The Artemis Podcast

The Collagen Cliff: Menopause and Your Skin

Thomas McCann, MD — Sat, 07 Nov 2026 13:39:02 -0500

Skin often changes fast around menopause. Dr. Tom McCann and Alexandra explain how falling estrogen affects collagen, what randomized trials of hormone therapy found for skin, what the small studies of estrogen creams on the face show, how the November 2025 FDA labeling change fits in, and which treatments have the strongest evidence.

Key facts. Brincat's group measured a skin collagen decline of about 1 to 2 percent a year after menopause (Obstet Gynecol 1987). In KEEPS, four years of oral or transdermal estrogen did not improve wrinkles or skin rigidity versus placebo (Owen 2016). Topical estradiol for two weeks raised collagen in sun-protected skin but not in photoaged facial skin (Rittié 2008). No estrogen product is FDA approved for facial skin. NASEM (2020) found insufficient evidence for the clinical utility of compounded bioidentical hormones. FDA requested removal of several boxed warnings from menopausal hormone therapy in November 2025; first updated labels approved February 2026.

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Coming January 12, 2027: Imaging the Filler Complication, Dr. McCann's online course on reading filler on ultrasound, MRI and CT. Join the waitlist for the founding price: https://claude.ai/artifact/KNPp4Wn1wLPz4YdmaDoS1o

References

Brincat M, et al. Skin collagen after menopause. Obstet Gynecol. 1987;70(6):840-845. PMID 3120067.
Calleja-Agius J, Muscat-Baron Y, Brincat MP. Skin ageing. Menopause Int. 2007;13(2):60-64. https://doi.org/10.1258/175404507780796325
Guyuron B, Rowe DJ, Weinfeld AB, et al. Factors contributing to the facial aging of identical twins. Plast Reconstr Surg. 2009;123(4):1321-1331. https://doi.org/10.1097/PRS.0b013e31819c4d42
Owen CM, et al. KEEPS ancillary skin study, four-year results. Fertil Steril. 2016;106(5):1170-1175.e3. https://doi.org/10.1016/j.fertnstert.2016.06.023
Phillips TJ, Symons J, Menon S; HT Study Group. Randomized placebo-controlled trial of low-dose norethindrone acetate and ethinyl estradiol for age-related skin changes. J Am Acad Dermatol. 2008;59(3):397-404. https://doi.org/10.1016/j.jaad.2008.05.009
Schmidt JB, Binder M, Demschik G, Bieglmayer C, Reiner A. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35(9):669-674. https://doi.org/10.1111/j.1365-4362.1996.tb03701.x
Rittié L, Kang S, Voorhees JJ, Fisher GJ. Induction of collagen by estradiol: difference between sun-protected and photodamaged human skin in vivo. Arch Dermatol. 2008;144(9):1129-1140. https://doi.org/10.1001/archderm.144.9.1129
Yoon HS, Lee SR, Chung JH. Long-term topical estrogen on sun-exposed facial skin in postmenopausal women. Acta Derm Venereol. 2014;94(1):4-8. PMID 23722352.
Wentworth AB. Menopause and skin. Menopause. 2026;33:1031-1033. https://doi.org/10.1097/GME.0000000000002889
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy. 2020. https://www.nationalacademies.org/read/25791/chapter/11
US HHS. Fact sheet: FDA initiates removal of black box warnings from menopausal hormone replacement therapy products. November 10, 2025. https://www.hhs.gov/press-room/fact-sheet-fda-initiates-removal-of-black-box-warnings-from-menopausal-hormone-replacement-therapy-products.html
US FDA. FDA approves labeling changes for menopausal hormone therapy products. February 12, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products
Griffiths CE, Russman AN, Majmudar G, Singer RS, Hamilton TA, Voorhees JJ. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid). N Engl J Med. 1993;329(8):530-535. https://doi.org/10.1056/NEJM199308193290803
Renova (tretinoin cream) 0.02% prescribing information, indications and limitations of use.

After the Weight Comes Off: Loose Skin on the Body

Thomas McCann, MD — Sat, 07 Nov 2026 13:38:25 -0500

Losing a lot of weight on a GLP-1 can leave loose skin on the arms, abdomen and thighs. Dr. Tom McCann and Alexandra cover why it happens, what you can do while you're still losing (strength training and protein), what diluted calcium hydroxylapatite, radiofrequency microneedling and ultrasound devices can and can't do, and how to tell when it's a job for a plastic surgeon.

Key facts. STEP 1: 14.9 percent mean weight loss at 68 weeks (Wilding 2021). SURMOUNT-1: 20.9 percent at 72 weeks on 15 mg (Jastreboff 2022); about 25 percent of weight lost was lean tissue (Look 2025). After bariatric surgery, excess skin tracked highest preoperative BMI and current BMI (Baillot 2023); no study found tested speed of loss. Protein of 1.2 to 1.6 g/kg/day has been proposed during active weight loss (Mozaffarian 2025). Diluted calcium hydroxylapatite on the body is off-label; a 2018 consensus recommended it for arms, abdomen, thighs and buttocks (Goldie 2018). ASPS 2025: arm lifts up 21 percent, thigh lifts up 20 percent.

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References

Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. https://doi.org/10.1056/NEJMoa2032183
Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. https://doi.org/10.1056/NEJMoa2206038
Look M, Dunn JP, Kushner RF, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes Obes Metab. 2025;27:2720-2729. https://doi.org/10.1111/dom.16275
Mozaffarian D, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory. Am J Clin Nutr. 2025;122:344-367. https://doi.org/10.1016/j.ajcnut.2025.04.023
Villareal DT, Aguirre L, Gurney AB, et al. Aerobic or resistance exercise, or both, in dieting obese older adults. N Engl J Med. 2017;376(20):1943-1955. https://doi.org/10.1056/NEJMoa1616338
Baillot A, et al. Excess skin after bariatric surgery (observational study). Obes Surg. 2023;33:2324-2334. https://doi.org/10.1007/s11695-023-06698-w
Goldie K, Peeters W, Alghoul M, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg. 2018;44 Suppl 1:S32-S41. https://doi.org/10.1097/DSS.0000000000001685
Yutskovskaya YA, Kogan EA. Improved neocollagenesis and skin mechanical properties after injection of diluted calcium hydroxylapatite in the neck and decolletage: a pilot study. J Drugs Dermatol. 2017;16(1):68-74. PMID 28095536.
Merz Aesthetics. FDA approval for Radiesse for the treatment of wrinkles in the decollete area. April 8, 2026. https://www.businesswire.com/news/home/20260408543561/en/
Yu SS, Juhász M, Mesinkovska NA. Subcutaneous radiofrequency microneedling for the treatment of thigh skin laxity caused by weight loss: a case study. J Clin Aesthet Dermatol. 2019;12(6):60-62. PMID 31360291.
Merz Aesthetics. Ultherapy PRIME FDA clearance for abdomen and arms. November 5, 2025. https://www.businesswire.com/news/home/20251105913327/en/
American Society of Plastic Surgeons. 2025 procedural statistics release, September 1, 2026. https://www.plasticsurgery.org/news/press-releases/lift-procedures-led-growth-as-demand-for-restoration-drove-plastic-surgery-in-2025-new-asps-report-reveals
American Society of Plastic Surgeons. Body contouring after major weight loss: candidates. https://www.plasticsurgery.org/cosmetic-procedures/body-contouring-after-major-weight-loss/candidates
Garbaccio N, et al. Meta-analysis of weight trajectory on GLP-1 receptor agonists (12 studies). Aesthetic Plast Surg. 2025;49:6078-6088. https://doi.org/10.1007/s00266-025-05112-3

Tethered: What Actually Works for Cellulite

Thomas McCann, MD — Sat, 07 Nov 2026 13:37:48 -0500

Cellulite affects most women after puberty, and most of what's sold for it does little. Dr. Tom McCann and Alexandra explain what MRI shows is causing the dimples, why treatments that release the fibrous bands last longest, where radiofrequency and acoustic wave therapy fit, what happened to the injectable Qwo, and what weight loss and creams can and can't do.

