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Krystie P. Lennox He is an expert in [inaudible 00:00:02] class that sold out very quickly. Those of you [inaudible 00:00:16] I'm sure you'll learn tons. Dr. Runels, to you.

Charles Runels: Thank you. So thank you guys for having me. Leonardo da Vinci said that he wanted to do miracles. And I think that if you are careful about selecting your patients, you can come close to doing miracles with PRP. And I think we might as well face it, if we wanted to make money, we could take half the energy and do real estate or something. But most of the people in this room, we're here because we want to do miracles.

I have a couple of things, disclaimers, I have a couple of non-profits, no companies making money, although we've been offered some interesting money to put our brand names on different devices. We do have a group though, and much of what I'm telling you today comes from that group. I've become more of a note taker. We've published 2 papers so far this year, and 2 more that were approved this month. We're in 50 countries now; this slide has gone up a lot just in the past couple of months. Many of the ideas that I'm giving you are from the people in our group. Many of whom are in this room, so my hat's off to them.

Facial aesthetics. You heard some interesting ideas yesterday about shape, and I think it's worth noting that some mathematicians have thought about shape. Leonardo da Vinci, Richard Feynman, actually 5 Jewish scientists won Nobel Prizes this year. Richard Feynman was a physicist who won 2 Nobel Prizes, and he was also interested in beauty. This is one of his notebooks where you see him sketching women on the same page where he's doing math, and he had ... If you go to the internet, these are all his sketches. Here's another mathematician, Dr. [Marcourt 00:02:24] who was a bridge engineer and became an oral surgeon, and he did that topographic map. Lots of measurements about shape.

Here's the guy for whom the movie The Elephant Man was made, and you can see that that shape would not be attractive no matter what color or texture. But the Blue Man Group, you can see even though they look like they're made of plastic, and they're blue, they would still be attractive because of the shape. So you heard a lot about shape yesterday, and when it comes to fillers, or HA fillers, I think there's nothing that beats an HA when it comes to shape.

A lot of people who are disheartened by platelet-rich plasma, it was because they were trying to make platelet-rich plasma change shape. On the other hand, if you know how to combine it, you can do some amazing things with shape if you combine the HA with the PRP. To me this is the perfect candidate for an HA filler. You can see that she has loss of volume in the cheeks, she's got some drooping. This is with an HA filler alone, this is no PRP, this is just an HA. Here's HA done the wrong way. Chasing nasolabial folds and that's me trying to correct it. So a lot of people tried to use, 8 years ago when I first started using PRP, a lot of people were trying to use it as a standalone, like an HA, and it will not work if you do it that way.

On the other hand, combined it can do ... Literally do some miracles. So what is the technology all about? I mean what exactly is it? I know a lot of you are doing this. This is just a picture of a test tube full of blood. If you just let it sit there, and do nothing to it, eventually it would settle as like a sediment, like if you put sand and dirt in water and just let it settle, with the heaviest settling to the bottom first. And the centrifuge just makes that go faster. So the red cells are the heaviest, they're at the bottom, and then that little pink thing in the center there is called the buffy coat, where most of the platelets live.

Now most of this technology evolved out of trying to heal hard to heal wounds. Dentists trying to heal a wound where someone had radiation for throat cancer. An orthopedic surgeon trying to heal tissue of the knee, where there's almost no blood flow and cartilage. That's where most of this technology came and a lot of the reason that the urologists, the gynecologists, and the facial plastic surgeons didn't really have to look at it, because it's a very vascular space, so there's not really a need to try to work on hard to heal tissue because it's not hard to heal. The devices that we are using were developed over the past 15 years by the dentists and orthopedic surgeons, and were just rebranded and repurposed for facial aesthetics and for the [inaudible 00:05:12] space, when we started figuring out that they worked in those areas.

So sort of an interesting opportunity in time if you think about it. Back in the 80s, as an example, the gynecologists were all using endoscopic surgery, but the general surgeons were not. The gynecologists were very proficient at doing hysterectomy endoscopically, and the general surgeons were still filleting people open to take out a gallbladder. And the first person to really teach how to take out a gallbladder endoscopically was a gynecologist. Something similar is happening now, in that you have a huge body of research that's been published over the past 15 years about how to use platelet-rich plasma, but it's mostly been looked at by orthopedic surgeons and dentists. And you are in opportunity, I think, to now take that research and apply it in these spaces. I'll get to some of the research we're doing, but first a couple of ideas about how it happens, and what about the FDA.

I hear this a lot, "Is this procedure FDA-approved?" And you may have patients who ask you that, about PRPs are FDA approved. The FDA does not govern your hair, your urine, your skin, or your blood. It's the Food and Drug Administration. You can also call it the Food, Drug, and Device Administration, and I'm glad we have the FDA, but they do not govern your blood. However, they should be governing, and they do, the devices that are used to prepare blood to go back into the body. So if you're doing these procedures, the correct answer is that the FDA does not govern your blood, but that's a procedure. Just like if you were suturing a wound, the suture material is a device that must be approved by the FDA. But the FDA has nothing to do with how you suture and tie a knot when you're sewing up a wound. In the same way, the FDA should and does govern the devices that process blood to go back into the body, but once that blood is in your hand, that's your business, and the FDA is never going to have anything to say about that.

