Skin Is In: The Growing Focus On Skin Quality

1
00:00:00,690 --> 00:00:04,560
Welcome to another episode of
Park Avenue Plastic Surgery Class,

2
00:00:04,620 --> 00:00:08,280
the podcast where we explore controversies
and breaking issues in plastic

3
00:00:08,281 --> 00:00:10,840
surgery. I'm your co-host Doreen Wu.

4
00:00:11,140 --> 00:00:15,840
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

5
00:00:15,840 --> 00:00:17,120
educator, and technology innovator.

6
00:00:17,780 --> 00:00:21,400
The title of today's
episode is Skin is In:

7
00:00:21,400 --> 00:00:23,880
The Growing Focus on Skin
Quality and How to Achieve It.

8
00:00:25,450 --> 00:00:27,400
Dr. Bass, we all want to be beautiful.

9
00:00:27,660 --> 00:00:30,080
Our skin is our biggest
and most visible organ.

10
00:00:30,570 --> 00:00:32,800
So what should we be
doing to maximize beauty?

11
00:00:32,801 --> 00:00:34,840
And what specifically is skin quality?

12
00:00:35,270 --> 00:00:39,400
Well, skin quality can be
broken down into multiple

13
00:00:40,010 --> 00:00:42,760
factors in a few different classes.

14
00:00:44,380 --> 00:00:47,720
But for almost any aspect of skin

15
00:00:47,721 --> 00:00:51,720
quality an approach is typically

16
00:00:53,080 --> 00:00:56,960
multiple treatments, and it's
typically multi-modality.

17
00:00:57,570 --> 00:01:00,200
So let's say skin texture, you know,

18
00:01:00,201 --> 00:01:04,760
if we get a little improvement by
using a skin product and doing a little

19
00:01:04,761 --> 00:01:08,800
improvement with an energy treatment,

20
00:01:08,800 --> 00:01:11,160
overall we cumulate to a really

21
00:01:11,161 --> 00:01:15,960
obvious, really beautiful
and quality to the skin,

22
00:01:17,250 --> 00:01:18,400
so that's important.

23
00:01:19,230 --> 00:01:22,840
Skin quality more recently has been

24
00:01:23,570 --> 00:01:27,160
defined in a little
more quantitative terms,

25
00:01:27,620 --> 00:01:32,320
and the distinction between skin quality

26
00:01:32,540 --> 00:01:36,240
and other skin facial
features like skin laxity,

27
00:01:36,640 --> 00:01:39,600
which were often all lumped
together in the past,

28
00:01:41,070 --> 00:01:44,960
have really been teased
out and separated because

29
00:01:45,630 --> 00:01:50,480
each attribute really needs
its own individual approach and

30
00:01:50,481 --> 00:01:51,314
treatments.

31
00:01:51,790 --> 00:01:52,281
Okay.

32
00:01:52,281 --> 00:01:56,240
So it sounds like skin changes are among
the most noticeable signs of aging.

33
00:01:56,380 --> 00:01:58,440
How does that start to
show as we get older?

34
00:01:59,560 --> 00:02:03,920
As we age, our skin thins,

35
00:02:03,920 --> 00:02:08,480
the metabolism of the skin slows down
the rate at which the cells produce

36
00:02:09,080 --> 00:02:10,160
energy and which they

37
00:02:11,920 --> 00:02:15,320
turn over or reproduce
the tissues of the skin.

38
00:02:16,520 --> 00:02:19,320
The structural proteins in the skin,

39
00:02:20,160 --> 00:02:21,640
collagen and elastin diminish,

40
00:02:22,960 --> 00:02:26,960
become less organized and have
some other damage changes,

41
00:02:28,200 --> 00:02:31,440
and that also happens to the
ground substance materials,

42
00:02:31,880 --> 00:02:35,560
sort of the glue or gel that
sticks together the structural

43
00:02:37,600 --> 00:02:40,960
proteins. That diminishes
in amount as we age.

44
00:02:42,520 --> 00:02:44,720
We also get some dyschromia,

45
00:02:46,320 --> 00:02:50,080
irregular pigmentation of the
skin and other pigment issues.

46
00:02:50,960 --> 00:02:54,840
We get some redness
issues, including rosacea,

47
00:02:56,400 --> 00:02:57,640
sort of red,

48
00:02:58,440 --> 00:03:01,640
plethora appearance to the cheeks
and other parts of the face,

49
00:03:02,120 --> 00:03:05,080
often with some bumps or
some actual breakouts.

50
00:03:06,320 --> 00:03:10,640
And we get a lot of changes
in surface smoothness.

51
00:03:12,080 --> 00:03:16,080
The visibility of pores,
the roughness of the skin,

52
00:03:16,560 --> 00:03:19,400
and eventually fine surface wrinkles,

53
00:03:19,800 --> 00:03:21,960
and then deep edged in wrinkles.

54
00:03:22,640 --> 00:03:24,680
Those are quite a lot of changes.

