 episode of Business in Hawaii. My name is Kevin Lai and we are broadcasting live from the ThinkTech studios in downtown Honolulu. Today we will be addressing one aspect of the 2019 HealthSpan Hawaii Summit sponsored by the Regenerative Medicine Association of Hawaii. Nobel Laureate Mario Capecchi was the keynote speaker and the exciting meeting combined reports about new medical technologies and encouraging the idea of health travel beyond that of typical medical tourism to further diversify the economy of the state of Hawaii. And we established Hawaii as a place to come to be treated to bring one's family and to stay for recovery thereafter. Does Hawaii have what it takes to achieve this goal? We have identified two clinicians in Hawaii with indelible interest in different aspects of rejuvenate of medicine who have plenty to say about this. In the studio today is Dr. Melanie Tantasira founder of the True Vision Center in Honolulu. Dr. Tantasira is a graduate of the John A. Burns School of Medicine, is a board certified ophthalmologist and is now an innovative entrepreneur maintaining an active practice in Honolulu while focusing on oculoplastic surgery. He also serves as an assistant clinical professor at Jebson. Welcome Dr. Tantasira. Thank you. Dr. Tantasira what is new in cosmetic technology in Hawaii these days? Oh we have quite a few techniques that we're applying into cosmetic medicine and good for example we have some medications that last longer these are very new and obviously anything that lasts longer is better for the patient. We can customize treatments to each individual patient therefore allowing access to a broader range of patients and that's wonderful for them. We also have medications that are created by recombinant DNA therapy treatments and we even use PRP which is platelet-rich plasma which is a component of each patient's blood. It's been used in other areas of medicine but now it's in cosmetic medicine and so that will help patients feel faster. Super is there anything else that comes to mind? Anything else that comes to mind? Well those are the main ones that are in my mind. Are you thinking of anything specific? I understand there's some treatments that could almost make a patient look as if they'd have a smartphone filter applied to them. Oh sure that's when we use the very customized treatments. We use therapies that we've already been doing and we apply them to each patient as an individual. We want to make them look more like themselves kind of better so they bring in what they want to look like and we create it for them so that's what I mean by very customized. Sure. Yeah we can do that definitely. What about the age ranges of some of the patients these days? Yeah okay this is very interesting. We're starting to see both younger patients and older patients. It used to be that when we thought about who would come in for treatments it would be kind of like this middle age you know we thought people who were in their 40s and 50s and we used to think it was females. Now I'm seeing patients come in in their 20s. They want to prevent any damage. They never want to see a wrinkle in their face. They never want to look older. They want to look the same as they do right then because they look fantastic. So they'll start treatment really really early and they'll never get any damage saved like a frown line here in Hawaii. We have a lot of squinting. They won't ever develop lines from squinting in the sun and so they'll never have to erase it later. I also have patients at the other end. My patient is coming in in their 70s. I even had a patient in her 90s. She knew exactly what she wanted and fixed the problem that she wanted without surgery. It sounds like you're pretty keen on preventative treatments as well. Oh definitely. The primary preventative thing I have every patient on right away is sunscreen because our son is not a friend to your looks or to your skin cancers. Fantastic. What can you tell us what you mentioned about using old technologies today, chemicals or what not? Well we do have fillers. Okay fillers have been around for quite a long time. What we do with fillers is they take up volume okay. Old style with fillers was we fill a space like you have a smile line fill it up and it looks better. Now we use it to place it in a higher spot and because most of the lines are created by gravity pulling down on the face. So now we'll place it higher and lift the face and that erases the lines just as well but it looks more natural. So that's kind of old technology. However we have newer fillers which now last a long time. We have studies showing that the newest filler lasts five years going on 10 years and with the type of technology that's involved in it I see no reason why it wouldn't last for the rest of the patient's life which is great because right now most of the fillers we have have to be replaced every four months and maybe two years. A true advantage for the patient. Yes the patients love it because they don't have to come in every one to two years. They're going to be really really happy. I know you mentioned PRP earlier. Can you tell us a bit more about that how it's made and how it's used? Sure okay so PRP stands for platelet rich plasma okay so platelets are the cells that stop bleeding when there's an injury and because they're rushing to injuries they bring along growth factors so that will help with feeling the injuries. So when we take it and make it rich in the plasma so platelet rich plasma we enrich the plasma with platelets then we're going to have a high concentration of platelets and growth factors and the way we create that is we draw some blood and then we concentrate the platelets within the blood by using a centrifuge and concentrating that and then when we use that we can promote healing and we can make it faster