On the other hand, it's called minimal manipulation. So if you take a piece of skin from one part of your body and you transplant it to the other, that's your skin, FDA has nothing to do with it. Same thing if you harvest an egg for implantation. But if you do a lot to the tissue, the FDA says, "No, this is no longer tissue, it's a drug," and they've been warning us for the past 5 years that, "We're going to start cracking down on the stem cell clinics, because stem cells are a drug." So just be careful, if you're doing or advertising stem cell work, you probably need to have that under the umbrella of the Institutional Review Board, because the FDA now counts that as a drug. But they specifically do not count platelet-rich plasma as a drug.

There's lots of PRP systems out there, and they all have to do with just the best way to get those platelets, because again this was developed with the idea of getting as many growth factors as you can into a tiny space. For example a surgical wound in the jaw, or in the knee, where you want a lot of growth factors in a small space. We don't really know what the absolute best therapeutic concentration is for easy to heal tissues. In the joint space, the research seems to indicate that somewhere around 5 times concentration of whole blood works the best. Honestly, I'm not so sure that whole blood has platelets in it. When you do surgery, when you do a biopsy, you don't have to go use the centrifuge. The same process, the [inaudible 00:08:52] cascade, the growth factors caused that wound to heal. So 1 to 1, the same concentration that is whole blood, that's all you need to heal a surgical wound.

I'm not so sure that wouldn't work with the face. We don't know. But there's 2 basic kinds of kits. There's a single centrifuge, like a gel kit, and there's a double centrifuge. The orthopedic surgeons would tell you, "You need a double centrifuge and 5 time concentration," but we don't know yet what we need for the face, and the [inaudible 00:09:27] space. Always laugh when people say, "Well there's no research to back this up." If you just go to PubMed and put in "platelet-rich plasma," there's 9,000 papers that have been published. Just 1 of the manufacturers, and there are over 20 of them that are FDA approved, just 1 of them sold over a million tubes last year alone. Do you really need to do, if you show wound healing, and fibroblast activity, and [inaudible 00:09:53] in the foot, do you need to go repeat that research for the arm and ear and the genitals? Maybe you do. But maybe, at least for some indications, you don't.

Section 1 of 5 [00:00:00 - 00:10:04]

Section 2 of 5 [00:10:00 - 00:20:04](NOTE: speaker names may be different in each section)

Charles Runels: But maybe, for the least some indications, you don't. And so we are publishing studies specifically for the genitalia and the face, but it's laughable to me when people say there's no research to back up what we're doing. Here's some of the growth factors. The other thing that people often get worried about is well, growth, is it indiscriminate? Like throwing fertilizer on your lawn and you're gonna grow bad horrible things like neoplasia? Or is it more intelligent? I think it's more intelligent because, if you think about what you're doing, these growth factors were ... They're made to heal a wound. So it makes sense that it would help fight infection, that it might help fight foreign bodies and nurture healthy tissues versus unhealthy tissue. And indeed, in all of those 9,000 plus papers, there's never been one neoplasia documented, there's never been one serious side effect documented, except in one case where it was injected into the eye, where they had a retinal detachment. So no one do a shot anywhere near the eyeball.

And if you had a serious side effect, you would literally have the first one known to mankind. So although it doesn't cure everything, this is something that can change lives and you never lose sleep over it. You're not going to cause blindness, necrosis. You're literally injecting what the body would use to heal itself if you did injury.

IG [inaudible 00:11:34], as a matter of fact, is what we use to document and measure acromegaly, that's one of the growth factors that are released. And people who have acromegaly, or high growth hormone levels, like Tony Robbins and these big guys. They have 25% less cancer than in the general population. So you could make the case that perhaps it's even protective for neoplasia.

So here's some of the things that PRP does. Collagen production, fiberglass neo angiogenesis, neurogenesis. Stefani did some nice work with some gel tubes back in 2010, 2011. Published quite a bit showing fiberglass activity and [inaudible 00:12:13] proliferation and not just numbers, but enlargement of fat cells, which makes it intense, right? What's the easiest thing to grow in you body? It's fatty tissue. And fat cells just go crazy with this. Which, if you think about it, that's helpful, because if you had fat in the cheek or the breast, you might be able to make those fat cells, enlarge and multiply and have a nice cosmetic effect. And indeed, I'll show you some pictures shortly, where that is true.

Now this is just an example of we do have double blind placebo randomized control studies in different parts of the body. Here's one with [dis 00:12:48] disease. Here's one where Stefani injected the back of the arm and biopsied and demonstrated all these tissue types generating healthy tissue. But here's two studies that are particularly interesting to what we're doing. In these studies, they had people who had exposed bone and tendon or the foot and ankle, from trauma. So the skin has been torn away. You're trying to regrow the skin.

And in one group, they had a layer cake, where you had an HA, like a Juvederm, but orthopedic version of it. And then you had on top of that, PRP. And the other group just got the HA covering. And they looked to see who could grow the skin back. And the people who had the layer cake, which is what we do when we do it in the face if we're trying to change shape, and HA followed by PRP, you do your best work with an HA filler and then polish that odd with platelet rich plasma, that's what they did. And the people who got that layer cake more easily and quickly grew back healthy tissue to cover the exposed bone and tendon.

So here's an example of a scar that I treated. You can see this woman had, the year before I did this, she had a cortisone injection in the ankle. This was little college woman who was embarrassed to wear a dress to sorority functions because she had cortisone that caused atrophy of the skin. And if you look carefully, there's to hypopigmented scars. One of them is where she was cleated playing soccer. And then when it didn't heal properly, she went to the dermatologist who biopsied it. And the dermatologist said, "Yes, this is atrophy from cortisone. There's nothing I can do." And then six months after that, so a year after the cortisone, she was a friend of one of my sons and asked me if I would treat her ankle. So she came in and you can see it goes all the way up the leg. And so I put one CC of an HA filler there, and five CC's of PRP. So you can still see the needle marks. This is a few days later. This is a month later. This is a year later.

