Jason Emer, MD - Dermatologic Surgeon in Beverly Hills, California

Eva Sheie (00:00:03):
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 Today on the Meet the Doctor podcast. My guest is Jason Emer. He is a dermatologic surgeon in Beverly Hills. Welcome Dr. Emer.

Dr. Emer (00:00:40):
Thank you so much. I'm very excited to be here. Just so everyone knows, this is my first podcast. Even though I have done significant amount of media in the past, I'm not sure if it has ever been truly a podcast. There's always cameras on me, so

Eva Sheie (00:00:55):
I'm actually thrilled that I get the distinction of being the first podcast you've ever done.

Dr. Emer (00:01:00):
You are extremely lucky.

Eva Sheie (00:01:02):
I feel lucky today. So the purpose of this podcast is for people to really just to get to know you, the person, and I think sometimes when we see someone online, we think we know them, so we want to try to go a little further than that and figure out what makes you tick. And I actually have followed you for a very long time because I've been in aesthetic surgery marketing for almost 20 years, and you're always way out in front of everyone else. So maybe I can get some of my own questions answered today too.

Dr. Emer (00:01:34):
I would love that. I always was the type of doctor that just wasn't okay with the standard norms before social media even became social media. I got in big trouble with the people that were teaching me. They thought I was overly marketing. They thought doctors shouldn't be in doing this, promoting themselves that a doctor was professionalism, was going to lectures at conferences and writing journal articles. It wasn't standing out in front of a crowd and saying, you're the best, or here's my results, or here's what I do unlike the entertainment industry or a celebrity or an athlete, but I was always that person to just never be okay with what was written in a textbook or what somebody told me. I always wanted to push the limits, not only to get the best results for my patients so that people who couldn't come to me would know what was out there, what truly was the best, and if they couldn't get to me, they would be able to find that somewhere nearby.

Eva Sheie (00:02:33):
Video is so good for the way that you're approaching that because you can actually show them too. And a lot of your video really pushes the boundaries. I see the NSFW warning on a lot of the things, and actually I've always thought it made people click on it more.

Dr. Emer (00:02:49):
I agree. A friend of mine is a very famous athlete from Australia and he just came to town last week on Friday night. So we went and got Korean barbecue and he said that more and more he continues to watch my stuff over his athlete friends, which are NBA players because it says graphic content and he still wants to click it. The sad part is honestly, half the stuff is not graphic content. It's actually real life content of surgical procedures or aesthetic procedures that maybe have a little blood or a needle involved or a little bit of pain. A laser sometimes gets flagged, but because of all the strict guidelines now on social media, everything is considered nude or graphic or relating to violence. They think laser is violence, and so we get flagged on everything, but it turns out that it's actually just a cosmetic procedure and it makes people want to know it more.

(00:03:45):
And one of the things that I think truly made me stand out was I was never okay with just posting a before and after because those can be manipulated. Photoshop before facetune and all these other body modification, there was Photoshop and there was graphic design capabilities and I knew so many doctors were doing that. So I said, you know what? I need to show this in video. I need to show the patient the day of the procedure immediately after the next day through the process. Because you can't fake that. You can't fake a person saying, I have all these scabs on my face and I'm in a little bit of pain, but I'm so excited for this result. Look at me now and look at what Dr. Emer's doing to help me get through this. You can't fake that when somebody's swelling and has blood and drainage after a liposuction procedure and they're not happy, those for 72 hours, but it makes the patients want to go to you more because they understand that full process.

(00:04:40):
They're prepared. And that's what I had always wanted to do. And that was what always got, I hate to say this, I ticked people off because I was the only one that could get people to want to do that. And this was 10, 15 years ago. Now it's commonplace. You even have celebrities that do it. I mean, look at yesterday, Christine Aguilera got signed as a lead ambassador for Xeomin. I mean, it's like every celebrity now is trying to represent an aesthetics brand because they know how many people do this. And so it's just commonplace. Sometimes I feel like that's way overdone. It's like you need the average person to give their representation. We already know that celebrities do treatments that they've done it forever to keep looking good and maintaining their aesthetics as they are in front of the spotlight. But the average person that goes to get treatment is really the one that we should be more concerned about because they're the ones that are doing it, the mass and with the masses. You have all these aesthetic nurses now and PAs and under less trained medical providers and those are the ones that are doing more treatments and what does that mean for the level of success? And that's, that's where I think those really need to show.

Eva Sheie (00:06:00):
What kinds of questions do you think that the everyday average people who can't come to Beverly Hills to see? You should ask providers to determine whether or not they've been trained or not.

Dr. Emer (00:06:12):
That is a really great question because I saw yesterday actually a nurse that I've been following for a while who started out as an esthetician, became a nurse, and yesterday she's doing filler for the first time on a video and on the face she had all these drawings. And these drawings are what the company trained her to be able to template her injections. And I'm not saying she shouldn't be able to do those injections legally she's allowed, but I went through eight years of aggressive training, three years in fellowships, one of those years doing skin cancer surgery and understanding cutting of the skin anatomy, all the different planes in the face and trying to understand what could happen if something went wrong. So I was trained well enough to be able to do significant treatments but also control complications if they were occur. And so it's difficult nowadays because someone looks at that and they think, oh, she knows how to do filler and maybe she does know how to place it on the average template, but every person's face is different and it's unique and you can't really understand that and the anatomy of it unless you've done thousands of treatments.

(00:07:23):
I started by doing skin tags and moles leading into skin cancers into major reconstructions, facelifts, eye surgeries, taking patients to the VA hospitals in Queens and having huge skin cancers covering their entire face, removing them being left with a hole the size of my hand and having to figure out how to reconstruct that with blood vessels and nerves. That's the type of physician my clients really want to go to because we've been through so much more than just a templated line. But these companies want to make all this money. So what are they going to do? They're going to train the providers that are allowed to do these treatments. And in mass quantities, you're going to get people doing what I call uncomplete treatment plans. So treating someone's cheek isn't enough for anti-aging. The jowls form, the lips lose volume, the eyes start to sag, the temples hollow. You can't understand the aspects of full true aging and the effect of the skin bone and muscle unless you've truly gone through a real residency, a detailed long-term fellowship or something like that. So my opinion is if you're a person looking to get best results, you want someone to know your face and understand what's best for you. And to limit the risk of complication, you go to somebody that has done a very detailed residency, potentially a fellowship and has done thousands of treatments, and even then complications can occur, but if they do must more likely to less lead to a long-term consequence because it can be able to be treated. And what's happened now is as these providers and other levels of service providers have come out, I thought it was going to affect my business negatively. I thought less people would come to me because Botox would be cheaper somewhere else.

