How-To Transition To Your Spring Skincare Routine Like a Dermatologist featuring Dr. Dendy Engelman

24:12what about stuff for hyperpigmentation because i think that's a big concern in the spring summer yes so is there anything because i think like there's some pretty strong treatments yes that are out there there are and you know melasma and states of hyperpigmentation are difficult to treat even in the best of hands i mean we have great results but it's not it's not a one-size-fits-all often. It depends on the depth of the pigment, people's skin type, what medications they're on. Certainly, we know that if people are on oral contraceptives, there's an increased risk of melasma. When you're pregnant, it's called colasma, which is the mask of pregnancy.

24:48But in these hormonal states and fluctuations, we can see that there's more pigment deposited into the skin. So the keys to that are, one, to wear sunscreen as if it is a medicine. And physical blockers are better for this because heat can stimulate it, infrared, you know, ambient lighting even. It's not even an ultraviolet. It's not solely ultraviolet radiation. So you think you're protected indoors. So why would you, you know, if you were just working from home, people often wouldn't put on their sunscreen. But you actually need to be protected indoors as well. And this is interesting. It needs to be tinted because the Iron oxide in tinted sunscreens actually gives more protection against hyperpigmentation than just a white or a clear zinc.

25:34Why is that? It's the way that it helps block the conversion and the stimulation of the melanocytes in the skin. Oh, interesting. So it's strange because a lot of people don't like tinted sunscreens. But in patients who have melasma, we found that if you just change to a tinted one, it actually helps to clear more readily. for active ingredients that help to lighten you know an easy one that's very well tolerated that even people who are like who are pregnant it's category b azelaic acid is good as a lightener hydroquinone in a you know i would say as prescribed by a doctor and monitored is is safe but in short you know bursts we don't want to be on it consistently throughout the year yeah i love chemical peels and i love lasering for it but you have to be careful obviously you can get like a paradoxical darkening with some of these.

26:23So you want to go to someone who like really manages hyperpigmented states because it is, it can be tricky. Sometimes we have to go on oral TXA in order to like clear it depending how deep the pigment is. And it certainly is a journey. I had a patch of melasma when I was a resident on my forehead. And then, you know, I think we kind of forgive it when we're looking in the mirror or like face to face, but it shows up so much worse in pictures. You know, people who look like they have a mustache, you really don't, or maybe you can cover it up, but the camera captures it so much more and patients will come in and be like, look at me in this picture.

26:57Like it reads much worse. Yeah. So with the hydroquinone, which you mentioned, is there a time of year that's better to do that or not? Because I know like peels, usually they would say there is a better time of year. So tell us about that seasonality. Yeah, I mean, we see so many different treatments come in and out of timing based on what the weather is giving us. So obviously, you know, right after the holidays, it tends to be like laser season until about May, or we'll do it right up before, depending on if people are traveling or where they're going for the summer. And that's not to say that there aren't people who I really trust to take care of their skin and do a peel or a major laser in the summer months.

27:44But by and large, I feel like it's just probably easier, unless they had a big event or something that they were getting ready for, to just do it when it's safest because we don't want to do any harm. And if somebody happened to be outdoors for too long after a laser and was sitting in brunch having a great time and forgot about, oh my gosh, and then they have hyperpigmentation. I only had one patient ever who, after I did like a CO2 resurfacing on her skin, she was not thinking. And we do get lulled into a false sense of security when we're indoors. And she was working from home, but by the window.

28:24And so one side of her face just hyperpigmented in the healing because it was like two days past Fraxel and it basically got a sunburn. Now we got her completely back to normal, but it was a little bit stressful for a bit that you've just undergone something. to look better. And then we're like created a new problem to address for a bit. So know that indoors by windows and in cars, we're not safe. There's still UV rays that are not filtered out and they can cause harm. So just because you're inside does not mean you don't need your sunscreen. That's happened to me in a car before for sure. And how about hydroquinone then?

28:59I would say if you can, I would skip it for June, July, August. Okay. Is there anything else when it comes to your personal routine that you would switch up come summer, like maybe a cleanser, the way you exfoliate, anything like that? Certainly. I mean, I think that, I mean, I love, I love wearing makeup. I'm a makeup girl. I, I tend to double cleanse all year round and like, because I use more of a balm or an oil-based cleanser to get, do the first step. And then I follow with this cleanser I love. I've used it forever. It's by a company called Epiance. It's called Lidic Gel. It just feels great.