It's now been seven years since I've treated this woman's ankle. She's an insurance salesman now. I bought some insurance from her to pay her back for me showing her ankle around the world. And it still looks like this. So when people ask you, "How long does this last?" Well, the answer is, if the edeology is gone, it's permanent. You do not have to go spin blood and do a centrifuge to keep a surgical wound from dehiscing, so if you have an operation and you suture a wound together, when it grows back together, it's there permanently. On the other hand, if the edeology is still present, then it will need to be repeated. For example, with we use PRP for a woman who has dyspareunia, she has dryness and painful intercourse because she cannot be on estrogens and she's had breast cancer. This is the balm. That's an easy treatment for us. And she will get lubricate and she will love you for it and you will change her life. But she'll have to have a repeated treatment in about a year because the edeology is still there.

When you treat a woman, however, who's had an episiotomy scar and has severe pain after she tore after she delivered a child, you will also change her life and she will love you for it. And I have people that I've treated like that six, seven years ago and they are still comfortable because they haven't delivered another 10 pound baby. With the face, however, age still goes on, as you guys know. We can't freeze people in time. So when you do this with the face, they're probably going to want ... They'll still want their Botox, they'll still want their everything you do to maintain the face, the creams and everything else and they'll probably want this procedure done again in a year and a half to two years, just because of age. But the tissue that grows there is permanent.

This is what you can do with one syringe of a filler. The fillers last longer and it's like it polishes off your work. This is one syringe of filler and five CC's of PRP. So you have an effect that is I think more natural, in some ways more dramatic than you can do by using larger volumes of filler. The other thing if you think about that ankle, it's growing based on the genetic code. When you use your filler, it's what you're seeing. It's your eye. But you cannot make an abnormal shape with PRP because the shape that grows is dictated by the genetic code. So it's a really nice combination where you make some structure with your filler, but then let the genetic code polish off the structure you've made to create a really nice natural shape, which of course is what your patients want. They want younger and they want natural.

Micro needling has been more well known. As you guys know, we have a name that we use to help promote that. We're all over the news. This time of the year is a great time to start to join our group because people love talking about us around Halloween. I won't say the name, but you guys know it. So if you use micro needling ... Split face studies have been done for scarring and for just rejuvenation and anti aging type effects. Comparing micro needling with platelet rich plasma versus micro needling with vitamin C, micro needling with platelet rich plasma compared to micro needling with saline, and the PRP wins. Multiple studies. Those are two examples. And the same thing with the hair. That treating alopecia areata, treating hair loss. Most women will get all their hair back. Men will get about 30 to 40 percent of their hair back. And those studies have been done over and over now. So much has come out in the past couple of years.

So let's switch to the sex part. I hope that the women in this room become angry. You have reasons to be angry. If you're not angry when I finish this next part, I don't know. Maybe you're not listening. Because you should be very angry with what I'm about to tell you next. So before I get to that, the people ... I can see several people in our group in this room, and they will tell you that this becomes some of the most rewarding things that you will ever do in medicine. If you think about it, even when you're doing the face, you're really a love doctor, is what you are. Because why do you need your face. You relate to the people you love. You relate to the people you work with.

If someone throws a baseball at you, you cover your face and your genitals because those are sacred and the reason they're sacred, it's because that's how we relate to our lovers. And Emerson called sex and beauty the scaffolding of love. This is me before I shaved my head. And those are my three sons. That kind of hair, [inaudible 00:19:46] about sex just doesn't work. This was more conservative. But this was me as an internist with my three boys. And the reason I give you that picture is so that you can see, this is not sex for pleasure, although pleasure's wonderful. This is sex for relation-

Section 2 of 5 [00:10:00 - 00:20:04]

Section 3 of 5 [00:20:00 - 00:30:04](NOTE: speaker names may be different in each section)

Charles Runels: - for pleasure, although pleasure is wonderful. This is sex for relationships. When sex doesn't work, then babies live down the street and they go back and forth and people get divorced and the ripple effect goes throughout the community. People are married for 40 years and they're soulmates, but they can't connect like they did when they were younger and it puts a strain. This is not just about pleasure. I've been amazed and the people in our group have been amazed at how grateful people are when you do these procedures and you save the relationships.

It's not just about sex. Real key talked about the creative experience being related to the sexual function. I have many women that I've treated who say, "Why should men have all the fun?" I don't even want a lover. I don't want a woman lover. I don't want a man lover, but I have sex with myself. My sexual function gives me energy and creativity. It makes me a better salesperson. It helps me sleep better at night. It makes me less depressed, so it's okay to love yourself. This is not just about even the relationships with another person. It's about relationships with your creativity. Sex is so all encompassing.

Now, this is the part that I hope makes you angry. In 1980, who knows what was thought to be the most common cause of erectile dysfunction. This should shock you. I'm 58 so I remember this. In 1980, the most common cause of erectile dysfunction, this is from urology in 1980, and I'll blow that up where you can read it, most instances of acquired impotence are psychogenic. It was thought to be 85%.

Urologists in particular were confronted with genital problems and may be best suited as therapists. It wasn't until we accidentally discovered that Viagra got a lot of these guys well who we thought it was all in their head that we figured out it's not 85% psychogenic, it's 85% neurovascular. I think it's useful to remember how not smart we were. Imagine being one of these guys where your erection won't work and you're trying to keep your marriage together and somebody's sending you home telling you it's all in your head. Okay?

