Beauty Series #10: Beauty Essentials w/ Dr. Jennifer Vickers

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Summer Hardy,
a medical student in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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Today's episode is part of our beauty
series and is titled Beauty Essentials.

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We've had many beauty episodes
in this series, Dr. Bass.

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What are we covering today?

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Well,

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we've had a number of episodes
discussing how to think about beauty and

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how to make decisions about your beauty
needs and options in a very general

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and conceptual way. And this
is important and useful,

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but today's episode is a
little bit more specific.

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We're talking about beauty essentials
to help you have great looking skin

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and look your best. This means
a couple of things. First,

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treatments, products,

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or categories of care that everyone
should have in their beauty

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plan.

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And this applies across different ages
and it's things that are more or less

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universal. Also,

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we're going to talk a little bit about
things that everyone's going to come to

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and are likely to do if they're
working with a core aesthetic provider,

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someone like a dermatologist
or plastic surgeon.

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Some people choose to have
facelifts, but many do not,

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so that's not a beauty essential.
Here,

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we're talking about things that
everyone or almost everyone would

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and should choose if they have the time
and budget to keep up their appearance.

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To add the detail and expertise
in this area about the latest

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in skin health and beauty, I've invited
the guest expert for this episode.

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Every time I meet with other doctors
at a consulting activity or at a

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medical meeting, I always learn a
tremendous amount from the other doctors,

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but there's some doctors who particularly
seem to have a lot of insight,

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and that's how I ran across
Dr. Jennifer Vickers,

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who's a board certified dermatologist
and also board certified in

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dermatopathology. She's a clinical
dermatologist at Sanova Dermatology

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in Austin, Texas,

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and participates in multiple
clinical trials of new technologies

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and products for skin
health. Dr. Vickers, welcome.

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Well, thank you, Dr. Bass,
and I appreciate you having
me on. I'm very excited,

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and it is a pleasure.

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Yes. Welcome, Dr. Vickers. So
let's get right into our subject.

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What is the number one line item on the
list of beauty essentials, Dr. Bass?

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Well, there's a pretty clear number one.

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This is something that's
probably not a surprise,

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and it's a holy mission for everyone
in dermatology and for plastic surgeons

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as well. I know Dr. Vickers is
thinking the same thing that I am,

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so I'll let her say it.

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Oh yeah. Sunscreen, for sure.

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Can you tell us a little bit
about why that's so important?

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Yeah, sure.

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So sunscreen is going to be your
number one protector against skin

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cancer. Of course,

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we always recommend using sun
avoidance and sun protective clothing,

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things like that. But let's be honest,

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that isn't always practical when you're
at a school event for your kids or

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you're out on vacation.

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So you really want to make sure that
you're regularly using sunscreen.

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We get an accumulation
of sun damage over time.

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So even if you're not a sun
worshiper, driving in your car,

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getting out of your car,
going into the grocery store,

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you're accumulating sun damage little by
little during that time and it does add

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up. So regular sunscreen use where you're
using it daily is what we recommend,

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even if you don't feel like
you're outside that much.

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And if the skin cancer aspect
isn't enough, which to be
honest, it isn't always,

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it does help us to prevent aging of the
skin as well. So that accumulation of

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sun damage that we get over time will
also lead to pigment changes, wrinkles,

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collagen, breakdown, as
well as sagging of the skin.

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So we have all of those signs
of aging because of sun damage.

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And a hundred percent,

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this is the number one and it's
the biggest along with smoking,

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the biggest controllable
factor in skin aging.

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But let's talk about some of the
controversies with sunscreens.

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Yes, we like to debug
myths on the podcast.

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So there have been some concerns about
the effects of the chemicals in the

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sunscreen that they could
have on those of us using it.

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And those are concerns about
toxicity of those chemical

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sunscreens and concerns that the
chemicals in the sunscreens can

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cause cells to prematurely
age or age more quickly.

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So is there any validity to these
concerns and how should that affect our

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behavior when it comes
to using sunscreens?

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So sunscreen definitely has
its share of controversy.

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I think a lot of the public's concerns
were sort of surrounding a study

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that came out in 2020 in the JAMA,

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the Journal of the American Medical
Association. So this study was looking at,

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with daily application
of common sunscreens,

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does our body absorb the chemicals
that are in those sunscreens?

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So they had participants
put the sunscreen on,

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and then they checked their blood to
see if those chemicals were within the

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bloodstream. And what they found
is that they are in fact there.

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So while I think this is
a really important study,

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it also begs to kind of
qualify those results.

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So let's talk about kind
of the design of the study.

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They had participants put on
approximately an ounce of sunscreen on

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all uncovered areas.

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So an ounce of sunscreen is generally
about the size of a shotglass. And

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I,

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with a full confidence can say that most
people are not going to be using that

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much sunscreen, myself included. I
don't use a full ounce of sunscreen,

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even though that's what's recommended.

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So they were using quite a bit
of sunscreen at that point.

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They were also asked to
apply it four times daily.

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So let's talk about that because I don't
know very many people who actually put

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sunscreen on four times a day. It is
recommended to reapply every two hours,

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so I understand why they designed it
that way and that every two hours over an

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eight-hour day is going to be about
four times. But for the average person,

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that is a much higher frequency than what
we would normally see. So all in all,

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this study had a higher amount and higher
frequency than what the average person

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would use. So I do think that's
worth noting. Additionally,

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it did show that those chemicals
are in the bloodstream,

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but what it doesn't tell
us is what that means.

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Is there actual toxicity
with those chemicals?

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And the study doesn't say
yes and it doesn't say no.

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So I don't think that there's
enough evidence there to justify not

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using sunscreen based on those results.

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What I think of it as a jumping
off point for further research.

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So you said something about
sunscreen aging cells,

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but actually what evidence tells us is
that sunscreen helps us to slow down the

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aging of cells,

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and there really isn't a lot of sound
evidence out there to justify not using

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it.

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And I think that's an example
of where the headline of a

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research result,

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which you often hear in the
news can be very deceptive and

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promote a fallacy rather than a fact,

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and you have to take a deeper dive
in the details. Unfortunately,

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almost everything in life really
turns on the details and not the

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headline. But based on that,

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can you say a little bit
about how you should use the

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sunscreen, what to look for
in an SPF number? An SPF,

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by the way, means sun protection factor,

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and basically it tells
you how many times longer

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it will take to get a sunburn compared to

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unprotected exposure.

