I loved this podcast with Dr Jayson Oates from Academy Face & Body in Subiaco WA & Crows Nest NSW – where we chat about the successes he has been having with the Mona Lisa Touch laser for vaginal regeneration, including helping to treat incontinence! This week is World Continence Week 2017 “Incontinence, no laughing matter!” is the theme for this year.
Yes there is an easy solution.
Trish: Great. Well I’m here today again with Dr Jayson Oates, who’s the primary cosmetic surgeon and medical director of Academy Face and Body in Subiaco, Perth. First of all, welcome.
Dr Jayson Oates: Good morning Trish. Good to be with you again.
Trish: Yeah, same. We thought we have that chat today. This year’s World Continence week is next week, which is 19th to 25th of June 2017. The theme this year is “Incontinence, No laughing matter”. We thought it’s perfect that we have a chat today about one of the treatments that you offer in your clinic for incontinence. Which is the MonaLisa Touch, which is a laser therapy.
Dr Jayson Oates: Yeah.
Trish: Tell us a bit about it, that would be great.
Dr Jayson Oates: It’s an interesting thing. I’ve been using carbon dioxide lasers on the face for a decade, and getting great results there. Then the manufacturer of our machine said, “Do you know that you can use it in the vagina?” I said, “No.” I really didn’t see how it was going to do anything and do what they thought it was going to do. Unfortunately, that delayed me two years of getting into this great treatment that really benefits women and does things that I just never imagined it was going to be able to do.
Trish: Yeah right, because I know there are a lot of women do suffer from this-
Dr Jayson Oates: Continence problems, yeah.
Trish: Yeah. Especially as they get older.
Dr Jayson Oates: Hugely common. Would you believe that one in four people over the age of 50 in Australia have problems with continence, one in four. In 2010 the stats were that there were 4.2 million Australians just with urinary incontinence, and 80% of those were women. That’s over three million women with continence problems. Half of those women are actually under the age of 50. This makes incontinence more common that asthma or anxiety or arthritis. Who would have thought?
Trish: Good for the Tena pad company.
Dr Jayson Oates: Exactly. This is the thing, that so many people aren’t doing something about it. They’re thinking that, well this is just part of ageing, this is the natural consequence of having had a couple of children or having had vaginal deliveries. This is just your lot in life and you can’t avoid it. You’ve got to be careful coughing or every time you cough or laugh you’re going to have a little bit of leakage. You can’t jog, you can’t jump on the trampoline with the kids, because you’re going to leak. You’ve got to worry about how quickly you can get to a toilet. You can’t let your bladder get too full because you’re going to have problems or get caught shot. Just so many women especially just live with that and don’t do something about it. But there’s so much that can be done.
It’s not all lasers. The basic things not surprisingly, what are good for everything is good for your bladder as well. You don’t want to be overweight, you’ve got to have a good diet, especially avoiding constipation. Constipation puts more pressure on your bladder. Even things like caffeine is not good because as well as being a diuretic and making you pass more urine, it actually irritates the bladder. But the real secret is in the pelvic floor muscles and exercising the pelvic floor. Most people have heard of the pelvic floor and have a bit of an idea about it. The way I explain it to people is that just like running around the block doesn’t get you ready for a marathon, doing your two minutes of pelvic floor exercises is not getting your pelvic floor toned.
Most people are also familiar with that idea of cutting off urine in midstream and that squeezing feeling is part of it. It’s learning where it is and where those muscles are to contract. Squeezing in around the vagina, around the anus, right down low, and that feeling of sucking and squeezing and lifting up. Some people just naturally get it and some people just can’t. I think it’s the more out of shape pelvic floor is, the harder it is to get the feeling and get the whole idea of it. There are nurse continence advisors, continence physiotherapists. In fact more and more so even your personal trainers and people who are fitness trainers becoming more and more aware of exercising the pelvic floor. A lot of people need that. A lot of people need somebody to explain to them and really get them going. Usually that’s best not being me.
Trish: Sure. I totally understand because I know that like myself as ignorant as it might be, I had no body awareness for my uterine, for that area, for my uterus, and I never even used to know when I ovulated. I had absolutely no awareness at all. I do now. There’s a lot of women out there that don’t have that awareness for a fact that first up, that they can actually do something about it when there’s a problem. I was shopping last week and there was a woman. She would have been about probably 40 years old. She was in front of me. She must have had about six packs of Tena pads in her basket. I just wanted to walk up to her and say, “Oh my God. There’s something that you can do about that.” But of course I didn’t, but I probably should have.
Dr Jayson Oates: It’s in the supermarket having people stare at what-
Trish: I know. I was just like, “No,” because she was so young, it just-
Dr Jayson Oates: Maybe she was buying it for somebody else. That’s what you always have to say.