in patients in any procedure that we're going to do. So PRP has been used in other areas of medicine and it's kind of new to cosmetic medicine. We have many different techniques that we use PRP in cosmetic medicine. I understand it can also be used for areas such as hair loss or for hair regrowth what can you tell us about that? Yes we do use that. In male and female balding it is felt that the hair follicles are somewhat damaged and so by injecting it into the areas of hair loss we are able to help repair those follicles and then we see regrowth of hair after a few treatments. So yeah it's a great area because given those side effects of having hair transplants if we can get growth of hair with just these simple treatments which are relatively non-invasive and are much shorter then that's a great advantage to the patients as well. Great I understand it may have some video of such a procedure. Yes I did bring a video that would be very nice. Okay so I'm meeting a patient here she's only 27 years old. This is my assistant who's prepping the patient and she will be drying some blood. You can see we use a very tiny needle and she will be drying a small amount of blood. So this patient suddenly had hair loss about a year ago and it's quite severe it causes her great distress so we're drying one tube of blood in this case it's about a teaspoon if we need more we can draw more than one tube okay so it's easily drawn just like giving blood at the lab then we're going to place this tube in the centrifuge. Our centrifuge is able to separate the blood components within seven minutes and then when you take out the tube you're going to be able to see the separation. The red blood cells are going to be at the bottom of the tube which is the outside the centrifuge and the top part has that golden fluid which is the plasma in the platelet and so now my assistant is going to withdraw the plasma through the long needle into the syringe and you can see how the blood cells are at the very bottom of the plasma is at the top and once she gets it into the syringe I can use it for any number of different methods and in this case because we're doing hair loss treatment I'm going to place a tiny needle on the end and here I'm prepping the treatment site I'm using alcohol I'm using a very strong alcohol to make sure it's disinfectant okay so once I disinfect the area I have this tiny needle and I'm just going to place small amounts all along the areas of hair loss okay so you can see it's a very small needle and it doesn't cause any pain or discomfort there's very little of any bleeding and I'm just going right along her part because her hair is quite thin along that area and I will just place it over her entire head the treatment took maybe 15 minutes here is the top of her head the crown where there's really significant thinning there's almost no hair growth in this area just finishing up a little bit of oozing is stopped by pressure and you can see that we're finishing up okay clean up the area and that's all there is to it okay and so the patient sits up she's doing great looking forward to having more hair in a few months thank you Dr. Tentas here that's fantastic I think we're going to take a quick break now for just a minute or two and we'll be back with Business in Hawaii in just a moment hi I'm Rusty Komori host of Beyond the Lines on Think Tech Hawaii my show is based on my book also titled Beyond the Lines and it's about creating a superior culture of excellence leadership and finding greatness I interview guests who are successful in business sports and life which is sure to inspire you in finding your greatness join me every Monday as we go Beyond the Lines at 11 a.m. Aloha Aloha I'm Wendy Lowe and I'm coming to you every other Tuesday at two o'clock live from Think Tech Hawaii and on our show we talk about taking your health back and what does that mean it means mind, body and soul anything you can do that makes your body healthier and happier is what we're going to be talking about whether it's spiritual health, mental health, fascia health, beautiful smile health whatever it means let's take healthy back Aloha back to this episode of Business in Hawaii and our discussion about how cosmetic and rejuvenate medicine could spark a new wave of health travel to Hawaii my name is Kevin Lai let's continue our conversation today we're going to hop over to Dr. Nat Ehrlich who's joining us today from his clinic in Makawau Maui Dr. Ehrlich thank you for making the time to join us today I wonder if you could share this a little bit about your practice and tell us about some of the procedures that you use to treat your patient okay well I've been in practice in Maui since 1988 with my area of specialization physical medicine and non-surgical orthopedic procedure, prolotherapy probably around 2003 prolotherapy is a system of injection regenerative techniques that use primarily higher concentrations of dextrose which is sugar to help remodel and repair damage can be such as 10 to that also PRP is one of the modalities I use that we you just heard about I use some cell-based therapies that are derived from autologous fat and bone marrow as well as neural prolotherapy and I use ultrasound guidance to both visualize in real time and guide my placement of the injections got it thank you Nat I wonder I understand that you were at the health span Hawaii summit and you were able to hear from Nobel laureate Mario Capecchi who shared the 2007 prize for physiology or medicine for his discoveries of principles for introducing specific gene modifications to mice what did you garner from Dr. Capecchi or from the summit itself well uh Dr. Capecchi was great I think he is on to a new eyes tier of medicine where you know we can start to look at gene modification in this particular situation was really interesting