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So an SPF of 15 means it
will take 15 times longer

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for you to burn if you're
wearing that as directed,

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which Dr. Vickers just talked about.

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So give us a little bit of guidance
on that, please, Dr. Vickers.

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Of course.

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So that is a really common question that
I get from patients is what sunscreen

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should I use? And that is a
difficult question to answer.

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There is a wide variety of sunscreens
out there, lots of different vehicles,

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and a lot of it really boils
down to patient preference.

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So some people want
something that's heavier,

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or some people want something lighter,
they want tinted, they don't want tinted.

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They prefer a powder or a gel or a stick.

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So there really are a
lot of things out there.

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And the main thing that I tell patients
is if you like it, you'll use it.

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So do some trial and error,
find something that you like,

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and you'll be more motivated to use it
if it's something that feels good to you.

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There are some general
guidelines that I give people.

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So 30 SPF or higher is what's recommended.
Broad spectrum, which these days,

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most sunscreens are broad spectrum. And
then that reapplication every two hours,

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particularly if you're
going to be out in the sun,

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you're supposed to do it when you're not
directly in the sun for a long amount

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of time, but especially when you're out
in the sun for a long amount of time.

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I have a lot of patients that come
in and say, "I don't understand.

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I got a sunburn. I have a tan. I
put my sunscreen on. " Inevitably,

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I always ask, "Did you
reapply?" And they say, "Oh no,

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I didn't." So it is really
important to reapply as well.

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So those are kind of my three things
that I tell people to look for on a

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sunscreen, the 30 SPF or
higher, broad spectrum,

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and then making sure that they're
reapplying every two hours.

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Okay. So we've settled on
sunscreen at the top of the list.

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What else goes into my beauty self-care?

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So I like to keep things
simple. I will say that.

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I recommend kind of a top three products
because I feel if things start to get

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overwhelming, then
compliance is compromised.

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The more things that people have to deal
with, the more overwhelmed they get.

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They don't know where to start.
They don't know what to pick.

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There are also limited resources
in terms of money and time.

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So I tell my patients
that my top three things,

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we've already covered
one of them, being one,

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and then also a good
moisturizer and a retinoid,

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preferably a prescription retinoid,

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which I can explain a little
bit more into that as well.

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So before we get to what should be in it,

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what are the goals of having
a moisturizer in your program,

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and then what kind of ingredients should
people look for or at least consider?

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Sure.

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So the basic aim with
the moisturizer is to,

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for one, keep the skin's barrier up. Two,

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it allows the skin to be more
pliable. And when it's more pliable,

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you're less likely to
start forming wrinkles.

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And so you can think of
brick and mortar in a way,

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and your skin cells
are sort of the bricks,

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and then they have a mortar
that holds them together.

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And when you use a moisturizer,
you're really fortifying that.

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You're really giving your skin
a chance to protect itself.

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In terms of what to use, again,

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that question is very similar
to the sunscreen question.

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There's a wide variety of
moisturizers out there,

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and what a 20-year-old is going to use
for their moisturizer is different from

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what a six-year-old would use.
So basic things that I recommend,

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a cream, not a lotion. Lotions
tend to have alcohol in them,

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and so they can be irritating and
drying, which is counterintuitive,

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but they are.
So a cream, something that's bland,

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something that doesn't have a lot
of fragrance in it or a lot of extra

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ingredients, and then something
that's non-comedogenic,

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so something that's not going to
clog up pores or cause congestion.

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So if you're looking for a moisturizer,

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those are the things that I want you to
look for. In terms of more specifics,

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we can tailor that to the
patient's needs. So for example,

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if it is somebody that's in their 50s
or 60s and they're looking for more

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anti-aging properties,

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then you can look for a moisturizer that
has peptides or growth factors in it.

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Whereas again, maybe a
20-year-old wouldn't necessarily
want those ingredients.

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So you can get a little more specific
depending on what the patient needs.

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That's a really important point that
the moisturizer needs to be in there as

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part of the program,

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but you're going to vary that
depending on how your skin is behaving,

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what your skin's issues are.

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And that's partly a
question of your skin type.

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Everyone's skin is a little different,
and that's part of the challenge,

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in my view in dermatology,

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that you're trying to solve the puzzle
of your individual skin and what works

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well for you. And that's trial and
error, but in as few steps as possible.

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And then it's partly your stage of aging.

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And also important to remember,

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if you've done some kind of
in-office medical treatments,

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having just a general
moisturizer and not necessarily a

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medicated product is really
important during the recovery period

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because some of the medicated products
are irritating and skin doesn't

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tolerate them well
right after an in-office

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00:13:10,320 --> 00:13:13,440
medical treatment for the skin.
On the other hand,

225
00:13:13,540 --> 00:13:18,520
some products are specifically
formulated to help skin heal

226
00:13:19,280 --> 00:13:24,000
after an in-office treatment like
an energy treatment with fractional

227
00:13:24,060 --> 00:13:26,880
lasers or with
radiofrequency microneedling.

228
00:13:27,320 --> 00:13:31,960
So it becomes very specific to
that time and that treatment

229
00:13:32,520 --> 00:13:36,060
in selecting something special
for that point in time.

230
00:13:37,020 --> 00:13:40,780
Yeah, absolutely. I
wanted to hit on, again,

231
00:13:40,860 --> 00:13:44,560
the wide range of things that are
available out there in terms of products,

232
00:13:44,620 --> 00:13:48,200
because I think that's important
to touch on as well. Again,

233
00:13:48,260 --> 00:13:51,620
it sort of comes down to patient
preference. So coming back to moisturizer,

234
00:13:52,040 --> 00:13:53,640
if some people want
something that's heavy,

235
00:13:53,820 --> 00:13:55,220
some people want something that's light,

236
00:13:55,600 --> 00:13:59,400
but sometimes there's medical grade
products which are typically physician

237
00:13:59,480 --> 00:14:02,720
distributed or you have to get them on
the website for the company that makes

238
00:14:02,740 --> 00:14:07,380
them versus something that you could
get in say a grocery store or a

239
00:14:07,480 --> 00:14:08,313
drugstore.