Key facts. Roughly 85 to 90 percent of post-pubertal women have cellulite (Young and DiBernardo 2021). MRI found a thickened fibrous septum under 96.7 percent of cellulite depressions (Hexsel 2009). Cellfina: 55 women, one treatment, mean severity 3.4 to 1.4 at one year, 94 percent satisfied, benefit maintained at three years in 45 (Kaminer 2015, 2017). Avéli: FDA cleared 2021, long-term reduction clearance 2022; improvement stable at 12 months (Stevens 2023). Qwo: approved 2020; discontinued December 2022 over bruising concerns (Endo). A 2025 review of 24 randomized trials found no treatment definitively established (Lim 2025).

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References

Young VL, DiBernardo BE. Comparison of cellulite severity scales and imaging methods. Aesthet Surg J. 2021;41(6):NP521-NP537. https://doi.org/10.1093/asj/sjaa226
Querleux B, Cornillon C, Jolivet O, Bittoun J. Anatomy and physiology of subcutaneous adipose tissue by in vivo magnetic resonance imaging and spectroscopy: relationships with sex and presence of cellulite. Skin Res Technol. 2002;8(2):118-124. https://doi.org/10.1034/j.1600-0846.2002.00331.x
Hexsel DM, Abreu M, Rodrigues TC, Soirefmann M, do Prado DZ, Gamboa MM. Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging. Dermatol Surg. 2009;35(10):1471-1477. https://doi.org/10.1111/j.1524-4725.2009.01260.x
Kaminer MS, Coleman WP, Weiss RA, Robinson DM, Coleman WP, Hornfeldt C. Cellfina multicenter pivotal study. Dermatol Surg. 2015;41(3):336-347. https://doi.org/10.1097/DSS.0000000000000280
Kaminer MS, Coleman WP, Weiss RA, Robinson DM, Grossman J. Cellfina 3-year follow-up. Dermatol Surg. 2017;43(10):1240-1248. https://doi.org/10.1097/DSS.0000000000001218
Stevens WG, et al. Avéli CONFFIRM trial, 12-month results. Aesthet Surg J. 2023;43(4):455-466. https://doi.org/10.1093/asj/sjac291
US FDA 510(k) K212399 (2021) and K221336 (2022), Avéli. https://fda.innolitics.com/device/K221336
Kaufman-Janette J, et al. RELEASE-1 and RELEASE-2 phase 3 trials of collagenase clostridium histolyticum-aaes for buttock cellulite. Dermatol Surg. 2021;47(5):649-656. https://doi.org/10.1097/DSS.0000000000002952
Endo. Endo to cease production and sale of Qwo. December 6, 2022. https://www.newswire.ca/news-releases/endo-to-cease-production-and-sale-of-qwo-r-collagenase-clostridium-histolyticum-aaes--832877618.html
Busso M, Born TM. Monopolar radiofrequency with targeted pressure energy for cellulite. J Clin Aesthet Dermatol. 2023;16(5):35-39. https://pmc.ncbi.nlm.nih.gov/articles/PMC10243725/
Knobloch K, Joest B, Krämer R, Vogt PM. Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther. 2013;3(2):143-155. https://doi.org/10.1007/s13555-013-0039-5
Collis N, Elliot LA, Sharpe C, Sharpe DT. Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plast Reconstr Surg. 1999;104(4):1110-1114.
Piérard-Franchimont C, Piérard GE, Henry F, Vroome V, Cauwenbergh G. A randomized, placebo-controlled trial of topical retinol in the treatment of cellulite. Am J Clin Dermatol. 2000;1(6):369-374. https://doi.org/10.2165/00128071-200001060-00005
Smalls LK, Hicks M, Passeretti D, et al. Effect of weight loss on cellulite: gynoid lipodystrophy. Plast Reconstr Surg. 2006;118(2):510-516. https://doi.org/10.1097/01.prs.0000227629.94768.be
Swearingen A, et al. Poly-L-lactic acid for cellulite of the lower extremities, double-blind saline-controlled trial. J Drugs Dermatol. 2021;20(5):529-533. https://doi.org/10.36849/JDD.5380
Lim J, et al. Comparative analysis of cellulite treatment modalities: a systematic review. Aesthetic Plast Surg. 2025;49(7):2051-2075. https://doi.org/10.1007/s00266-024-04365-8
US FDA 510(k) K122579 (2012), VelaShape III, Syneron Medical. Indicated for temporary reduction in the appearance of cellulite. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K122579

Still There: What MRI Shows About Filler That Was Supposed to Be Gone

Thomas McCann, MD — Sat, 07 Nov 2026 13:37:07 -0500

Dr. Tom McCann, a board-certified diagnostic radiologist, and Alexandra explain what imaging shows about hyaluronic acid filler years after injection: a 2024 MRI study that found filler in all 33 midface patients studied, one at about 15 years; what filler looks like on MRI, ultrasound and CT; a 2026 case in which MRI found chin filler that two ultrasounds missed; a 2026 case of upper eyelid swelling traced to temple filler from two years earlier; and the realities of dissolving filler with hyaluronidase.

Key facts. Master 2024: 33 patients (24 asymptomatic, 9 with edema concerns), HA visible on MRI in all; 12 not injected for more than 5 years; longevity up to about 15 years; small, selected cohort. Mariluis 2026: persistent chin pressure 2 years after high-G-prime HA; two high-frequency ultrasounds showed only a small supraperiosteal bolus; MRI showed diffuse HA in subcutaneous fat; 150 IU targeted hyaluronidase gave complete relief, confirmed on follow-up MRI. El Feghaly and Tawa 2026: bilateral upper eyelid edema with unremarkable labs and orbital MRI; blepharoplasty histology showed HA; temple filler 2 years earlier recalled after surgery. Elective use of hyaluronidase to dissolve filler is off-label.