29:37It has a little bit of salicylic acid in it and AHAs. It's also like very slightly mentholated. So it kind of gives you that like clean, clean feel. But guys, guys love it. Everybody I recommend it to is like, I really like that cleanser. And cleanser is one of those things where, I mean, you like it or not, but it's on your face for like 12 seconds. So it's not like you're in love, you know, you don't see tons of change, but it feels great. And it does like cleanse my skin very well. so that I need to try that yeah it's great and we'll link to everything on our website guys and you you can also use it like as a body wash too which is really nice okay but I switch you know I will not use as thick of a night cream I think that that's something that we all kind of transition into and then for body I feel like body's having a huge moment oh yeah I mean scalp care every mailer I get is for the scalp or for the body yeah it's like we just discovered that we have skin above our hairline and below our chin.

30:38So, you know, everybody's coming out with like either a vitamin C serum for the body or a retinol for the body, which is great. And they really do work. And I think before, you know, you weren't going to spend a hundred dollars of your tretinoin like trying to make it, you know, you would go through a tube a week, but now they're making it way more economical and also well tolerated so that you're not like red and peely and retinizing the skin of your body. I think it's a lower concentration. But those are certainly things that I'm way more mindful of using when I'm going to be showing more skin.

31:13What about the Decollete? Do you use like a specific product for that area or do you take your skincare all the way down? I do, but then I follow. I like Revisions Nectifirm. I think I think that's a really good one. Yeah. They do a great job. I also like Neck Correct by Skin Medica. I think that's a great one. They have this extract in there called Pericris or something like that, I think. And it works on the platysmal muscles to decrease that contraction. So these are the muscles that like pull your chin down. Yes. Right? The vertical muscles in your neck. So not the horizontal from Tech Neck.

31:50Right. But the vertical ones that mine are so strong. I've Botoxed them like seven times trying to make them lie. I look like a Gila monster. Stop. But that muscle is the most superficial muscle on the body. I mean, when you're in gross anatomy, which is gross, dissecting it from the skin is virtually impossible. I mean, it's almost like they're so, it's so superficial. It's right underneath the surface of the skin. And that's what makes us kind of go. But over time, it also, the way it attaches anatomically, it's up here, above, onto the face. so when it starts to as we're aging it pulls down so that's where the Botox if you put it in at the base of the mandible and along these platysmal lines it helps to like counteract a bit of a lift oh really yeah is this what's called plasma oh platysmal Botox yeah I saw that you're doing this on your yeah just on your Instagram that you're doing it you've done this on yourself then tell me do you interject your own neck yes with Botox yeah how do you what you You do that in front of a mirror?

32:51I do it in front of a mirror. I mean, mine are very easy because they're prominent. But that's an easy, easy muscle to Botox because it is so superficial. You literally, have y 'all ever gotten a PPD? Like when people are testing you for tuberculosis. Oh, no, I haven't. It's like a little tiny bleb under the skin when they test you and they see if it reacts or not. If you're in medicine or work in any medical facility, you have to be tested to make sure you don't have tuberculosis. So anyway, that's kind of how you inject here. It's very superficial. So it looks like after you inject, it looks like tiny little blebs under the skin, just temporarily.

33:28But that is very easy to hit because you can see where it is. And then you just inject it right under the mandible or the jawline where it's going to attach onto the skin. And you will see that improvement of this little pre-jowl where we all, I feel like the lower face as far as something that aesthetically people are coming in for. It is all day, every day. Like, you know, I think we've bought into, we're all on board for Botox from the cheekbones up and then like filler here, we get it. But this is like now the new thing. Completely agree. I also got blepharoplasty to be transparent, but I don't get Botox around my eyes.

34:07I'm not saying I never will, but I kind of like the lines there. I think it's very natural and I don't find it unattractive. But what I don't like for myself is the sagging in my lower face where it starts to look like I'm sad when I'm not sad. 100%. And where it's all just my face is going into my neck. So I'm more interested in that these days. And I'm just leaving my eyes alone. I love when patients come in and say, I don't want Botox here. Because I agree, looking at you, that is part of your aesthetic. You have a smiley eye. Yeah. It's really nice. And I think it's lovely. And so I think that's important for you to hear as a provider, like what you don't want changed.

34:54Because, you know, a lot of times, because there are so many people in aesthetics, it's kind of like paint by number. Right. And that is not how it should be because that takes away your uniqueness. Right. Now, I would be lying if I didn't tell you that a week ago I got a bunch of pictures back and I had that exact same thing. Yeah. I was animating. It was on camera. And, you know, I'm sure you all get it, like some kind of screen grab and you're like, what face was I making? But everything looked like I was frowning. Well, I was telling Jill that my son all of a sudden started saying to me when I was just resting face, he was like, why do you look so sad?

35:32Why do you look sad? And I was like, why is he asking me this now? Like, I'm not doing anything, you know. And then I realized the more I started to look that I think, you know, I just hit that point, that threshold, where all of a sudden my mouth is pointing downwards at the sides. So I did my DAOs, or the depressor angularis oris, that's the muscle that does that, depresses the angles of your mouth. After I got that back, I literally Botoxed them the next day because I was like, this has to go. And it does turn that frown upside down. Like it literally, because over time we do get this like kind of frowny face.

36:09And it doesn't make you look like the Joker. It just really, like I will show you in a minute after we finish a video of me. It looked like an upside down you. Like I was very strong in pulling those down. And now like when I get a frown, watch what I can, I can't do it. Right. Like it won't do. Obsessed. But wait till you see how bad it was a week ago. So we do have, you know, we have ways to combat that. But it is annoying that like everything for the lower face is going against us. This is getting more tense, pulling down. These are pulling down. We're resorbing bone. Like the whole scaffolding of our jaw is shrinking.

36:45So this is coming this way. In addition to losing all of our dermal components, the collagen, the elastin, the hyaluronic acid. So it's like this isn't easy. This is a chip shot. Botox, Botox, Botox, little filler. But here it's like many things. You got to build out the mandible. You got to Botox the masseter. You got to Botox the platysmal. You got to hit these. And it's like, then you got to help with the crepiness of the neck. Well, at the end of the day, it's really trying to replace surgery, which is a pretty big ass, right? It's trying to like the effects of a lower facelift. And it's not just one thing.

37:20That's a lot. Yeah.

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39:19we got a little off track there but want to ask you about in office treatments that you're excited about this spring is there anything new that we should know about like i want to erase the winter blase for my face what do i come to you and say do it beautiful i don't see any blase here but you know i do like that kind of reawakening that occurs when you're like okay we're all emerging from our hibernation and we're ready to like literally shed skin and get ready for fun in the sun without getting fun. Yeah. And so, you know, we still will do, I don't do any chemical peels personally, but my assistant does his work and those are always easy and great and like give you a little boost.

40:02I tend to lean into more aggressive things to help with evening out skin tone and skin texture. What would be like Fraxel or? Fraxel. I love fractionated CO2. I think it really does help to stimulate collagen and elastin and we can dial it up or down based on your tolerance for social downtime. So if you have a day, I'll give you a day. You know, if you have a week, we can do a week. But I do feel like that's a great investment and you literally only need to do it when we're not, where we're doing something to like refresh and prevent and kind of collagen bank as, you know, has become in vogue.

40:41Like for y 'all, you need one a year. That's it. Your skin looks good. You've been taking care of it. We're just keeping things where they need to be. And that's kind of what I do once a year. And it's nice versus it embarking on like, okay, a series six. You know, that's a lot for people to undergo. And even if each one has one day of downtime, that's still a week out of your life that you've had to like skip stuff. So I'd rather just bang it out. And most people can figure that out for like a one-time treatment. I really want to do PRP under the eyes. Okay. Yeah, we do that. And CO2, right? Yes.

41:18So tell me why that is so beneficial because, you know, some people can do blepharoplasty under the eye, but I've heard that the PRP is like incredible. Yeah, it's great. We're having a huge, huge... I mean, it is funny. You can just tell what's going viral based on the calls. Like the salmon sperm, you know, we were one of the first in New York to have that. And the phone was like ringing off the hook. It was so funny. And PRP, you know, I think fractionated CO2 around the eye on thin skin, whether it's neck or eye. Because those are the first signs, first areas to show signs of aging. But they're the easiest to reverse.

41:57because if you just build a little bit of collagen in thin skin, it translates clinically into much smoother skin. If you build the same amount of collagen on your cheek, it's not like you're going to see a huge lift. I mean, this is too heavy and the dermis is too thick. But here, it really, because the dermis is microns thick. So if you build more collagen in that area, it really smooths it out. So it's kind of the silver lining to these areas that are like the first to show signs of aging. we can reverse that so much easier. And then adding the PRP, it's just your self-proteins that have your own stem cells, your own growth factors in order to help like one, expedite healing and two, turbocharge the results.

42:40Okay. And the salmon facial, salmon sperm facial, I need to ask you about this because you offer them. You're one of the first people in the city to do that. So tell us like who is the best candidate for that? And then I'm also curious what your take is on the at-home products that now are claiming this. I know the PDRN, which is the active ingredient, which is a polydeoxyribonucleotide from salmon, is just a DNA derivative that they found that salmon's DNA was 97 % bioidentical with humans. So ideally, you know, it would be human, which you're getting from your PRP. But in order to create that in mass quantities, like you would have to get it from other people.

43:26And that's kind of yucky to think about like someone's like life of suctioned, out of post derived stem cells that weren't from you, you know, being slathered all over your. So this kind of takes that ick factor out of it. And they do it in a very like humane way where they're post spawn and they're going to die anyway. And that's how it's extracted. So, you know, for animal lovers out there, you know, that I think is important that it's ethically sourced, at least the one that we use. And it helps with recovery. So people who've done microneedling, microneedling with radiofrequency, skin resurfacing, all of it, it's amazing the difference because I've done this for 17 years.

44:06And I know how red people are going to get and how they're going to look post-treatment. And when you put this on, it's like a miracle recovery. The redness goes down. it really expedites the healing. So that's a win-win in New York. I mean, nobody has time to miss anything. And it boosts the benefits. And so I really was kind of skeptical at first as to how would I really feel about it. But I see a great difference in how patients recover and they all love it. Like everyone who's done it comes back for more. And apparently the PDRN has been used in Korea for like a decade. Yes. So it's well proven at this point.

44:462 ,000 journals that are, obviously we're not going to do anything experimental that isn't FDA cleared here. But it's not only safe, but also effective. And so it's been around for a long time. You know who else uses it in their skincare? Belmont. Oh, really? Belmont has been using it since day one. Oh, I love that brand. Yeah. Yeah. And it's funny because I think it was a little bit of smoke and mirrors there because it was, you know, it was one of those things where you just, it sounded a bit icky. So it wasn't like on the front lines in terms of their communications, but that is their key ingredient, always has been.

45:30And it's kind of like Biologique Recherche, where if you look too closely into their ingredients at one point, you know, it's like they come from the world of, you know, they're doing. We're putting placenta. Oh, yeah. Yeah. Right. And so, of course, now it's all that particular brand is transitioning to vegan. But Belmont. That's good to know. Thank you. I learned something. And I think that's like why it's so expensive as well. Yeah. I mean, I really do like it. and I love Valmalt, so that makes sense. But that's such a luxury one. And that, to me, I love that sensorial experience with theirs.

46:07Yeah. What are your thoughts on spicules in skincare? Maybe you can quickly explain what they are and why you think they're good or not. Another K-beauty trend. Yeah, K-beauty trend. With like the tiny little particles that almost feel like... Harden. It starts out as almost like a moisturizer or a putty and then it hardens into the spicule that frankly feels kind of like glass on your skin. Yeah, there's one that we have at the office called Cell Story. Yes, we tried that one. And it feels like shards of glass that you put into your skin. And I mean, I will eat shards of glass if you told me I would make me look better.

46:42But like, it's hard to say, especially in that because it's like seven steps and everything else is luxurious and lovely. And then we put numbing cream on the patient just so because we don't want it to be like this beautiful thing and then you're in agony for one of the steps but you know I never try anything numbed because I want to be able to like explain in the worst case yeah and I was like I'm not gonna lie that did not feel good yeah like you were you know yeah being cut a million times I do like the results I think it's good I think you know the same concept of creating micro injury in the skin through CO2 or other different devices is the same thought of like, just like microneedling, like creating a controlled injury that then tricks your body into thinking it needs to heal something.

47:30And when we heal something, we create collagen and elastin. That said, I'd love to see microscopically. Yes, I know. I'm worried about the micro injury to the skin, where it's like, then they have dilated vessels and, you know, people with rosacea, I think that would really flare them. I don't feel like it should be made for mass. I feel like back bar for people who know, like say someone had acne scarring and they're pretty durable in their skin, maybe that's a great place for it. But when you put things into just the consumer's hand where, especially in America, it's like if a little is good, more is better.

48:04If you recommend it twice a week and they do it every night, like you can't control for the potential harm that could occur. Yeah. And the one thing I would say about the liquid microneedling that I thought was interesting is that you could use on active acne versus microneedling where you cannot go near anyone that has any kind of breakout at all. So for texture that way, it's good. But then I agree these at home ones, I'm not so sure, like these VT Riedel shots and things that look, they almost make them look like a syringe, frankly. I don't know that I would be that comfortable using it all the time.

48:38Yeah. You know? I mean, I feel like that too with a lot of at-home microneedlers. It's like either you're not really doing anything because we do know that in order to get into the dermis, like you need pinpoints of blood. But I don't want people doing that at home. That's too much trauma, you know, for you to be inducing and potential for infection or irritation or hyperpigmentation or scarring. So I tend to try to encourage my patients to like leave the heavy lifting to me. And then at home, we're going to do like lovely, nourishing, supportive skincare to augment what we've done in office. But like you don't need to be the home alchemist who's like mixing up your own potions and ordering 70 % gycolic from the internet and burning your face, you know?

49:26Yeah. Yeah. The December issue of New Scientist was actually dedicated entirely to skincare. And they came out with quite a few articles that we won't have time to go over them all. But I wanted to ask you, this whole world is exploded of exosomes and growth factors and all of that. Peptides. Do you think that that's making the grade? I love this question. I think it's kind of the Wild West right now. It was like that a bit with PRP at first because we knew that there was something there, but you couldn't really get the concentration right. There weren't results that you could count on often. And the variation with PRP for patients is like, even though it's my blood draw and my self-proteins, I might be really dehydrated on a Monday and not get the same results that I would get a month later.

50:16It's still a variable. Right. Exactly. And so if you want true science that is dependable, I don't know that we're there yet with it, but I do think there's real promise in those categories. It's real buzzy. People love to talk about exosomes. Patients will ask me for them post-procedure. And I don't even know what they are truly looking for as an added benefit, but it's very invoked. They know what to ask for. But I do think that they show promise. I will say that. Yeah. But I would like to see more studies to like really have it more reliable as far as results and concentrations and like where we see like true indication for them.

50:58I just want to circle back because at the beginning of our conversation, you mentioned the skin repairing enzymes in products. And I've heard a lot of dermatologists talking about these recently. What has impressed you and what are they exactly? well the one that i was talking about out of barcelona is a dna repair enzyme and we know that when we have ultraviolet radiation exposure we have free radical formation that can then cause cellular damage and we get this dna mismatch where the c's and t's and the a's and g's of the double helix if you remember that yeah like fifth grade science get kind of mispaired and so this enzyme comes and reconnects them in a proper way so that there aren't bad outcomes like skin cancer or premature aging and collagen breakdown.

51:48And so I think that there's a lot of promise in that space of finding these kind of corrective ways to work on a cellular level. And I love that we're alive in this time, at least in skincare, not politically. There's so many cool things that We're like sitting on, you know, I feel like we're going to look great and feel great, hopefully, for so much longer than we ever maybe were intended because we've figured out these little hacks. Would it be on the label as clearly as skin repairing enzymes or is it, are we looking for a word? Are we looking for? Yeah, let me. When I Googled it, it said photolyase.

52:30Photolyase. Yes. And T4 endonucleus V. Rolls right off the tongue. Yeah, I know. just like Arafatona. Are those the two main ones? Yes. Okay. Would they actually be on a label? Often. Really? Okay. They are. But I mean, you can tell that that's clearly like not a U.S. brand because like the name sounds Latin and it's not very well, like it's not beautifully marketed as to what it does. Right. But those who know it, physician dispense predominantly as well. So we're able to like walk them through that. But I feel like most of the U.S. companies who would be marketing would certainly call that out.

53:10But it may be one that's also a deterrent because it may then get them categorized as a drug and have to be cleared through the FDA. So from what I've read, well, I assume the photo is like activated by light. Is that right? Would that be? You know, ACE is like what's at the end of any enzyme. And so what it does is breaks down whatever's in front of it. Essentially, I assume that it's breaking down the enzyme that was then causing DNA damage. So it's like stopping that process. Yeah, this sounds like it would be very powerful to prevent like a skin cancer. Yeah, I mean, it's great. And it's a treatment in Europe that people who are covered in actinic keratosis, which are precancers and have had a history of squamous cell carcinoma, they prescribe this.

53:57is like not only is it preventative, but it's also correcting and hopefully preventing subsequent skin cancer. So it's cool. I mean, it's really neat technology. Well, thank you so much for sharing all of your amazing intel with us and helping us switch our routine to spring, leaving winter behind us. So thank you so much. Thank you. Thank you. Thanks for listening. You can find details on every product mentioned in today's episode, along with our exclusive promo codes on our blog at breakingbeautypodcast.com. While you're there, be sure to sign up for our newsletter. Every episode will be delivered directly to your inbox so you won't miss a single thing.

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55:22Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.