This is the part that should make you angry. Female sexual dysfunction, what are we telling people? Education, counseling, psychotherapy. We finally got the first drug approved to help women with sexual function and it's a psych drug. You have to become a teetotaler to use it. It's basically a spinoff of a serotonin dopamine Prozac sort of drug. We're taking it every day the average is one extra sexual encounter per month. It's just for libido. Nothing for painful intercourse or trouble with orgasm.

What I'm about to show you, I have no intention to tell you that this is some magic shot. I still think you have to think about endocrinology and relationships and surgical problems like ovarian cysts and cervical cancer and all that. I also want to propose to you that the penis is physically and embryologically like a small ... the clitoris is very much like a penis and that maybe it may also have things that can go wrong vascular and neurologically.

To tell a woman that it's all psychogenic who has pain because she delivered a 12 pound baby and ripped her vagina is criminal in my opinion, or at least should make you angry. That goes on every day, "Oh, here's a little lidocaine cream. Go home baby. It's all right." I've had so many gynecologists tell me they do not want to talk about sex. Research bares it out, even though 40% of women will have sexual problems. They'll only have the conversation 14% of the time, and if they bring up the subject, the doctor will change the subject after the first question. Now, if you're not angry you should just go have lunch because that should make you very angry.

I don't claim to have all the answers, but I claim to have a tool that I think is useful and I'm about to show you the research that shows that it's useful. I hope that some of you guys will jump in on this revolution. Now, the sex revolution of the 1960's was it's okay for a woman to have sex. I'm from Alabama, so I'm from the Bible Belt. The 1960's I can remember as a child all the ladies carrying their New Testament around. Now, they all carry their 50 Shades of Gray around. Okay? Which is a good thing because now the new sex revolution, and this was a cover of a Newsweek magazine article about the time 50 Shades came out, is that now it's okay for women to want to have good sex. You don't have to put up with bad sex. We are part of that revolution.

Now, we just went through this. The reason I show you those pictures again is the idea that maybe if there's a genetic code and you put platelet rich plasma there and the tissue grows back to recreate tissue the way it was genetically intended to happen, maybe that might happen around the urogenital space and create something nice.

First, let me show you what happens with the breast. I'm not trying to give you something that would take the place of implants, but look what we can do. This was a woman who had two separate surgeries. First, to get implants at a major university in a big city from an amazing surgeon, but this just happens. You see where she has a little double bubble there? The cleavage is a little bit apart, so she had it repeated. This is beautiful surgery, but it's a nuisance, so she had to wear that blue bathing suit right there to cover up that little double bubble. I took two syringes of Juvederm, filled in that little double bubble.

Now, remember the ankle? What happened there? This is six months later. By the way, she looked like that immediately, but I'm showing you the six month view and the bathing suit she wears now so you can see that just like with that ankle, it's not going away because she recreated tissue to fill in that double bubble. I treated both breasts, so it also brought the cleavage.

Anybody in here think you might have a patient that would like you to do that for them? They love it and they can go ... I've treated Playboy Bunnies that shot, one shot three weeks after doing this. She could have shot the same day with a little makeup. I've treated women that went straight from my office to the swimming pool. People love this procedure. Not as a replacement for implants, but for a touch up for women who've got a little nuisance defect or for a woman who's not really wanting implants, she's just wanting a touch up to make her breasts more like they were 5 or 10 years ago.

As far as the safety of that, here's some studies showing the platelet rich mixed with fat helps the fat survive. Most surgeons are now mixing fats with platelet rich plasma before they put it in the breast and we have multiple studies showing ... I'd just as soon buy that, but there's two different really long-term studies looking at what happens with re-biopsy rates and cancer rates when you put fat in the breast trying to reconstruct post-breast cancer.

The trend is towards less cancer. It wasn't statistically significant. There was no increase in biopsy rates. No increase in recurrence of breast cancer. The trend was towards less, which makes sense if you buy the idea that platelet rich plasma is somehow helps fight infection, fight abnormal tissue. I'm not claiming this is an inoculation against breast cancer, but I think 20, 30 years from now someone is going to do some long-term study that shows that perhaps it decreases the chances.

This is another woman that I treated. That's day one. I use a combination of HA with PRP. I wound up using three Juvederm syringes and about 15 ccs of PRP. These are saline implants that are about 15 years old and that's 8 weeks after that procedure. Remember how easy fat grows and remember my ankle? This was a combination of fertilizing fat and using an HA filler to help correct, and her husband calls me up belated because he doesn't have to suffer with her through another surgery.

As far as the genitalia itself, imagine this woman walks into your office. She's got that callus because she has to use a vibrator that's like a jackhammer and it takes her an hour to have an orgasm. The reason is her ex-husband abused her and the genitalia, the anus and the vagina, and left her with so much scar tissue it hurts to have intercourse with a man. She feels unlovable. All of her hormones are normal. Multiple gynecologists. What can she do?

She saw me on her lunch hour. I gave her platelet rich plasma into that callus and into the scarring that she had. I didn't think of the idea that PRP helps scarring. We've known it for 10 years. It's just a new idea to it treats scars in the vagina. People are afraid for some reason to go down there, but that has collagen and blood flow just like your arm or your face. Six months later she was engaged to a high school sweetheart for something that took me 30 minutes on the lunch hour after she had suffered for years.