240
00:14:08,740 --> 00:14:12,960
And so I think you also have to take
into account what your budget is and what

241
00:14:13,000 --> 00:14:15,620
you're willing to spend there because
not everybody can spend a fortune on

242
00:14:15,660 --> 00:14:18,860
skincare products. So kind
of coming back to that,

243
00:14:19,400 --> 00:14:21,380
tailoring to the things that
you need, like you said,

244
00:14:21,500 --> 00:14:22,920
do you need something post-procedure,

245
00:14:23,080 --> 00:14:26,360
keeping it bland and not having a lot
of extra ingredients when you are trying

246
00:14:26,380 --> 00:14:30,560
to heal, as well as finding something
that sort of fits to your budget and time.

247
00:14:31,520 --> 00:14:35,720
And then kind of on that note, we're
looping back to prescription retinoids,

248
00:14:35,800 --> 00:14:38,980
you specifically said
prescription. Why exactly?

249
00:14:39,120 --> 00:14:43,080
And does that mean that an
over-the-counter retinoid
at that corner drugstore

250
00:14:43,160 --> 00:14:44,940
that Cosmetics counter won't do then?

251
00:14:45,660 --> 00:14:46,640
Not necessarily.

252
00:14:47,140 --> 00:14:51,870
The reasons why I prefer a prescription
retinoid is because those are typically

253
00:14:51,920 --> 00:14:52,900
retinoic acid.

254
00:14:53,060 --> 00:14:58,010
So it is the active molecule that
interacts with the cell to tell

255
00:14:58,050 --> 00:15:01,130
it to produce collagen and do the
things that it's supposed to be doing.

256
00:15:01,650 --> 00:15:04,410
When you buy something from the
grocery store or the drugstore,

257
00:15:04,490 --> 00:15:09,230
it's generally not retinoic acid. It's
going to be one of the precursors to it.

258
00:15:09,290 --> 00:15:13,990
And so it has to undergo a conversion
process before it becomes retinoic acid

259
00:15:14,350 --> 00:15:18,250
and before it actually becomes active.
So with a prescription retinoid,

260
00:15:18,310 --> 00:15:19,970
you have an element of potency there.

261
00:15:20,690 --> 00:15:24,090
The trade off with potency
sometimes is some side effects.

262
00:15:24,330 --> 00:15:28,310
So the more potent it is, the more likely
you might experience some irritation,

263
00:15:28,830 --> 00:15:31,770
but there are things that ... I use
a compounding pharmacy, for example,

264
00:15:31,830 --> 00:15:34,510
and there are things that I can put into
the retinoid that make it a little bit

265
00:15:34,550 --> 00:15:38,490
more tolerable, even if it is a
prescription. So at the end of the day,

266
00:15:39,030 --> 00:15:40,710
cost-wise, the prescription,

267
00:15:40,770 --> 00:15:45,710
if I use the compounding pharmacy
is oftentimes less than what a

268
00:15:45,750 --> 00:15:46,910
medical grade product would be,

269
00:15:47,570 --> 00:15:50,930
and sometimes it's even less expensive
than what the over-the-counter products

270
00:15:51,070 --> 00:15:54,870
are. So if I can get you something
that is very efficacious,

271
00:15:55,270 --> 00:15:58,330
but not necessarily very
expensive, then why not?

272
00:15:59,430 --> 00:16:04,390
And I think the other important
thing about doctor's office

273
00:16:04,430 --> 00:16:09,410
products, prescription products
is you know you're getting an

274
00:16:09,430 --> 00:16:14,010
effective dose when you're using
those products where many of the

275
00:16:14,110 --> 00:16:18,510
over-counter products
have some of the active

276
00:16:18,570 --> 00:16:23,010
material, but it's harder to
know for sure that the dose,

277
00:16:23,450 --> 00:16:25,010
and as Dr. Vickers pointed out,

278
00:16:25,070 --> 00:16:29,950
the form of the medication
is adequate to really

279
00:16:30,070 --> 00:16:31,930
create a therapeutic effect.

280
00:16:32,510 --> 00:16:36,290
So you may feel good knowing you're
using something good on your skin,

281
00:16:36,370 --> 00:16:39,710
but you may not really be getting
the effect you're going for.

282
00:16:40,210 --> 00:16:44,630
And the prescription products are
more likely to let you know that.

283
00:16:44,730 --> 00:16:49,490
Most of the cost of the over-counter
products is related to marketing or

284
00:16:49,590 --> 00:16:53,990
advertising the product and
not the expensive special

285
00:16:54,050 --> 00:16:54,883
ingredient.

286
00:16:55,470 --> 00:16:59,490
A lot of the cost of the
prescription products is the

287
00:17:00,110 --> 00:17:03,090
regulation of getting it FDA approved,

288
00:17:03,570 --> 00:17:08,220
but at least you know with that cost
that you're getting an effective

289
00:17:08,290 --> 00:17:10,910
dose of the requisite medication.

290
00:17:11,790 --> 00:17:16,390
Exactly. And I know at the beginning
of this, you said three products,

291
00:17:16,650 --> 00:17:19,710
very simple, but are those
three products enough?

292
00:17:20,510 --> 00:17:24,610
Yes and no. And I may have some
dermatologists who disagree with me here,

293
00:17:24,720 --> 00:17:27,720
but again, I think simplicity
is important. Again,

294
00:17:27,910 --> 00:17:30,870
I think it's a little overwhelming with
the number of things that are out there.

295
00:17:31,390 --> 00:17:33,960
So in kind of talking about my top three,

296
00:17:34,050 --> 00:17:37,720
what I'm essentially doing is giving
permission to people to use something

297
00:17:37,790 --> 00:17:39,790
simple because they still
will get benefit from it.

298
00:17:40,830 --> 00:17:43,810
Some people like to have that
multiple step skin regimen.

299
00:17:44,220 --> 00:17:46,270
I think it's kind of
part of their routine.

300
00:17:46,330 --> 00:17:48,350
It sort of centers them
at the end of the night.

301
00:17:48,890 --> 00:17:51,750
I know some dermatologists that
have a two-hour nightly routine.

