The Holistic Plastic Surgeon: Devices, Ozempic Face, and What Your Habits Do to Aging Skin

23:06And so, you know, if you do too little, you're letting yourself go. If you do too much, you're vain. Like, how do you counsel your patients about that? I mean, I think it's first thing we have to realize society is not kind to women who age. I can't tell you how many patients told me that I feel invisible after I get to a certain age because I'm not 20 years old anymore. And then just like you said, then they get some stuff done and people judge them for it and say that they're vain. And it's a difficult place to be. And I sympathize with my patients and my followers who tell me these stories all the time.

23:39I think there's a couple of things to keep in mind. The first thing I think is that we all have a desire to feel good about how we look. And that desire, I think, is really universal. And it's in men as well. And it can be something as simple as how you feel when you go to the store and you buy a new outfit and you wear that outfit out and you just feel good. Like there's this part of you that feels good because you're wearing a new outfit. And other people may not even notice it, but you feel that. It's a great thing. It's a good thing. There's nothing wrong with it. Obviously, getting a cosmetic procedure is a similar type of a feeling, but obviously you're doing something different with that.

24:15And I think the way I would recommend people to think about it is, number one, don't feel guilty if you want to get that feeling, because I think we all want that, even men do too. And number two, we're all on a certain continuum of what we are willing to do for that. And wherever you are on that continuum, it's okay. I have patients of mine who'll do Botox, but they don't want to do filler, and other people who will have surgery. And wherever you are on that whole continuum, it's okay. You know, as long as you're happy with that, if you are considering a cosmetic procedure, the thing that I would recommend that you really, really take into account is kind of this principle that I have in holistic plastic surgery, but it's do the least amount of procedures necessary to make you happy.

24:58Okay. Cause you never regret not getting something done. Especially when you're talking about surgery, you only regret when you did something that maybe you shouldn't have. Okay. So if you're not ready and if you're not a hundred percent gung ho, so it's like, if somebody says, hey, I'm thinking about a facelift, you know, I've gone through menopause, I'm 55, I've had some changes and stuff. Do you think it's the right time for me? I'll tell them, look, you'll know it's the right time when you really, really dislike the appearance of the lower face and neck so much that the thought of spending tens of thousands of dollars going under the knife for three or four hours, getting permanent scars in front of them behind the ears, we cannot guarantee how they're going to heal in the end with the potential risk of complications, the thinking about all that, you are still excited to do it because, man, you can't stand looking at this turkey gobbler neck or the jowls, whatever.

25:46Then maybe that's the right time for you. But if the fear is more or the concern is more of these complications than the excitement, then maybe it's best to wait, you know, because at some point maybe you'll get there. If you could rewrite the standard of care for aesthetic medicine, the way that we're kind of rewriting the standard of care for menopause, what would that look like? You just briefly mentioned, and we're going to get into this, you are the world's holistic plastic surgeon. And so, you know, we're going to talk about lifestyle here, but how would you rewrite that? So I would look at it, the whole kind of anti-aging is like you're building a house.

26:22And when you build a house, the foundation of the house is what you always start with. And what's the foundation of anti-aging? It's really what you eat. So that's going to be the foundation. That's the first thing I recommend. If you're thinking, hey, I'm not liking what I'm seeing or I want to prevent the aging, what do I do? The first thing to think about is your diet. Second thing after that is going to be skincare, okay? Because it can be very, very effective along with supplements. Actually, probably number two would be supplements and then skincare, going in order of how much they are technically as a foundation.

26:50So let's say the first floor is going to be supplements. Second floor of the house is going to be skincare. And then the attic of the house is going to be the non-invasive or minimally invasive treatments. and then the spire way at the top or the chimney, that's actual surgery. Okay. And you may not need that, which is totally fine, but anybody can stop at any of that point. Like you may say, hey, you know what? I built the house and I just want a one floor ranch and you're doing supplements and a good diet and wearing your sunscreen and that's good for you. That's fine, you know, but if you want to take it up higher, you can always add those added floors if you'd like.

27:22The big thing really that I would want to change a paradigm, there's, I think there's too many plastic surgeons who are a cut first mentality. And for me, my goal of being a plastic surgeon is to keep my patients out of the operating room and keeping plastic surgery only as a last resort.

27:58skin that's still more clear at one year with monthly dosing.