These have been reorganized recently, but these are the description of female sexual dysfunction. As I mentioned, we only have one approved drug by the FDA to help these problems. It's only for arousal and desire. Nothing for orgasmic disorder. The treatment for pain is lidocaine cream and-

Section 3 of 5 [00:20:00 - 00:30:04]

Section 4 of 5 [00:30:00 - 00:40:04](NOTE: speaker names may be different in each section)

Charles Runels: ... [inaudible 00:30:00] cream and anti-depressants. It's really aggravating.

Now when it comes to incontinence, who in here would put Radiance in the mouth? Nobody, right? Because it links to granuloma. But there's an FDA approved version of calcium ascorbate crystals called Coaptite to inject around the urethra, approved by the FDA for urinary incontinence. And as you might expect, one in 40 women get the granuloma, that has to be surgically removed, because it causes obstruction. But it does work, and it's approved because it does work. There has never been a documented granuloma from PRP. So, I didn't think of the idea to inject something around the urethra that you can use a little 27-gauge needle, and I promise you, if you learn it the way I teach it to you, they will tell you it hurts less than Botox.

People think the vagina is sensitive. You can literally make a laceration on the vagina without numbing cream. All the sensation is on the other side, where the clitoris drapes down around the vagina and the urethra. That was Doctor Grafenberg's big idea. Doctor G. for the G-Spot, that all the stimulation is happening on the other side of the vagina. So, you can do these injections with almost no pain, usually zero pain and have dramatic effects on -

This is just some of the research showing the granulomas that happen when you use the calcium ascorbate crystals.

But, you can do this without fear of granulomas and sure, it does not work all the time, but it does work in a young woman who's leaking because she's exercising or because she had a baby, and she's dripping a bit enough to where it bothers her at work and keeps her from doing aerobics. We get over 80-percent efficacy and even if it doesn't work, these ladies are usually very grateful that you have offered them something non-surgical before they went for a mid-urethral sling or had to take anticholinergic or a diaper. So they'll love you when you do this.

These are all the other things. All those still stay there. Kegels. They all still there. There's still a need for slings. But, in between physical therapies and anticholinergic, that's a big jump. Something that makes you feel stupid and constipated, you might want to try a 10-minute shot before you jump to that step. We get lots of press.

This is a cartoon of an urethra up on top, and the reason I put this here, I want to see where we put this injection when we're treating incontinence. It's like a liquid sling. Where you see a green material there, that's a cartoon of the skins glands and the periurethral glands. It's literally like the prostate gland of a man, but a man ejaculates once the fluid comes from the prostate gland.

And women who ejaculate, we have ultrasound studies and physiological studies. The fluid that comes from that, if you gave it to a pathologist, she would not be able to tell the difference between that and prostate fluid. It tests positive for PSA. It's not like the goal is to have all women ejaculating, but when you put the injection right there, you will have women who will tell you their orgasms become...they use words that sound like some infomercial. They're exploding and thunder and all sorts of things.

I can read you a text I got yesterday about this. It's amazing and women in their 60s becoming ejaculatory. Wasn't their goal to do that, but their orgasms become amazing. And I think part of what's happening is that we are making that tissue there wake up. So, the space most distant from the bladder between the vagina and urethra, that's where we do the injection. Simple little technique. Don't even need a speculum. Takes five minutes.

Now this is the clitoris. Most people when they think of the clitoris, they think about the part that you can see. But, you can see it drapes down around the vagina, and we have ultrasound studies that showing that when we inject the platelet rich plasma, which travels like saline, it's aqueous, we can see it going down into corpus cavernosi, bilaterally. And even the weigh form changes to what you see in a flaccid penis to what you see in an erect penis. It wakes it up.

Now, we have studies. This is one that was posted in the Journal of Sexual Medicine, showing that when you do an MRI of women who can easily have an orgasm and when you do MRIs with women who have difficulty with orgasm, the women who easily have orgasm tend to have a clitoris that's larger and closer to the vagina.

It's kind of odd thing to think about but when men and women have sex, they're basically rubbing penises together. Or you can say they're both rubbing clitorises together, however you want to look at it. But, it's the same structure. It's just like a penis that you unzipped when you think about the clitoris. And so it makes sense that if it's closer to the vagina, then it's more easily to have the orgasm. But the conclusion of the study was, "Well we know this, but we don't know what to do about it." I'm telling you there may be something to do about it. Because when you inject the clitoris with PRP, it wakes up.

Because one of the studies we did when we looked at female sexual function index, the female sexual distress score, and all the ranks improved. Satisfaction, which is another thing that I hope makes you angry. Satisfaction did not always improve. But this is the interesting thing about drugs in men verses drugs in women. If you went to approve a drug for a man that gets...of course we have over 20 FDA devices and drugs for men. Now I just told you we have one for women. Does that make you angry? It should make you angry. If it doesn't, just go have lunch.

Men have over 20. Women have one. And the one women have is a psych drug, but to prove, we'll say you want to get a drug approved for a man. All you have to do is to prove that it makes his penis hard. Boom. You can say. If you want to approve a drug for women, you have to approve that not only that said libido goes up, orgasms improve. You have to prove that she's more satisfied. That's not the same thing. For example, one of the ladies I treated became less satisfied, even though her orgasms improved because she said her lover couldn't keep up with her anymore. So, if that were a drug, it would have been disproved because she became less satisfied. So, hopefully that's making you angry.

It sounds cool to say that we will have a couple thousand providers in 50 countries, but there's 35,000 gynecologists in the United States alone and there's another 30,000 urologists. There's 200,000 primary care providers, including nurse practitioners and MDs, and we have 2,000 worldwide. That's nothing.