302
00:17:52,370 --> 00:17:56,490
I am not one of those. I feel
lucky if I can wash my face,

303
00:17:56,550 --> 00:17:57,510
slap on some moisturizer,

304
00:17:57,590 --> 00:17:59,710
brush my teeth and fall into
bed at the end of the night.

305
00:17:59,810 --> 00:18:02,610
So I'm one of the people that
needs that sort of simple regimen,

306
00:18:03,110 --> 00:18:07,010
but there's nothing wrong necessarily
with having a multi-step regimen if that's

307
00:18:07,270 --> 00:18:07,990
what you like,

308
00:18:07,990 --> 00:18:10,790
if you have the time to give it and
that's something that you enjoy,

309
00:18:11,370 --> 00:18:14,570
but there's also nothing wrong with
having something simple. So again,

310
00:18:14,730 --> 00:18:18,810
I just want to give people permission
to use a little bit more simple of a

311
00:18:18,890 --> 00:18:23,590
regimen and find things that work with
their schedule and their time and their

312
00:18:23,630 --> 00:18:24,463
money.

313
00:18:24,990 --> 00:18:28,910
I couldn't agree more. I like simple,

314
00:18:29,670 --> 00:18:34,170
simple gets done and complex often is

315
00:18:34,350 --> 00:18:38,250
very hard to execute
consistently over time.

316
00:18:38,330 --> 00:18:41,350
And unless you do this day in and day out,

317
00:18:41,450 --> 00:18:44,590
it's not going to reap the
benefits you're hoping for.

318
00:18:45,050 --> 00:18:49,670
So I always try to look for a
simple approach like what Dr.

319
00:18:49,710 --> 00:18:53,590
Vickers has shared with us
here today. It saves on time.

320
00:18:53,990 --> 00:18:58,650
It's easier to accurately
follow the program and

321
00:18:59,050 --> 00:19:03,830
a simple program is probably
going to give you 80 or 90% of the

322
00:19:03,870 --> 00:19:08,470
benefit you'd get from something
considerably more time-consuming and

323
00:19:08,530 --> 00:19:11,110
expensive and complex. Now,

324
00:19:11,170 --> 00:19:15,990
if there's a specific problem in your
skin that you need to address with an

325
00:19:16,030 --> 00:19:17,250
additional product,

326
00:19:17,550 --> 00:19:22,070
it's okay to add something
temporarily or even long-term in your

327
00:19:22,170 --> 00:19:26,870
skincare program. So for
specific problems and needs,

328
00:19:27,110 --> 00:19:30,730
and the skin is always changing,
always doing something new,

329
00:19:31,410 --> 00:19:36,230
it may be worth adding something,
but your day in, day out routine,

330
00:19:36,470 --> 00:19:37,470
month after month,

331
00:19:37,550 --> 00:19:42,550
year after year probably is
better off focused in a simple

332
00:19:42,590 --> 00:19:47,390
way. And that's more likely to
keep your skin where you want it

333
00:19:47,890 --> 00:19:52,750
and realistically give you what a home
skincare program can accomplish for

334
00:19:52,870 --> 00:19:53,703
you.

335
00:19:54,030 --> 00:19:54,863
Absolutely.

336
00:19:55,770 --> 00:19:58,390
This has been really
insightful so far. Previously,

337
00:19:58,750 --> 00:20:01,150
you mentioned washing your
face at the end of the night,

338
00:20:01,250 --> 00:20:05,490
but I noticed you didn't say any specific
cleansers or any information about

339
00:20:05,510 --> 00:20:07,550
them. Do you have anything
to add about cleansers? I.

340
00:20:08,410 --> 00:20:09,470
Feel like a broken record,

341
00:20:09,530 --> 00:20:13,830
but I'm going to come back to a lot of
it just depends on what the patient's

342
00:20:13,910 --> 00:20:17,590
need is, what the person's need is.
Again, I'd recommend something gentle,

343
00:20:17,730 --> 00:20:20,870
something that doesn't have a lot of
extra ingredients unless you're trying to

344
00:20:20,950 --> 00:20:22,430
specifically address something.

345
00:20:22,990 --> 00:20:26,210
So there are a lot of preferences
with cleansers as well.

346
00:20:26,290 --> 00:20:29,250
Some people like things that foam and
some people like things that don't foam.

347
00:20:29,650 --> 00:20:30,510
And at the end of the day,

348
00:20:30,710 --> 00:20:34,050
I think just finding something that's
nice and gentle is probably your best bet.

349
00:20:34,870 --> 00:20:39,870
And there's a specific
reason for that advice that I

350
00:20:39,950 --> 00:20:44,370
think is really important. The
skin has an emollient barrier.

351
00:20:44,510 --> 00:20:48,910
That's how the skin protects
itself from the environment,

352
00:20:49,010 --> 00:20:52,150
from dust and dirt, from dry,

353
00:20:52,310 --> 00:20:56,350
low humidity air in wintertime,
all kinds of things.

354
00:20:56,570 --> 00:21:01,470
And an excessively harsh cleanser
is going to strip away that

355
00:21:01,510 --> 00:21:05,690
emollient barrier that your
skin needs to protect itself.

356
00:21:05,770 --> 00:21:08,490
Just like having alcohol in a lotion,

357
00:21:08,770 --> 00:21:13,530
same idea that may take away
more of the barrier and be

358
00:21:13,710 --> 00:21:16,850
drying than is good for your skin.

359
00:21:17,410 --> 00:21:21,910
And so a gentle cleanser will
help your skin stay clean

360
00:21:22,370 --> 00:21:26,330
while minimizing the
erosion of that barrier.

361
00:21:27,170 --> 00:21:30,810
Yeah, absolutely. If I can
kind of expand on that,

362
00:21:31,230 --> 00:21:33,470
I'd like to talk a little
bit about exfoliations.

363
00:21:33,870 --> 00:21:37,110
I do think that people tend
to overexfoliate these days.

364
00:21:37,290 --> 00:21:42,250
I don't know if that's a result of social
media or if that's just been a trend

365
00:21:42,270 --> 00:21:43,103
for some time,

366
00:21:43,130 --> 00:21:47,490
but a lot of people feel like they
really need to kind of scrub their skin

367
00:21:47,590 --> 00:21:51,510
clean. And what they end up doing
is very much irritating the skin,

368
00:21:51,670 --> 00:21:53,310
sort of like what you
were saying, Dr. Bass,

369
00:21:53,830 --> 00:21:57,970
kind of stripping that skin
barrier down. So for example,

370
00:21:58,030 --> 00:22:01,470
I'll have patients who come in who want
me to treat their acne and what I'm

371
00:22:01,550 --> 00:22:05,590
finding is that their skin is
extremely irritated, very red, upset.

