Vial Presents: The Landscape of Aesthetic Dermatology with Dr. James Wang

Dr. James Wang, board-certified dermatologist and dermatopathologist and founder of Metropolis Dermatology, discusses the current landscape of aesthetic dermatology with Vial’s Head of Dermatology, Betsey Zbyszynski.

Betsey Zbyszynski: It’s Betsey Zbyszynski again from Vial. I’m head of clinical operations here. And today we’re talking to Dr. James Wang, really excited to talk about an exciting topic aesthetic dermatology, which I know everybody’s always interested in. Hi, Dr. Wang.

Dr. James Wang: Hi, good morning. How are you?

Betsey Zbyszynski: Good. How you doing?

Dr. James Wang: Not too bad. Just living the good life.

Betsey Zbyszynski: Do you wanna…

Dr. James Wang: [laughs]

Betsey Zbyszynski: Do you wanna give a brief introduction? 

Dr. James Wang: So I’m Dr. James Wang. I’m a board certified Dermatologist in Los Angeles. And I am the founder of Metropolis Dermatology, which we currently have two and soon to be three locations in the Los Angeles metropolitan area. Very excited. We’re combination of both medical and cosmetic dermatology, which includes injectables, energy-based devices, like lasers, and many other non-laser services as well. So we are kind of in the midst of all of it, and all this exciting developments are happening in the past decade or so. So I’m more than happy to talk about these today. It’s a great topic.

Betsey Zbyszynski: Yeah, great. And Los Angeles, what a good area to be in for diversity, and I’m sure people seeking cosmetic treatments. 

Dr. James Wang: Yeah, I mean, and I think all around the countries, I do a lot of speaking, and education of providers around the country, you realize that it’s universal, it’s everywhere. But in LA, it just happens to be less stigmatized and more open. And so people talk about it here, you know, LA is the center of entertainment, and so that’s where everyone sees it happening, but definitely is happening around the country and around the world.

Betsey Zbyszynski: Yeah, that’s interesting you say that. I was a manager at a dermal filler device company. And we had sites in LA, Beverly Hills, New York City, Dallas, of course, the big, big hubs. And you’re exactly right. LA, it’s more accepted. People would talk about it, New York City, like everyone was doing it, but you couldn’t say anything about it.

Dr. James Wang: [laughs]. People are the same everywhere.

People are the same-

Betsey Zbyszynski: Yeah.

Dr. James Wang: … everywhere in the world, right? We’re all human beings. And so, um, it’s the regional differences in terms of preferences, but certainly, when it comes to aesthetics, people really expect and want the same things.

Betsey Zbyszynski: Okay, let me start by asking you what is the most exciting recent development in aesthetic dermatology that you did not expect?

Dr. James Wang: You know, I think the last decade has been really focused on a lot of injectables, which have come a really long way in terms of how long they last as well as the different technologies to make things very, um, kind of suitable for injection that feel natural in the skin. But what really has surprised me is the progress of the other side of aesthetics, which a lot of it is the energy-based treatments, which include different types of lasers and non-laser devices. And this in the last year to two years have just exploded in the ability for us to achieve near surgical results without surgery.

And that’s, that the really exciting part, that really lets people, kind of enter aesthetics without feeling like they have to get something more invasive, that leads to a lot of downtime. It’s something that oftentimes can happen, just kind of, “Oh, I wanna do it this weekend.” And you can get it done and just go back to work and feel great and look great, already. So that’s really where I think aesthetics is going. It’s very exciting to see this happen the last couple of years, because just five years ago, we would never have thought that we have the tools to make this happen. So that’s really been surprising. The speed at which energy-based devices have progressed over time.

Betsey Zbyszynski: That’s so cool. That just shows how fast technology progresses. Obviously, in this area for cosmetic dermatology, but even in so many other areas, too. It just progresses so fast. So that’s great. And I know that patients always want less downtime, of course, so they can get back to their routine. 

Dr. James Wang: Faster results, safer results, um, less downtime. That’s really the, the name of the game these days, right?

Betsey Zbyszynski: Yeah. Well, good, at least, people are able to have options out there for sure.

Dr. James Wang: Absolutely. Absolutely.

Betsey Zbyszynski: When was the last time you changed your mind about a new approach to treating an indication in cosmetic dermatology?

Dr. James Wang: Happens every day.

Betsey Zbyszynski: [laughs].

Dr. James Wang: Um, we are not set in our ways. You know, there’s the dogma of what can and should happen. And I think that’s really held dermatology and cosmetics back because you have these, “Do not deviate from this road,” kind of mentality. And I think the only way for innovation and forward thinking is really to understand the underlying anatomy, and to take your expertise and bring the fields forward. For example, one of the biggest issues that need to be treated in dermatology, or aesthetics is melasma. Melasma is the pigmentation of the skin, that happens a lot [00:05:00] from hormonal issues as well as other causes. And in the past, everyone’s been focused on, how do we just focus on the pigmentation and lighten and brighten it with tons of topical medications.