The average time to adopt a new procedure is 20 years. The first heart cath done in the 1940s. So the fact you're even listening to me makes you know you're a doctor. It takes 10 years to do the research. 10 years for people to adopt it. We're eight years in, and now, the first year we publish one study. This year, by the end of the year, we'll have five studies published this year alone. And so, the research is taking off and now is the time to jump in.

Again, I don't claim that these procedures are magic shots. You still have to think, "these are the hormones I think about when I think about a woman's sexuality". I want to know about her prolactin, her DHA, her testosterone. All these things. So, you don't quit thinking about this. On the other hand, it sort of aggravates me when I have a sex therapist want to therapy and counsel someone out of their dyspareunia when they have a [inaudible 00:37:51] up there that I can treat.

So, this is a young woman and I've just treated one side so you can see. I get a lot of flack from people sometimes, saying, "well you should just let women let their vagina be whatever it is," and that's okay. But what if we said the same thing about the face? When people say "Well, you should just age gracefully." always go back up and would you say that about your house? Would you not paint it? Not wash it? Not mop the floors? Are you just gonna let it age gracefully? If you have the right to take care of your home and your face, it is okay to take care of your labia. And so, this is just taking some platelet rich plasma and half a syringe of an HA filler and just treating one of the labia majora and it just wakes up and looks happier. Who wouldn't want that?

And I'm not going to show you my more dramatic cases. This is a woman in her mid-30s. When you do it to a woman in her 60s or 70s, we know sometimes they look in the mirror and start sobbing, because "Oh! That's what I used to see when I was 30." So, that's just something else.

Now, there's a lot of devices out there. Lasers, radio frequency, and it's not a new idea. When you do the face, we've known for 10 years, when you do a laser, you follow it with platelet rich plasma, you get a more rapid healing and get a better result. So, the same thing happens with the vagina and all the luminaries who are doing research with the different lasers and radio frequency devices, they will tell you that if you follow it with platelet rich plasma, you get a better result. I don't use the words, "tighter vagina" or because [inaudible 00:39:28]. Maybe it needs to be tighter. Maybe it needs to be more - maybe she's married to King Kong. I don't know.

And there are quite a few people who, due to surgery or because of some sort of disease process, they use dilators. So, not everyone needs a device, but I would say to you before you buy a device, consider doing it like you do at your facial practice. You start with your injectables, and when that part of your practice is going, then you buy the device. You don't the device and let it sit there and eat up your bank account while you look for patients. So, in the same way, once you get to where you're doing these procedures...

Section 4 of 5 [00:30:00 - 00:40:04]

Section 5 of 5 [00:40:00 - 00:58:28](NOTE: speaker names may be different in each section)

Charles Runels: ... patients. So in the same way once you get to where you're doing these procedures, then you go buy the device and some of them will benefit by using that along with your platelet rich plasma. So we published a paper this year in the Journal of the American Academy of Dermatology. I'm very proud of that article because until we published this, there was really nothing out there for women with blackened sclerosis other than [inaudible 00:40:26] which leaves them with a 10 percent chance of squamous cell carcinoma. Now that may sound rare to you, blackened sclerosis, but it's about one in 80 women and also goes undiagnosed and I'm showing you this eczema because imagine that's your labia because that's what it looks like, and these ladies because of our research have let me into their closed Facebook groups and the stories are just heart wrenching.

One woman posted I was rocking because it attacks prepubescent girls and it eats their labia away and by the time they reach puberty their labia is gone. So one woman's post how she was rocking her 12 year old and her 12 year old's crying and she doesn't know what to tell her. Another one posted she's sitting there on the couch with her husband whom she loves and has been married to for 20 years. They're watching television, get the picture? They're sitting on the couch. She loves the man, and she wants to hold his hand, but she doesn't because she's afraid he'll become aroused because that's what her vagina looks like, and she's hurting and bleeding and does not want to have to tell him no. Can you imagine the loneliness? And that's out there, and they're not going to talk about it with you if you're their best friend because they're embarrassed by it.

But anyway, so this is eczema, the same autoimmune process, both processes are autoimmune, and this woman was treated with PRP by one of our gynecologists and that's six weeks later, and she was disabled from that eczema, okay? So anyway, we published first in the Journal of Lower Genital Tract Disease. Andrew Goldstein spearheaded this research for us, and then we published again in the Journal of American Academy of Dermatology. This had already been done with stem cells, but most of the stem cell studies, the stem cells have to be in something, and they're usually in PRP. So it's really two variables. So we just skipped the stem cells and did it with platelet rich plasma by itself, and we showed benefit. These are biopsies from our patients and this is the same magnification, so you can see the hyperkeratosis, the paleness, the sclerosis, and this is after platelet rich plasma.

So that's what the pathology looks like, but this is what it looks like when you go to the bathroom, those ulcerative type sclerotic bleeding, cracking, painful lesions and that's what you see six weeks later. So that's a little article that we published, and this is, we had two [inaudible 00:42:54] pathologists who looked at it and told us it was better. This is what it looks like long term. This lady, you could put about half of your thumb in that space that used to be her vagina and she had not had sex with her adoring husband for seven years. You can't pull her clitoral hood back but it's under all that scarring. Normally if you release that, it would be back like that within a couple of months because of the active lichen sclerosus, but if you, in this study, and Kathleen Posey's one of our gynecologists who just presented this down at a big meeting in Argentina and this series will be published, actually it's already out online but it'll be in one of the journals this upcoming month. She dissected this out in the office, injected with PRP and that's eight weeks later.