(00:09:29):
What I found was what people say is I want the artist, I want the person that is the most experienced, that I can trust their eye and they understand my face and they make me look natural. And so as these other providers have increased in sales, we've actually increased more because I've had to fix a lot of bad work. And because the people who have tried to go somewhere cheaper have then come back saying they were unhappy and they realize the person wasn't complete. And so my opinion is if you're a younger provider starting out, get that training work with someone like me and I'm going to start offering a masterclass and actually more of a preceptorship than just videos. I'm going to have a five or 10 different providers that for one year I'm going to train to be elite. And I think that's what you need to do to really be an expert or if you're starting out, you have to do lots of treatments. And that's how I started when I was a resident. There was no such thing as eyebrow lifting or jawline contouring. And when I started doing that, people laughed at me. It literally, my teachers who are now on the circuit telling everybody to do this told me I was an idiot. And they're like, why would anyone want the eyebrows lifted? And now everything is the cat eye, the fox eye, the threads, the filler there. What devices are going to lift the brows? It's literally a whole nother world.

Eva Sheie (00:11:07):
Were you the first one to do that?

Dr. Emer (00:11:10):
I mean, I was probably the first actually published the use of fillers on the forehead and I published a case, it's in the journal of a JDD in probably 2016 or 17 of a girl that had a disease called en coup de sabre where the skin and soft tissue contract and make a hole in the forehead. And the only reports in the eighties were to fill that with fat. Well, she had no fat. So we used fillers and I used a cannula all the way up here to protect the blood vessels and filled this whole area and reported it. And everyone was like, I can't believe someone would do that, but it makes sense. And what it did was it lifted her brow. So from there I said, you know what? Everyone's going to want an open eye. As we age in our twenties and thirties, the eyes start to sag, so why not?

(00:12:04):
Why wait until you have to have surgery, do these treatments now? And so every nurse in all Mount Sinai, I had them all do brow filler and they loved it and I posted pictures of stuff on it and I got in trouble for posting these pictures because they said I shouldn't be promoting myself, but it wasn't promoting myself. It was advancing the field. And that's the thing, it was always for me about advancing the field and teaching people what is available, what's new, what's going to really make you look natural and healthy. I mean, I can take 10 syringes and make it look like no one's had anything done because we're doing what I call foundational lifting. You're treating the bone, you're treating the soft tissue, you're treating the contours, you're not filling a line or volumizing, but it's because of being more of a cowboy and kind of pushing the limits is where it got me to where I am now and why people come to me and trust me.

Eva Sheie (00:13:05):
When you get in trouble, don't you sort of now say, oh, I must be onto something.

Dr. Emer (00:13:10):
Well, that's the funny thing. My social media team, six people with a manager, I'm very fortunate to be able to even have that and the level of where we've gone with what we've done with our career. But when they say to me, oh, someone else is doing this video of the treatment you just did, or they're saying, I got a video yesterday. Someone basically saying thread lifts were bad, but using my name saying that I'm the one promoting it, my team was like, look, this doctor is jealous of you. He's a facelift surgeon. So of course he's going to say, I don't want people to do threads that's going to hold their face up for a year and slow down the number of years you need a facelift. My opinion is if someone's willing to do it, they should do it. I have no issues with a facelift surgeon.

(00:13:54):
I want people to do it as early as possible because then I can maintain their results better. You get a facelift in your mid thirties, you're set to your 50 55, and then I could do threads once a year and microneedling radiofrequency and now Ellacor micro coring a year and make you look unbelievable. And so that's what the surgeons don't get. You want to partner with a dermatologist like me because I'm the one that's going to tell people to do these treatments first. It's not about invasive or not, it's about what somebody needs. If you're 25 and you lost 150 pounds, your face is going to sag. It doesn't matter. So you may need a facelift at 25. So going to a doctor that's real that will tell you what you truly need is the most important. What I have found is people that are only trained in a little bit of this or a little bit of that, they only provide you with a sprinkle.

(00:14:50):
And so they'll tell you to do Botox or filler when you may not need it or you may need other things with it, but they can't provide that. And so that's the comprehensiveness of going to somebody experienced and why my clients really go to me. I had, I'll give you an example. I had a girl come to me the other day. She lost 50 pounds over the past year. She had a picture of herself a year ago, and now her face is sagging, her eyelids are hollow and she feels a lot older at 41. And so I said to her, well, maybe we need a lift, but if you're not willing to do it, let's volumize. Let's start skin tightening. And one of the areas for her was her eyes an eyelid surgeon, an oculoplastic surgeon specialized in eyes, sent her to me for filler on her eyes.

(00:15:39):
And it's not the brow or the under eye like you see everywhere. Now it's the eyelid here, the hollows in the lid, not a common thing that people do. But years of experience in treating HIV patients that had severe facial hollowing had eye bags that were popping out everywhere and had the inability to have surgery allowed me to get experience in treating that area so I can treat the lid. So we treated the lid and instantly this woman felt self-confident.

Eva Sheie (00:16:08):
You put filler in her eyelid.

Dr. Emer (00:16:09):
I mean that is life changing, in the eyelid itself. Now it's a very common thing to do and I see it a lot in my Asian clients. I see it a lot in my very, very thin women where this area gets super hollow. And for those that can't see the upper eyelid and not the brow, we're talking about below the boney prominence.