But now, in addition to lasers, we’re understanding that melasma actually is partially vascular, it’s actually partly, has to do with the blood vessels underlying the melasma as well. So this has shifted in terms of the way we treat these conditions and like many conditions, it’s not just one issue that’s the problem is many different underlying factors that lead to the final issue, right. And so now that we have the tools to treat them, we can experiment and kind of play around the different lasers or injectables to really kind of bring the field forward. So I think that’s one example of something that we constantly are learning and changing our thoughts and treatment options for.

Betsey Zbyszynski: Yeah, that’s really interesting. I remember one cosmetic dermatologist I worked with a long time ago, he did a lot of our studies, he always said, ” Treating an aesthetic indication or cosmetic dermatology indication is more of an art than a science.” You have to be creative, and as you said, forward thinking and be a little bit more open. It’s not just , “Here, try this topical product, and let me know if it works.” As a physician, you’re looking at it as you’re creating something and maybe, you know, an art type of project.

Dr. James Wang: Yeah. I think the science is the foundation of all of it. But certainly science is not set in stone either. Science is really the process of discovery and the process of overturning old information as new ones become available, right? So the science we learn about in medical school and, in a lot of our training, but certainly the art is what really allows someone to be a good provider, not only a sense of the, “Right treatments,” but also the way we counsel people and the way we talk about the choices that people have these days. And so, the big difference between, a top aesthetic provider versus one that’s mediocre, is really the way that you approach skin issues or really kind of cosmetic issues, and you’re able to encapsulate the overall number of diagnosis as well as giving people the option and the pros and cons of each, each old and new techniques that are available now. 

Betsey Zbyszynski: Interesting. Yeah. So the year is 2030, what is everybody talking about in aesthetic dermatology circles?

Dr. James Wang: Oh, that is a great question. I wish I had a crystal ball to see into the future. But I think if I were… You know, you know, by that time, I think a lot of the lasers will have been quite advanced. I think one of the main issues we’re running into in terms of injectables, for example, is that as we have more and more options for injectables, and as the public becomes more knowledgeable about them, there are a lot of things that the public don’t want. For example, recently, Xeomin ran a new kind of ad campaign with [inaudible 00:08:43] about what is a more natural neuromodulator right? One of the more natural ways to relax winkles? What are the more natural ways to fill the skin. So things like Sculptra from Galderma.

So, as people understand injectables, they start to know that they’re different options. They do different things. And very, very recently, as of, you know, last week, it looks like a new injectable version of botulinum toxin was released, and FDA approved that. So the paradigm is shifting where we do less for more effects. And with that continue to have proven safety, right. So 2030, I think we’re gonna be able to have those tools where people have to come back every three months for injections, where it’s once a year someone comes in, but you don’t have to inject more products, right, where someone that looks completely frozen, or it gives you a less than optimal aesthetic results. So I think there are many different tracks in aesthetics in general, but I think that , in 2030, that would be one of the biggest breakthroughs that we’re able to have injectables that lasts a long time that look natural and are more naturally processed with fewer adverse events.

Betsey Zbyszynski: Yeah. And that’s interesting, because there have been some products out there that have just been the monopoly for years. Like, “This is all there is, that’s your only option.” So to have other options, and especially something longer lasting, of course that’s always key for a patient, you know, I’m sure seeking that type of treatment.

Dr. James Wang: Yes, so we’re living in a good era right now for aesthetics.

Betsey Zbyszynski: Mm-hmm. You know what I heard too? That since COVID everybody’s on Zoom, you’re looking at yourself more, people have been seeking different types, even just skincare lines, skincare products, as well as maybe some aesthetic treatments or injectable, because they may be noticing themselves more than they had before, because of the video conferencing.

Dr. James Wang: Yes. And we did notice that, in the beginning, a lot of people like to [00:10:00] trip the upper part of their face for the mask was still required and on. And then over time, you’ll sort of put in the lower part. It’s just very funny, instance that we saw. But, I think one of the biggest things, you know, since that masks have overall come off in the US is that people have started to realize the importance of maintenance, and the importance of combinations, right? It used to be that, “Oh, I’m gonna do this procedure and look this way.” But now people know, it’s a combination of skincare, injectables, as well as energy-based devices, because they work on different parts of the skin, right?

One really can help with kind of overall prevention of sun damage and oxidation. And then you have injectables which help with volume, as well as relaxing muscles and overlying wrinkles. And you also have the ability now to do a lot of collagen generation, decrease in pigment synthesis, tightening of the skin. So all these things is what makes skin healthy and youthful. The old ideas of you know, necessary, just a lift, making someone look younger, is no longer there. People realize that overdoing filler, over lifting the face doesn’t make someone look younger or better, it just makes them look lifted or filled, right?