This woman is now two years out and still having comfortable sex with her husband. She had not had sex with her husband for seven years and was being treated with high dose clobetasol, high dose cortico-steroids and still had that scarring like that. Now, if you're not a gynecologist you couldn't do the surgery, but you could treat the lesions in people who did not have that hood phimosis and they will love you for it and they will come from everywhere. So, I have 17 minutes. Let me get to the men side. So, John Grisham has a rule. He says he will never write a book that would embarrass his mother. So, Priapus to this being the Greek god of fertility is from, and spelled with a lower case letter is the synonym for penis, so that's why I call this the priapus shot so that I don't embarrass mothers and grandmothers out there. Sort of code for penis shot. This was the research that first kind of alerted me to it. This is from Urology 2003.

If you're using Viagra and Cialis or a penile implant or every one of the 20 something devices and drugs that are approved to treat erectile dysfunction, if you're using one of those, you might be making the penis hard but you're not correcting the underlining etiology, and so this article was just bringing up the idea 2003 that neovascularization was shown in animal models and maybe it might help in people. So, 2010, this article came out where they took diabetic rats and they used stem cells, adipocyte derived stem cells, injected the penis of that rats and then they harvested the penis. You can see why they wouldn't have men volunteering for this, but they harvested the penis and they demonstrated that increased nitrate oxide activity in the dorsal nerve and new endothelial growth which means a harder, bigger penis. Now, women, I think God sort of plays a bad joke on us because let's think about the normal progression. You get married at 20 or 30 or whatever and you have your soul mate and sex works. Now, the woman delivers a few children and her vagina's growing and the average man by the time he reaches 65, half of his endothelium goes away, so his penis is shrinking and her vagina is growing.

It's just a bad joke, isn't it? But when they come in as a couple and we inject the penis on the man, it's almost like, it is a romantic thing. They've been married 40 years, they're going on vacation. You inject his penis. Then he sits at the head of the bed while you inject her vagina and they're like little teenagers and you get a text a week later how they're rediscovering their bodies because they work different and they feel different. So they get to keep the soul mate and get new genitals. It's really very touching.

But anyway, in this study, they documented that but the stem cells were tagged and they died, and so they postulated it was the growth factors as in the PRP that caused the growth. So that's what encouraged me to sort of try this thing out first on my own penis and then other patients and now we've published. A study came out of India, one of our providers in India treating men who had smaller almost micropenis, three inches, showing that he could demonstrate growth, and for Peyronie's disease which is the equivalent of dyspareunia in women, we have a crooked penis that hurts. So Dr. Varag who is the Parisian urologist who came up with TriMix, now his focus is on looking at what platelet rich plasma will do for a crooked penis which looks like that. So this is the equivalent of a woman who hurts. The man loves his wife, but he knows if he gets an erection it's not going to fit into her vagina and it hurts and basically he feels like he's out of commission, and the treatment for that is surgery which can leave you impotent and with a shorter penis and it can recur because it's autoimmune.

You can cut out that scar tissue and next year you can have it back. Well, there's a new FDA drug out called Zyflex that costs 50,000 dollars for a series and Dr. Varag has a study, he's already published one but he has another one that should be out soon, I saw him present in Venice that shows that PRP works better with fewer side effects than Zyflex. So you will see that research published soon, and this is a procedure that takes you ten minutes in your office. This is the study that he, the first study he demonstrated that PRP works for Peyronie's disease. We combine it with a penis pump which also helps Peyronie's disease, and we get some of the hard cases for the urologists are our easy cases. Here's two rat studies that came out showing that PRP helps regrow the nerve in a penis. Where would you need that? In men who have prostate surgery. So there's a whole protocol about penile rehabilitation post-prostate surgery.

You think there are a few of those men out there, trying to get their penis to come back after they've had, there's just so many of these men, and many of them have gone through this protocol but when we go back through it, which is a, basically you keep, it's just a glorified water balloon so you keep the penis stretched out until it recovers blood flow, and then you add a daily low dose Cialis, but when we add the PRP to that protocol, I'm having men that are a year or two years out when it didn't work and now six months later they're back able to have sexual relations with their wife of 50 years. So really, really moving stories, and it's just using, injecting into the penis platelet rich plasma just like, it's easier than the face. It's just right there to look at. You go into the corpus cavernosum with your needle and into the glans penis and get amazing results.

Just like with a face, you can combine it with devices like the shockwave therapies. So you do shockwave to the penis and PRP afterwards, and get a synergy that's like crazy, so once you get to where you're doing two or three of these a week, you add in the shockwave therapy and you get even better results and a really nice cash flow and a lot of healthy patients. So, I have ten minutes left. I think I'm going to stop there. Can we take questions or should ...

Speaker 2: [inaudible 00:50:21]

Charles Runels: So that'll give us time for questions. Before I take questions just let me say we have a booth here and your money's no good, but we're giving away stuff. We give away research. We give away free training on [inaudible 00:50:35] because I know if I just showed you one of the videos to how to do the O-shot or the vagina shot that'd be 20 minutes of a video but we're giving away a chance to see those things and of course if you stay in our group then we might ask you for money but we let you look at everything and so go pick up, if nothing else, a free t-shirt. Okay. So, and that's where you can go online and get access to a lot of things for free. So, it's okay to take questions?

Speaker 2: [inaudible 00:51:03].

Speaker 3: I think I have a loud voice. I don't know. Can everybody hear me?

Speaker 2: [inaudible 00:51:23].

Speaker 3: Okay. So, when you said [inaudible 00:51:26] when you do [inaudible 00:51:28] then do you do micro-needling or are you going to PRP with injecting ...