with anxiety and obsessive compulsive disorders as everybody probably knows anxiety disorders are becoming increasingly a problem in the american population especially in women and to be that there's a future in being able to get into the gene aspect of it and help control it was really promising fantastic thank you well as you know there was a clear push during the health span Hawaii summit to address the concept of promoting health travel to Hawaii and there was a specific track dedicated to that process and I think that we may have a slide that displays what we call the continuum of care for health travel and there are a number of steps that are involved there and just a few of them are the actual medical and clinical treatment side of things which clinicians such as yourself and Dr. Tanta Sierra would focus it's important to realize that there is a large number of other aspects of providing a suitable safe friendly place for different patients and their families to come to be treated I wonder if you could tell us a little bit about what you think it would take for Hawaii to become a leader in international health travel well as a destination it's pretty easy to see all the benefits that we enjoy here as residents of Hawaii the lifestyle the year-round sun and access to fresh water and fresh air not fresh produce it's actually you know grown here like papayas and all the keeps us healthy which is a big part of our recovery in a lot of these regenerative procedures is remember for example a lot of the techniques I use are autologous meaning we're drawing cells and biologics from our own bodies or say from the body of the patient that's being treated and in that milieu that you're drawing from you're drawing cells and proteins that are sending the health of that particular individual so it's really important no matter what whether we're recovering or preparing or just in general to maintain a very healthy status Hawaii is one of the best states in the country to be able to offer that type of life so it's not hard to be able to imagine people wanting to seek Hawaii as a destination it's just a matter of to accommodate their needs as whatever procedures that they underwent would require of them I do a lot of work and typically after the given inflammatory after the procedure there's some downtime and then after you know a week or so they can begin to engage in some light whether it's weight resistance or swimming they can begin to rehabilitate and what better place than Hawaii for their families to come down enjoy a vacation while they give support to their family member that's you know undergoing these procedures that we're doing let me turn back to Dr. Tanzas Sir now for a moment what are your thoughts on the vision of markedly increasing and promoting Hawaii as a place for health travel well I think it's a great place to market and we have all the infrastructure in place so we you know we have already the tourism base and we have experience with taking care of the kind of a luxury market because medical medical tourism is relatively expensive we also have great clinicians we can offer cosmetic services and the broad gamut from very simple procedures to total body makeovers and I do agree about the environment being a large part of the healing mechanism so we have everything in place I think it would be a great place and a great industry to access maybe it will take some kind of coordination we may need a medical tourism board in order to make that happen but I do think it would be very popular and wonderful for the patients I mean many people dream of coming to Hawaii just once in their lifetime I've talked to those people and if they can also have a procedure done that they want or need then what better place to come than to come here right on thank you now Dr. Ehrlich I know you mentioned that some of your work is dealing with orthopedics and those types of procedures could you tell us a little bit more about that and perhaps how the environment of Hawaii could be beneficial for your patients Hawaii is attractive to a lot of people worldwide because of the lifestyle we have a weekend both of a very free lifestyle that Hawaii can offer whether it's on water or sports and as a result people tend to seek out practitioners that are doing regenerative procedures in the world of orthopedics and regenerative medicine it it's it makes sense to a lot of people who are very active if they incur an injury that a prudent approach to their recovery would be instead of just jumping right into surgery that they do try something which would be more natural basically trying to harness the body's own ability to heal itself and use those factors for example PRP and then stimulate the body itself in most cases especially with osteoarthritis and degenerative joint disease these conditions aren't necessarily emergency conditions for surgery it is prudent to try something that won't hurt the patients such as PRP or some of these therapies chemotherapy especially when they're autologous meaning that the cells are being generated from that patient when these conditions are met and it's and it's not immediate surgery the worst I can see is that those particular procedures won't completely offer the 100 percent recovery and then in the long run surgery waits for that patient but in the best case scenario is and it happens often in my experience is that surgery can be averted so for people that are very active you know this this is actually very attractive think that we'll be seeing a greater degree of numbers of practitioners that are practicing regenerative medicine and for sure in the future this will be the future of medicine certainly now I'll toss this out to either of you are there any regulatory issues or concerns that patients should be aware about when dealing and seeking regenerative