And it's amazing how quickly I get a reply from some of my colleagues, whether in Chicago, Florida, west coast, and it's really a big family. People that just really want our patience in the end to get the best result. That's the end reward.

Eva Sheie (17:54):
Now I want to ask you something that might be maybe a little controversial, maybe not, but I heard about micro coring mm-hmm. <affirmative> last week. Yes. And I, we did a long episode about Ellacor. And I am curious what your take is on that one.

Dr. Shelton (18:11):
Well, why would that be controversial? May I ask before I answer?

Eva Sheie (18:15):
Well, doctors often disagree with each other until they figure stuff out. Right. So that's the only reason that it might be. But I also find that no matter what I ask you, I'll already have an answer. Ready. So <laugh>,

Dr. Shelton (18:28):
No. I would say that there's big promise with Ellacor. Dr. Geronemus has used it extensively in the IRB testing and using it on our private patients going forward. I've been trained in it and I'm interested in using it. I have treated one of my long-term patients and still awaiting to see the results. I believe that with any device it takes time. There's a learning curve because you are making improvements yourself to the technique that was taught to you. And that's what I'm in the midst of with Ellacor. But I think that I've been impressed that the short term shows virtually no downtime. And that was initially one of my big concerns. But I always have to believe for myself, you know, I really appreciate the representatives of the company coming to me, educating me about the device. And as much as I trust them and their company to tell me what the results have been, I still have to see it for myself not just in the first week month, but I have to see it over years. How does that transition to true effects? You know, is it tightening? Is it tightening, lasting? Is it really lifting? Are the lines going away, et cetera?

Eva Sheie (19:58):
The way I heard the Ellacor described was that instead of injuring the skin, the way that the thermal devices or radiofrequency devices, they all depend on creating an injury to then stimulate healing was that there is no injury with Ellacor, it's just removing.

Dr. Shelton (20:17):
But that is injury.

Eva Sheie (20:19):
That's what I thought.

Dr. Shelton (20:19):
It's not, it's not thermal injury, but you are removing. So when you think about getting a vaccination, that little needle prick, you know it, it's an injury, it's going into the dermis or muscle or fat and that your body responds to heal and it responds with collagen production. It may be extremely minute and no one would notice with a vaccination needle. But once needles are larger or the thermal or heat response to a laser is significant to produce collagen, then you start to see improvement, whether it's micro coring or thermal injury.

Eva Sheie (21:05):
One of the seats I sit at a lot is how do I translate what I'm reading from the company? Mm-hmm. <affirmative> or what I'm reading from, you know, the the highly approved language side of things, right. To what is really going on here for the consumer and, and how do I make it make sense?

Dr. Shelton (21:20):
But the doctors are going through that too, right. You know, we go go to conferences to see new devices and that's what I'm saying, we have to see it for ourselves. So I reach out to colleagues of mine and now being in a very big prestigious laser cosmetic dermatology practice, we are at the forefront. We are in involved with a lot of the research for the lasers. And I learn from my colleagues that are more involved with the primary steps of the research than I. But then as I said, I'm able to reach out to national colleagues as well. That sorts through a lot of the hype because I've said for many years I remember the olden days where new treatments had to be practiced for quite a while to see the one year follow-ups before they were put into a journal article. And now we're getting things direct to consumer before physicians have a chance to use the devices.

Eva Sheie (22:30):
Is that good or bad?

Dr. Shelton (22:32):
I think that's bad because I have to remain neutral and make sure that my patients get as true a story as possible. And again, I have to believe it for my own eyes. I have to read the science, which I do. I have to believe in it to promote to my patients what I think would be not only good for them effectively, but safe for them.

Eva Sheie (22:57):
Can you think of any technologies that you've seen kind of come and go that looked like they were really promising and then fell flat and disappeared?