55
00:03:25,030 --> 00:03:29,600
I never realized how much was going
on beneath the surface. So, Dr. Bass,

56
00:03:29,601 --> 00:03:32,640
what are some of the main approaches
that we have to treating skin quality?

57
00:03:33,410 --> 00:03:38,290
There are a few big categories,
each of which contain many,

58
00:03:38,530 --> 00:03:39,370
many entries.

59
00:03:39,620 --> 00:03:44,450
So skin products like
moisturizers that contain

60
00:03:45,450 --> 00:03:46,970
biologically active agents. Basically,

61
00:03:47,890 --> 00:03:52,170
medications that not only
protect the skin, but

62
00:03:55,330 --> 00:03:59,650
induce the skin pharmacologically
to behave more like

63
00:04:00,450 --> 00:04:03,610
youthful skin, energy based treatments,

64
00:04:04,410 --> 00:04:08,490
and injectables. Those are
the big groups of things.

65
00:04:09,730 --> 00:04:13,410
So any selection of treatments
has to be focused on

66
00:04:14,930 --> 00:04:19,610
whatever the most visible or
most troublesome attributes of

67
00:04:20,010 --> 00:04:23,970
skin quality are at that
given point in time.

68
00:04:25,730 --> 00:04:29,810
But again, often more
than one treatment done,

69
00:04:30,450 --> 00:04:34,690
just a little bit done
lightly works best and

70
00:04:35,650 --> 00:04:40,330
between a few different
options, cumulates to a real

71
00:04:42,050 --> 00:04:44,570
substantial improvement
in skin quality. You know,

72
00:04:44,571 --> 00:04:48,930
the problem is skin
quality is a very subtle

73
00:04:48,970 --> 00:04:53,010
attribute. You know, how
much glow does the skin have?

74
00:04:53,011 --> 00:04:57,890
How firm and fold does it look
separate even from all the other

75
00:04:57,891 --> 00:05:01,930
issues that I listed
earlier? So it's subtle,

76
00:05:01,990 --> 00:05:05,330
but it's also a very
emotionally persuasive feature.

77
00:05:05,440 --> 00:05:08,850
People see it without
thinking consciously about it,

78
00:05:08,851 --> 00:05:10,490
but they can recognize young,

79
00:05:10,491 --> 00:05:15,090
healthy skin and older
worn out skin without any

80
00:05:15,091 --> 00:05:15,924
difficulty.

81
00:05:16,500 --> 00:05:18,730
Is skin quality only an aging feature?

82
00:05:19,360 --> 00:05:22,690
That's a great question,
and the answer is no.

83
00:05:22,691 --> 00:05:27,570
There are plenty of young people
who have one or more skin quality

84
00:05:27,720 --> 00:05:32,330
issues from teens with active acne

85
00:05:32,420 --> 00:05:37,170
to very senior years. A variety
of things show on our skin,

86
00:05:37,190 --> 00:05:41,490
but, but typically we're showing
more of these things as we age.

87
00:05:42,220 --> 00:05:46,780
Given that people of all ages
are affected. Why haven't
I heard of this before?

88
00:05:46,950 --> 00:05:47,783
Is it new?

89
00:05:48,370 --> 00:05:49,780
It's not really new,

90
00:05:50,050 --> 00:05:54,700
really what dermatologists and
facialists and aestheticians

91
00:05:54,930 --> 00:05:59,120
have been trying to help
people with since time was.

92
00:06:00,500 --> 00:06:01,880
But more recently,

93
00:06:02,250 --> 00:06:06,720
there's been much better definition of

94
00:06:07,540 --> 00:06:12,080
the degree or severity
of specific findings and

95
00:06:12,081 --> 00:06:16,760
parsing out all these different
aspects in skin. So we've basically had

96
00:06:18,580 --> 00:06:23,550
more clarity that allows us a more

97
00:06:23,790 --> 00:06:27,110
rational basis for diagnosis,
for treatment planning,

98
00:06:27,111 --> 00:06:28,630
and for outcome assessment.

99
00:06:28,890 --> 00:06:32,790
And that's led to a big
emphasis on skin quality

100
00:06:33,600 --> 00:06:38,550
as an important thing to
chase at all stages of

101
00:06:38,790 --> 00:06:40,630
aging, including when you're young.

102
00:06:41,840 --> 00:06:46,620
So it's resulted in a lot
of new products things

103
00:06:46,621 --> 00:06:48,900
that are probably a better fit. You know,

104
00:06:48,901 --> 00:06:53,660
the big selling point
for skin lotions 20 years

105
00:06:53,661 --> 00:06:58,260
ago was, you know, facelift in
a bottle or liquid facelift.

106
00:07:00,600 --> 00:07:03,380
And these moisturizers,

107
00:07:03,381 --> 00:07:07,580
even medicated ones don't
really impact skin laxity,

108
00:07:08,400 --> 00:07:12,860
but they can have all kinds of effects
depending what medications are in them

109
00:07:13,430 --> 00:07:14,820
on skin quality.