372
00:22:05,650 --> 00:22:08,390
They're attributing that to their
acne, but at the end of the day,

373
00:22:08,450 --> 00:22:12,590
it really is just the products that
they're using. So sometimes I say, "Okay,

374
00:22:12,670 --> 00:22:17,370
let's take a step back, let's simplify
your regimen, let's use gentle products,

375
00:22:17,550 --> 00:22:21,010
and then you can come back and we'll
revisit the acne aspect of it. " And when

376
00:22:21,030 --> 00:22:24,310
they come back, a lot of times their
skin is much happier, it's calmer,

377
00:22:24,850 --> 00:22:28,930
and we can sort of tease out what is
actually something like acne and what is

378
00:22:28,990 --> 00:22:30,790
actually just due to
the products themselves.

379
00:22:31,350 --> 00:22:36,250
So I like to tell patients exfoliation
really needs to happen only about one to

380
00:22:36,290 --> 00:22:41,150
two times per week tops. And I prefer
medicinal or chemical exfoliators.

381
00:22:41,370 --> 00:22:44,250
So as opposed to like a
mechanical exfoliator,

382
00:22:44,370 --> 00:22:49,150
which is a brush or some sort of scrubber
that they use that they really can

383
00:22:49,230 --> 00:22:53,130
irritate the skin with. But something
more like an alpha-hydroxyacid wash,

384
00:22:53,190 --> 00:22:57,830
beta-hydroxyacid wash is a good sort of
medicinal or chemical exfoliator that

385
00:22:57,870 --> 00:22:59,790
works well as long as
you're not overusing it.

386
00:23:00,590 --> 00:23:03,730
And I'm a little bit
older than Dr. Vickers,

387
00:23:03,790 --> 00:23:08,410
so I'm going to tell a story
from skincare in the 1990s.

388
00:23:08,710 --> 00:23:09,890
And at that time,

389
00:23:10,190 --> 00:23:15,110
that was when things like alpha and
beta hydroxy acids were relatively new

390
00:23:15,590 --> 00:23:20,270
and people were experimenting with
how to incorporate them into skincare

391
00:23:20,310 --> 00:23:20,950
programs.

392
00:23:20,950 --> 00:23:25,570
And there was a huge trend
for aggressive exfoliation

393
00:23:25,990 --> 00:23:30,610
and pushing the skin as hard
as you could for more results.

394
00:23:31,130 --> 00:23:35,390
And there were prominent dermatologists
at the time who advocated

395
00:23:35,790 --> 00:23:40,430
pushing this hard enough, this
exfoliation to leave the skin red.

396
00:23:40,950 --> 00:23:42,130
If you weren't doing that,

397
00:23:42,190 --> 00:23:46,470
you weren't getting the best result in
terms of wrinkle improvement and texture

398
00:23:46,510 --> 00:23:49,810
improvement in the skin.
But if you're doing that,

399
00:23:50,290 --> 00:23:55,090
it's a very mean way to treat
your skin because for sure you're

400
00:23:55,130 --> 00:23:57,290
eliminating that protective barrier,

401
00:23:57,510 --> 00:24:00,530
you're making the skin much more reactive.

402
00:24:00,730 --> 00:24:05,530
So it's a very heavy-handed and
crude way of approaching skincare,

403
00:24:05,910 --> 00:24:10,670
which I think we've really
transcended and moved past in the

404
00:24:10,750 --> 00:24:15,550
decade since then and a softer
approach encouraging good behavior

405
00:24:15,650 --> 00:24:20,110
from the skin rather than punishing
the skin for bad behavior.

406
00:24:20,550 --> 00:24:25,550
It philosophically, I think, is a more
constructive way to approach skincare.

407
00:24:25,610 --> 00:24:29,330
And I see this just as Dr. Vickers
mentioned with a lot of patients,

408
00:24:29,430 --> 00:24:30,410
both young and old,

409
00:24:30,770 --> 00:24:35,210
young patients who are breaking out are
frustrated with their skin and they want

410
00:24:35,270 --> 00:24:39,710
to punish the skin for the bad
behavior and do something harsh,

411
00:24:40,190 --> 00:24:42,430
thinking that's going to
get them to a better place,

412
00:24:42,490 --> 00:24:46,810
but it really often just stirs
up more reactivity in the skin.

413
00:24:47,350 --> 00:24:51,330
And in older people who are
trying to chase aging changes,

414
00:24:52,330 --> 00:24:52,990
same thing,

415
00:24:52,990 --> 00:24:57,650
it's resetting some of the
youthful biology in the skin
that's probably going to

416
00:24:57,670 --> 00:25:02,050
be more constructive than just
taking this already older,

417
00:25:02,170 --> 00:25:06,790
less metabolically active skin
and trying to speed up metabolism

418
00:25:07,150 --> 00:25:10,230
while totally stripping
it of all its defenses.

419
00:25:11,770 --> 00:25:12,750
Yeah, I agree.

420
00:25:13,750 --> 00:25:15,990
Okay. So shifting gears a little bit,

421
00:25:16,170 --> 00:25:18,970
what are some of the in-office
things people should think about?

422
00:25:19,650 --> 00:25:24,570
Well, we know that neuromodulators
like Botox and injectable fillers

423
00:25:24,850 --> 00:25:29,590
are extremely popular once you've
reached a certain stage of aging,

424
00:25:30,050 --> 00:25:32,530
but that's really only
part of the equation.

425
00:25:33,390 --> 00:25:34,150
Yes.

426
00:25:34,150 --> 00:25:39,130
I think that one of the missing
aspects of the equation is what I like

427
00:25:39,150 --> 00:25:40,530
to refer to as skin integrity.

428
00:25:40,710 --> 00:25:45,110
So I feel like a lot of people are
familiar with the neuromodulators,

429
00:25:45,210 --> 00:25:47,190
fillers. You see a lot of that online,

430
00:25:47,250 --> 00:25:48,850
and so that's the first
thing they ask about.