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29:43Let's talk about lifestyle factors. Well, first of all, can we out-procedure a lifestyle that is not conducive to a healthy life? No, although, you know, there are interesting studies that show that the younger you look, the healthier you are and the longer that you live in general. Okay, that is a general fact. So they've actually taken twins and have done twin studies. And the twin that actually looked younger tended to be healthier and live longer. Which if you think about it, it kind of makes sense. We're talking, you know, why does this twin look younger? Probably because they eat better and they sleep more and they exercise and all the things.

30:19All right, let's get into habits then, sleep. So sleep is going to be huge. And really, I mean, you've talked about sleep on your podcast before. or it's such a hard thing after menopause, but it is so, so incredibly important, just like stress, sleep and stress I put together. The good thing is there's a lot of tools that you can use. I'll tell you, my mom, she called me, gosh, this was probably about nine months ago. She called me because she was supposed to come visit. And she said, Tony, I have to cancel my trip because I cannot sleep. And she said, I'm literally sleeping one night out of every three.

30:51Two nights in a row, she would not sleep. And then she would sleep the third night and then go another two nights. And so we put her on a bunch of, we've tried different supplements. I tried L-theanine. We tried magnesium. Each of those would work for like once or twice, one or two nights, and then it would go back. And you know the thing that really made the big difference? I called a friend of mine, he's a gynecologist, and he said, well, put her on some progesterone. So I started on the progesterone and it was a game changer. Wow. Absolute game changer. And she's in her eighties. She just turned 80, just less than a year ago.

31:21And she had never been on any really HRT because she was part of that group where they're like, no, don't do it, don't do it. And she's always had sleeping problems, but not to the extent where it just recently got so bad for her. And that progesterone has like saved her life. We need more studies, but in our patient population, you know, it's a miracle. We know it converts to allopregnenolone, which goes into the brain and binds to the GABA receptor, which causes relaxation. And I mean, for our patients, it is night and day for their sleep. I mean, it's not hot flashes waking them up. You know, this is like that 3 a.m.

31:53cortisol spike for whatever reason. And GABA just seems to kind of railroad right over that. You've touched on stress. What about sugar? So sugar is the great ager of the skin. So sugar ages the skin in two different ways. Actually, I just put an email out today all about sugar to my followers, but really what it is, is two things. It's glycation, meaning that sugar will actually bond to the collagen of your skin, as well as the collagen of all the other parts of your body, and will deform those collagen fibers. So we're getting back to that kind of that log cabin with this tight, tight logs and sugar will actually bind to it and will cause those logs to kind of kink and, and be in an abnormal position essentially.

32:30And those hybrids, that sugar protein combination are called advanced glycation end products or AGEs. And so that happens in the skin, but also happens in all these other parts of the body too. So sugar really ages the skin with that. Plus you get these chronic insulin spikes, which can cause chronic inflammation on top of that. Having too much insulin can also increase issues with acne and a lot of skin disorders too. So sugar really is a great age of the skin. So how much sugar, is there amount of sugar that's okay? For the way I look at it with my followers is I tell them, look, just try to reduce what you have.

33:01So I encourage people, don't worry like, oh, I've got to get rid of sugar. Just reduce, you know, start by reducing it. You know, if you're having a can of soda pop a day, maybe switch to, you know, half a can, you know, then maybe even do one every two days or something like that. Really trying to reduce it is going to be huge. And that's the main place that people are getting sugar in their diets. That's, I think, the easiest. Yeah. And the coffee drinks now. And energy drinks too. It's like all of those that are just not, not good for you. Inflammation and skin aging. You mentioned that briefly.

33:30Can you talk a little bit more about that connection? Yeah. So inflammation is one of the main agers of the skin, you know, along with collagen degradation, along with oxidation, inflammation is, and one of the things really is the whole sugar thing. And so that's going to create chronic inflammation by actually, you know, causing those insulin spikes, but also inflammation comes from the gut too. And so that's where certain types of foods that you eat can really help with inflammation as well. So we can talk about products like antioxidants that can help with it. There are certain things actually in your diet that can help with overall chronic inflammation.

34:00So eating good, healthy sources of fat, so cold water fish, nuts and seeds, you know, all that is great to try to get those healthy fats, avocados, olive oil. And so really reducing inflammation. For me, the way I look at inflammation is sugar and microbiome. And so doing things for the microbiome can really help with overall chronic inflammation. And so that's gonna be taking daily probiotic and or eating good fermented foods as well. What about fiber? I mean, fiber is huge, you know, so that's gonna be the prebiotic. And what is it, like 90 % of Americans are deficient in fiber? Yeah, I think the average American woman, of course, I only look at female data, so that's our audience.