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

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References

Master M, Azizeddin A, Master V. Hyaluronic acid filler longevity in the mid-face: a review of 33 magnetic resonance imaging studies. Plast Reconstr Surg Glob Open. 2024;12(7):e5934. https://doi.org/10.1097/GOX.0000000000005934
Mariluis CA, Lagonegro D, Cavallieri F, Barrera P. Where is the filler? Magnetic resonance imaging reveals hidden hyaluronic acid in a delayed chin complication. Plast Reconstr Surg Glob Open. 2026;14(1):e7412. https://doi.org/10.1097/GOX.0000000000007412
El Feghaly C, Tawa P. Late-onset upper eyelid edema following temporal hollow correction with hyaluronic acid. Plast Reconstr Surg Glob Open. 2026;14(4):e7612. https://doi.org/10.1097/GOX.0000000000007612
DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J. 2017;37(7):814-825. https://doi.org/10.1093/asj/sjw251

Botox Bought Online: What a CDC Report on One Med Spa Teaches Everyone

Thomas McCann, MD — Sat, 07 Nov 2026 13:36:22 -0500

Dr. Tom McCann and Alexandra go through the CDC's October 8, 2026 report on three women who developed botulism-like symptoms after injections of a non-FDA-approved botulinum toxin bought online by a Colorado medical spa. They explain why symptoms after only 3 to 24 units point to the product, the handling failures investigators found, the symptoms to watch for and why antitoxin should be given early, the six FDA-approved cosmetic toxins, and what to ask before any toxin injection.

Key facts. Colorado (MMWR, October 8, 2026): non-FDA-approved toxin bought from an online supplier; 3 women symptomatic after 24, 3 and 10 units of the same lot, onset within 24 hours; none hospitalized, all recovered; 27 of 52 surveyed patients responded. Failures: preservative-containing diluent, single-dose vials used on multiple patients, inadequate temperature monitoring, unlabeled reconstituted product used past its beyond-use date. FDA warning letter to a Texas med spa, April 1, 2026, for obtaining toxin outside the legal supply chain. About 9.8 million US cosmetic toxin recipients in 2024. 2024 CDC alert: 22 people, 11 states including New Jersey, 11 of 20 with information hospitalized, 6 given antitoxin, no deaths. FDA-approved cosmetic toxins as of April 2026: Botox, Daxxify, Dysport, Jeuveau, Letybo, Xeomin. Labeled Botox Cosmetic doses: 20 units glabellar lines, 24 units lateral canthal lines.

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

Book a consult: artemisnj.com

References

Centers for Disease Control and Prevention. Notes from the Field: Unapproved botulinum toxin product administered at a medical spa, Colorado. MMWR Morb Mortal Wkly Rep. 2026;75(39):597-599. https://www.cdc.gov/mmwr/volumes/75/wr/mm7539a2.htm
Centers for Disease Control and Prevention. How to stay safe when getting botulinum toxin injections. Updated April 22, 2026. https://www.cdc.gov/botulism/prevention/botulinum-toxin-injections.html
Centers for Disease Control and Prevention. Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections. Health Alert Network, HAN 00507, April 23, 2024. https://www.cdc.gov/han/2024/han00507.html
Qiu H, Shen J, Tang Y, Ji Q, Lin X, Wu D. A retrospective case series study of illegal cosmetic iatrogenic botulism: outbreak analysis and response lessons. Aesthet Surg J. 2025;45(9):936-946. https://doi.org/10.1093/asj/sjaf088

Compounded Weight-Loss Drugs: What Changed

Thomas McCann, MD — Sat, 07 Nov 2026 13:34:28 -0500

Dr. Tom McCann and Alexandra explain what happened to compounded semaglutide and tirzepatide: why they became so common during the 2022 to 2025 shortages, how the FDA's end of the shortages and two 2025 court decisions ended the grace periods, what "essentially a copy" means, the FDA's April 30, 2026 proposal to keep semaglutide, tirzepatide and liraglutide off the 503B bulks list, why dosing in syringe units causes errors, and why adding B12 to tirzepatide raised a new safety question in 2026.

Key facts. Tirzepatide shortage declared resolved October 2, 2024, reaffirmed December 19, 2024; semaglutide February 21, 2025. Preliminary injunctions denied March 5, 2025 (tirzepatide) and April 24, 2025 (semaglutide); 503B grace periods ended March 19, 2025 and May 22, 2025. FDA does not intend to act against a 503A pharmacy filling four or fewer "essentially a copy" prescriptions in a calendar month. FDA proposed on April 30, 2026 not to include semaglutide, tirzepatide or liraglutide on the 503B bulks list (Federal Register May 1, 2026; 4,279 comments); still a proposal in every source found as of November 7, 2026. Stanford Medicine (July 2026): nearly 1 in 3 GLP-1 users got compounded product at the 2024 peak; poison center calls for injected weight-loss drugs up more than 15-fold since 2019; FDA has flagged 10 to 20 times the prescribed dose from multidose vials.

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

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References

US Food and Drug Administration. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. Content current as of April 1, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize
US Food and Drug Administration. FDA proposes to exclude semaglutide, tirzepatide, and liraglutide from 503B bulks list. April 30, 2026. https://www.fda.gov/news-events/press-announcements/fda-proposes-exclude-semaglutide-tirzepatide-and-liraglutide-503b-bulks-list
Federal Register. List of Bulk Drug Substances for Which There Is a Clinical Need Under Section 503B of the Federal Food, Drug, and Cosmetic Act. 91 FR 23431, May 1, 2026. https://www.federalregister.gov/documents/2026/05/01/2026-08552/list-of-bulk-drug-substances-for-which-there-is-a-clinical-need-under-section-503b-of-the-federal
Williams S. Compounded GLP-1s: why doctors worry and the FDA is cracking down. Stanford Medicine Insights, July 16, 2026. https://med.stanford.edu/news/insights/2026/07/glp1s-compounded-why-doctors-worry-about-safety.html
PharmExec. Eli Lilly releases open letter warning of potential safety risks of compounded tirzepatide plus vitamin B12. March 12, 2026. https://www.pharmexec.com/view/eli-lilly-releases-open-letter-warning-potential-safety-risks-compounded-tirzepatide-plus-vitamin-b12

Same Photons, Different Job: What Radiation Physics Teaches About Lasers

Thomas McCann, MD — Sat, 07 Nov 2026 12:26:26 -0500

Why is a radiologist running the lasers? Dr. Tom McCann and Alexandra explain how radiation physics applies to light-based treatments: X-rays and lasers are both photons, but differ about ten-thousand-fold in energy per photon. They cover selective photothermolysis, scatter and reflection, the ALARA habit, where the X-ray analogy breaks (collimated beams), why the eye is the main hazard, published eye injuries during laser hair removal, how eyes should be protected, and why physics knowledge is a foundation rather than proof of procedure-specific skill.

Key facts. Selective photothermolysis: wavelength matched to the target, pulse shorter than the target's cooling time, and enough fluence (Anderson and Parrish, 1983). Light from about 400 to 1400 nm is focused onto the retina. Published eye injuries during laser hair removal include anterior uveitis, iris damage and retinal injury (Parver 2012; Asiri 2017). In 31 private laser hair removal clinics, only 9.5% of observed sessions showed acceptable adherence to optical safety guidelines (AlTaleb 2019). ANSI Z136.3 is the US standard for safe use of lasers in health care.