431
00:25:48,910 --> 00:25:52,610
But I do find that a lot of people
forget to address skin integrity.

432
00:25:52,770 --> 00:25:56,090
So preserving collagen, building collagen,

433
00:25:56,210 --> 00:26:00,370
things that sort of help the skin have
the scaffolding that it needs beyond just

434
00:26:00,390 --> 00:26:04,590
the injectables. So examples of
that would be like microneedling,

435
00:26:05,030 --> 00:26:05,850
laser treatments,

436
00:26:05,850 --> 00:26:09,270
particularly ablative or even
partially ablative laser treatments,

437
00:26:09,710 --> 00:26:14,410
and then even biostimulants,
these substances that we
can use that we do inject,

438
00:26:14,630 --> 00:26:16,110
but rather than just filling,

439
00:26:16,510 --> 00:26:19,910
they stimulate the fibroblasts
in the skin to produce collagen.

440
00:26:19,970 --> 00:26:23,010
So you're actually building on your
own collagen. And so in that way,

441
00:26:23,070 --> 00:26:26,670
you are maintaining skin integrity.
There are tightening procedures,

442
00:26:26,990 --> 00:26:29,730
things like radiofrequency or ultrasound.

443
00:26:30,310 --> 00:26:33,230
There are varying opinions on that
that I feel like are becoming more

444
00:26:33,270 --> 00:26:37,470
diversified recently, so I'm not really
going to get too much into those.

445
00:26:37,830 --> 00:26:41,050
Dr. Bass, you may have some opinions
on those tightening procedures,

446
00:26:41,110 --> 00:26:45,610
but those are out there as possibilities
to help build collagen and maintain

447
00:26:45,670 --> 00:26:46,650
skin integrity as well.

448
00:26:47,410 --> 00:26:47,970
Yeah. I mean,

449
00:26:47,970 --> 00:26:52,830
I think those treatments are
beneficial for the right person at the

450
00:26:52,930 --> 00:26:57,290
right time with relatively
early in the aging

451
00:26:57,350 --> 00:27:01,230
process with a modest
need for improvement.

452
00:27:01,870 --> 00:27:06,850
And I think as we start to
understand actually a lot of the

453
00:27:07,190 --> 00:27:08,710
body treatments,

454
00:27:09,070 --> 00:27:13,510
it's contributed to our understanding
of face treatments because I think a lot

455
00:27:13,530 --> 00:27:16,030
of those laxity treatments using energy,

456
00:27:16,410 --> 00:27:19,530
these are things like
Softwave and Althera,

457
00:27:19,990 --> 00:27:21,690
but there are others as well.

458
00:27:22,150 --> 00:27:25,750
They're really changing
the fibroceptal network,

459
00:27:25,830 --> 00:27:30,790
the connective tissue matrix in
the subcutaneous fat in between

460
00:27:30,930 --> 00:27:35,710
the skin and the underlying
fascia or connective tissue.

461
00:27:36,230 --> 00:27:39,730
And so you're adding collagen,
organizing, thickening,

462
00:27:39,870 --> 00:27:42,450
strengthening that fibroceptal network,

463
00:27:43,050 --> 00:27:46,410
and that helps with laxity modestly.

464
00:27:46,950 --> 00:27:51,430
But I think actually you raised a
really interesting point, Dr. Vickers,

465
00:27:51,490 --> 00:27:55,150
you used the word maintain skin integrity,

466
00:27:55,850 --> 00:28:00,530
and that's an important concept
to understand because it

467
00:28:00,790 --> 00:28:05,750
underscores the recurrent nature
of these treatments. And we're

468
00:28:05,790 --> 00:28:08,950
Americans, we're in a rush.
We've got a busy schedule.

469
00:28:09,430 --> 00:28:13,750
We want one intense treatment
to give us a really big result,

470
00:28:14,170 --> 00:28:18,370
and that's really not how
anti-aging is going to go.

471
00:28:19,110 --> 00:28:20,990
These are recurrent treatments.

472
00:28:21,530 --> 00:28:25,730
They help restore and maintain modestly,

473
00:28:25,990 --> 00:28:30,790
but they need to be a repeated part of any

474
00:28:30,890 --> 00:28:35,550
kind of beauty program to help you
age the slowest to help you look your

475
00:28:35,650 --> 00:28:37,870
best at any point in time,

476
00:28:38,390 --> 00:28:43,290
rather than just expecting you're going
to pop in and everything is going to

477
00:28:43,330 --> 00:28:44,163
be fixed.

478
00:28:44,470 --> 00:28:49,090
And I draw this analogy recurrently
with my patients and on the

479
00:28:49,130 --> 00:28:52,270
podcast that it's very much
like taking care of your teeth.

480
00:28:52,530 --> 00:28:56,230
It's not enough to brush your teeth
or get a really good dental cleaning.

481
00:28:56,910 --> 00:29:00,490
Once you have to brush your teeth every
day or you're not going to keep your

482
00:29:00,550 --> 00:29:01,890
teeth for very long.

483
00:29:02,510 --> 00:29:07,050
And this is the same thing.
These treatments need to be employed

484
00:29:07,330 --> 00:29:11,950
periodically and everyone does
this based on how much time and

485
00:29:11,990 --> 00:29:15,070
energy and money they want to put into it,

486
00:29:15,350 --> 00:29:20,030
but it's important to recognize that
that kind of process is what's going to

487
00:29:20,190 --> 00:29:24,970
work and trying to just
hit it once is going to

488
00:29:25,630 --> 00:29:27,950
pretty uniformly be disappointing.

489
00:29:29,130 --> 00:29:30,250
Yes, absolutely.

490
00:29:31,130 --> 00:29:35,990
So that was also insightful to hear
about in-office options. Dr. Vickers,

491
00:29:36,330 --> 00:29:38,830
can you tell us a little bit about
your projections for the future?

492
00:29:39,050 --> 00:29:42,270
What are the products or treatments that
will be available to patients in the

493
00:29:42,290 --> 00:29:44,970
next few years and what
treatments are further off,

494
00:29:45,050 --> 00:29:47,390
but you see as a
possibility for the future?