34:39I know the data for men though for this one. Women get 10 to 12 grams per day for female cardio for gut health it's 25 for minutes 35 but for cardiovascular health add another 10 yeah so it's it's amazing and so we're getting half to a third to a fourth of what we really should be getting and most of your fiber i mean here this is from a doctor who sells a fiber supplement but you really should get most of it from food because those foods are packed with all the other things that we need yeah that's why i don't understand the carnivore diet because there's so little fiber in it and I don't understand how you can go without.

35:14But yeah. And I think people need to realize there's soluble and insoluble fiber. They work kind of differently. And I think a lot of people forget about soluble fiber. A lot of people are now, and I'm taking psyllium husk. I think it's great. And honestly, it makes bowel movement so much easier and less messy, I guess is the way to describe it. So I'm a huge fan of fiber. As far as the impacts of fiber on the skin, I think that, you know, I would look at that more as a microbiome type of a thing and reducing inflammation just because you've got a healthy microbiome. I don't know of any studies that have ever looked at technically fiber and skin and aging necessarily, but I think you're looking at kind of the whole holistic body in the whole way.

35:50So just a good basic anti-inflammatory diet. That's high in fiber. Okay. What about, like you said, carnivore? Are there, you know, is there too much protein that's bad for skin? Has anybody looked at protein? So, I mean, I think from the skin standpoint, collagen is a protein and we do have to get enough protein in our body in order to support that collagen. And with the collagen loss, you know, looking at it from a purely vain and aging, you know, skin aging perspective, you definitely need enough protein in your diet. Now, how much protein that is to help to support collagen production, I don't think that's really been elucidated yet.

36:23But what we have seen, though, in general, is that the reduction in collagen in the body and how long it takes to kind of replenish it, that seems to follow a lot of what you see in the bones as well. Right. Like I tell my patients the same thing that gives you from as far as food, nutrition, supplements and exercise, the same things that help your heart, help your brain, help your gut, help your I mean. 100%. But interestingly, it's very similar amounts. So when you're looking at aging of the skin, you see a similar reduction in collagen in the same way as you see with the bones and the muscles and all that as well.

36:57So it's interesting. But in general, I would say increased amount of protein in general, because we do know that it's necessary for collagen production. How much is necessary, like I said, I think is still being figured out. Before we jump into supplements, because I know everyone's interested, what is Ozempic base? So Ozempic obviously causes weight loss. And with weight loss, you would lose fat in the face too. And fat does provide structure to the skin. Okay. So if you, it helps to plump the skin out. And when the skin is not plumped out, it drops. And that's some of what we're seeing with those Olympic face.

37:28But there are other things to keep in mind. GLP-1s also have an anti-inflammatory effect. Now we're still learning just how much of an anti-inflammatory effect, how, you know, how much that and what that does. But that can be actually beneficial for the skin. But then at the same time, we do know that there are stem cells that are created by fat. And so there are some early studies that are showing that losing some of those stem cells from the fat reducing may cause negative impacts on the skin. I've actually talked to a few plastic surgeons, which I found this really interesting because I see now in my practice, I swear 70 % of my patients are on GLP-1s.

38:01We prescribe them in our clinic, not to everyone, but we use them. I see a lot of patients with it. I have plastic surgeons that tell me that they believe that being on a GLP-1 and losing weight on GLP-1 impacts the quality of the collagen of your skin different than losing it in a different way. Wow. I have not seen that in my patients. I had one doctor tell me that when he does breast surgery now, if it's a patient who's on a GLP-1, he'll use actual mesh as a way to stabilize things because of the effects of collagen on the tissues. Wow. I have not seen that in my patients personally yet, but maybe I just haven't seen enough of it yet to really say.

38:38So I think the jury is still out on that. But that's really an ozempic face. It's kind of that rapid weight loss causing the loose skin. There are things you can do. Injecting fat into the face is a surgical way to do it. Fillers, biostimulators, those are other ways to try to improve it. What about supplements? What do you recommend? What's the evidence say? So first one is going to be my favorite one is collagen. And the evidence is pretty strong with collagen. Okay. What about the naysayers who are saying, oh, what do they say? That it all just breaks down to amino acids. So first of all, just to set up, the general data is actually quite strong.