So people are gravitating towards a more natural look. I’ve noticed this in the last five to six years or so, from really, really large lifts and really kind of like overblown proportions. To really have a more natural, more subtle way to approach aesthetics. I think overall, that’s a good thing.

Betsey Zbyszynski: Oh, for sure. Sometimes, it’s tough being in that industry, because people’s own perception changes, you know, whereas outside people look at somebody, but when you look at yourself, you might think, ” I need more, I want this, or I want that. So that’s a hard balance there.

Dr. James Wang: Absolutely. I completely agree with you.

Betsey Zbyszynski: What advice do you give new patients seeking aesthetic dermatology treatments?

Dr. James Wang: This is a complicated question, right, because, it’s multifactorial. And, I think when you’re approaching aesthetics, it’s good to have some key questions in mind, you know, what are the things that are bothering you the most? I would say, one of the key reasons to select a provider that fits with you is that you really don’t want someone else to tell you what you need, right? And I never do that. When someone comes in, it’s the most important thing to me is , “What are the things that you’re looking at in the mirror that really bother you?” ‘Cause I like to work on those things first, yes, we can come up with a comprehensive plan. But the key is someone who respects you, who will do what you want, right? They’re the expert in the technique and the evaluation. But someone who really respects the way you want to look because that is what ultimately you’ll be happy with, right?

So there’s that component, like you being able to communicate well with your… provider, [inaudible 00:13:58] good training, right? But also good technology, some who invests in newer lasers, newer technologies, who knows about newer injectables. If you go somewhere, and everything’s a little dingy, and everything’s a bit old, you can get great, probably traditional treatments, but they’re probably not gonna be your go-to for newer things that are coming up . Not to say there’s 100% of the case, but certainly, the vibe of the place will give you an overall sense of what kind of treatments you’d expect there and the quality as well.

So certainly, I think, do your research. Interview a couple different providers before settling in one, but I think communication is probably the most important aspect of choosing a provider. In addition to the fact that they’ll have different options. I tell people, if you go to a place and have one laser or one injectable, they’re gonna be doing that to everyone. It’s not any, any kind of customized experience. But people actually have invested in different options, different lasers and combinations for injectables we’ll have the ability to truly customized treatment plans for you. And I think overall, people will be happier, ’cause they get the look, they finally want with the best technology that’s out there.

Betsey Zbyszynski: Yeah, options are key. And then also, everybody’s so different, it’s so individualized. So while one person might, be so upset with their crow’s feet, someone’s on their forehead, someone’s on their neck. So for you to be able to offer those different options or combination, that’s probably, a really, really nice thing to offer patients. Plus, I feel like, a lot of people read so much. There’s so much online. I mean media and print of what to use, what not to use. So it’s nice to be able to come in and speak to you, and know that you are on the cutting edge and know what’s new today and what you could try on each individual.

Dr. James Wang: Yeah, we do it a lot. We help to distill information and that’s out there. It’s not, you know, necessarily that all information online is wrong, ’cause it’s not, there’s a lot of great information online and social media. It’s just knowing, you know, how these things fit into the niche of what they’re supposed to do, right? It’s a lot about education, about understanding what things are, how do you think is the combination? The combination of things is truly the art form of skincare and aesthetics because that’s when you will have to think about the underlying process of what’s [00:15:00] going on, what are the most effective ways? What is the underlying biology of it, that makes something work better than other something else.

Betsey Zbyszynski: Okay, our last question for today, if you could allocate $250 million to a therapeutic development, what would it be?

Dr. James Wang: Oh, this is great. That’s, that’s a lot of money to play with. Certainly, um, I think you mentioned before is that in the skill of developing new products and technology, it’s actually not a lot of money, it takes sometimes over a billion dollars to develop a product. So I think in terms of the seed money that this could really potentially go into, I do think a lot of the allocation should go towards kind of the safety of injectables. And I say this because injectables are fantastic. But a lot of the side effects from injectables don’t occur until years later, right?

And so as we’re understanding the biology behind these things, we wanna make sure that people who get injectables, which is still the number one kind of most done thing in aesthetics, um, years down the road are not suffering from buyer’s remorse, right? And that these things are truly safe over time. So spending money to ensure that the products are as natural as they can be, that have been tested thoroughly, and that don’t cause long-term immune system, immune reactions issues down the road. That’s where I would personally put the money. I think aesthetics is a safety always comes first. You know, efficacy will naturally come. You can see that with your naked eye. But really investing money in the safety and underlying safety profile is going to be what I hope companies are focused on going forward.

Betsey Zbyszynski: I totally agree, patient safety, and the long term safety, always key in any development, of any new drug or new device or new therapeutic treatment.

Dr. James Wang: Absolutely.

Betsey Zbyszynski: So this has been great. I love talking about this subject, and it’s been really nice talking to you about it, too. Dr. Wang.

Dr. James Wang: Thank you so much. Thanks for having me.

Betsey Zbyszynski: Yeah. Thanks. Have a good day.

Dr. James Wang: Thank you. Bye-bye.