495
00:29:48,470 --> 00:29:52,470
So I think the phrase du
jour right now in skincare is

496
00:29:52,610 --> 00:29:56,090
regenerative cosmetics,
regenerative skincare.

497
00:29:56,790 --> 00:29:59,730
We're especially interested in
what's called the secretome.

498
00:30:00,230 --> 00:30:02,170
I recently went to a
conference here in Austin.

499
00:30:02,230 --> 00:30:05,590
It's called the Science of Skin Summit
is put on by one of my colleagues and

500
00:30:05,990 --> 00:30:09,090
really that was the topic that came
up over and over and over again.

501
00:30:09,710 --> 00:30:10,890
So the secretome,

502
00:30:11,970 --> 00:30:16,550
it's sort of an umbrella term
for things within the cell that

503
00:30:16,670 --> 00:30:21,550
stimulate other cells to heal and produce

504
00:30:21,590 --> 00:30:25,090
collagen and overall help with anti-aging.

505
00:30:25,910 --> 00:30:30,830
There's some controversy behind those
products because we don't always know

506
00:30:31,310 --> 00:30:34,150
how it's regulated right
now. It's still kind of new.

507
00:30:34,930 --> 00:30:39,650
So how are they harvested? Where did
they come from? Is it a safe product?

508
00:30:39,790 --> 00:30:43,330
Because it's kind of the wild west out
there with those right now. Specifically,

509
00:30:43,390 --> 00:30:45,150
people are really interested in exosomes.

510
00:30:45,210 --> 00:30:49,550
So there's a lot about
exosomes and platelet-derived
growth factors as well. And

511
00:30:49,570 --> 00:30:52,490
there's a lot of mixed opinions
on those things. But all in all,

512
00:30:52,550 --> 00:30:53,950
that regenerative medicine,

513
00:30:54,010 --> 00:30:57,590
that regenerative cosmetics is what's
sort of in the pipeline, I think.

514
00:30:58,370 --> 00:30:59,290
That being said,

515
00:30:59,450 --> 00:31:03,490
there are some companies that are
looking into plant derived products,

516
00:31:03,570 --> 00:31:06,110
so plant-derived growth
factors, plant-derived exosomes,

517
00:31:06,490 --> 00:31:11,290
which being from plants
tend to be a little bit less
risky than something that's

518
00:31:11,310 --> 00:31:13,670
say human derived. And lastly,

519
00:31:14,090 --> 00:31:17,970
a thing that I kind of keep hearing
about a lot is supplements for skin.

520
00:31:18,110 --> 00:31:21,590
So we have a lot of supplements out there
for hair, hair loss, hair thickening,

521
00:31:21,950 --> 00:31:25,150
but there are a lot of companies that
are really trying to focus on sort of

522
00:31:25,230 --> 00:31:27,050
healing the skin from the inside out.

523
00:31:27,170 --> 00:31:31,930
So really tailoring supplements for
the skin itself to kind of help with

524
00:31:32,230 --> 00:31:35,930
protecting against the sun, anti-aging,
building collagen, all of that.

525
00:31:36,830 --> 00:31:40,150
So I'm curious, since you
mentioned plant exosomes,

526
00:31:40,550 --> 00:31:44,610
the safety issues, clearly
it's more controllable,

527
00:31:44,950 --> 00:31:48,890
more predictable where you're getting
it from and what you're getting.

528
00:31:49,110 --> 00:31:53,850
But do you think there's data
that shows there's response to

529
00:31:53,990 --> 00:31:58,870
these plant messages by human skin or are

530
00:31:58,950 --> 00:32:03,330
human products more likely to have
a message that the skin is able to

531
00:32:03,450 --> 00:32:06,850
receive? What do we know
about that at this point?

532
00:32:08,950 --> 00:32:12,490
I can't really say I know the nitty
gritty behind the science with those,

533
00:32:12,630 --> 00:32:17,110
but I will say that they've done some
studies with plant-derived products where

534
00:32:17,530 --> 00:32:22,150
they even looked at ultrasound to see
how the skin was responding to these

535
00:32:22,190 --> 00:32:25,430
products. And the results
have been very promising,

536
00:32:25,550 --> 00:32:27,270
even with something like ultrasound,

537
00:32:27,330 --> 00:32:32,070
which it's very difficult to get a
noticeable result with ultrasound

538
00:32:32,110 --> 00:32:35,110
technology. So I do think
there's a lot of promise there.

539
00:32:35,230 --> 00:32:38,830
I think the skin is responding
to these treatments,

540
00:32:39,110 --> 00:32:41,990
but in terms of the
nitty-gritty science, not sure.

541
00:32:43,010 --> 00:32:43,590
Yeah. I mean,

542
00:32:43,590 --> 00:32:48,390
clearly this is an evolving
area and very exciting

543
00:32:48,470 --> 00:32:50,850
because the potential seems huge,

544
00:32:50,950 --> 00:32:55,910
but it's hard to know at this
point as much about it as we'd like

545
00:32:55,970 --> 00:33:00,050
to. So stay tuned, but there's
a lot of potential there.

546
00:33:00,170 --> 00:33:04,590
I think particularly
relating to skin integrity,

547
00:33:04,710 --> 00:33:06,610
as you termed it, skin quality,

548
00:33:07,250 --> 00:33:11,130
these are things that these products
really may be able to reset.

549
00:33:11,190 --> 00:33:13,050
And if I go and do a facelift,

550
00:33:13,830 --> 00:33:17,910
I reposition skin back
to a youthful location,

551
00:33:18,470 --> 00:33:23,170
but it's still your skin that has
three or four or five decades of

552
00:33:23,250 --> 00:33:26,790
aging since your twenties
when the skin was youthful.

553
00:33:27,930 --> 00:33:32,710
These products can work on
the skin to behave more like

554
00:33:32,790 --> 00:33:34,070
young people's skin,

555
00:33:34,650 --> 00:33:39,450
and that's really what this
regenerative approach is targeted

556
00:33:39,550 --> 00:33:40,130
at.