(00:16:31):
And that makes it extremely challenging. It's a movement area. You feel your bone above your eye, go below it, you feel your eyeball. It's in between. So that area, I know it doesn't seem like that's an important area, but you lose fat as you age there and while the skin sags and you lose fat, think about that on your face. It's the same thing. You see the bone underneath. She didn't like that she could see the bone of her eye. It made her feel like a skeleton. So we treated it in half a syringe of filler is life changing. And now can that be done surgically? Yes. Could I inject fat? Sure, that's a much more difficult procedure. I could do this with a filler and a cannula completely safe. And so those types of things you can't teach. This is experience over time. I want to be able to teach people that, but I want to be able to get providers that are complete and comprehensive with the knowledge of anatomy and the understanding of full facial balancing to be able to take under my wing, not somebody who just wants to do this for financial reasons, which is why a lot of people go into aesthetics.

Eva Sheie (00:17:45):
So you mentioned an oculoplastic surgeon and a facial plastic surgeon, and then there's plastic surgeons and you're a dermatologic surgeon. So is there an easy way for us to kind of understand where you all overlap and where you should stay in your lane?

Dr. Emer (00:18:00):
Yeah, I think it's actually really important. I think that's a really important question is what are all these titles nowadays? Because you see cosmetic surgeon that's not the same as a plastic surgeon. That's not the same as a facial plastic surgeon or an oculoplastic surgeon. So what does it all mean? Well, what the most important thing is the board certification because the board certification represents the residency, right? The residency is what did the person learn? So I'm a dermatologic surgeon. I went to dermatology. My board is dermatology. So I will tell you it has limited the amount of liposuction patients I see because in the old days, dermatologists were actually the first to do liposuction. A lot of people don't know that they think that plastic surgeons did because nowadays everyone goes, you need to go to a plastic surgeon for all surgeries. But they didn't realize that dermatologists were actually the first to do liposuction.

(00:18:50):
And I'm like the last of the Mohicans for though that knows that movie because very few dermatologists now learn lipo within the next couple of years, Dermatologists will not be doing lipo anymore, at least in their residency, most likely. They're going to learn it if they learn it at all after their residency in these little fly-by-night courses. And that's the cosmetic surgeons. What's a cosmetic surgeon? Cosmetic surgeon is a surgeon that went to another residency unrelated to surgery, family practice, emergency medicine, maybe a PMNR which is rehab. And they all want to get into aesthetics. So they take courses and get verified by the American Board of Cosmetic Surgery or cosmetic surgery, I forgot the AACS or whatever the other ones are. And they get a certification of cosmetic surgery. They're allowed to do some surgeries with this extra training, but they were not doing a residency of surgery.

(00:19:50):
A little more risky for somebody that's going to that person because maybe that person's experience and maybe they're not. My opinion is you want to go to somebody that does a core board residency, plastic surgery, dermatology, ocular surgery or ENT facial plastics. So any of these core surgeries are going to be the one. So facial plastics is usually ENT or ear nose and throat. They're doing head and neck surgery all residency. They know what they're doing with surgery. Maxillofacial surgery, they're doing bone, they know what they're doing. And then plastic surgery is a full plastic surgery residency and a board. But if you don't do fellowship in something specific, you might not be that experienced. I have a lot of plastic surgeons that do not know how to do liposuction and they get very upset that when they do a bad job and I have to revise it, they get upset about it.

(00:20:45):
So this is what I keep saying is you want to go to somebody that's experienced in a unique procedure. Nobody can do everything. So even if you're a plastic surgeon, you can't do breast and nose. It's literally impossible. You have to be a specialist in one. Maybe you're good at body. I don't know many that are good at body and face. I know they try to do it, but they may not be. So that's why even in my practice I have four body surgeons, two facial surgeons, and that's all they do. One of my facial surgeons only does rhinoplasty in eyes, another one does facelifts. So to me, you have to look at what the person's trained in and then what they specialized in because most of the true training comes from specialty training. So I have plastic surgery residents reaching out to me now to come to me for liposuction training because they know that's what I do.

(00:21:38):
That's the only surgery I do and that's what I'm best at. And now because of cosmetic surgeons and plastic surgeons not learning this in their residencies and taking these courses, I'm seeing more revisions than I've ever seen in my entire life. And what's happening is 60 to 70% of my practice is revisions and the price to fix them is two to three times more. So people are getting so upset that the cost of what they spent initially was nothing. And now is so much they get mad at me. It's an six to eight hour surgery requiring multiple technologies, skin removal, fat grafting techniques, aftercare. I mean to fix some of this is almost impossible. And to be able to do it is a unique skill. So it's one of those things where I tell people, you got to pick the right person first.

Eva Sheie (00:22:33):
Here's my marketing analogy to what you just said. And do you remember in the olden days, especially in the Los Angeles market, you would go by somebody's office and they would have every procedure in a decal on the front windows of the office that I was always like, you can't actually do all of those things well.

Dr. Emer (00:22:51):
You can't. I mean, right? You can do a little bit of everything okay, or you could pick one or two things and be the best. And so when I moved to Beverly Hills and I was a young dermatologist, there were no real young dermatologists. There weren't ones that worked out. There weren't one that were men, and there weren't ones were they gay. So I said, you know what? I'm going to use the unique skill and I'm going to say I do two things, liposuction and more for men and facial sculpting with fillers, and I would be known for those two things. So all I did for two years was promote that even though I was really good at lasers and I was known for acne scars and treating burns, that's what I came from to doing. I would get those patients when they came to me.

(00:23:35):
So I would do a lipo and I would see their skin. I'd say, you know what? Let's do a laser. While you're getting your liposuction, you're going to have downtime or their daughter have acne. I say bring her in. And I would build that over time. And now I'm known for all the things I'm known for, but I focused on hyper-focused on two things, and that's all I talked about all the time. And one of the first videos that I still have is one of my biggest videos on YouTube millions of views was this young model who happens to be now one of the biggest models in the world on every billboard. But I made a video using a cannula on his jawline with Radiesse. Seems so simple now, but at that time nobody did that. This is in 2014. So in 2014 I did that and it went viral and all these people started coming to me for the facial sculpting and the fillers and then what do they do?