Charles Runels: So that's a good question. So, if you want to, a lot of people tried PRP back eight years ago when I first started playing with it, and then sort of threw it aside because people said use it like Juvena. It doesn't work like a filler if you inject it subdermally. You get new collagen, but it's like your putting new upholstery but you're not changing the shape of the mattress. So if you want color, texture, the picture you see of Kardashian, she was pregnant when she had that done. PRP is very safe, but so micro-needling with PRP topically would help color, texture, but if you want shape then that would be going in subdermally with your HA of choice, doing your best work and then going subdermally with PRP behind it to polish off that work similar to what you saw with the breast and the ankle. Does that make sense? So the facelift would be subdermally, the facial, so frankly speaking what happens when a patient comes in if they have acne scars, I may use a filler as you saw those beautiful photographs yesterday in the lectures to expand it and make it better and then you put PRP subdermally and then micro-needling and PRP topically on top of that.

So use a combination of tools based on what you're seeing.

Speaker 3: So you're saying both, micro-needling and ...

Charles Runels: Depending on what I'm seeing. If someone came in like yourself who has a nice color, texture already but wanted a little touch up with the shape, then I may not do micro-needling. I may just do subdermally with the HA and the PRP, where if you were complaining of crepe papering under the eyes and some acne scars, I may just do micro-needling with PRP topically, so it's kind of based on what you're seeing.

Speaker 2: [inaudible 00:53:19] question. Okay, so [inaudible 00:53:22]. So I have a question.

Charles Runels: Okay.

Speaker 2: If you [inaudible 00:53:31] tear troughs, how much [inaudible 00:53:35]?

Charles Runels: Oh, yeah. Yeah. Thanks for asking that. So I'm doing a experiment with my face. I'm not sure if it shows up here, but I have a little trick that I do where I take a small [inaudible 00:53:46] of an HA and mix it with a larger [inaudible 00:53:49] of PRP and make a little emulsion and using that, you can use it, it'll flow in the tear trough like water but you don't have to worry about a Tyndall effect and you don't have to worry about causing too much unsightly lumpiness that you get if you're not careful with an HA. So, that's what I'm using in the tear troughs.

Speaker 2: [inaudible 00:54:15].

Charles Runels: Yeah. So it's okay to use brand names. Yeah. So, with that ankle picture that I showed you, that was Juvena multiplus, one cc with five ccs of PRP on top of it. What I found is that when you put the PRP, well you saw it. That ankle's now eight years out and still looks like that, so that combination is very dramatic. If you go to the wound care and it lasts longer. So if you go to the wound care literature, you see that using an HA with a PRP overlay sort of layer cake with amazing results. It just hasn't been published as far as I know in the facial aesthetics literature. I've been all about the sex. That's where our group spends about 200,000 a year on research and like I said we'll have five papers published this year because there are so many things out for the face already, but nothing. Are you angry yet? Hopefully you're angry. You should be angry when you leave here. That part makes me angry that women have one drug for sex and it's a site drug. So that's where my resources have gone.

Speaker 2: So we're going to take [inaudible 00:55:30].

Speaker 4: [inaudible 00:55:32].

Charles Runels: Have I treated children with lichen sclerosus? Was that the question? I'm sorry. I couldn't hear.

Speaker 4: Have you treated children with lichen sclerosus [inaudible 00:55:50]?

Charles Runels: So I personally have not, but we have gynecologists in the group who have treated children and they're usually in the nine to 11 year age group. Because it's PRP, there's really, there's nothing dangerous about your own platelets, and so there's no contraindication to treating a child with platelet rich plasma.

Speaker 4: [inaudible 00:56:21]? [inaudible 00:56:33] versus platelet rich plasma?

Charles Runels: Oh, yeah. Yeah. So, I like when sales people play with words and I have, did your dad ever tell you jokes you wish you could forget? So my dad told me about this woman who just, in high school, that just had sex twice, once with the football team and once with the basketball team, so you kind of have to know what people mean and I know people throw around the platelet rich fibrin matrix and say oh, that's, this one's not good because it has red cells or this one has a different kind of white cells, and all the sales people are confusing everybody, and this one makes fibrin matrix and this one just makes PRP. When you do surgery if you just stop and use your common sense, when someone does surgery or you scraped your knee as a child nobody had to sort out the different types of white cells, you just grew new skin. And it's the same process. It's the thrombin cascade is growth factors from the platelets and then it's recruitment of [inaudible 00:57:30] stem cells that migrate from the bone marrow and regrow healthy tissue, and it happens with platelets.

Now, as far as the matrix goes there is a kit that's out there that comes with a little calcium chloride. We activate the platelet rich plasma and it turns to a matrix in your syringe, and I sometimes do that. I just buy calcium chloride as a vial and add a few drops and I do that as part of the process, but when you inject platelet rich plasma into the tissue as soon as it contacts the collagen it turns to platelet rich fibrin matrix. So you can't use it without making that matrix and if somebody kind of plays the semantics game with you, although it's technically true that only one kit comes with the calcium, to make the matrix in the syringe. We're all making it every time you inject platelet rich plasma into the tissue.

Okay. Thank you guys for having me.

Lichen Sclerosus Before & Afters

Here's an example of what is possible using O-Shot® methodology to treat lichen sclerosus. These photos are courtesy of Dr. Red Alinsod, who also enjoys a world-wide reputation for labial surgeries and is expert at freeing the phimosis that can happen with the clitoral hood.

lichen-oshot-red-alinsod
Possible results after treating lichen sclerosus with O-Shot® methodology.Courtesy of Dr.Red Alinsod

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