or even rejuvenative medical procedures? I don't see any new regulatory issues some of this therapy is not necessarily regulated as it's new and it falls under the practice of medicine the for example the PRP is not an quote FDA approved statement but it is something that has been used over and over over the years in orthopedics as Dr. Ehrlich has mentioned and in dental procedures so there is a standard of care that has been established and it's actually becoming quite common in cosmetic treatments so that's not something that is regulated by the FDA it becomes something that is standard of care within the practice and that is still not it's certainly not disapproved by the FDA no no regulatory issues are known in that regular treatment and thank you and Dr. Ehrlich I know you may have done some additional research about this is anything else come to mind? Well you know the field is broad and there's a lot of talk these days about those stem cells are being heralded now for treatment and cure of a lot of conditions my practice tends to focus almost entirely in orthopedic work and so I don't treat a lot of general medical conditions with a lot of the biologics that are that I previously mentioned for the majority of my cases I use PRP and PRP is great if you go to my website drnat.com slash nd there's a section on all the research and articles that I have amassed there and it's organized by areas of the body PRP I think it's safe to say is fairly well accepted even though it's not yet entirely FDA approved there's so many studies that show the efficacy of that particular care that I don't think that one's falling into question on question regarding cell therapies and for the most part the FDA is looking in the position that that I'm understanding that they're taking as of you know a week or so ago is that if you take you take either bone marrow or you take fat out of the body it must be minima at the best minimally manipulated so when you begin to add other agents or culture that particular milieu then you're going to start to enter into an area where he is going to call that you know autologous product a drug and once it becomes a drug then it needs to comply with a whole host of different types of requirements that the FDA has and so that's not an area that I really get this point I'm wondering what happens there's other countries that are way I would say more advanced in this world of these types of cell cellular treatments and that's because they federal or FDA type regulation imposed upon them so you hear of a lot of American citizens going abroad to get these treatments and a lot of it is pretty good I mean from what I've seen and from what I've empirically observed most of these patients that are going abroad to get them they're paying a lot but they're getting good results with it so yeah I'm going to wait and see how this plays out like I said the PRPs for me is an area that I've been doing since 2010 and I've not seen any kind of problems with it at all only really great results and in the more cases where somebody's really back up against the wall potentially facing surgery and they're going to need some kind of cellular therapy then I'll go with bone marrow in those kind of situations but I'm not really doing it any kind of the concoctions with that it's just extracting the bone marrow and they're acting okay thank you well in the few minutes that we have left let's turn back to a couple of exciting therapies that patients might be able to have when they would come to Hawaii for treatments in the future Dr. Tendaseer can you tell us a little bit about lasers lasers I love talking about lasers um yes I do skin lasers which is for rejuvenation or making the skin look younger my favorite one is a CO2 because it goes deep and creates a lot of change and rejuvenates very very well so it goes down to the dermis which is the deepest layer of the skin and it creates a lot of cellular activity that's where most of the rejuvenation can occur so I actually combine it with PRP treatment because immediately after the treatment there are openings from the surface of the skin down to the dermal layer intact skin in between so it heals excuse me fast and then when we add the PRP just it the PRP is just absorbed into this dermis and the growth factors can go to work it heals faster that way um more collagen is developed and the more collagen that's developed the thicker the skin is the fine lines go away because the skin is so thick um the medium wrinkles are improved and patients just love their new skin and they tell me oh my skin is as smooth as a baby's bottom sounds kind of crazy but that's the way it is just very briefly can you tell us a little bit about the use of needles or micro needles okay yes micro needles um they sort of create the same sort of um activity but without without the amount of trauma a laser does so they also will pierce the skin we use hundreds of little needles on a device that then goes all over the entire face um in the office we can go deeper and of course we maintain spiral technique we can numb the patient so we can do a slightly more aggressive treatment also we now our device doing PRP because again it can help with the healing and it does something similar to the laser just not quite as much all right thank you well with that appears to be almost all the time available for this edition of business in hawaii on think tech I'd like to thank our esteemed guest Dr. Melanie Tantasira and Dr. Nat Erlich for joining us today providing their candid commentaries so my name is Kevin Lai on behalf of guild consulting I would like to thank each of you as well for watching this episode of business in hawaii and learning about the potential role of cosmetic and rejuvenated medicine in the future of health travel to hawaii let us know what you think aloha