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

Book a consult: artemisnj.com

References

Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524-527. https://doi.org/10.1126/science.6836297
Laser Institute of America. ANSI Z136.3, American National Standard for Safe Use of Lasers in Health Care. https://lia.org/store/ansi-z1363-2018-safe-use-lasers-health-care
American Board of Radiology. ABR Physics Study Guide. https://www.theabr.org/wp-content/uploads/2023/06/ABR-Physics-Study-Guide-2023.pdf
Parver DL, Dreher RJ, Kohanim S, et al. Ocular injury after laser hair reduction treatment to the eyebrow. Arch Ophthalmol. 2012;130(10):1330-1334. https://doi.org/10.1001/archophthalmol.2012.1988
Asiri MS, Alharbi M, Alkadi T, et al. Ocular injuries secondary to alexandrite laser-assisted hair removal. Can J Ophthalmol. 2017;52(2):e71-e75. https://doi.org/10.1016/j.jcjo.2016.09.013
AlTaleb RM, Alsharif HM, Younis AS, et al. Adherence to optical safety guidelines for laser-assisted hair removal. Photodermatol Photoimmunol Photomed. 2019;35(5):313-317. https://doi.org/10.1111/phpp.12473
New Jersey Administrative Code 13:28-2.15(b)(7) (laser hair removal and injections as medical services). https://regulations.justia.com/states/new-jersey/title-13/chapter-28/subchapter-2/section-13-28-2-15

The Thirty-Second Scan: Mapping Your Face With Ultrasound Before You're Injected

Thomas McCann, MD — Sat, 07 Nov 2026 12:25:35 -0500

Dr. Tom McCann and Alexandra go inside the thirty-second ultrasound scan Tom does before injecting. They explain why landmark-based danger zones describe averages, what Doppler mapping shows about patient-specific arteries in the forehead and smile lines, what a 2025 international expert consensus recommends, early trial evidence for ultrasound-guided toxin, ultrasound-guided treatment of filler complications, and the limits: ultrasound lowers risk but does not eliminate vascular occlusion and is not a universal standard of care.

Key facts. A 15-expert, seven-specialty Delphi consensus (2025) found ultrasound before injection mandatory in certain high-risk areas, recommended identifying prior filler before injecting, and called ultrasound guidance necessary for precise injections in complication treatment; minimum linear 15 MHz probe with color Doppler. Doppler before nasolabial filler in 40 patients (80 folds): facial artery lateral to the fold in 31%, beneath it in the rest at depths from subdermal to submuscular. Supratrochlear artery 1.8 to 5.9 mm under the skin at the eyebrow. A 40-subject randomized trial found faster and greater improvement with ultrasound-guided glabellar toxin than blind injection. Targeted ultrasound-guided hyaluronidase used a mean 122.5 IU versus 1,519.4 IU with flooding in a 39-patient retrospective series.

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

Book a consult: artemisnj.com

References

Velthuis PJ, Alfageme F, Cartier H, et al. The use of ultrasound imaging in aesthetic injectables: a modified Delphi consensus. J Plast Reconstr Aesthet Surg. 2025;104:33-37. https://doi.org/10.1016/j.bjps.2025.03.001
Schelke LW, Decates TS, Velthuis PJ. Ultrasound to improve the safety of hyaluronic acid filler treatments. J Cosmet Dermatol. 2018;17(6):1019-1024. https://doi.org/10.1111/jocd.12726
Lee W, Kim JS, Moon HJ, Yang EJ. A safe Doppler ultrasound-guided method for nasolabial fold correction with hyaluronic acid filler. Aesthet Surg J. 2021;41(6):NP486-NP492. https://doi.org/10.1093/asj/sjaa153
Ten B, Kara T, Kaya TI, et al. Evaluation of facial artery course variations and depth by Doppler ultrasonography. J Cosmet Dermatol. 2021;20(7):2247-2258. https://doi.org/10.1111/jocd.13838
Güvenç U, Ten B, Kaya TI, et al. Evaluation of supratrochlear artery depth and course variations by Doppler ultrasonography along the glabellar frown lines for safer filler injections. J Cosmet Dermatol. 2022;21(12):6717-6726. https://doi.org/10.1111/jocd.15338
Wu Y, Zhang Y, Li H, et al. A prospective and randomized study comparing ultrasound-guided real time injection to conventional blind injection of botulinum neurotoxin for glabellar wrinkles. J Cosmet Dermatol. 2024;23(9):2867-2875. https://doi.org/10.1111/jocd.16365
Schelke LW, Velthuis PJ, Decates T, et al. Ultrasound-guided targeted vs regional flooding: a comparative study for improving the clinical outcome in soft tissue filler vascular adverse event management. Aesthet Surg J. 2023;43(1):86-96. https://doi.org/10.1093/asj/sjac227

Why a Radiologist? Anatomy, Ultrasound, and the Needle

Thomas McCann, MD — Sat, 07 Nov 2026 12:24:46 -0500

Why is a radiologist doing aesthetic injections? Dr. Tom McCann and Alexandra explain what radiology training involves, the image-guided procedures radiologists do every day, and why anatomy in cross section and ultrasound are relevant to injecting the face safely. They cover research mapping facial arteries with Doppler ultrasound, ultrasound-guided treatment of filler complications, and where radiology training stops: it is a foundation, not a substitute for aesthetic training and experience.

Key facts. Radiologists performed 11.3% of Medicare lumbar punctures in 1991 and 46.6% in 2011 (Kroll 2015), and 54.0% in 2017 (Johnson 2021). Radiologists' share of Medicare paracentesis rose from 16% in 1993 to 74% in 2008, and of thoracentesis from 10% to 52% (Duszak 2010). Doppler mapping of 168 hemifaces found the facial artery as shallow as 2.5 mm and as deep as 23.5 mm, with no absolutely safe depth for nasolabial filler (Ten 2021). Ultrasound-guided hyaluronidase into the occluding filler deposit, given in time, prevented skin necrosis in a single treatment in a published series (Schelke 2023).

The voices in this episode were generated with AI (ElevenLabs). Dr. McCann reviews every script.

Book a consult: artemisnj.com

References

Kroll H, Duszak R Jr, Nsiah E, et al. Trends in lumbar puncture over 2 decades: a dramatic shift to radiology. AJR Am J Roentgenol. 2015;204(1):15-19. https://doi.org/10.2214/AJR.14.12622
Johnson DR, Waid MD, Rula EY, et al. Comparison of radiologists and other specialists in the performance of lumbar puncture procedures over time. AJNR Am J Neuroradiol. 2021;42(6):1174-1181. https://doi.org/10.3174/ajnr.A7049
Duszak R Jr, Chatterjee AR, Schneider DA. National fluid shifts: fifteen-year trends in paracentesis and thoracentesis procedures. J Am Coll Radiol. 2010;7(11):859-864. https://doi.org/10.1016/j.jacr.2010.04.013
Ten B, Kara T, Kaya TI, et al. Evaluation of facial artery course variations and depth by Doppler ultrasonography. J Cosmet Dermatol. 2021;20(7):2247-2258. https://doi.org/10.1111/jocd.13838
Shen WW, Du JN, Ma JX, et al. Evaluation of supratrochlear, supraorbital and angular artery course variations and depth by Doppler ultrasound. Aesthetic Plast Surg. 2023;47(2):791-798. https://doi.org/10.1007/s00266-022-03188-9
Schelke LW, Velthuis P, Kadouch J, Swift A. Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers. J Cosmet Dermatol. 2023;88(1):79-85. https://doi.org/10.1016/j.jaad.2019.07.032

Who's Holding the Needle? How to Choose an Aesthetic Provider

Thomas McCann, MD — Sat, 07 Nov 2026 08:10:16 -0500

Season finale. Dr. Tom McCann and Alexandra explain how to choose an aesthetic provider, starting from the 2024 CDC alert on counterfeit or mishandled botulinum toxin, which included New Jersey. They cover who may inject in New Jersey, how to verify a license, how to confirm a product is genuine, what a proper consultation looks like, and the red and green flags that tie together the whole season.