Dr. Shelton (23:07):
Yes, I do a lot of body tightening treatment. I mean it's, it's a passion for mine and the last several years there's really been a big push for that. The companies are seeing the market demand and so I've seen a lot of devices, there is a lot of hype about it. But some years ago I was actually very enamored with the science of some ultrasound devices to reduce fat. And I was also awaiting for that. But it took many, many years for the FDA to approve it. And while they were still waiting, CoolSculpting evolved and I started CoolSculpting at that point and have had a lot of experience with CoolSculpting. Fortunately very significant high patient satisfaction rate. And when the ultrasound treatment did come out, I didn't see the results. I didn't, you know, I had spoken with the lead investigator, I saw the treatment being done, I saw the studies, but I could never get the improvement that was shown to me. And the same thing with certain radio frequency devices including massage with radio frequency. And I did not see the benefit.

Eva Sheie (24:35):
Have you ever seen any that you thought might not work that then surprised you? Has that happened too?

Dr. Shelton (24:42):
No, nothing's coming to mind right now. Although that might have occurred. If I think of it, I will let you know.

Eva Sheie (24:48):
You probably at this point don't really get excited until you start seeing anything happen. You know?

Dr. Shelton (24:55):
Well we were very excited when collagenase came out, the enzyme to break up collagen to treat cellulite.

Eva Sheie (25:05):
Yes, I remember this.

Dr. Shelton (25:06):
And unfortunately it was a lot of bruising and so I was about to embark upon it and it took them a while to get on the market because it happened that COVID, the pandemic evolved right before. So when it did come to market, that's when the bruising potential was noted. And so I never really treated my patients with it. We have had some very good success with restonic force cellulite and we're working with other devices for skin tightening that might improve cellulite, including the soft wave, high intensity ultrasound. And we'll be working with minimally invasive procedures as well. We had initially done work with Cellfina for cellulite and I wasn't happy with continuing the treatment. I just felt there was too much downtime and there was some hyperpigmentation or darkening and certain individuals from that trauma. But Avéli is a relatively new device that I'll be doing.

Eva Sheie (26:23):
There's a lot of people excited about that one. Yes. And it's, it's pretty simple. It's almost like the entire fat cellulite treatment was scaled all the way back to the simplest part.

Dr. Shelton (26:35):
Yes. I mean it is minimally invasive. There is some anesthetic involved local anesthetic injected into the area and I would expect going to be some bruising and swelling. The RESONIC is an acoustic treatment and we're one of the 16 centers in the country that have been using it from day one. It's not really marketed yet, but it's totally noninvasive, very well tolerated. The discomfort factor is for the average patient, not more than two out of 10. Maybe certain areas might be a little bit more just for that one minute per treatment. And we're still trying to perfect that. We're still trying to improve it.

Eva Sheie (27:20):
The treatment takes one minute?

Dr. Shelton (27:22):
No per dimple of cellulite. Ah, it's anywhere from one to four minutes now and eventually it'll be one to two minutes.

Eva Sheie (27:30):
That sounds promising. Yes. So let's come full circle here. Okay. And very early in the beginning of this conversation, you mentioned your family and I'm curious if you could tell us more about them.

Dr. Shelton (27:43):
Well, I'm blessed to have a really great family. It's my wife is a very bright, knowledgeable woman who tries to keep me younger in my thinking and more socially active to know what's going on in the real world as I'm at the office for, for so long and dealing with medicine. And she has really brought up an amazing pair of children. My daughter is 30 and just about to be married and couple of weeks. And my son is 28 and is a, an expert angler fly fisherman and is a general manager of a high-end fishing resort in Montana.

Eva Sheie (28:26):
In Montana?

Dr. Shelton (28:26):
Yes. So the side benefits are going out there to visit him and see the fruits of his labor while enjoying that beautiful nature and and fishing at the same time.

Eva Sheie (28:36):
Do they know he is from New York City and they've still let him in?

Dr. Shelton (28:39):
They still let him in? Yes.

Eva Sheie (28:43):
 do you think he'll stay there forever?

Dr. Shelton (28:46):
 he will stay I think in the outdoors and environment. He's been back to New York and does well with it. But I don't think that's his passion.