(00:24:29):
Oh, you also do lipo. Let's do that too. I have a little area here. Or, oh, I have some acne scars and that builds. But to be really known, you have to hyperfocus on one or two things and be the best at it. That's what I did. Even nowadays, I have every day five to seven, maybe eight facial sculpting consults. And the other day I had a young guy, he literally had 10 pictures from my Instagram of the exact look he wanted, and I told him which filler was in each one because of his comfort level, reversible versus not reversible, semi-permanent versus permanent. And he picked what he wanted based on hyper focused marketing and being able to look and find people like him. And that's the reality nowadays is you have to show your expertise and skill and make people trust you and feel confident with you before they even see you. I have a number of patients that hug me the second I come in or say, oh my God, you're a celebrity. I've watching every one of your videos and you're so nice in person. And then after being able to show the results that make them want to continue to come back to you.

Eva Sheie (00:25:45):
Let's go back to some of the things that you've invented over the years, some of these innovations that are truly yours. Can you recall anything that you started that now everybody is doing?

Dr. Emer (00:25:58):
Yeah, there's a few things. So the first one I vividly remember when I was a fellow at UCSF in San Francisco, I was asked by the American Academy of Dermatology this is 2013 to lecture on the use of microneedling with PRP. It was the first time anyone in dermatology was ever asked to talk about PRP. And now everyone knows PRP, whether it's for hair, whether it's post-laser treatment, whether it's injection for rejuvenation on the phase, whether it's combined with a filler, like we said, our fat to help prolong the longevity of it, et cetera. There's a million uses. So I got booed off stage at the AAD 2013 was devastated and actually two very famous dermatologists still at the time were saying bad things about me in the crowd. My partner and my best friend were right behind them and recorded it. And even in afterwards they kept saying that this is ridiculous.

(00:27:00):
And what I had invented was not combining the two to get the best result. It was adding a laser, doing laser with microneedling plus PRP. The idea was the needles go at certain depth. There's no inflammation because there's no heat. Let's add a laser at a higher surface and let's hit it at both levels and let's use that PRP to heal. Let's get more collagen, let's get more brightening, et cetera. I did a demo during the demo, I got booed and what do you know, one year later, 2014, one of the dermatologists that was saying bad things about me was reported in the New York Times as coming up with one of the most innovative thing of 2014. And what was it? Combining the laser clear and brilliant with microneedling and PRP. And I couldn't believe it because myself and Dr. Vic Narurkar, I dunno if you know who he was, but he was an amazing dermatologist.

(00:28:00):
Partners with Kathy Fields, one of my very good friends in San Francisco. We developed this and we even did a clinical trial with SkinCeuticals adding vitamin C at the same time, an hydroquinone and everyone even booed that because they said, you shouldn't be putting this medicine on inflamed skin, but commonplace now is everyone does it. You add PRP to every laser, you microneedle in combination with lasers, especially for acne scars. You do add vitamin C growth factors, peptides, stem cells, exosomes immediately when someone lasers or microneedles, you even microneedle it into the skin and you get these results. I created that. I was the first to report it. Now, I didn't write a journal article on it, but I was doing that and that's why my patients were coming to me because they were seeing transformational results with progressive treatment. So what are we even doing now more than that?

(00:29:00):
Micro coring, for example, one of the newest treatments out, very few doctors haven't even know how to use it. Even the person that developed it doesn't know how to use it, no offense if he hears this podcast, because he's doing very low densities and low levels. I watch his Instagram and he shows the treatment minimal results compared to what we're getting because we're combining micro coring and lasers. We're doing micro coring with exosomes, we're doing micro coring with injectables. The results are astounding. But again, that would be something where even he would tell me, I'm out of my mind, but I'm proving that the results are great through real treatments. And so that is one of those things that I had developed. The same thing was with acne scars combining two lasers at once. In the old days, people used to do a fully ablative erbium before they did a CO2 because the results showed that you actually healed more quickly.

(00:29:59):
Now it doesn't make sense. Why would you heal more quickly combining two lasers versus one? But there is a lot of research on that use of erbium with the CO2, the cooling and the heat allows for more rapid recovery. So fast forward 15 years, I do this treatment for 15 years, everyone says I'm crazy, but I get amazing results. And what does a laser company come out with? Hybrid fusion laser, hybrid fractional laser Sciton halo, erbium plus Fraxel. It's the same technology that I've been using for 15 years. I developed that laser. That was my idea years ago. Luckily I actually helped them develop it, which is great, but what I mean is these are the things that you need to be supportive and understanding of because if you don't do this, you're not going to get improvement in progression over time. The industry will not advance.

(00:31:01):
And so like I was saying, these eyelid and this facial contouring and sculpting of the face and what I used to call foundational volumization or structural volumization, people thought I was crazy. But now that's all everyone talks about lifting and sculpting of the face with fillers and not filling a line. I did that 15 years ago. That's what I talked about with my HIV patients whose entire faces were withering away and you had to use fillers to shape them, to rebuild their structure. So those are some of the key things on the nonsurgical side, on the surgical side with liposuction, it really changed a lot. And I actually posted today a memory from 2018 on my Instagram and today is what? March 12th. I know we're doing a podcast, so in case people need to go back to my Instagram, I posted today a memory from 2018, so we're five years ago of a result that I thought was good at the time.

(00:32:04):
Amazing video I have on YouTube. This guy got botched and now we fixed it with lipo, but the results now are a hundred times better. I look at that and I go, oh my God, that's traditional. That's not, how could I have been advanced at that time? And at that time I used energy-based devices, but I didn't have internal heating like RenuVion and BodyTite, and I didn't have the idea of the sculpting at the more superficial levels of the skin without causing skin damage like we can now or comprehensive 360, not just the torso and sides, but the chest, the arms, the lifting at the same time. And in the textbooks they say, you can't do lipo with skin removal. You can't do X, Y, and Z together. It's going to increase the risk of complications. But I was the first 10 years ago to combine an ultrasonic lipo with a tummy tuck or to combine an ultrasonic lipo with internal heating and fat rafting and glands removal, and now we've progressed in the artistry of it, the sculpting portion, and so it's gotten better and better.