Trish: True, didn’t think of that.
Dr Jayson Oates: Once you’ve got that feeling of what the exercise is, then it’s actually doing it. It’s like all exercising. You’ve got to then squeeze it and hold it for eight to 10 seconds or ideally for maybe three breaths, breathing in and out. If you can hold that tone and actually breathe, then you’re probably more likely doing it correctly. Then you’ve got to repeat that.
Trish: Sorry. Probably good for your butt muscles as well.
Dr Jayson Oates: Yeah. But yeah, if you’re squeezing your tummy muscles especially higher up and above your belly button, then you’re doing it wrong. In fact, you’re maybe making it worse if you’re not getting that real pelvic floor squeeze and lift feeling. It’s going to take five minutes. It’s not something you just do while you’re watching TV or something, unless you’re experiencing, you can really do it. It takes concentration effort. People say, “Well, that sounds like exercising and hard work.” Then I’m saying, “I think you’ve got it, that’s what it is.” It’s exercise, you’ve got to put hard work into it. That’s in the end when people end up coming to see us and saying, “Well, I’ve tried to do it but I’ve just … Like exercising the rest of my life. I’m not doing it enough to make the difference. What else is there to do?”
We still want to encourage women to do the exercises, they’re really important. But the MonaLisa Touch, one of the things that it is useful for is incontinence. The MonaLisa touch, it shoots tiny little laser beams spaced one millimetre apart. Each laser beam penetrates about one millimetre into the lining of the wall of the vagina. It actually sets up a process, and it rejuvenates the lining of the wall to a more youthful form. We especially find this useful for menopausal women and that’s who it’s really was originally designed for. It was designed to treat the local vaginal effects of menopause so that the dryness, burning, itching, the painful sex because of lack of lubrication, MonaLisa Touch is just magic for that.
Biopsies show that you can turn an old, thin, dry lining into the same lining that they would have had when they were 21. In fact, probably the final pathway is same effect that is produced by oestrogen, and oestrogen is what normally keeps the lining of the vagina thick, and moist and healthy. That lining is really special lining as well because the cells are packed full of something called glycogen which is a storage form of sugar. When the cells are shed into the vagina, they’re metabolised by … Broke down by lactobacilli. Lactobacilli produce lactic acid, and that’s the natural bacteria that lives there. That lactic acid is actually a lubricant. When we do facial peels with lactic acid we can feel that slipperiness.
In fact, in moisturisers sometimes they’ll have lactic acid, one, because it rejuvenates, but also because it hold moisture into the tissues. The lactic acid makes it acidic in the vagina. The acidity stops other bacteria growing, it stops thrush infections, things like that. That’s why a lot of these things become more common after menopause, because that lining slowly changes, becomes thinner, it loses that glycogen. The laser treatment turns all of that back, and at the same time makes this really useful improvement in urge and stress incontinence.
Trish: As you’re having declining oestrogen over the years it makes everything dry. What the laser does, it works by not damaging, but heating and increasing the collagen from the inside.
Dr Jayson Oates: Interesting. It works through something called heat shock protein, which is a very appropriate name when you’re using a laser that’s shooting little packages of heating. Heat shock protein, it changes the lining of the vagina into that youthful, thick, moist lining. Interestingly, oestrogen also has in its pathway the same heat shock protein that maintains the vagina in that youthful state. They’ve got a really good understanding of the physiology and the biochemistry that’s going on with the laser. Which I didn’t get five or six years ago when it first came out. There’s been a lot of studies into the effectiveness of MonaLisa Touch, especially menopausal women.
Another big one is women who are on treatment for breast cancer or who had their ovaries out for cancer prevention. With the breast cancer treatment, Tamoxifen is an anti-estrogen medication. It blocks the effects of oestrogen and reduces further risk of breast cancer. But when you block your oestrogen, the vagina dries up. That’s the big problem that people have. Women who are already feeling a bit body conscious because maybe they’ve had a lumpectomy or a mastectomy, maybe a reconstruction, then you give them Tamoxifen and it dries their vagina up, it affects their femininity. We find with MonaLisa Touch, frequently within one week of having the treatment, it’s feeling moist and youthful and it makes a huge difference. There’ve been a number of published studies now specifically treating women with breast cancer with MonaLisa Touch.