Key facts. CDC HAN 00507 (April 23, 2024): 22 people in 11 jurisdictions including New Jersey; 11 of 20 with information hospitalized; 6 received antitoxin; all reported injections by unlicensed or untrained people or in non-healthcare settings. N.J.A.C. 13:28-2.15(b)(7): cosmetology licensees may not perform services the Board of Medical Examiners has determined to be medical, including laser hair removal and injections of Botox, Restylane, or similar products. New Jersey Attorney General, October 18, 2023: $22,500 in penalties against a skin care specialist for alleged unlicensed injections.

Verify a New Jersey license: New Jersey Division of Consumer Affairs license verification. Check board certification: abms.org/verify-certification.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Centers for Disease Control and Prevention. Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections. Health Alert Network, HAN 00507, April 23, 2024. https://www.cdc.gov/han/2024/han00507.html
New Jersey Administrative Code 13:28-2.15 (Board of Cosmetology and Hairstyling, prohibited practices), subsection (b)(7). https://regulations.justia.com/states/new-jersey/title-13/chapter-28/subchapter-2/section-13-28-2-15
Office of the New Jersey Attorney General. Press release, October 18, 2023: consent order against a Union County skin care specialist for alleged unlicensed medical procedures including Botox and filler. https://www.njoag.gov/?p=120123
New Jersey Division of Consumer Affairs. License verification. https://njconsumeraffairs.gov/pages/verification.aspx
American Board of Medical Specialties. Verify Certification. https://www.abms.org/verify-certification/

Is "Ozempic Face" Real?

Thomas McCann, MD — Sat, 07 Nov 2026 08:10:09 -0500

"Ozempic face" is everywhere. Dr. Tom McCann and Alexandra explain what it is (facial volume loss and laxity from rapid or substantial weight loss, not a proven drug-specific effect), the anatomy of facial fat compartments, who is most at risk, how to reduce it during weight loss, and how filler, biostimulators, skin treatments and surgery fit in. They also flag why deep-heating devices deserve caution in a face that has already lost fat.

Key facts. Facial fat sits in discrete compartments (Rohrich and Pessa 2007). A 2026 review concluded the facial changes "more plausibly reflect rapid or substantial weight loss than a proven drug-specific facial effect." Risk factors in a 2026 systematic review: older age, longer obesity history, rapid weight loss, poor hydration, insufficient protein. Google searches for "Ozempic face" rose about 4,600% from November 2021 to December 2024.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219-2227. https://doi.org/10.1097/01.prs.0000265403.66886.54
Humphrey CD, Lawrence AC. Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons. Facial Plast Surg. 2023;39(6):719-721. https://doi.org/10.1055/a-2148-6321
Ersan M, Özturhan O. Effects of GLP-1 receptor agonists on aesthetic surgery practice: A contemporary review. Turk J Surg. 2026. https://doi.org/10.47717/turkjsurg.2026.2026-4-35
Barone M, Brunetti B, D'Emilio R, et al. Effects of GLP-1 Receptor Agonists on Skin Quality: A Comprehensive Literature Review. Aesthetic Plast Surg. 2026;50(13):5403-5407. https://doi.org/10.1007/s00266-026-05820-4
Cho CH, Koo S, Yoo K. Energy-Based Devices for GLP-1 Receptor Agonist-Associated Facial Aging: A Tissue-Specific Safety Framework. Clin Cosmet Investig Dermatol. 2026;19:628537. https://doi.org/10.2147/CCID.S628537
McCarthy AD, Durairaj K, Linneman-Heath J, et al. Rising Public Interest in Weight Loss Medications and Growing Awareness of Their Aesthetic Sequelae: An Infodemiologic Google Trends Analysis. J Cosmet Dermatol. 2026;25(1):e70670. https://doi.org/10.1111/jocd.70670
Seidel DU, Bode S. Rapid weight loss through GLP-1 receptor agonists as lifestyle phenomenon and implications for plastic esthetic medicine. HNO. 2025;73(11):765-770. https://doi.org/10.1007/s00106-025-01653-w

Peptides: Hype, Hope, and Washington's 2026 Rule Changes

Thomas McCann, MD — Sat, 07 Nov 2026 08:10:00 -0500

Peptides are everywhere on social media. Dr. Tom McCann and Alexandra explain what a peptide is (insulin and semaglutide are peptides too), what the evidence actually shows for BPC-157, and what changed in 2026: removal from the FDA's Category 2 safety-concern list in April, a July advisory committee vote recommending six peptides for the compounding bulks list, and an October 28 HHS interim policy that tolerates compounding of those six under strict conditions. They explain why none of that is FDA approval and why gray-market "research chemicals" are a separate and bigger risk.

Key facts. HSS Journal 2025 systematic review: 36 studies included, 35 preclinical and 1 clinical; no clinical safety data found; half-life under 30 minutes. Human reports: a retrospective knee pain chart review (11 of 12 reported improvement, no controls) and a two-person IV safety pilot. Poolton et al., Acta Orthop Belg 2026 (PROSPERO-registered systematic review, searched to June 1, 2026): three human studies, 30 participants (intra-articular knee, n=16; intravesical for interstitial cystitis, n=12; IV safety pilot, n=2); all poor quality, GRADE certainty very low; the authors advise against clinical use outside regulated trials. FDA Pharmacy Compounding Advisory Committee, July 23 to 24, 2026: recommended BPC-157 (8 to 6), TB-500 (8 to 6), KPV (8 to 6), MOTS-c (7 to 5), Epitalon (7 to 4), Semax (8 to 5); did not recommend DSIP (6 to 7). The vote is advisory; FDA rulemaking is required before any change takes effect. HHS interim enforcement policy, October 28, 2026 (Federal Register October 30): covers BPC-157, TB-500, KPV, MOTS-c, Epitalon and Semax for 503A compounding with a patient-specific prescription, an FDA-registered API source, required testing, one active ingredient, and route limits; it does not add them to the bulks list.

Status reflects public information as of November 8, 2026. HHS is taking comments through November 13, 2026, and the policy can change.