(00:33:17):
And so as much as I love that my patients trusted me, then I hope they come to me now because the results are going to be significantly better and it's going to happen as time goes on. But I remember when I first started doing this, even the people that told caught me lipo thought I was out of my mind. They told me, you shouldn't be doing that many areas at watch. You shouldn't be doing skin removal at the same time, but there was no way to get that same outcome, that better outcome, that transformational outcome. You can make people look a little better, but you couldn't get a transformation. Why did I bring up the memory from 18? Because the result of that looks like CoolSculpting. Now it looks like what you can get with a noninvasive treatment, which is unbelievable because we have advanced so much in some of the body treatments that we can burn fat, we could tighten skin, you could use needles to heat it and contract it. You could use radio frequency to melt it or cold to cool it. There's so much you could do on the improvement level, but on the sculpting and transformational level, you still need surgery and you need more aggressive surgery. The stuff that I do now, that was the question about and yelled at years ago.

Eva Sheie (00:34:31):
Is there something from your early life or from the way that you grew up that led you to be this risk taker? I think you're taking calculated scientific risks.

Dr. Emer (00:34:40):
No I think that's a good word,

Eva Sheie (00:34:40):
But how did you become this brave?

Dr. Emer (00:34:46):
I don't know. To be honest. I think a lot of it came from the fact that I just never wanted to be able to tell someone I couldn't do something. And this comes back to one of my first stories. You've never heard this, but I've told my staff this story. So when I was a fellow in my dermatology residency, didn't know anything about cosmetics at the time, I was doing a psoriasis clinical trials with a very famous doctor in New York, Mark Lebwohl. So anyone that knows psoriasis or complex dermatology, he is the person. He literally can see anything and cure it. I learned from him and one of the things he said to me when I was his fellow was, you need to do what's in the best interest of your patient always. It doesn't matter what it is, you got to do it even if other people tell you you're wrong.

(00:35:33):
I had a patient, Esther at the time who was 93 and she had terrible psoriasis and we put her in a clinical trial that cleared her psoriasis and improved her arthritis. So what did she do? She went out and got an 87-year-old boyfriend and she was having sex and telling me all about it and she said, honey, this doesn't, this is when I actually started investigating about the sexual treatments because she said, sex doesn't just end because you're 93. I learned a lot from her, but one of the things I learned from her was she was a Holocaust survivor and she told me a lot about her story. This is important because she said to me, I need to look good for George, which is 87-year-old boy toy as she called it, and I need a chemical peel. I want you to do a chemical peel.

(00:36:22):
And that time lasers, this was 2006 and seven, there wasn't many lasers except for fully ablated, CO2 or a Sciton erbium, a lot of downtime. So I said, I can do it for you. And I had no idea how to do a chemical peel. I was literally a second week of my fellowship in residency, and so I read every textbook that was out there. Turns out I did my second fellowship with the creator of chemical peels after my residency in UCSF. I read his textbook and I looked at pictures and there was no YouTube. You can't look this up on YouTube. And I ordered chemicals from our manager at our Mount Sinai department and I ordered them to the office. They're very inexpensive, some TCA, some jesner, a little retinol, and I mixed and concocted like a scientist to put together this peel combo that I thought was going to give her a great result.

(00:37:18):
Thank God she was as light-skinned as you and blue eyed as you because I did a peel on her, that's equivalent now nowadays, to know to a fully ablated multiple pass, CO2 had no clue what I was doing. Her face was burned. I couldn't sleep for two weeks. She was red, peeling, looked like a burn victim, and she said to me, this honey, this is worse than the Holocaust. Swear to God, she told me that. How bad would you think I would feel? Then about two, three weeks later, she came back. I thought she was never going to talk to me again and she had no wrinkles. Her face was perfectly clear porcelain. She said, this is the best thing she ever did. And I couldn't believe her self-confidence. She actually took me to a German restaurant with George to thank me because she's German and she introduced me to German food and we became really good friends since now it's been 15, 16 years later she's passed away.

(00:38:19):
But she always told me that her self confidence was boosted so much by that peel. I had another person who's a doctor, one of my teachers that the end of my residency got a divorce and he said to me, you know what? I really need to feel good about myself. I need to date again. Will you do a CO2 laser on me? He had watched me do it all through my residency. I was the only resident doing these lasers. I helped Fraxel become to light. I helped all these other devices come as I was a resident. I did a CO2 laser on him. He went to work every day looking like a burn patient. And two or three weeks later, he sent me an email saying how appreciative he was that his whole life has changed because he feels so much better about himself and that no matter what I do when I finish, I need to hang up, this is what he said, I need to hang up your shingle at the most expensive place in the world where people are going to want to do treatments with you. And you sit and wait. When I was, and I didn't think about this until about 10 years later when I moved to Los Angeles, place, everyone wants cosmetics, very expensive in Beverly Hills, and I put up my shingle and I waited. And nine years later, which is August 14th, 2014 where I started, nine years, it will be nine years that I'm in practice. We have 42 plus employees, I have my own skincare line. I have New York, Miami, Dubai, and Los Angeles, and we're probably going to keep spreading all because of what these other people saw in me and what we was able to do for them. That feeling that I got made me always want to be able to do something for someone.

(00:40:05):
Don't know why I took the risks, but I wanted to be able to treat them. And as a doctor, you take an oath to do what's right and to do what's in the best benefit of those people. And I knew if I wouldn't hurt them or harm them, I would be able to make them feel good about themselves. Every year on my birthday, that doctor sends me a message, a card, and he says, you still have changed my life because a year after having that CO2 laser, I met the love of my life and he's been with her ever since. And so these stories are very impactful. I mean, it really brings tears to your eyes when you realize what you can do for people. And I remember when I was a resident, even my program director would tell me how stupid cosmetics was and how I was dumb wanting to do aesthetics.

(00:40:57):
And I said, but it is transformative for people. I had HIV patients who literally couldn't get jobs because people thought they were on drugs when they weren't even drug seekers. These patients even got HIV from blood transfusions in the eighties. It wasn't sexually related or being gay or anything like that. And then I would do a little Sculptra on them and some filler and they would get a job and change their whole life. I mean, there is no denying that in those cases lives have been changed. And that's why I wanted to do aesthetics and that's why I always wanted to take the risk. I even remember the first liposuction I did, I opened a cabinet at Mount Sinai and I saw this equipment and I said to my program director, what is this? And he said, in the eighties, we used to teach a lot of liposuction here with Dr. Bruce Katz in New York, and he's very famous doctor.