Trish: Wow. Tell me about the procedure itself. I know that procedure because I have actually had it. But can you explain to-
Dr Jayson Oates: My big worry when they were first telling me about using a laser in the vagina is, this is going to hurt. Because I know when I do it on the face, it’s hot. I’ve got to put local anaesthetic cream on, if I don’t do that it’s going to hurt. In the vagina we’re not using the local anaesthetic cream. The magic thing is internally in the vagina, there’s very little in the way of pain fibres in the lining, and they just don’t feel it. Maybe get this little bit of warmth. It blows air in and you get this little vibration feeling. But the treatment takes about five minutes, and zapping, zapping, zapping, and it’s painless, painless, painless. Then just as you come all the way to the outside, you’re really getting to the labia themselves, it’s a change in nerves. It goes from nothing, nothing, nothing, hot. They notice that change in the nerve sensation. Then when we get to the outside then we just turn it down and finish off.
The whole treatment takes few minutes. They walk in, they walk out. They basically go back to their normal activities. We do ask people to refrain from having sex for three days. But for a lot of the women that we’re doing this treatment for, that’s not a concern at all, at least not for the first treatment. Ones they’ve had one treatment and everything is coming back to the way it was when they were young, yeah, then staying away from sex for three days become more of an issue.
Trish: Okay. It only takes five minutes. Is it a one-treatment procedure or do you have to come back a couple of times?
Dr Jayson Oates: The routine is to have three treatments. You get a big change for most people after the first treatment, and then incrementally [inaudible 00:14:50] by three treatments. Some women who have got really severe atrophy, sometimes for women who’ve got really more severe stress and urge incontinence, we may go on to even four or five treatments. But it’s fairly unusual. What the multiple treatments also get is the longevity of the benefit. Most people will go around about 12 months. Interestingly, I just had a patient contacting me this week who had her treatment two years ago and is now saying that she wants to come back and have a repeat treatment. Most people when they come back around about 12 months, then just have a single top up treatment, and that seems to keep the going again for another year.
Trish: Yeah, right, okay. You may not need them so close apart, you might decide to have a bit later on.
Dr Jayson Oates: Well, some people spread them out as well. Routinely it’s one treatment a month, for three treatments. Then yeah, single treatment in 12 months. But yeah, depending on people’s commitments and stuff, you can spread them out as much as possible. Sometimes we’ll do two treatments close together, and we might do the third treatment six months later or even a year later. Varies a lot on the women.
Trish: Yeah, of course.
Dr Jayson Oates: This other thing that we then add on to it is the platelet rich plasma. Start throwing another thing in that mix as well. The platelet rich plasma is where we take some blood out, we spin it in a centrifuge, and we suck out just the platelets, which are the little cell particles that help with blood clotting. When you get a cut, the first thing that starts sticking the lining of the blood vessels together is the platelets. The platelets are full of growth factors. Somebody came up with the idea that, what if we just collect all of these platelets, concentrate them, and inject them back into an area and get all those growth factors going. What are they going to do?
It’s getting used all over the body, and there’s an increasing scientific literature backing platelets as being useful in all kinds of conditions. In orthopaedic problems, knee arthritis, that sort of thing, that was getting a lot of research. But it’s also getting used more and more in women for stress and urge incontinence. In fact the big thing it’s picking out there is also sexual function and orgasmic function. Women who are struggling with that enjoyment of sex, injecting platelets into that front wall of the vagina, in fact even into the clitoris itself, that makes quite a difference in the sensitivity of that area. By injecting it around the opening of the urethra where the urine comes out, that seems to make a really useful addition for stress and urge incontinence. Now we’re starting to combine the MonaLisa Touch and the platelet rich plasma treatments together.
Trish: Just to make it clear, only because someone did ask me that this week. When you take the blood, you actually take it just from the arm, don’t you?
Dr Jayson Oates: Yes.
Trish: You don’t take it from the part that’s going to be injected.
Dr Jayson Oates: No, no.
Trish: I just had to clarify that because I was asked that question this week. I thought, “Okay, I didn’t think someone would think that.” But yeah.
Dr Jayson Oates: I’m glad you brought that up, have to make sure you … Make that very clear to people.
Trish: Yeah. Do you have to have a consultation first? Are there anything that people should be aware of, because I-?
Dr Jayson Oates: We make sure that women have had a pap smear within the last 12 months. Probably the main contraindication is having had genital herpes. It’s a bit like when we use laser on the face around the lips, you can activate the cold sore virus and set off cold sores when you use it on the lips, when we do that we cover people with antiviral medication. For people who have been exposed to the herpes virus in the genital region, then you can activate that with a laser. It’s either don’t have it or you need to be covered with an antiviral medication before you have the treatment.
Trish: Yeah. That’s just something you can take a couple of days before or can you take it on the day or?
Dr Jayson Oates: It’s not exactly established, but yeah, we generally like people to start taking it one or two days before and continue it for several days afterwards, and do that to each time we do a treatment.