39:16There are meta-analyses, thousands of patients that have found that taking a daily hydrolyzed collagen supplement can improve the hydration of your skin, the quality of your skin. It can help improve fine lines and wrinkles and the collagen content in the skin. There've even been biopsies done of patients who've been on collagen supplements and found an increase in the pre-collagen precursors in the skin. Okay. So I do think that it's pretty straightforward that it definitely helps. That being said, how much collagen is necessary? Okay, because there are some studies that are very small amounts, like two or three grams of collagen a day is minimum for it.

39:47My recommendation would be at least 10 grams a day if you're gonna do collagen. So the key really then is the hydrolyzed collagen. That's the key. Because it is true, collagen is a large protein. And if you put, let's say, a collagen cream on your skin, it's gonna do nothing because it's just a big protein sitting on the surface of your skin. So then the question is, how do you know that it actually gets absorbed through your gut into your bloodstream. And so the key really is hydrolyzing collagen, take that large protein, and they break it down into its individual amino acids and peptides. Peptides are short chains of amino acids.

40:18Those are much smaller, and those are the ideas that they are gonna be absorbed. Now, they actually have done a study looking at patients who have taken collagen, hydrolyzed collagen supplements, and they've actually drawn their blood and found an increase in collagen, pre-collagen precursors in the blood in those patients. So there are actual studies that do show that it does get absorbed. But once again, it depends on the quality of the collagen. One question a lot of people ask is, what about bone broth then? Are there any studies to support bone broth that's almost pure collagen into improving the skin?

40:49There are no studies on bone broth that have ever been done that I know of. I'm still watching to see, but so far still none. But it does seem to make sense. And a lot of people tell you that, oh yeah, I drink bone broth and it does seem to improve my skin, my hair, my nails and all that. What about other supplements? Anything else? So I am bullish on some general supplements. Like I'm not a biohacker. So fiber, I think is so, so important. I do think a daily multivitamin is good because I do think our food's not as nutritious as it used to be. There's so much ultra processed foods that we're eating.

41:17I'm a fan of taking a daily probiotic, 3 billion or more colony forming units. I think omega-3 fatty acid supplement is good. And then ideally, if you can get like an antioxidant mixture of antioxidants, I think that's good as well. Those would be kind of the basic ones for me that I think really people really wouldn't argue. You know, right now, one of the big things that people are talking about is like NAD and NMN and NR. Not a lot of science to support those yet. I think we'll see. You know, some people are saying that that can help promote longevity. For your listeners, okay, what exactly is NAD?

41:50NAD is a naturally-occurring substance in our body that helps to essentially extract energy from the food that we eat. And so people are doing IVs of NAD, IV drifts. I heard it, we don't absorb it very well. If you're gonna do it, you should do - oral NAD. So people are doing the drips. But the problem with the drips for me, you know, is that I spent a couple of years in the surgical ICUs and we've been in the hospitals and we know that sometimes people get older, getting IV access can be very difficult for some older people. And you know, you can always get access by doing a central line where you put a big IV into their neck or into their groin.

42:21My fear with people who are doing all these IV treatments like hydration and NAD is that you are scarring up your vein every time you, you know, put an IV into it. And are you going to get to the point where at some point you need those veins, but you can't really use them because they've been all scarred up from treatments that you didn't really benefit from? And so I'm not a fan of IV. If you want to try NAD, I do have friends of mine who say, oh, I take NR or NMN. These are precursors to NAD. You can do those orally. I tried NR for several months and really didn't feel anything different. But you can increase NAD levels by exercising.

42:55Which we do every day. Exactly. So, I mean, you don't necessarily need to spend the money. If you want to try the oral, I think you want to spend the money, you can try it. But yeah, the IV, I discourage people. Awesome. Dr. Anthony Yoon, Tony, thank you so much for coming to Unpaused. You've educated our audience. I'm sure they're going to rush out of here and go right to their drugstore and start picking out products and calling their plastic surgeons. To find out more about Dr. Yoon and his products, go to his website, YoonBeauty.com. You can also follow him on Instagram at Tony Yoon MD or on YouTube at Dr.

43:32Tony. His newest book, Younger for Life, is available wherever you buy your books. I would love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepawslife.com. My new book, The New Perimenopause, is available now everywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and share the show with women you love.

44:08We would be so grateful. You can also find full episodes on YouTube. Unpaused is presented by Odyssey in collaboration with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Did you know if your windows are bare, indoor temperatures can go up 20 degrees? Turn the temperature down with Blinds.com and get up to 50 % off custom window treatments like solar roller shades and more during the Memorial Day mega sale.

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