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AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Vasireddi N, Hahamyan H, Salata MJ, et al. Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review. HSS J. 2025;21(4):485-495. https://doi.org/10.1177/15563316251355551
Lee E, Padgett B. Intra-Articular Injection of BPC 157 for Multiple Types of Knee Pain. Altern Ther Health Med. 2021;27(4):8-13. https://pubmed.ncbi.nlm.nih.gov/34324435/
Lee E, Burgess K. Safety of Intravenous Infusion of BPC157 in Humans: A Pilot Study. Altern Ther Health Med. 2025;31(5):20-24. https://pubmed.ncbi.nlm.nih.gov/40131143/
Federal Register. Pharmacy Compounding Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments. Bulk Drug Substances Nominated for Inclusion on the Section 503A Bulk Drug Substances List. April 16, 2026. https://www.federalregister.gov/documents/2026/04/16/2026-07361/pharmacy-compounding-advisory-committee-notice-of-meeting-establishment-of-a-public-docket-request
US Food and Drug Administration. July 23-24, 2026: Meeting of the Pharmacy Compounding Advisory Committee. https://www.fda.gov/advisory-committees/advisory-committee-calendar/july-23-24-2026-meeting-pharmacy-compounding-advisory-committee-07232026
Holt D. BPC-157 in 2026: Why Regulatory Limbo Is Not the Same as a Green Light (legal analysis, updated August 2026). https://djholtlaw.com/regulatory-alert-the-legal-status-of-bpc-157-in-compounding-and-clinical-practice/
Robinson LR, et al. Topical palmitoyl pentapeptide provides improvement in photoaged human facial skin. Int J Cosmet Sci. 2005;27(3):155-160. https://doi.org/10.1111/j.1467-2494.2005.00261.x
US Department of Health and Human Services. HHS Enforcement Discretion Policy Regarding 503A Compounding Using Certain Peptide Bulk Drug Substances (interim), October 28, 2026. https://www.hhs.gov/sites/default/files/hhs-503a-peptide-enforcement-discretion-policy-appendix-b.pdf
National Law Review. Peptides: HHS Announces Limited Enforcement Discretion for Compounding of Six Peptides. October 30, 2026. https://natlawreview.com/article/peptides-hhs-announces-limited-enforcement-discretion-compounding-six-peptides
Poolton JT, Minett J, Kazmi A. Human evidence for BPC-157 in orthopaedic and regenerative medicine: a systematic review of efficacy and safety. Acta Orthop Belg. 2026;92(3). https://doi.org/10.52628/92.3.15837

Same Laser, Different Skin: Lasers, Devices, and Skin Tone

Thomas McCann, MD — Sat, 07 Nov 2026 08:09:47 -0500

Why can the same laser help one person and harm another? Dr. Tom McCann and Alexandra explain selective photothermolysis, the Fitzpatrick skin types, why postinflammatory hyperpigmentation is the key risk in deeper and tanned skin, and the three levers that make laser and device treatment safe across skin tones: wavelength, fractional delivery, and pigment-independent energy such as radiofrequency microneedling. They close with five questions to ask before any laser.

Key facts. Selective photothermolysis (1983): match wavelength to the target and keep the pulse shorter than its cooling time. Fractional photothermolysis (2004): microscopic treatment zones about 100 micrometers wide and 300 micrometers deep, healed within a day. ESLD guidelines: dark-skinned and especially tanned patients are at higher risk of pigment change and scarring.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524-527. https://doi.org/10.1126/science.6836297
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-438. https://doi.org/10.1002/lsm.20048
Silpa-Archa N, Kohli I, Chaowattanapanit S, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: A comprehensive overview. J Am Acad Dermatol. 2017;77(4):591-605. https://doi.org/10.1016/j.jaad.2017.01.035
Adamic M, Troilius A, Adatto M, Drosner M, Dahmane R. Vascular lasers and IPLS: guidelines for care from the European Society for Laser Dermatology (ESLD). J Cosmet Laser Ther. 2007;9(2):113-124. https://doi.org/10.1080/14764170701280693
Arsiwala SZ, Desai SR. Fractional Carbon Dioxide Laser: Optimizing Treatment Outcomes for Pigmented Atrophic Acne Scars in Skin of Color. J Cutan Aesthet Surg. 2019;12(2):85-94. https://doi.org/10.4103/JCAS.JCAS_171_18
Chen A, Choi J, Balazic E, Zhu TR, Kobets K. Review of laser and energy-based devices to treat rosacea in skin of color. J Cosmet Laser Ther. 2024;26(1-4):43-53. https://doi.org/10.1080/14764172.2024.2376701

The Two Things That Actually Work: Sunscreen and Retinoids

Thomas McCann, MD — Sat, 07 Nov 2026 08:09:38 -0500

Dr. Tom McCann and Alexandra cut through the skin-care aisle to the two interventions with strong randomized evidence against visible aging: daily sunscreen and retinoids. They walk through the Nambour sunscreen trial, the 1988 tretinoin trial in JAMA, and the 2007 retinol trial in adults averaging 87 years old, and they explain how to start a retinoid without quitting.

Key numbers. Nambour trial (n = 903, 4.5 years): daily sunscreen group showed no detectable increase in skin aging; 24% less aging than discretionary use; beta-carotene had no overall effect. Tretinoin trial (JAMA 1988): 14 of 15 faces improved on tretinoin vs none on vehicle at 16 weeks. Retinol trial (2007): 0.4% retinol improved fine wrinkling in 36 adults with mean age 87 over 24 weeks, with increased procollagen and glycosaminoglycans.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med. 2013;158(11):781-790. https://doi.org/10.7326/0003-4819-158-11-201306040-00002
Weiss JS, Ellis CN, Headington JT, Tincoff T, Hamilton TA, Voorhees JJ. Topical tretinoin improves photoaged skin. A double-blind vehicle-controlled study. JAMA. 1988;259(4):527-532. https://pubmed.ncbi.nlm.nih.gov/3336176/
Kafi R, Kwak HSR, Schumacher WE, et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol. 2007;143(5):606-612. https://doi.org/10.1001/archderm.143.5.606
Robinson LR, Fitzgerald NC, Doughty DG, Dawes NC, Berge CA, Bissett DL. Topical palmitoyl pentapeptide provides improvement in photoaged human facial skin. Int J Cosmet Sci. 2005;27(3):155-160. https://doi.org/10.1111/j.1467-2494.2005.00261.x
American Academy of Dermatology. How to select a sunscreen. https://www.aad.org/sun-protection/how-to-select-sunscreen

Why Your Body Doesn't Get Used to a GLP-1

Thomas McCann, MD — Sat, 07 Nov 2026 08:09:14 -0500

Why doesn't the body develop tolerance to GLP-1 medications the way it does to opioids, nitrates, or a decongestant spray? Dr. Tom McCann and Alexandra explain how receptor desensitization normally works, why the GLP-1 receptor seems to escape it (receptor recycling and drugs that recruit little beta-arrestin, including tirzepatide's biased signaling), which effect does fade (gastric slowing and the nausea that comes with it), and why the weight loss plateau is a new energy balance rather than the drug wearing off.