(00:41:52):
So I called him up and I said, you need to teach me. And he said no. So I went to my program director behind his back, and I can say this now because we're friends. I went to my program director behind my back and he called him up and he said, if you want to stay on the faculty of Mount Sinai, you're going to teach Dr. Emer. So I went to his office for six months once a week during my residency, and he taught me a little bit of awake lipo. Now everyone who does listening, he was the pioneer of smart lipo. He was one of the first dermatologists to do liposuction in the United States. He was the one that gave me the tools. So I used all his tools. I created a clinic, and I remember my first friend at Equinox said, oh, this little bit of fat I have on my stomach now remind you, no noninvasive treatments existed for fat removal at this time.

(00:42:43):
There was no vanquish, CoolSculpting, truSculpt id, all these body tone devices, there's none of that, Kybella, it didn't exist. So I said, I can remove that. And I bought every book. I maxed out my credit card on all the textbooks of liposuction, and I still have them in my office. Actually, we laughed because I have 800 books that I read during my residency and fellowships. Oh my God, it's insane. I'll take pictures of 'em and send it to you. I even giving some now with my plastic surgeons, my nurses, I'm saying, you guys need to read this. This is how I got good. And I remember saying to him, I can do a little bit of liposuction. And I bought every tool that was in these books, the tumescent, the cannulas, the device. I even put the first power assisted handpiece on my credit card.

(00:43:31):
I had no money. And I did my friend's case with my program director overseeing me, and I remember having a heart attack because I saw a little bit of blood come out on one part. I thought it killed the person, but it was all normal. I had no idea, never done it before. I mean, I did it with Dr. Katz, but not at this level. So I started at the lower stomach, then I went to the full stomach, then I went to the stomach and sides, then stomach 360, added the arms, the chest, the neck, and just kept going, going, going, going and went from being a dermatologist to what people are confused now as what they think plastic surgeons do, which is my transformational gladiator and supermodel lipos, which is with plastic surgeons and does require a plastic surgeon to do skin cutting, breast removal, implants, body lifting, but the sculpting and defining is from a dermatologist doing lipo properly with combination techniques and innovations that we just didn't have years ago.

(00:44:36):
And each one of these cases had gotten me to a point where I just felt more and more confident by taking risks. Ellacor, I mean, I'll give you an example. EOR is a brand new device. No one knows how to use it, but we're doing it. We're testing it, we're using it right now and seeing how it's going to go. And sometimes nothing's perfect, but if it's not, you have to have good patience to be able to work through those complications. I'll give you an example with Ellacor, I have one lady. There's all these little dots on her chin from the Ellacor. Everything else tightened unbelievable, but the little dots. But you know what? She's like, I know you're going to fix it. It's fine. She's coming in for another laser. It'll be clear with one laser. But that's the process of learning. So now I know in this area we have to do a different level or we don't treat it at all.

(00:45:24):
But I won't know that unless you've done lots of treatments and now we've done probably 50 to a hundred treatments even on the body, the knees, the inner thighs, the chest, the armpit, the little bit of skin in the bra roll, back roll and seeing some amazing results. But we won't get that to that level of progression if we don't take the risks. So some people aren't going to be and some people are, but I actually learned from an amazing surgeon in Richmond, Virginia. I don't even know him, Joe Niemtu, he wrote one of the biggest textbooks. My chapters are in there as well. And when I was a resident, I went up to him at a conference and I said, I want to be like you. And he said, here's my card. You can come shadow me. I don't let anyone else shadow, but I'm going to let you because I've never met anyone like you.

(00:46:11):
So confident to come up and say that. And I went to his office one week every year when I was a resident and I learned how to do facelifts and eyelid surgery, maxillofacial surgery and nerve blocks and all these things. And he said to me, no matter what you do, the more you do it, the more you're going to see a complication. The more risk you take, the more chances you're going to have of seeing something that will go wrong. But you have to be okay with when it does go wrong, being able to be the person to fix it, otherwise you shouldn't do it. And that's the advice I always took. And he's also a pioneer doing implants at the same day. He's doing facelifts and doing aggressive bone breaking and facelifts at the same time and scar revisions and things like I do.

(00:47:01):
And he has amazing results. And look at him, not everything's perfect. He's seen complications. He has it in his textbook and he's one of the only ones that actually publishes that. And I think that's the key. You have to understand you even the best isn't always going to be the best. There's going to be days that it's not perfect. There's going to be days, there's complications. And part of his consent forms is to understand that there are risks that people take both the doctor and the patient, but the doctor still needs to do what's in the best interest of the person. And if something goes wrong, they have to be able to fix it.

Eva Sheie (00:47:38):
Has there ever been anyone who you haven't been able to fix after you've made a mistake or not gotten results?

Dr. Emer (00:47:44):
That's actually a good question. I know the answer's no, but I have had a couple patients where their expectations of what the results were supposed to be were much more than I was able to convey to them before that they would get, and they either threatened to sue me or they just didn't get the result they wanted and complained. And I said, you know what? These are the results that your body is going to allow. You can't look like this guy that works out 10 hours a day unless you do that. The lipo I do or the laser that I do requires you to do other things. The one treatment's not going to change your life. You have to do other stuff to maintain it. Or for acne scars for patients, for example, they'll do one CO2 aggressive treatment and think that their scars are going to go away completely.

(00:48:37):
And that's not true, and I tell them that. But to truly understand that and hear that is different. So a lot of times I feel like it's just the expectation of the outcome. I do have one girl where I've done a significant number of lasers more than I've ever thought I was going to do on her, and her scars will just not improve. I cannot figure out why. Whereas I have somebody I treated last week, one session and 70 80 percent's gone, and I've tried everything. I even now tried Ellacor on her scars and it worked. Actually, it improved 25% in one treatment. So that's the next thing we're doing. And I did it for free because I needed to do something for her. But there's some cases where you can't, I haven't really had major complications, thank God, but I have had situations where I didn't get the outcomes that I wanted.