Eva Sheie (28:55):
Does his cell phone work out there? Can you still reach him? Yes. Oh good.

Dr. Shelton (29:00):
Yes. When he picks up he's probably busier than I am. <laugh>.

Eva Sheie (29:04):
It's in the waterproof pouch and it's hard right. Hard to answer. Yes. Yeah. When's the next time you're going to go out there to see him?

Dr. Shelton (29:12):
Probably August or September.

Eva Sheie (29:15):
It's beautiful. It's not very warm though

Dr. Shelton (29:18):
At that time. No,

Eva Sheie (29:19):
Not ever. Pretty much all year. It's not warm in Montana. When patients come to see you for the first time, what can they expect from that visit?

Dr. Shelton (29:30):
A healthy amount of conversation after listening to them. I really want to hear from them what's bothering them, what they want to see improved. Often I pass them a mirror so they can, as I say, "take me on a tour of your face tell me what bothers you." And then we candidly go through different alternatives and tell them what I think does work. And there are a fair number of patients that come to me that should not have treatment for what they're interested because there's too higher risk that it won't be effective enough to make them see improvement. I don't want them wasting money. I don't want them doing something because they saw it on Instagram or direct to consumer if I don't think that it's going to work on them for their particular indication. So we talk about what does work and the reality of mm, this may take a few laser treatments, this may take several syringes of filler.

(30:34):
If your budget is of X amount, I'm not just going to put in one syringe to fulfill that budget if it's not going to do anything. I'd rather you not waste that money when certain individuals come to me and they want Botox and fillers and a laser or radio frequency to tighten their face. But they could spend an incredible number of thousands of dollars to do all that. And in the end, their sagging is so much that they are a true facelift candidate. I'm going to tell them, save all that money that they would've spent with me and use it as a down payment towards their facelift. There are other people that can have a facelift surgically, medically, they can't undergo that surgery. And then we can do those things. Mm-hmm. <affirmative>. But certainly the patient will come in and when they leave, I hope that they will be leaving with a healthy amount of information that they understand and we give them a line item, quote sheet so they know what those finances are ahead of it ahead of schedule.

Eva Sheie (31:45):
So transparency is important to you?

Dr. Shelton (31:47):
Very important education for me to comprehend what the patient is interested in. And the communication is all very important.

Eva Sheie (31:58):
Is it relatively easy to get in to see you or?

Dr. Shelton (32:01):
Within a few weeks? Often. Not more than a month.

Eva Sheie (32:06):
And then are there things that you don't do that other people in your practice take care of?

Dr. Shelton (32:13):
I don't practice any general dermatology, you know, acne, psoriasis wards or skin checks and biopsies for skin cancer. My most surgical patients come to me with biopsy in hand, having been done by their referring doctor.

Eva Sheie (32:28):
But you do all the injectables, lasers and all of those things yourself?

Dr. Shelton (32:32):
Yes. So that is 50% of my practice.

Eva Sheie (32:35):
How do you think about injecting these days?

Dr. Shelton (32:39):
Well, I do it every day. The fillers are really a solid part of the practice. The hyaluronic acid fillers are so much better than the old collagen fillers we had from cowhide. And what's nice is that they're a natural substance. We all have hyaluronic acid in our dermis and this is synthetically made in the laboratory and there's an enzyme to dissolve it if we don't like the result, which does happen. I, you know, do see on my own work occasionally where either the patient has absorbed more water in that filler cuz that's how many fillers work. Then we can reduce it just gradually, which is very nice.

Eva Sheie (33:29):
Do you see people who've had filler elsewhere and it's gone wrong and and they come to you to fix it? Yes.

Dr. Shelton (33:34):
Yeah. Mm-hmm. <affirmative>,

Eva Sheie (33:37):
Do you remember when you reminded me that there was a filler, I can't remember which one, where you had to have a patch test to get it

Dr. Shelton (33:45):
Right. That was one of the cowhide fillers. Right? The Zyderm, Zyplast. Yeah. We were doing two tests. We would do one, I can't remember. It was on the forearm and then I, maybe the other was on the face, but they had it theoretically after two tests. If they were negative then they only had like a one and a half percent of becoming allergic to it.