Key facts. Nauck 2011: GLP-1 slowed gastric emptying significantly less after a second meal four hours into the same infusion. STEP 1 to 3 pooled: nausea in 43.9% on semaglutide vs 16.1% placebo, mostly mild to moderate and transient; 4.3% discontinued for GI events; less than 1 percentage point of weight loss was mediated by GI side effects. STEP 5: -15.2% at 104 weeks. SELECT: weight loss continued to week 65 and was sustained to 4 years (-10.2% vs -1.5% placebo at week 208). Hall 2011: body weight responds to a change in intake with a half time of about a year.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Nauck MA, Kemmeries G, Holst JJ, Meier JJ. Rapid tachyphylaxis of the glucagon-like peptide 1-induced deceleration of gastric emptying in humans. Diabetes. 2011;60(5):1561-1565. https://doi.org/10.2337/db10-0474
Jones B, Buenaventura T, Kanda N, et al. Targeting GLP-1 receptor trafficking to improve agonist efficacy. Nat Commun. 2018;9(1):1602. https://doi.org/10.1038/s41467-018-03941-2
Willard FS, Douros JD, Gabe MB, et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5(17):e140532. https://doi.org/10.1172/jci.insight.140532
Wharton S, Calanna S, Davies M, et al. Gastrointestinal tolerability of once-weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss. Diabetes Obes Metab. 2022;24(1):94-105. https://doi.org/10.1111/dom.14551
Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083-2091. https://doi.org/10.1038/s41591-022-02026-4
Ryan DH, Lingvay I, Deanfield J, et al. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049-2057. https://doi.org/10.1038/s41591-024-02996-7
Hall KD, Sacks G, Chandramohan D, et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011;378(9793):826-837. https://doi.org/10.1016/S0140-6736(11)60812-X
Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metab. 2018;27(4):740-756. https://doi.org/10.1016/j.cmet.2018.03.001
Daiber A, Münzel T. Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction. Antioxid Redox Signal. 2015;23(11):899-942. https://doi.org/10.1089/ars.2015.6376
Bahouth SW, Nooh MM. Barcoding of GPCR trafficking and signaling through the various trafficking roadmaps by compartmentalized signaling networks. Cell Signal. 2017;36:42-55. https://doi.org/10.1016/j.cellsig.2017.04.015

The Day You Stop: What Happens After a GLP-1

Thomas McCann, MD — Sat, 07 Nov 2026 08:09:05 -0500

What happens when you stop a GLP-1 medication? Dr. Tom McCann and Alexandra walk through the randomized withdrawal trials for semaglutide (STEP 1 extension and STEP 4) and tirzepatide (SURMOUNT-4), then the Copenhagen trial that followed people for a year after stopping both medication and exercise. The takeaway: most people regain most of the weight after stopping, but people who built an exercise habit kept more of their results.

Key numbers. STEP 1 extension: 17.3% loss at week 68; about two thirds regained one year after stopping; net loss 5.6%. STEP 4: continued semaglutide -7.9% vs placebo +6.9% (weeks 20 to 68). SURMOUNT-4: 20.9% lead-in loss; continued tirzepatide -5.5% vs placebo +14.0%; 89.5% vs 16.6% kept at least 80% of their loss. Copenhagen: one year after stopping, prior combination therapy was 5.1 kg lighter than prior liraglutide alone; regain after stopping liraglutide was 6.0 kg greater than after stopping exercise.

Individual results vary. This episode is general education and does not replace a discussion with your own physician about starting, continuing, or stopping any medication.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. https://doi.org/10.1111/dom.14725
Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. https://doi.org/10.1001/jama.2021.3224
Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38-48. https://doi.org/10.1001/jama.2023.24945
Lundgren JR, Janus C, Jensen SBK, et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. N Engl J Med. 2021;384(18):1719-1730. https://doi.org/10.1056/NEJMoa2028198
Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment. eClinicalMedicine. 2024;69:102475. https://doi.org/10.1016/j.eclinm.2024.102475
US Food and Drug Administration. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize

The Map and the Mirror: How We Plan and Chart Your Face at Artemis

Thomas McCann, MD — Sat, 07 Nov 2026 08:08:40 -0500

Dr. Tom McCann and Alexandra go inside the two tools Artemis uses to plan and document treatment: an injection map that records every toxin and filler point on the patient's own photo (product, dose, depth, technique, lot number, side-to-side totals, visit-to-visit comparison), and a facial balance planner that measures standardized frontal, profile, and oblique photos against classical proportions with editable male and female targets. They explain why the golden ratio is a reference and not a goal, why photo distance distorts the nose by about 30 percent at selfie range, and why the photos never leave the device.

Key facts. Farkas 1985: the best-performing neoclassical canon held in about 40 percent of 153 young adults; the canons do not describe average faces. Pallett 2010: attractiveness peaked at an eye-to-mouth distance of about 36 percent of face length and an interocular distance of about 46 percent of face width, which match the average face. Holland 2008: the phi mask best fits masculinized European fashion-model faces and fits non-European faces poorly. Ward 2018: a camera at 12 inches increases perceived nasal breadth by roughly 30 percent compared with 5 feet. Urdiales-Galvez 2017 consensus: standardized photography before filler treatment is crucial.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. https://doi.org/10.1097/00006534-198503000-00005
Pallett PM, Link S, Lee K. New "golden" ratios for facial beauty. Vision Res. 2010;50(2):149-154. https://doi.org/10.1016/j.visres.2009.11.003
Holland E. Marquardt's Phi mask: pitfalls of relying on fashion models and the golden ratio to describe a beautiful face. Aesthetic Plast Surg. 2008;32(2):200-208. https://doi.org/10.1007/s00266-007-9080-z
Ward B, Ward M, Fried O, Paskhover B. Nasal Distortion in Short-Distance Photographs: The Selfie Effect. JAMA Facial Plast Surg. 2018;20(4):333-335. https://doi.org/10.1001/jamafacial.2018.0009
Urdiales-Galvez F, Delgado NE, Figueiredo V, et al. Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic Plast Surg. 2017;41(3):667-677. https://doi.org/10.1007/s00266-017-0798-y
U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule (full-face photographic images are among the identifiers of protected health information). https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

What's Under the Skin: Filler Safety Through a Radiologist's Eyes

Thomas McCann, MD — Sat, 07 Nov 2026 08:08:33 -0500

Dr. Tom McCann, a board-certified diagnostic radiologist, and Alexandra walk through the rare but serious vascular complications of dermal filler: why they happen, which areas carry the most risk, why aspiration and memorized anatomy are not enough, how Doppler ultrasound is being used to map facial arteries, and how hyaluronidase is used to rescue a blocked vessel. They close with four questions every patient should ask before filler.

Key numbers. Beleznay 2015: 98 published cases of vision change from filler; glabella 38.8%, nose 25.5%, nasolabial fold 13.3%, forehead 12.2%; fat 47.9%, hyaluronic acid 23.5%. Beleznay 2019: 48 new cases (January 2015 to September 2018); nose 56.3%, glabella 27.1%; hyaluronic acid 81.3%; complete visual recovery 20.8%. Teixeira 2025: 503 patients with Doppler mapping, no vascular complications; arteries over 0.8 mm at the site in 34.7% of glabellas and 13.2% of nasolabial folds. Kadouch 2021: prior filler found on ultrasound in 16 of 20 patients.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Beleznay K, Carruthers JD, Humphrey S, Jones D. Avoiding and Treating Blindness From Fillers: A Review of the World Literature. Dermatol Surg. 2015;41(10):1097-1117. https://doi.org/10.1097/DSS.0000000000000486
Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. 2019;39(6):662-674. https://doi.org/10.1093/asj/sjz053
US Food and Drug Administration. Unintentional Injection of Soft Tissue Filler into Blood Vessels in the Face: FDA Safety Communication. May 28, 2015. Summary: https://www.healio.com/news/dermatology/20150529/fda-risk-of-soft-tissue-filler-injection-into-blood-vessels-in-face
DeLorenzi C. New High Dose Pulsed Hyaluronidase Protocol for Hyaluronic Acid Filler Vascular Adverse Events. Aesthet Surg J. 2017;37(7):814-825. https://doi.org/10.1093/asj/sjw251
Teixeira DA. A New Time-Saving Technique for Ultrasound-Guided Filler Injection: A 3-Year Retrospective Study. Aesthet Surg J Open Forum. 2025;7:ojaf061. https://doi.org/10.1093/asjof/ojaf061
Nguyen TT, Nguyen NB, Tran CQ, et al. Mapping the nasal arterial topography: a dual-cohort ultrasound and cadaveric study. Surg Radiol Anat. 2026;48(1). https://doi.org/10.1007/s00276-026-03990-z
Kadouch J, Schelke LW, Swift A. Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples. Aesthet Surg J. 2021;41(5):603-612. https://doi.org/10.1093/asj/sjaa066
Rocha PS, Guerra TA, Teixeira DA. Description of a safe doppler ultrasound-guided technique for hyaluronic acid filler in the face. J Cosmet Dermatol. 2021;21(7):2783-2787. https://doi.org/10.1111/jocd.14492
Issa A, Ben Ishai M, Wilde CL, et al. Longevity and Volume Expansion of Hyaluronic Acid Dermal Fillers: A Cross-sectional 3-dimensional Magnetic Resonance Imaging Study. Plast Reconstr Surg Glob Open. 2026;14(7):e7894. https://doi.org/10.1097/GOX.0000000000007894