Eva Sheie (00:49:28):
Entertain me with this question a little bit. There's another podcast I listen to called Founders and the guy who does this show reads the autobiographies and biographies of the most famous people in business that you've ever, we all know there's seven episodes about Steve Jobs and there all these different people. Estee Lauder was one of my favorites, and he described her from her autobiography, I think as being absolutely obsessed. She could not stop herself from trying to make people's skin look better. And so she would do weird things. She always had products in her purse. She was mixing her concoctions and she would attack people in elevators in New York City and she would have to put stuff on their face to make them look better.

Dr. Emer (00:50:12):
Oh my God.

Eva Sheie (00:50:14):
And it was so single-minded that everything around her crumbled. If she couldn't do that, she couldn't do anything else. She didn't even start the company until she was 40. So she was working on this. They said when she started when she was eight. And there's so much of what you're saying that sounds to me like the patterns I hear in that podcast about these people because they cannot stop themselves from doing the thing that they do. They have to do it

Dr. Emer (00:50:44):
Right. That's kind of like how I am, but not in an obsessive compulsive way. It's in a love for the game. It's like an athlete. Some athletes just can't stop playing. They like it so much. It's how I feel about my working out, which is why my Jason Emer official Instagram is actually surpassed my Jason Emer MD Instagram. I mean, obviously I'm taking my shirt off on it and showing abs, maybe that's why. But in general though, it's one of my passions I have to work out. If I don't, it doesn't make me perform as well. It doesn't make me think at the highest level I need to do it to be an entrepreneur like I am. But my thing is I can't be standard. I can't take a laser and have a company tell me what to do and do that on a patient.

(00:51:31):
I need to figure out what's going to get the best results for people. And that's why these, what I am known for are these combinations that I do when people go all in the same day and I go, yeah, that's why you're coming to me because I get the best results by doing that. I want people to show me the pictures at their wedding and how happy they are after they did treatments with me or I had a patient, I'm watching a Netflix show a couple weeks ago, and I'm like, wow, that guy's jawline is amazing on this TV show. So I snap a picture and I send it to my best friend and he is like, who's my manager, and he goes, Jason, that's your client.

Eva Sheie (00:52:09):
Oh no.

Dr. Emer (00:52:09):
And I'm like, I didn't even remember because I'm so hyperfocused on the artistry of it.

(00:52:14):
And I go, oh my God, you're right. When he doesn't have the beard and he's not wearing the Game of Thrones, look, that's not the show. But the look, I didn't recognize him. And a friend of mine just got engaged and she got a Hollywood walk us fame, and we did her whole face for the Grammys and everything, and she looked so good. She was actually one of the people where people thought she didn't have anything done, and that is so killer for me. That makes me feel so good. I went to a movie last night to see Scream six two of my clients are in it. I'm there making sure they look perfect. I don't want anyone to know they had anything done and they looked amazing. No one would ever know. So that's what makes me feel how good I feel about myself and why I do this every day and why even if I were to ever sell my practice or get capital to grow, I would never stop doing treatments because I have to. It's my lifeblood.

Eva Sheie (00:53:09):
Very obvious.

Dr. Emer (00:53:12):
Thank you.

Eva Sheie (00:53:13):
This is second time this week. We've heard about Ellacor, so I feel like it's about to blow up.

Dr. Emer (00:53:18):
To me, it's the newest technology on the block. I think that if in this category there is no category for this, it can be pretty amazing for skin tightening and for problems, specifically thinner women and people that have poor structural anatomy on their lower face, making them sag a lot earlier or with now with having peptides like Ozempic for example, that makes people lose weight more quickly. Now you could do big gastric sleeve, you can go on a fad diet, you can just work out a lot and still get the same results that Ozempic gives. It doesn't change the face, it just made people lose weight. But if you notice the sagging and the face more soon, you can get a lot of reversal in it without much complication at all. I mean, people look great now, the only negative for it to do it, well, again, like I was saying, even the developer of it, I don't think is doing the levels that I'm doing. You have to do aggressive skincare, otherwise you could be left with little spots. You could be left with redness for a while or you could get, like I was talking about those little dots on areas that are tighter like the chin. So you have to do aggressive skincare protocols, which is now we have perfected after about 25 treatments.

Eva Sheie (00:54:34):
Doesn't the manufacturer have to follow whatever guidelines the FDA kind of puts them in a box?

Dr. Emer (00:54:39):
Yes. So I don't, especially if my patients are okay with it. So we do almost the full face. I've even done a forehead in people with acne scars and who want some brow lifting. We do all the way around the mouth and we do neck all the way down to the cartilage.

Eva Sheie (00:54:55):
And it's primary purpos is tightening.

Dr. Emer (00:54:58):
Yeah, it only functions for tightening some fine wrinkle improvement and some acne scar improvement depending on what type.

Eva Sheie (00:55:05):
Nothing has really been great at tightening, so it's encouraging.

Dr. Emer (00:55:09):
I'll say this plus microneedling RF regularly. If you did microneedling RF every month or every six weeks, you would see a great result, but not the same as Ellacor. Ellacor is more what I call the shrink wrapping. The micro needling radio frequency is contraction and lifting. You need both for tightening.

Eva Sheie (00:55:31):
Are there any other products or technologies coming that you're excited about? Do the companies bring stuff to you now?

Dr. Emer (00:55:38):
Yeah, all the time. Avalite is probably one of the best vascular laser I've ever seen. It's a component of a yellow laser technology with a non-ablative wavelength, so it's non-ablative plus vascular with zero downtime. What I think this is great for is the resistant rosacea. The people with a lot of redness in the background of their skin and people on Accutane. If you're on Accutane, your skin's very irritated. Do Avalite every twice a month, your skin will look pristine. It's unbelievable. You're getting ready for wedding. You better get Avalite a couple times a week because your skin will look unbelievable. You will not have a breakout. Your skin will look clear. It won't be red, you won't flush or blush. It just improves the quality of the skin. And those with a lot of that background redness, flushing, blushing, sensitive, irritated skin, eczema, that type of thing, and combine that with laser and it's just amazing results.