557
00:33:40,130 --> 00:33:44,950
But I see a lot of patients confusing
this and trying to use these

558
00:33:45,010 --> 00:33:49,950
treatments as major laxity treatments.
And they

559
00:33:50,050 --> 00:33:54,930
probably at this stage don't have much
promise for that as we're doing it

560
00:33:54,990 --> 00:33:59,950
in 2025. But for skin
quality, skin integrity,

561
00:34:00,110 --> 00:34:04,960
helping restore and maintain collagen
in the skin and some of the connective

562
00:34:04,980 --> 00:34:06,460
tissue elements in the skin,

563
00:34:06,880 --> 00:34:10,860
there's a lot of potential to
help with your beauty plan.

564
00:34:12,180 --> 00:34:15,540
Absolutely. I think everything
... We've touched on this a bit,

565
00:34:15,660 --> 00:34:19,300
but it has to have a
multifaceted approach.

566
00:34:19,840 --> 00:34:23,640
You can't really expect that one element
is going to do everything that you want

567
00:34:23,660 --> 00:34:26,570
it to do for your skin. So you have
to take care of it on multiple levels,

568
00:34:26,640 --> 00:34:29,860
just like you were saying, and
also have realistic expectations.

569
00:34:30,940 --> 00:34:31,773
And also,

570
00:34:32,420 --> 00:34:36,920
there's no one size fits all or no
magic bullet that's going to fix

571
00:34:37,540 --> 00:34:39,660
even a single problem for everyone,

572
00:34:39,720 --> 00:34:42,070
and certainly not every
problem for everyone.

573
00:34:42,570 --> 00:34:45,740
And that's why an experienced, talented,

574
00:34:45,840 --> 00:34:49,220
skillful dermatologist
who can look at your skin,

575
00:34:49,360 --> 00:34:53,320
see how your skin is reacting to the
products you're using and adjust your

576
00:34:53,400 --> 00:34:58,180
beauty plan is also an
important part of that beauty

577
00:34:58,300 --> 00:35:01,020
plan. Everyone wants to do it themselves.

578
00:35:01,080 --> 00:35:05,840
Everyone tries to read on the
internet and decide they're now a

579
00:35:06,040 --> 00:35:07,200
skin expert.

580
00:35:07,800 --> 00:35:12,360
And things like this podcast are designed
to help improve your expertise in

581
00:35:12,440 --> 00:35:13,760
making your skin plan,

582
00:35:13,980 --> 00:35:18,620
but it's very hard to substitute for
the expertise of somebody who has spent

583
00:35:19,000 --> 00:35:19,560
years,

584
00:35:19,560 --> 00:35:24,320
years studying this and then
decades treating people's skin to

585
00:35:24,380 --> 00:35:26,940
try to help their skin to be its best.

586
00:35:28,120 --> 00:35:31,660
I agree. And Dr. Bass, can
you share your takeaways?

587
00:35:32,400 --> 00:35:37,280
So I'm just going to reiterate a
couple of the central points that we've

588
00:35:37,320 --> 00:35:39,400
discussed during this episode.

589
00:35:39,740 --> 00:35:44,680
A simple program is going to give
you most of the benefit you can get,

590
00:35:45,100 --> 00:35:49,680
even from a much more complex,
time-consuming and expensive program.

591
00:35:50,340 --> 00:35:55,260
Sunscreen is central to that because
one of the biggest preventable

592
00:35:55,360 --> 00:35:59,820
factors in skin aging is
sun or ultraviolet light

593
00:35:59,860 --> 00:36:00,693
exposure,

594
00:36:01,320 --> 00:36:06,300
along with moisturizers to
protect the skin and if need be to

595
00:36:06,340 --> 00:36:10,760
add a medicated product. And
in terms of medicated products,

596
00:36:11,000 --> 00:36:14,760
a prescription retinoid,
as Dr. Vickers explained,

597
00:36:15,300 --> 00:36:19,660
is probably the mainstay
in almost everyone's beauty

598
00:36:19,740 --> 00:36:23,620
program. There's an occasional
patient that just can't tolerate them,

599
00:36:23,680 --> 00:36:24,540
but most patients,

600
00:36:24,800 --> 00:36:29,760
if the regimen is adjusted and they
work through a break-in period can be

601
00:36:29,900 --> 00:36:34,020
on that. And that product
probably has the most data,

602
00:36:34,400 --> 00:36:38,640
the most experience at the
ability to restore collagen,

603
00:36:38,940 --> 00:36:43,660
connective tissue elements, which
is ground substance materials,

604
00:36:43,720 --> 00:36:48,620
that mortar, that glues together
the collagen in the skin. And so

605
00:36:48,720 --> 00:36:49,920
retinoids,

606
00:36:50,160 --> 00:36:54,870
particularly prescription retinoids
are key for that and that's a mainstay.

607
00:36:54,990 --> 00:36:59,910
And every dermatologist I know
has been on them since their 30s,

608
00:37:00,270 --> 00:37:04,110
if not sooner. So they not
only say it, but they live it.

609
00:37:04,870 --> 00:37:09,790
And I think it's been great having
Dr. Vickers on the podcast today to

610
00:37:09,910 --> 00:37:11,110
share her expertise.

611
00:37:11,590 --> 00:37:16,470
It's very practical down to earth
information that you can put to

612
00:37:16,610 --> 00:37:20,390
use in planning your beauty
regimen every day. So Dr. Vickers,

613
00:37:20,510 --> 00:37:23,270
thank you for joining us and
sharing that knowledge with us.

614
00:37:24,190 --> 00:37:26,270
Well, thank you so much for
having me. It's been fun.

615
00:37:26,790 --> 00:37:30,190
Thank you, Dr. Vickers, for sharing
your secrets to beauty essentials.

616
00:37:30,310 --> 00:37:32,630
I loved hearing them, and I'm
sure our listeners did too.

617
00:37:33,550 --> 00:37:37,430
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.

618
00:37:37,750 --> 00:37:40,350
Follow us on Apple
Podcasts, write a review,

619
00:37:40,470 --> 00:37:41,750
and share the show with your friends.

620
00:37:41,990 --> 00:37:45,440
Be sure to join us next time to avoid
missing all the great content that is

621
00:37:45,710 --> 00:37:49,110
coming your way. If you want to
contact us with comments or questions,

622
00:37:49,270 --> 00:37:53,950
we'd love to hear from you. Send
us an email at podcast@drbass.net,

623
00:37:54,190 --> 00:37:57,350
or DM us on Instagram @drbassnyc.