Trish: Okay. That sounds pretty simple. Probably everyone is going to want to know, how much does it cost? How much it cost for a treatment or a cost of treatments or do you have a package? Or how does that work?
Dr Jayson Oates: Yeah. It will probably vary from location to location. But it’s around about $800 for a single treatment. Often for a single treatment it’s slightly more, and then as a package it’s around about $2000 for the package of three.
Trish: That’s good. You get a nice discount for a package of three.
Dr Jayson Oates: Yeah. We generally want people to do the three treatments because all the studies have generally been done on a series of three treatments. We want to stick to the way the science shows that it works the best.
Trish: Yeah. Would it matter if it wasn’t three months apart? Say for example if it was like over six months, would that make a difference or?
Dr Jayson Oates: Well, it’s not been clinically studied and demonstrated. All the studies are done three treatments roughly one month apart. But from our experience is, you get significant improvement in that first treatment, second treatment. If you didn’t space the third treatment, third month it doesn’t seem to be losing a lot of the benefit. Depends on I guess that particular person. If they’ve got more advanced issues, and they need to have the three treatments to get the benefit, then they want to probably do those at the one-month apart. But if you’ve done really well after two treatments and you want to space the third one out, I think that’s fine.
Trish: Yep. That sounds good. It’s good because you tell people who it’s for, how long it’s going to take, how much it costs, and the great results that women can have.
Dr Jayson Oates: It’s really important that the message gets out there to women that there are these options. On the incontinence side, if it’s gone beyond that, if the incontinence is such an impediment to your life, that you need to do something more, you’re then starting to look at surgery. Fortunately the surgery in this area has become a lot less invasive. It usually involves the implantation of an artificial device, so it’s a foreign body. There have been some issues with placing of foreign bodies in this region. But the bladder neck slings seem to be quite safe, and most people find it not a hugely invasive surgery. But it’s still surgery. A lot of people are looking for an alternative before they get to surgery. MonaLisa Touch and the PRP are that step before you have surgery.
Trish: Yeah. I think most of the time people want to go for that natural option at first anyway, so just makes sense.
Dr Jayson Oates: It is very natural because it’s not the laser itself, it’s not the PRP itself that is fixing the problem; it’s the body’s healing response that is making all the difference. Yes, it is much more natural.
Trish: Yeah, fantastic. That’s been great. That’s been really, really insightful. Basically if you do suffer from incontinence, you don’t need for that to happen. Even if you don’t suffer from incontinence and you just want a bit of regeneration I suppose of the tissue … Would that be the right word Jayson, regeneration?
Dr Jayson Oates: Yeah.
Trish: Regeneration of the vaginal tissue to make sex not painful, to make it a bit more lubricated and just to be a bit more sex friendly I suppose for one of a better word, the MonaLisa Touch could be a great solution for you.
Dr Jayson Oates: Yeah, the sex one is a really interesting one and it’s a whole another area. Interesting, I just got a blog on our website, monalisatouchclinics.com.au about how there was a research paper just published on market research on the vaginal laxity treatment market of the world in the next years. I thought, it’s really a market research paper that’s been published on vaginal laxity market? But yes, there is.
Trish: I need to read that.
Dr Jayson Oates: We’ve got lots of information actually on that website, monalisatouchclinics.com.au. If people want to find out more about MonaLisa Touch, PRP, just anything about management of menopausal symptoms and incontinence symptoms, there’s a lot of information there.
Trish: Yep, awesome. That’s monalisatouchclinics.com.au?
Dr Jayson Oates: Yeah.
Trish: Yeah, I’m looking at it now. Yeah, some great, interesting stuff on there. Awesome. Well, thanks Jayson. Thanks so much for taking the time.
Dr Jayson Oates: Good to talk to you Trish.
Trish: Okay. If you ladies out there are interested in getting in touch with Dr Oates, you can do at the Plastic Surgery Hub or his website, which is academyfaceandbody.com.au. The other one that he mentioned was monalisatouchclinics.com.au, which has got a whole lot of info on here, there’s treatment options, there’s a blog, there’s a bit of a forum and chat room, and you can find a doctor as well. Thanks-
Dr Jayson Oates: We have a clinic for MonaLisaTouch in Sydney, in Crows Nest.
Trish: Great. You’ve got Crows Nest and Subiaco in WA for yourself?
Dr Jayson Oates: Yeah.
Trish: Awesome, great. Thanks Jayson. Will look forward to our next time chat.
Dr Jayson Oates: I look forward to it. Bye-bye.
Trish: Thank you. Bye.
For more info you can check out
And, if you’d like to find out even more about the Mona Lisa Touch, check out these blogs: