Best Skincare for Aging Skin: 7 Myths You Need to Stop Today | Dr. Sara Cherem

33:40It gets shared. The gut serves as a reservoir for the loctopaceae of the vagina. And whenever I say that, people are like, ew, and I'm like, I know it sounds kind of icky. And yet you're perfectly designed. Like this is just the way it is. So I want to shift the conversation to fillers because there's been so much coming up on social media about fillers. And one thing we're seeing is that a lot of celebrities are starting to dissolve their filler. Like we saw, do you know Demi Moore? Yeah, complete transformation. Let's talk about what even happened in that situation to begin with, and then why the trend of dissolving these fillers?

34:18So I must start by saying that I love fillers. Fillers are amazing. Okay, why do you love fillers? When done right. Okay, okay. In moderation. A little filler here and there for beautification, for repositioning tissue for enhancing certain aspects a little bit on the lips a little bit on the chin really gives amazing results what has happened is that the social media face the instagram head face has distorted the way we see beauty yeah we are normalizing this alienized look the cheeks the jawline the chin the lips and we're starting to think that that's beautiful yeah when it's not um there's something very interesting that i read recently that whenever there's like an like obscene over the top result with fillers on instagram that gets a lot more views share saves than a beautiful natural result yeah and i realize it happened to me if i see like this there's this trend called the russian lips which are like enormous what are the russian lips no tell us russian lips they're huge yeah they do columns they like completely change the anatomy of the lip is this like the hot dog look where you got like two hot dogs flapping like have you seen those lips that are like just big rolls unfortunately we have very bad injectors that have other things other than the best, the best thing for the patients in their minds that overdo fillers.

36:06So we have all of these faces that are very recognizable that were deformed with fillers. Yeah. So I started by saying, I love fillers, but in moderation, you cannot do everything with fillers. You cannot refill every single line, every single fold with fillers. And this is something we have learned over time. This is one thing. And the other thing is, in order to have a good result with filler, it depends on the right technique. When we do fillers, there are a bunch of things we need to take into consideration. The face we are treating. It's an individual. We always have these diagrams of how to put on fillers.

36:49We have patients. We're not treating diagrams. So individualize each treatment for the patient's needs. Number one. Number two, choosing the right product and the right technique. So it has become evident that fillers do not dissolve completely over time. And we're starting to understand a little bit more of why this happens. Because in reality, fillers do dissolve. Yeah. Like in the lab, but in the face it doesn't. Ever? So what has been shown is that certain aspects are making fillers stay there longer. Okay. And the number one is the biofill. Okay. So when we apply fillers, it's not a completely sterile environment.

37:39We don't do it in an OR. To starters, when we open the syringe, the box itself is not sterile. What's inside is sterile. But it's not a completely sterile technique. So when a bacteria enters and it coats the filler, it creates a biofilm. And that doesn't allow our body to dissolve the filler. Fortunately, we have an insight that we can inject on the face that reverts this process. And this is something I'm doing very often in the clinic. I actually started myself. So I went to a course on injectables because I always like to keep updated. And looking around the room and seeing all the other doctors, I got dysmorphophobic.

38:29And I was like, please take everything off my face. And I injected yellow in the days all over my face to see what happened. Yeah. And it was very interesting. The only thing that went away was a filler I had on my under eye that had been there five years ago. I didn't even thought it was there. Yeah. Yeah. So right. Because the manufacturers tell us it's like 18 months, like two years max. But that's not true. That is true in the idea situation. So true in a lab, true if everything's perfect. True if everything's perfect. In terms of technique, product selection and the biofilm thing. Okay. So why are celebrities now?

39:09We're seeing more and more getting their fillers dissolved. So the thing with fillers is you need to know when to stop. Because if not, you get the overfilled face. Yeah. What is the problem with HA fillers? HA fillers pull water. They're highly hydrophilling. That means that they will love water. Which is why people use them because then you plump up and they have a more full look. Yes. But as women, we tend to retain liquids just because. Yeah. And then you add that you ate sushi for dinner and you drank alcohol and you didn't sleep very well and you're dehydrated because you're at the beach, all of your fillers pump up.

39:54So the thing with the overfilled phase is using too much product, not waiting for the product to dissolve. And again, trying to fix everything with fillers. Mm-hmm. That's where we get into the energy-based technologies. Because when we use energy-based devices, we can reposition tissue, increase like the screen quality, do a lot, and then just sprinkle filler here and there. Okay. When you say energy-based technologies, are you talking about laser? So lasers are the ones that involve light, but we also have radiofrequency, HIFU, which is high-intensity focused ultrasound, LED therapy. So there's a bunch of ways we can use energy-based devices to rejuvenate our skin.

40:45Okay. Well, I definitely, I want to talk more about that. But you had said like the injector matters. I feel like everybody and their mother is like an injector now, right? Like you're just seeing, and it's so many different licensed practitioners can do these injectables. And I don't even know that the license matters as much as the skill, the technique, the training. So what can people look for? Like if they're like, okay, I do want just a little touch up of fill. I do want this moderate amount to get a little, you know, a little plumpness, a little bit of more volume, but I don't want that overfilled look.

41:23So how can somebody navigate finding an injector? I would say always look for doctors. Okay. The world in Mexico is a little bit different than in the States. So I'm going to talk specifically about how it works in Mexico. Perfect. Find either a plastic surgeon, a dermatologist, or an aesthetic doctor. Look up your credentials. Unfortunately, there are a lot of people pretending to be doctors that are not. That's wild. it's wild it's wild make sure of what they're using look at the so whenever we we open a syringe we show the patient like this is new yeah this is the box this is yeah even when you get a blood jaw in mexico they're like this is nuevo like see like and i'm like claro like every time they want you to know that it is brand new, the needle that they're going to use.

42:21It happens to me with patients that are, they have been with me for a very long time that they don't even turn it around. And I'm like, no, yes, please turn it around. Look at, see that it's like, like do your job. Do your homework and make sure to know what is being injected. And number two is the informed consent. Yes. There's nothing sadder for me than to see a patient come in and say, I got an inject, Something injected into my face and this happened to me and I didn't know that it could happen. Informed consent is one of the most important things that came after World War II and all the horrible experiments that were done in the consultation camps.

43:00It's a human right to have an informed consent. Great. And so make sure, read it, make sure you understand it, ask questions, and make sure you're being with someone that is worth your trust. trustworthy yeah i think that's important that your injector for you know people who are like well i don't like i don't maybe they don't even know what fillers are you said choose the right material so let's talk about what fillers are and what's like the pros and cons of it so when we say injectables there's a big gap so we have botulin toxin which paralyzes muscles Yes. And that should be used specifically to target the muscles that pull down and decrease the negative emotions in our faces.

43:53But negative emotions like frown, scrawling. Okay. Botox is not meant to erase every single line or to completely freeze your or to completely freeze your forehead. Yeah. It's meant to decrease the negative expressions of our faces. There's a very interesting, there's abundant, there's abundant evidence regarding this. Using bottling toxin can help in the treatment of depression. Interesting. So if you don't look sad and if you don't look angry and you look at yourself in the mirror and you don't see that, that creates a feedback to your brain that says i'm not that angry wow i'm not that sad and it helps with the way you feel the smile every time you get yes yes and i always tell tell my patients we need to speak nicely to ourselves totally well there's uh research that shows that people who engage in negative self-talk it actually raises inflammatory cytokines in their blood so there's a lot uh in the medicine of just talking pretty to yourself So that's Botox.

45:06That's Botox. We're going to talk more about that. Fillers. Fillers. We mainly have HA fillers, which is hyaluronic acid. Hyaluronic acid is a natural part of our skin, which in theory disintegrates over time. Yeah. And what it does is it pulls water. And we have different products made for every indication. So we have like super soft products for just hydrating or what they call skin boosters, which makes your skin look very nice. And then we have everything in the middle towards fillers that resemble bone. So we have everything in the middle. I would seriously disencourage people into going into anything that is permanent.

45:51Okay. So is the bone like one permanent? No, no, no. But one can be, it's like the one from Galerian. From Allerian, it's called Bollux. It's just a very firm gel. Okay. That there's something called the G prime, which is basically like, imagine it's jello. It can be like a firm jello or like a soft. Oh, okay. So this is like a firm jello that like really pumps, like gives you very nice projection. Then we have Caja, which is calcium hydroxylapatite, which is wonderful because it can be a filler, but it's also a biostimulant. I personally prefer it as a bio-stimulant because we can inject it into the skin in a diluted way, which makes it a lot safer.

46:33Yeah. And it helps build beautiful collagen. So we have this product called El Ancena. This is another type of filler slash bio-stimulant that is very nice, that gives very nice projection and creates beautiful collagen. And the newer one we have, it's called Harmonica. I don't think it's available in the States yet. It's by Allergan, which is caja with hyaluronic acid. So it is a very nice filler that we can use to reposition tissue created by a stimulant effect. And in the early stages, it gives you that fill effect, but it lasts up to 18 months. And over that time, what it does is it improves your collagen.

47:18And there's this very nice thing with them, which is the pinch test. Yeah. which is how much your skin can retract before and after. And then we get into PLLA, which is Sculptra. Sculptra, it's a powder that we dissolve in saline. We inject into the skin. And what it does is it increases the collagen production up to 30 % in the next three months. Oh, wow. So it creates a beautiful foundation for healthier looking skin. We place it very strategically in the periphery of the face where we have the fixed face. So we pull back. Okay. And it's a great way to prepare the skin for lasers. I really appreciate you spelling all that out because I think a lot of times when people think fillers, they just think replacement.

48:10and yet you just outlined all these biostimulants which these are injectables that will encourage your body to replenish its collagen and to rejuvenate itself and I don't know that that is talked a lot about I think it's because in part not all of these are available in the United States which I find very interesting because you will see products go through rigorous testing and the EU will approve them Mexico will approve them many countries will approve them And the United States seems to fall behind. And I almost feel like it's maybe on purpose so that you're just getting these, like not to be a conspiracy theorist, but I don't think it is conspiracy when we live in a capitalistic market.

48:50As if maybe these companies want to corner the market and make sure that they are most profitable before something comes in that could actually help your body do it itself. Well, Caja and PLLA is available in the States. Okay. The thing is, the FDA, it's a very, very strange route because fillers get approval for specific indications. Like the one that I said that resembles bone, it only has indication for jawline. Okay, okay. So navigating the U.S. regulatory system is extremely complex. But I think all of these products will be available. Like, and Monica is by Alarcanzo. It will be available soon.

49:41I think you said something very interesting because you said reposition. So in the history of fillers, before my time, first they would just fill the lines. So they would fill the nasal labia full. Fill it, fill it, refill it, refill it. And then you would get the face. And then it was reposition tissue. But if we rely solely on the filler tree, position filler, you get the overfilled face. And that's where energy-based devices and different types of technology can really help lift the face and body and then allow us to use the fillers in a very strategic way. I just want to give you the space to process it, Michael said.

50:32Elena paused. I don't think I want to see anybody else. This is the love story of real hinge couple Elena and Michael, written and read by me, Raven Smith. Listen to the free audiobook now. So how are you using these then with filler, these energy-based techniques? So what I like to do is prepare the skin with sculpture. PLLA is one of the most studied biostimulants. It started in the 90s as a treatment of the lipodystrophia associated to AIDS medicine. So it's a product that has been around for a very long time and we know how it works. And we're still learning all of the amazing things it does.

51:13So if you use a PLLA sculpture a few months before we do any kind of laser, we are kickstarting the collagen production. And then the way energy-based devices work in a very minimalistic manner is they create micro-injuries, controlled micro-injuries in the skin that will make your own skin repair itself. Yeah. And by doing that, it will increase the production of collagen and elastin, which means you make your own skin be healthier. A lot of people know what collagen is, but maybe not elastin. Can you explain that? Yes. So collagen is the big hero of the youthful face. Yes. But elastin, it's the Robin of the Batman and Robin face.

52:08Oh, Batman and Robin. I love it. I was like, Robin Hood? Who's Robin? Yeah, no, no. So elastin. Collagen gives you firmness. Yeah. But elastin is what makes your skin come whack. Mm-hmm. Tonight, go and check your baby's skin. When you go like this, it immediately comes back. Yeah, yeah. That is the last thing. I don't know if I want to do this side by side. I might be in the mirror going, hmm. So when we lose, and when you think of an older person, you go like this. Yeah, and it comes with you. Yeah. So that is the last thing. Last thing makes our skin sag. And the only topical product that has shown to increase the elastin production is a trihex from elastin.

52:52Okay. So producing elastin will make your skin bounce back. And so that is very important because we want collagen. We certainly want collagen, but we also want elastin. And so you were saying using these like laser techniques, this energy technology. So you're using the biostimulator and then a couple months later, that's when you come in with the laser, correct? Okay. So I first prepare the skin with the TriHest, the Elasticse Skin Nectar, which is a complete game changer when we talk about lasers. We prepare the skin for about two or three weeks and then we perform the laser. and after the laser you continue with that which helps the recovery process like the study takes down downtime by time by half okay so instead of going to 10 days we're talking about like five days and the beauty about lasers is that we have always thought about lasers in terms of rejuvenation and wrinkles but what we are learning now with a biopsies and further animal studies is that laser restores skin health it makes the skins so we have the cells in our skin that are called senescent cells these are like little zombies yep they consume energy they don't allow the cells to act the way they should ask, and they create a bad environment in the skin that makes everything age.

54:30These cells are particularly susceptible to laser. So when we apply, I like to call them magic bullets, because light is electrons. They're like magic bullets are super specific for certain things in the skin. We can create these micro injuries that will destroy the bad cells and make the good cells reproduce. So the main thing about aging is losing function and accumulating damage. So by doing this, we restore the function of the skin and we eliminate the damage. And when I talk about eliminating the damage, there's this very interesting study. It's talking about non-melanoma skin cancer. But doing laser resurfacing can decrease the risk of developing non-melanoma skin cancer by 30%.

55:27Wow, that's significant. Yes, because we are eliminating all of that damage, all of those mutations. Misbehaving cells, kick them out. Exactly. We're evicting the bad cells, the zombies. When you're talking about laser treatments, like what should people be looking for in terms of like other specific devices, specific therapies? So there's a specific laser for each need. Okay. So for example, we have specific lasers that are for vascular things. Part of aging is having a lot of redness and tele-injectation, like the broken capillaries. So pulse eye laser is the go-to treatment for that. Okay. In terms of pigmentation, we have the picosecond lasers, which are specifically directed toward pigment, endogenous, our own pigment or isogenous.

56:23It can be done. So this is like melasma, what women get in pregnancy if they're on birth control pills or if they've been using their apricot scrub. Am I correct? So. The like dark pigment. You got into kind of a tricky subject because. Okay, okay. Melasma is a disease we do not understand. Mm-hmm. We do not know what causes it. We have a bunch of ideas around it. It was thought to be more about estrogen. Now it's thought to be more about progesterone. It's thought to be a disease of photoaging, of like the cumulative sun in your skin. But since we don't know exactly what causes it, we don't have one specific way to treat it.

57:05Okay. I'm going to start by saying that melasma should not be solely treated with laser. Okay. Because it can really go bad with lasers. Because if you hit melasma, it can turn much worse. What about vitamin C, glutathione, those kinds of topicals? Those are amazing. There are protocols. I do a specific protocol in the clinic where we use LED therapy, Then the B-beam laser with a pulsite laser and then picotonin for melasma, which is a great way to really bring the pigment down really fast. But it has to be in conjunction with topicals. Okay. And sunscreen. Sunscreen, sunscreen, sunscreen, sunscreen.

57:52Melasma is definitely one. I mean, if somebody is listening to this right now and they're like, yeah, I don't know, like sunscreen, good or bad. if you have melasma, if you want it to get worse, don't wear sunscreen and you will have worse melasma. Like that's the only guarantee. I think that's like definitely one that I have seen people online and it's raised concern where people are like, well, isn't sunscreen toxic? And it's like, you are also talking about how you got melasma. You used to get really bad sunburns and you have all these skin issues. And so that's where it's like, friends, go see a dermatologist, Have an individualized conversation rather than the one size fits all sensational like, you know, thing that the influencer gave you in a 15 second reel.

58:35I have two things to say about this. So the thing about sunscreen being toxic, this was based on a rat model where the sunscreen was injected. Let's not do that. You're not a rat and you're not injecting it. So I think you should be fine. Number one. Number two, the study was made thinking of people using the right amount in the entire body's surface over a long period of time. If we have a problem, it's that people love their sunscreen here and there. Nobody uses sunscreen in their entire body every single day. So I think the New York Times was kind of irresponsible with that article. And I love the New York Times.

59:24But OK, that's the first thing. And the second thing is for the melasma patients. Unfortunately, you cannot solely rely on sunscreen. It's sunscreen. It's your hat. is the sun visor and it's oral antioxidants. Okay. So there's one called polypodium leucotemos. Okay. In Mexico, it's called Heliocare Caps. I think it's available in the States, but I don't know the name. So polypodium leucotemos was developed for people with skin cancer and it's an antioxidant that repairs whatever is happening in the skin with the sun. So that... So this is an oral antioxidant? It's an oral antioxidant. Okay, okay.

1:00:04It's oral sunscreen. Okay. It's not sunscreen. It doesn't replace sunscreen. It's oral sunscreen. Astaxanthin? It's another one. Okay, okay. It's another one. This is what we'll put in the cootermus. Then you have salt, superoxidismatase, which is an amazing antioxidant. There's a brand called Glycerin, and they have DSV formula, which is specifically made for melasma. It also has lycopene, which is another form of oral sunscreen. You have glutathione. You have a bunch of oral antioxidants. So when we're talking about melasma is some precaution, which is sunscreen and avoiding the sun, oral antioxidants, your skincare routine, and then we can talk about lasers.

1:00:48The very interesting way in way picotoning works is, so picolasers deliver the energy in super, super fast manners. So it creates very little heat, which is something that melasma doesn't like. So the melanocyte is like a little octopus. It's a dendritic cell. So when we pass the laser, we shorten the dendrites, which makes the spot itself become smaller. And it breaks down the melanin particles, which makes the dark spot become lighter much faster. and this is a wonderful way to make to keep melasma clear I personally have melasma and to be honest I do all of it yeah so I had melasma I actually I'm going to tell this story I had melasma I had bought this device that was supposed to be like this skin rejuvenating light laser device and I was using it on my forehead and it was like oh yeah like use it the more the better and I, it wasn't even subtle.

1:02:00It was almost like an overnight thing. I woke up and I had just this horrible melasma on my forehead. Um, and then I moved to Puerto Rico and like, that's not good because there's so much sun, but it was sunscreen, definitely wearing hats. I've always done lots of antioxidants, but I, whatever I did to my skin, I overdid it, but it was topical glutathione and vitamin C that like really took it away. Um, I didn't know of any lasers. No one was talking to me about lasers. My dermatologist that I had there didn't talk to me about lasers, but I stopped the glutathione because that can bleach your skin.

1:02:34Am I correct? Yeah. So I stopped the glutathione after that, but I am like religiously always about the vitamin C and I'm always afraid that's going to come back. So in some cases it can be reversed, but I think the worst thing you can do is try to go at yourself and try to figure out how to reverse melasma yourself am i correct i feel like just the more diy i mean diy is like how i got there to begin with so inflammation leads to post-inflammatory hyperpigmentation so if you have melasma you're prone to it yeah so if you inflate your skin by applying god knows what you're going to do that it's interesting what you said about the light so led therapy is very in fashion and I really like the masks in 99 % of the cases.

1:03:19If you have melasma, do not put red LED therapy on it because it will make it worse. That is really solid advice. But we were talking about lasers. We took this melasma little journey and I love that we did because I think it's going to help a lot of people. But I feel like I stopped your role in talking about all of the ways that lasers can help our skin? So the microinjury created by laser will stimulate collagen. Yes. So that gives us firmness, which helps with wrinkles and so on. And then by killing the senescent cells and by getting rid of all that damage, we improve our skin's health. And with the pigment and vascular laser, we can reach this term, I love this term, normalization.

1:04:13Bringing the skin back to normal, and there is a normal to the skin, which means less red, less brown, less discoloration. There's this term in dermatology called poikilodermia, which is white, brown, red. When you have all those three colors combined, and then underneath we get a little yellow, that makes skin look really old. Okay. And with laser, we can get rid of all that. When it comes to laser, are people using this, is this like every three months? Is it once a year? Like what are the protocols typically? So it really depends on the patient's needs. And this kind of treatments really need to be individualized for each patient.

1:05:01And the way I like to start is, as I said, PLLA, Trihex, Sculptra, Elastin Skin Nectar. We do a laser treatment and I usually never do resurfacing before three months because we need to let our own body react to the laser. Yeah. So we do as many sessions as necessary to achieve, let's say, the result that we want. And after that, we have maintenance therapy maybe once or twice a year. Choosing the right type of laser depends on the patient's needs, but also on their lifestyles. Because we have the ablative lasers, which literally disrupt a column of skin, which are the most effective, but with the most downtime.

1:05:52And we have the non-ablative ones, which are very beautiful. They're a little bit slower in showing results, but have less downtime and are more compatible with people with like very busy schedules. I actually have a device, the Yama Hybrid, which has both in them together. So we can synergistically use the two energies to target different aspects inside the skin to tailor the treatment for the skin of the patient. Are lasers painful? I'm going to say that with a good topical cream, oral analgesic, oral painkillers, and we have this beautiful device that cools the skin. It is very tolerable. I do not do, I personally do not do lasers under anesthesia.

1:06:48Yeah, well, I will say I think Mexico does pain management right. I've seen it in so many ways. and somebody, you know, I've done a lot, but, you know, you offering oral pain meds, making sure that there's a cream that's going to help reduce the pain and then doing the cooling after is something that people should be looking for or talking to their provider about if they're going to have a laser treatment. Because, you know, people will, people have shared online, like how excruciatingly painful their laser procedure was and how they'll never go back. And that's always my thought of like, was pain management discussed ahead of time?

1:07:25And so I think it's always a good question to ask. Will this be painful? And how can we mitigate that? Well, I must say that pain variates from patient to patient. Sure. It's totally subjective. It's totally subjective. Yeah. And the pain threshold of different people is very different. So what I might say is not that painful, might be very painful for a patient. I don't like to do anything that is very painful. I literally suffer with a patient while I'm doing it. So I always try to have patients be as comfortable as possible. And I also think it's important to raise your hand and say, hey, this is too painful.

1:08:01Can you please? Yeah. And what we do is we decrease the energy. Does that make it less effective? It depends. Sometimes it does. Okay. Because I think maybe that might be why a patient's like, well, I don't want to say anything because I want to get my money's worth right now. I'll suffer through it. Well, there was an interesting article published recently that said, when we said more is more, more is not necessarily more when it comes in terms of the energy we use and the results we get with laser. And then in that same article, they talked about patient satisfaction. Yeah. So if it was very painful and they had a beautiful result, but the patient had suffered through the process, they didn't appreciate the treatment.

1:08:46Oh. And we also have the contrary, no pain, no gain. Bring it strong. I want to feel it. And everything in the middle. Yeah. No. I want to go back to the Botox conversation because there's a lot of people who have concerns that it's a toxin and that it's going systemic and that maybe it's affecting their brain health or it's affecting them in some other way. What does the research say? The number one aesthetic treatment in the world is Botox. Botox. Botulin toxin. It is the safest in terms of less complications and it lasts for four months. It only lasts for four months. Yeah. So the botulin toxin we inject to this muscle has a diffusion halo of one centimeter.

1:09:34No more. What I inject here doesn't go here. It doesn't drop your eyelid. We know that Botox, it's very target specific. If we have a problem with Botox is that it's lasting less because since we're doing it more frequently, we get more antibodies and it's lasting less. Okay. So you said every four months it lasts, but if somebody is doing it more frequently, they can actually, their immune system will break it down faster. They can over time. Yes. So there's a curve of antibodies. Yeah. So you inject it and we do the touch up always before day 21st because at that after that your antibodies start peaking okay if you apply toxin while your antibodies are high you're going to produce more antibodies which means that your next application will last less okay so you can build up tolerance basically to well let me say let me say that you can build up resistance to botox um what are some things that people can do to make their botox last longer or have a better effect?

1:10:35Zinc supplements. Zinc. Okay. Tell us about it. You start before and you continue it throughout and that helps the toxin lock itself better to the receptor. There is another study that says that when you get the injections, you make facial exercises. Like face yoga? But only on the upper third. Yes, you do face yoga for that week. It latches better. Okay. And avoiding heat. Heat breaks down the toxin. Okay, so hot yoga. Hot yoga, hot showers, sun exposure. Sun exposure, saunas. Saunas. That's good to know because I'm a big sauna fan. Continue to be. Saunas are very good for our health. Yeah. So it's just in that first week that you would avoid the heat exposure?

1:11:29No, it should be throughout the entire duration. For four months? Sorry to my sauna people who are also doing Botox. Keep your sauna up. Keep your sauna. Just realize that. Well, there's also something very interesting. So we all like the soft Botox. I like soft Botox. Well, what do you mean when you say soft Botox? Well, we call baby Botox, right? So it's like not Kardashian Botox. Exactly. Yeah. For you to move your entire face. And specifically on the forehead. I like to only sprinkle it here and there to have a lot of movement. Yeah. And when we do that, so duration is directly proportional to dosage.

1:12:09Yes. So we do very little, it's going to last very little. And it's something you need to evaluate. Do you rather have to go in just twice a year and have a super frozen effect? Or maybe do it a little more frequently, like four months, which is a recommendation, but look more natural. I want to talk about face taping because people, you giggle. okay, I think I know your answer, but I'm gonna ask it anyways. People are like, don't do Botox, facetaping said, does facetaping give you the same effect? Of course not. So I must say, we're living under two realities, the social media reality and the evidence-based science reality.

1:12:52The real world versus like the social media, where I have to say, sometimes you see people saying, oh just you know use x y and z and i'm like i can see you have a filter on you literally have a filter on right now um like i don't know i'm not savvy enough to figure out how to take a filter like tiktok puts a filter on my face and it'll be weird because i have like this little mustache where i'm like what is that like it's a filter i don't know how to get it off of me and i'm like the default of tiktok if you record a video there is to have a filter but you will see like influencers saying like oh i just did these things and now look at my skin and i'm like you clearly have a filter on.

1:13:29And no shame if you want to use filters, but don't act like your face yoga, your face taping is doing what the filter is actually doing. I think something that has always happened, but now with social media is more evident, is that we always want one quick fix to all our problems. Of course. Yes. So instead of diet, exercising, a healthy mind, a good skincare routine going to your dermatologist three times a year so on and so on take duct tape and put it on your face yeah wait but duct tape works for warts well that is that is different that is that is a very interesting study because osam apparently it's more like a placebo effect thing yeah but yeah no no if your child has warts and removing warts from children it's so horrible because they suffer and we all suffer with them and it's not nice yeah duct tape for words can work yeah but not on your face no no not in your face and for people that are like placebo it's because you draw so much attention to it the thought is that then your immune system follows and throws down on that virus but face taping does it have any benefits no no no okay you can Like if you want to do your makeup and you want to do like the little tapey thing for the eye.

1:14:50Yeah. Yeah. No, tape in your face. Okay. No. And what about when you see somebody that is like, I had Botox and it caused severe headaches or I ended up having like drooping eyes. Like I had these side effects. Are those side effects that we expect or is there something more going on? No, those are side effects that can happen. So the thing with headache, I said that doing face yoga can make your toxin latch on faster, but that can also create a headache. Because as you stop moving your forehead, you start moving your face with the muscles in your scalp, and then you get a headache. So yeah, headaches after Botox can happen, tends to be transitory.

1:15:35Illytosis. So this is one of the most feared effects of toxin, that is that it migrates. So we have this little, very, very, very, very thin, very, very tiny muscle that lifts the eyelid. And we inject right there for the corrugator. So the toxin can migrate. I always explain to patients that it is a risk. Yeah. I've been injecting people for 10 years and it has happened to me twice. Complications are part of doing something many times. But there are things we can do to make it better. There are specific eye drops that help stimulate another muscle that pulls up. Okay. And then we have this amazing technology called Ultraformer, which is a HIFU, a high-intensity focused ultrasound.

1:16:27And we can use it to lift the eyebrow. So it has happened to me twice. the most times we did that. And the results were almost unnoticeable, except for the patient, because when you know your face, you see it. But yeah, this is not your injector's fault. It can be dependent on the technique. And we always try to take safe margins. But as I said, we treat individual patients that may not match the anatomy on the book. So you were saying touch-ups happen about three weeks later, like within that three-week window. So if somebody was concerned about this, could they ask for less and then always come back two weeks later if they're like, okay, think I need a little more?

1:17:12Whenever I treat a patient for the first time, I always act like that. Okay. I hate when patients come back and say, I feel frozen. It's a horrible effect. Yeah. I much rather they come in and say, give me a little more than to feel that they had too much. Okay. Okay. Botox, fillers, and I think laser as well. We can't be doing these in pregnancy, correct?

1:17:37So nobody will perform a study on a pregnant woman. Yeah. So there's not one single study that says that any of this is safe. And as a mother, the most important thing is your child's well-being. Yeah. So having a little wrinkles for nine months is just a thing you have to deal with. Mm-hmm. What can, well, let me just say this. If people are like, why are they not studying pregnant women? Because sometimes people are like, that's not fair. And I say, a baby can't opt in. A baby can't say, okay, sign me up for this trial. And maybe this ruins my entire existence of being. So we're very, very cautious with that.

1:18:14But for women who are pregnant and, you know, they're, so we're seeing more mothers over the age of 35. Like if I get pregnant again i'm going to be 44 no retinol no nothing right like none of that stuff to help me out and because of our age collagen's already declining elastin we're not snapping back the same what can pregnant women do to care for their skin so we have ahas okay so the exfoliants are safe ahas and bhas are safe peptides are safe okay and it's just it's a pregnancy pause it's nine months I always tell patients, the moment you don't have a baby inside of you, come and see me. Yeah.

1:18:56And we can do everything. It's just nine months. Patients. Realizing what matters and what comes first, which is your babies and your own health. And with these exfoliants, can you be more sensitive in pregnancy to them? Well, this is very interesting. So the skin changes with pregnancy. The dry becomes oily, the oily becomes dry, and everything in the middle. Our immune system has to like navigate pregnancy in terms of accepting the baby and in terms of increasing the immune response to other things to protect the baby. So, yes, the skin can become a lot more sensitive with pregnancy. So just take it slowly.

1:19:41And when do you recommend, so if women are pregnant, should they have a dermatology appointment to help with their skin? because, you know, all kinds, so melasma, we talked about that, that can come up. Some women get reddening, some women get rosacea. Like we can see things that can make women feel very distressed. And so what would you recommend in terms of care? So for all my patients, the minute they're pregnant, I, because they always text, I'm pregnant, what should I do? Come in. So they come in and we first discuss their skincare. Okay. We review all the ingredients, all the products, review all the ingredients, make sure that everything they have is safe.

1:20:21How much of whatever you apply on the face is being absorbed and can cross the placenta and get to the baby? I don't know. But I won't risk it. That's number one. Number two, I explain all the changes so they know what to expect. For example, you're going to have beautiful hair. Yeah, but nobody's doing that. So I love this. I love that you're doing that. You're going to have beautiful hair. Afterwards, you won't. So let's start with a good shampoo to encourage hair growth. And I always do a mulch. So the hormone they test on your blood to see if you're pregnant structurally resembles the hormone that simulates the production of melanin.

1:21:08Okay. So everything pigments. And this is for a beautiful reason. You know how when babies are born, they only see black and white? Our nipples are supposed to become darker so they can find them easier. So this is a nice justification to understand that your nipples get darker. And it's not nice, but it's for a good cause. And everything becomes darker, including the moles. So I always like to do a mole check at the beginning of pregnancy. Okay. We do the photo finder. we map everything. So in case somebody comes in at month six and say, this looks weird, we can objectively see if it's actually weird or not.

1:21:51Because with pregnancy, all the moles change and become a little bit like darker, more pigmented, a little bit more scary. Okay. All right. I love that. So meeting with your doctor, reviewing all the skincare that you have, getting the lowdown on what is going to happen. You brought up postpartum hair loss. everybody I you know I've heard from patients and they're like can I just start minoxidil can I like start Rogaine like because my hair my hair's falling out what can women do postpartum for that hair loss it's and why does it happen because it happens to everybody and anyone that I've seen people say like no I didn't have that I don't know why you had it I'm like liar liar pants on fire everybody has this otherwise like you're a mutant something's wrong so why does it happen what can people do so it's called effluvium telogenum um to be honest i did not understand the level of stress it causes till it happened yeah when you're like why do i have receding hairlines yeah and you take a shower and you have a hairball like this and it's super scary yeah so you give birth whichever way you give birth that is a very stressful process for the body and whenever we enter a stress process a stress moment in our body our body has to manage the resources okay so what comes first brain heart kidney la la la la la la and at the end of the list you have the hair so first you have the trauma the stress of childbirth and then the stress of producing milk.

1:23:32Yes. Which is, it requires a lot of energy from our body. So our hair cycle has a growth phase, a transitionary phase, and then a phase where it falls off. What happens after pregnancy is that all the hairs that were supposed to fall off enter at the same time into the telogen phase and everything falls out at the same time. So everybody listening, your hair's cruising around, grow, grow, grow, grow, grow. And then all at once it decides, let's just shed. And it all sheds at the beginning. Yes. What is very important to understand is the word cycle. A new hair is down there and it's going to come out with time and patience.

1:24:17And there are things we can do to make it stronger. So minoxidil is not recommended during lactation. I don't know if you saw this is the this articles recently about babies getting hyperchicosis like wolf babies. Yeah. That reminds me like when I was a kid there like in the groceries or there was the Inquirer magazine and there was always like Bat Boy and like what wolf baby. And like that's that's what it's giving me. People can comment. Let me know. Do you remember these? And this has been shown with the mother and the father. Like if the father uses topical minoxidil and then hugs the baby, they get the minoxidil into them.

1:24:58Yes. So yeah, we usually wait with minoxidil. Minoxidil can also be oral, but this should not be used during pregnancy. No pregnancy, no lactation. So as long as you're breastfeeding, no minoxidil. And afterwards, and we have a bunch of other things we can do. We can, there are supplements that can help with the hair. there are shampoos for it and a tip I always give my patient I did it myself it's cutting your hair it won't help with the hair loss but it does help with the stress of the ball of hairs you see in the shower yeah because if you have less volume you will see less and I think that stress causes more hair loss so when you say supplements what kinds of supplements can help So the first thing would be to check your iron levels.

1:25:55Because after giving birth, you can have anemia. Yes. And if you have anemia, your oxygen doesn't get to where it has to go. So it would be to check that. It's always good to always check the thyroid function to make sure everything's okay there. Because if it's not, your hair is not going to be okay. Everybody who has hair loss, those are two things you should be checking anyways. even if you're not pregnant. I just want to underscore that. What about derma rollers? So derma rollers, micronealing, it's an amazing way to stimulate the production of collagen and introduce substance to the skin.

1:26:34We do it in the clinic with a machine that instead of rolls, it stamps. So instead of having like this shape, you have like a nice color. This is for the hair or this is the face? For everything. Okay. I am really concerned with derma rollers at home. and how clean they can be. Yes, that's my concern as well. If you're not cleaning them between use, like if you don't have the means to clean it, don't use it. But I wonder, is there any efficacy to it? Will it help? Okay, so it will help, but clean it, ladies, clean it. Clean it, be mild with it. So the thing is, the idea is when you create the microinjury, you start the repair process of the skin, which enhances the blood flow.

1:27:17And this is kind of the similar mechanism in which LED therapy works for hair loss. So it does work. But I personally do not recommend it for patients because I know what we are is the infections in scalp. Yeah. And so you just mentioned LED. So like the ball cap LEDs, those can help with hair loss. Those can really help. Okay. If you use them. And if you're not pregnant, then you consider going the minoxidil route. Do you prefer topical or oral with women? So the study has proven that they're as efficacious. Okay. So this is a conversation. Who are you? A person that prefers to take a tablet at night or a person that prefers to put on a spray at night.

1:27:59Okay. As a minoxidil user, I must say that it's kind of, I don't know, bothersome to put it on and you have to put it and massage that then wash your hands and your face because if not you start getting hair all over. Yeah. So I think with the oral, we have better usage from the patients and better results, but they're as efficacious. Yeah. So better compliance with the oral. If somebody is on oral minoxidil or the topical and they decide to get pregnant, how, when do they have to stop? Is it like as soon as they know they're pregnant? Is it two months before? Is there, are there actually any guidelines on this?

1:28:37I actually do not know. Yeah. I think that that's why I was like, are there actually any guidelines? Because I'm like, I actually haven't seen that. Like, you know, we know with like GLP-1s, they'll say two months before. With retinols, it's like if you're trying to conceive, like you should stop that. But I actually haven't seen anything on that as well. But I would imagine you stop, you're going to see some hair fall. Yes. So, not just for that thing, there is a formula. I don't know. I don't remember it from the top of my head. That is the Vida de Eliminación Media, the mean elimination time.

1:29:10Times a lot. Yeah. Like 40. And that is how fast you need to get off it. So Minoxidil can cause shedding at the beginning because it makes the hair cycle go faster. Yeah. So the little hair that was about to fall will fall, but a new one is coming. So have no fear. and yes today all the treatments we have for hair loss are only effective during treatment okay so it's very common for people to come in and say i stopped minoxidil and all my hair fell off and i always have to say well it's not that all your hair fell off is that all the hair that was maintained thanks to the minoxidil over the last 10 years when it stopped having the stimulus of the minoxidil didn't have enough oxygen to continue growing.

1:30:07Okay. So you can expect it to fall out, but you can always get back on it after you're done breastfeeding, but you have a baby in the meantime. Also, I think when you're a new mom, at least it's true for me, when I've got a newborn, my hair is up in a bun and I'm not even paying attention anyways. And then it's like a hat and Like, it's like I've got spit up everywhere right now. So this has been an excellent conversation. We have covered so much. I think there's something for everybody in today's episode. Is there anything you want to leave listeners with that you wish that everybody knew about their skin?

1:30:42So we are very fortunate to live in an age where true skin rejuvenation is possible. We have the science, we have the technology, and we understand how to use all of these devices to rejuvenate the skin. And it's not about chasing youth. It's about being healthy. So well said. Well, thank you so very much. I appreciate you. Yes, I'm like, we should do this again. I had such a good time. Me too. Thank you for your time. I want to date with Rawls, Carti says. rules? Raka asks this is the love story of real hinge couple Carti and Raka written and read by me Nicola Dinan listen to the free audiobook now class is now in session and the UPS store is here to help you ace arriving on campus our certified packing experts can pack everything you need from desktops to decor plus when you pack and ship with us you get our exclusive pack and ship guarantee.

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