(00:56:31):
So all my Accutane patients are getting Avalite plus either clear and brilliant or moxy aite and a peel every single month to just maintain their skin and improve the results before we start treating their acne scars. That's actually one of the cooler treatments out there. A plasma pen I think is unbelievable if people know how to use it. And the Ferrari of plasma pens by plasma pen official UK is going to be FDA approved very soon for the United States. We have been using it, and it's phenomenal in terms of results in every skin type, including African-American and Indian skin when it's used right. So that was skincare. Now, the skincare, I mean, is exosomes and what I'm talking about is highly concentrated exosomes, not exosomes combined with vitamins. So there are some exosomes combined with vitamins out there that work well to decrease redness and help you heal. But highly concentrated exosomes like the Antioch Exosomes that we just launched in Dubai that will be coming out very soon are unbelievable for long-term, true anti-aging and for healing. But if you want quick healing and redness, the Benev exosomes are quite amazing. They have a high level of niacinamide to decrease redness immediately after laser, or if you have redness that persists after a laser.

Eva Sheie (00:58:00):
How often are you traveling to these other locations yourself?

Dr. Emer (00:58:04):
Usually every two months, six to eight weeks, leaving next week for New York for a week, and then two weeks later to Dubai and to Miami.

Eva Sheie (00:58:12):
Do you stack the trips together? So you're gone for a while and then you're home for a while?

Dr. Emer (00:58:15):
No, not usually. We separate them just because we want to be able to do it on a cycle so that people can get their Botox at the right times and have their maintenance treatments at the right time.

Eva Sheie (00:58:26):
Can ordinary people still see you?

Dr. Emer (00:58:29):
 Yeah, of course. I mean, two days ago we posted a review online on our Instagram that was of a patient that said, I know Dr. Emer sees tons of celebrities and takes care of all these people on Hollywood, but when I went to him, he treated me like the normal person I am, made me feel like a celebrity, and I still got the same type of results. We also have the ability at any level to get treatment. I have a facial plastic surgeon that does Botox and fillers less than me. I have two nurses and a PA that do it much less than me. So there's every level of pricing. We have four aestheticians, two master aestheticians, and two younger estheticians. The lightest facial, for example, is 150. I mean, I used to get teenage facials for a hundred, 150 bucks. So there's every level of pricing to be able to be seen.

Eva Sheie (00:59:23):
What do you like to do outside of work?

Dr. Emer (00:59:26):
Work out, No, I love working out and I love cars. When I have enough money, I want to have a fleet of very expensive cars. I just love detail and Aston Martins and Ferraris and Lamborghinis. I like modifying cars. I'm actually looking right now to invest in a car shop that does all these modifications so that eventually I can get my own taken care of. But because I have so many lasers, I don't get to have all that stuff. My lasers are very expensive.

Eva Sheie (00:59:54):
Yes.

Dr. Emer (00:59:56):
I love food. And for those that follow Jason Emer official, even last night I posted being at Pasta Bar, which is Michelin Star pasta restaurant where you sit in the kitchen, only 10 people and you get a 10 course tasting menu. So I love that. And so just so you know, I can't disclose much, but in the next two to three months, an app that I feel is going to change the world with food is going to be coming out, and I'm one of the owners. It's in development, the Instagram for, it's called Food Tune. You can look it up. We're just starting postings on it right now, but the app will be out soon. I can't really say much more yet till the apps, it's in beta testing right now. When it comes out, we'll do a podcast.

Eva Sheie (01:00:41):
Oh, for sure. Yeah. I want to hear all about that. I love how many things you're working on. It's just awesome to see.

Dr. Emer (01:00:51):
I know. It just gets me excited.

Eva Sheie (01:00:54):
If we want to learn more about seeing you as a patient, where's the best place to go and then?

Dr. Emer (01:00:59):
Well, the best is to go to my Instagram Jason Emer rmd and follow my official Instagram because it's more of my personal life behind the scenes working out. My supplement line's going to be coming out very soon. It's called Emer Wellness. That's going to be out very soon. There's even a sexual supplement that you take daily to enhance sexual activity. It's making sex feel better, making it more enhanced, better orgasms with women and increases moisture with men. It gives them more blood flow. So all that's coming out. And then go to jason emer md.com. There's even a virtual tour of my office on there that's unbelievable. It's remarkable. So you can follow and you can walk through my entire office. And then we have an app, mirage cosmetics.com, which is my online store. We have 27 brands right now. We're adding about two to three brands every month, over 450 products on there.

(01:01:52):
We'll have tools on there very soon and supplements, and it's going to be the next derm store. Right now, it's increasing dramatically. We do about 60 to a hundred orders a day, and the app is on there, and it's all my top products. I just hired somebody that's going to be the face of the brand and she's going to be making videos of every product, how Dr. Emer differentiates it and why it's important to be in your protocols. So let's say you're getting a microneedling or a Fraxel somewhere else, and you can't come to me. You're going to be able to see a video talking about how Dr. Emer does Fraxel and what you need to do for your skin before, during, and after. Everything will be on there and you can order it directly. The skincare consults are basically free. They're virtual. We can customize a regimen for you, $25 for the skincare consult, but then it goes towards credit to purchase, so you can use that for skincare. And so we do about eight to 10 a day with my four estheticians.

Eva Sheie (01:02:53):
Are we going to be able to smell the products through the app?

Dr. Emer (01:02:56):
I wish. Honestly, I have tried to figure out some way to do that, but we're going to have a sort of monthly subscription where we select products that we send to you based on your goals and your initial regimen, and that's going to allow you to try and buy. But I like the idea that people can get a customized regimen because you can go to a doctor to get that, but you can't go to a Sephora by somebody well-trained and you can't get a dermatologist to give you a true regimen. They're not experienced enough in skincare. But because we have all these treatments we've done for years, the multiple aestheticians we do, the celebrity clients, we treat for red carpet events, for tv, for et cetera, we have developed so many protocols of the combination of things for every areas. You're going to even be able to search by ingredient, age concerns, skin type ingredient, everything you're going to be able to search by. But we do have the current app, emerage cosmetics.com right now, and the app store and the website.

Eva Sheie (01:04:00):
I'll check it out. Thank you for joining us today. It was such a pleasure.

Dr. Emer (01:04:04):
Yeah, this is phenomenal. Let me know when else you want to talk about things and I'm ready.

Eva Sheie (01:04:11):
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.