The Face Cheats: Why You Treat the Upper Face as a Unit

Thomas McCann, MD — Sat, 07 Nov 2026 08:08:07 -0500

Dr. Tom McCann and Alexandra follow up on the crow's feet finding from the Penn four-toxin trial. They explain the tug of war between the frontalis, the only brow elevator, and the brow depressors; why the forehead is never treated alone; what the 787-patient upper-face trial showed; why men usually need higher doses; and what a well-planned first toxin visit looks like.

Key numbers. Penn trial: crow's feet strain rose above baseline at day 3 and day 30 after frown-only treatment, back to baseline by day 90 (post hoc). Botox forehead approval trials: 20 U forehead plus 20 U glabella together. Upper-face phase 3 trial (n = 787): mostly or very satisfied at day 30 in 87.9% (64 U, forehead plus frown plus crow's feet), 81.4% (40 U, forehead plus frown), 3.2% placebo. Men: 40, 60 and 80 U outperformed 20 U in the glabella with no increase in adverse events.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Lemdani MS, Honig SE, Habarth-Morales TE, et al. Comparison of Botulinum Toxin A Formulations for Glabellar Strain Treatment in Women: A Double-Blind Randomized Clinical Trial. JAMA Dermatol. 2025;161(7):723-730. https://doi.org/10.1001/jamadermatol.2025.1335
De Boulle K, Carruthers A, Solish N, et al. OnabotulinumtoxinA Treatment for Moderate to Severe Forehead Lines: A Review. Plast Reconstr Surg Glob Open. 2020;8(3):e2669. https://doi.org/10.1097/GOX.0000000000002669
Rivkin AZ, Ogilvie P, Dayan S, et al. OnabotulinumtoxinA for Simultaneous Treatment of Upper Facial Lines: Subject-Reported Satisfaction and Impact From a Phase 3 Study. Dermatol Surg. 2020;46(1):50-60. https://doi.org/10.1097/DSS.0000000000001883
Ogilvie P, Rivkin AZ, Dayan S, et al. Pooled Subject-Reported Outcomes From 2 Phase 3 Studies of OnabotulinumtoxinA for Simultaneous Treatment of Forehead and Glabellar Lines. Dermatol Surg. 2020;46(7):950-957. https://doi.org/10.1097/DSS.0000000000002153
Carruthers A, Carruthers J. Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids. Dermatol Surg. 2005;31(10):1297-1303. https://doi.org/10.1111/j.1524-4725.2005.31206

The Scan Said I Was Wrong

Thomas McCann, MD — Sat, 07 Nov 2026 08:04:00 -0500

Dr. Tom McCann, a board-certified diagnostic radiologist and owner of Artemis Modern Aesthetics in Medford, NJ, and his wife Alexandra talk through what a 3D body composition scan revealed about his own weight loss, what he changed, and what anyone starting a GLP-1 medication should measure.

Key numbers. Baseline 289 lb at 30.6% body fat (October 2025). Mid-March 2026: 263 lb at 30.8%, with roughly 8 lb of the 26 lb lost as fat. Plan rewritten March 13, 2026: protein from about 108 g to 200 g per day, resistance training four days a week, intake of 2,850 kcal per day (about 500 below expenditure), Styku rescan every six weeks. About two months later: 11 lb further loss, roughly two thirds fat. Mid-July 2026: 243 lb at 28.1% body fat.

Book a consult: artemisnj.com

Individual results shown; typical outcomes vary. This episode describes Dr. McCann's personal experience and is not medical advice. Body composition, GLP-1 therapy, and any weight-loss medication should be discussed with a licensed physician.

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med 2021;384:989-1002. https://doi.org/10.1056/NEJMoa2032183. DXA substudy: fat mass fell about 19% and lean mass about 10%, so lean mass was roughly 40% of weight lost.
Jastreboff AM, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med 2022;387:205-216. https://doi.org/10.1056/NEJMoa2206038. DXA substudy: fat mass fell about 34% and lean mass about 11%, so lean mass was roughly a quarter of weight lost.

The First True Head-to-Head

Thomas McCann, MD — Sat, 07 Nov 2026 08:00:00 -0500

Dr. Tom McCann and Alexandra break down the first rigorous head-to-head trial of four botulinum toxins for frown lines, published in JAMA Dermatology in 2025. They cover how fast each product works, whether any of them is stronger at peak, how long each one lasts, two findings most people missed, how Tom chooses toxins in his own practice, and the limits of the study, including its funding by Evolus.

Key numbers. 143 women aged 30 to 65, randomized to Botox 20 U, Dysport 50 U, Jeuveau 20 U or Xeomin 20 U, measured with 3D photogrammetry; 139 analyzed. Day 3 median strain reduction: Dysport 67%, Jeuveau 62%, Botox 48%, Xeomin 40%. Day 30: no significant difference between products. Day 180: Jeuveau and Xeomin still significantly below baseline, Botox and Dysport not; Jeuveau significantly better than Botox (median about 20% vs 0.5%).

Disclosure: Tom carries Jeuveau and Xeomin at Artemis Modern Aesthetics and has no financial relationship with any toxin manufacturer. The trial was funded by an investigator-initiated grant from Evolus, the maker of Jeuveau.

Book a consult: artemisnj.com

AI voice disclosure: the voices in this episode were generated with AI using ElevenLabs. Dr. Tom McCann reviews every script, and the sources are listed below.

References

Lemdani MS, Honig SE, Habarth-Morales TE, et al. Comparison of Botulinum Toxin A Formulations for Glabellar Strain Treatment in Women: A Double-Blind Randomized Clinical Trial. JAMA Dermatol. 2025;161(7):723-730. https://doi.org/10.1001/jamadermatol.2025.1335
PubMed record (PMID 40434770): https://pubmed.ncbi.nlm.nih.gov/40434770/
American Society of Plastic Surgeons. 2022 procedural statistics press release: https://www.plasticsurgery.org/news/press-releases/american-society-of-plastic-surgeons-reveals-2022s-most-sought-after-procedures