Eva Sheie (34:07):
I wonder why that one didn't make it.

Dr. Shelton (34:10):
Yeah. But the, you know, that is where the, the basic evidence of science came from for fillers. It was really fascinating.

Eva Sheie (34:18):
And I'm sure it got us where we are today. But I'm glad that we're past this.

Dr. Shelton (34:22):
Yes. I'm glad that we're beyond it and, and the fillers today last at least double the time of those.

Eva Sheie (34:29):
So before we wrap it up, I want to ask you what you like to do outside of work?

Dr. Shelton (34:35):
Well, I, I'm a gym rat <laugh>. So I do like to exercise and stay fit. I love nature and I love learning language. I'm just not good at it. So it forces me to be on Netflix watching a foreign language with the foreign subtitles and I'm trying to improve myself.

Eva Sheie (35:02):
What language are you learning?

Dr. Shelton (35:04):
Trying to learn French for about four decades, <laugh>? Oh no. One of my passions had been certainly to take a year off between college and med school and go to France and even study in a cooking school or et cetera. And you know, a side passion has been or dream to, you know, live with that country for a month or so. But I'm too conservative and I have obligations at least that I make for myself. And I can't take myself away from family and and practice to do that.

Eva Sheie (35:39):
Well, I hope you get a chance someday.

Dr. Shelton (35:41):
Well, thank you.

Eva Sheie (35:42):
Certainly there's a lot going on and you're very busy and I think it's remarkable what you're doing for your patients.

Dr. Shelton (35:52):
Well, I'm very appreciative that I have the patience who come to me and, and I really respect them. I know it's hard to make the decisions as to whom to see. So when they come through my door I'm the one that feels privileged.

Eva Sheie (36:08):
I've often thought the biggest barrier with dermatology in particular is realizing when it's time to stop solving problems on our own and go get help,

Dr. Shelton (36:18):
You know? Well that's, I think one of the best things about the internet and specifically even RealSelf because what I've loved from the website, how many years ago did RealSelf? 2007. 2007. So for 16 years I've been a participant because it really was a fantastic medium for patients to go online, learn about procedures, learn about conditions, and hear from other patients what they've been through. Mm-hmm. <affirmative>. So one of the great things that I experience consistently are my educated patients and virtually all nowadays are educated about their condition. So they're asking questions and as we have this communication, it's really meaningful, what I'm saying is not going over their head. And they're very insightful and it, it really helps me target as to what we should be doing on them.

Eva Sheie (37:23):
I think we could extend our, our old the way we knew that we were successful was when patients would come in and say, I feel like I already know you. And I think you're adding to that a really nice new piece, which is, and I know why I'm here

Dr. Shelton (37:40):
And I've gotten many times, "I'm so glad to finally meet you. I've seen, you know, your videos on RealSelf and I've read your answers." You know, I never want to consider myself a celebrity because first of all, I never will be and never wanted fame. But it's nice that they have that validating factor. They can really feel comfortable because they're not referred by a doctor, they're referred by the public.

Eva Sheie (38:11):
That's nice to hear you say that. Yeah. That, that was our mission all along.

Dr. Shelton (38:14):
So well. It worked.

Eva Sheie (38:16):
Thank you so much.

Dr. Shelton (38:18):
You're welcome. I really appreciated being here and having our discussion.

Eva Sheie (38:22):
If someone is interested in finding out more about you mm-hmm. <affirmative>, where should they go?

Dr. Shelton (38:26):
They can go to RealSelf, <laugh> of course. Or just Dr. Ron Shelton on Google. We're on 34th Street between first and second Avenue and New York City, Manhattan.

Eva Sheie (38:40):
Thank you for sharing so much of yourself with us today.

Dr. Shelton (38:42):
You're so welcome. Real pleasure to be here. As I said, thank you.

Eva Sheie (38:48):
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 t h e a x i s.io.