110
00:07:17,110 --> 00:07:20,780
So even people who have no laxity,

111
00:07:20,781 --> 00:07:25,700
they've had a great facelift and
laxity has been brought down to

112
00:07:25,701 --> 00:07:27,540
a bare minimum,

113
00:07:27,540 --> 00:07:31,060
we still see that the fabric
of the skin on their face

114
00:07:31,990 --> 00:07:36,500
is aged. You know, it's
had decades of age,

115
00:07:36,680 --> 00:07:37,540
sun exposure,

116
00:07:38,680 --> 00:07:43,460
all the things that make us look
older than we did in our teens or

117
00:07:43,461 --> 00:07:44,294
twenties.

118
00:07:44,400 --> 00:07:49,100
And so working on the fabric of
the skin itself does a tremendous

119
00:07:49,101 --> 00:07:53,660
amount to improve and rejuvenate
our appearance when we're in our

120
00:07:53,710 --> 00:07:55,540
fifties, sixties, seventies,

121
00:07:56,200 --> 00:08:00,420
and working to protect and
prevent those kind of changes when

122
00:08:00,860 --> 00:08:02,820
we're in our twenties, thirties,

123
00:08:02,821 --> 00:08:07,820
and forties delays when
we have to address the big

124
00:08:08,100 --> 00:08:11,860
aging features and preserves
our skin at its youthful

125
00:08:12,170 --> 00:08:15,580
best. It improves how we look, you know,

126
00:08:15,581 --> 00:08:18,100
even while we're still
relatively youthful.

127
00:08:18,990 --> 00:08:22,260
So does this mean that skin
quality is for everybody?

128
00:08:23,050 --> 00:08:25,130
Basically, yes. You know,

129
00:08:25,140 --> 00:08:29,330
we all have to just as
part of basic hygiene,

130
00:08:30,080 --> 00:08:34,250
take care of our teeth and
our hair and our nails,

131
00:08:34,470 --> 00:08:37,450
and we also have to take care of our skin.

132
00:08:38,150 --> 00:08:43,130
But how far you want to take it varies
depending on your personal preferences

133
00:08:44,070 --> 00:08:47,730
and what other more prominent
features may be showing.

134
00:08:49,010 --> 00:08:52,610
if you are older with a
lot of laxity in your skin,

135
00:08:53,000 --> 00:08:57,640
that laxity may stand out a whole
lot more than some of the texture

136
00:08:57,641 --> 00:09:02,440
and pigment changes and
laxity probably should be

137
00:09:02,441 --> 00:09:05,480
the starting place for what
you do with your appearance.

138
00:09:07,220 --> 00:09:12,040
but if laxity has been corrected, you
can get a big improvement in pigment,

139
00:09:12,041 --> 00:09:13,360
irregularity, and texture,

140
00:09:13,640 --> 00:09:17,200
and that projects a much
more youthful appearance

141
00:09:18,310 --> 00:09:20,590
early in the game. In
your twenties to forties,

142
00:09:21,460 --> 00:09:26,390
skin quality has a much
more central role in how

143
00:09:26,391 --> 00:09:31,350
good you look, and it's
also your chance to have

144
00:09:32,020 --> 00:09:36,550
prevention and keep yourself
out of trouble for the longest

145
00:09:37,070 --> 00:09:37,903
possible time.

146
00:09:40,040 --> 00:09:43,470
so you may not get a drastic improvement,

147
00:09:43,690 --> 00:09:48,630
but you're still likely to get to
get an improvement in appearance but

148
00:09:48,631 --> 00:09:51,710
you're also preventing aging changes,

149
00:09:51,711 --> 00:09:53,870
slowing the whole process down,

150
00:09:53,871 --> 00:09:57,670
and that's going to pay you
huge dividends down the line.

151
00:09:58,660 --> 00:10:02,520
Now, you've touched on some of these
treatments throughout the episode,

152
00:10:02,540 --> 00:10:05,040
but what are some specific
treatment examples?

153
00:10:05,670 --> 00:10:09,160
Skin products are always the basics,

154
00:10:09,780 --> 00:10:13,240
and retinoids

155
00:10:14,360 --> 00:10:19,160
alpha and beta hydroxy acids are
things that are very commonly

156
00:10:19,161 --> 00:10:22,160
used increasingly as we go forward.

157
00:10:22,240 --> 00:10:26,520
There are growth factor products in skin

158
00:10:26,620 --> 00:10:31,320
moisturizers and post-treatment skin

159
00:10:31,321 --> 00:10:33,840
preparations to protect the skin,

160
00:10:33,841 --> 00:10:38,720
help it heal and help
amplify the results of energy

161
00:10:38,721 --> 00:10:39,640
based treatments.

162
00:10:40,870 --> 00:10:45,760
Energy based treatments of many types
are also important for skin quality.

163
00:10:46,820 --> 00:10:51,800
And what's happened more recently is the

164
00:10:51,801 --> 00:10:56,320
beginning of introduction in the United
States of more superficial fillers.

165
00:10:56,480 --> 00:10:58,200
So we've had, you know,

166
00:10:58,201 --> 00:11:02,320
mid-level fillers for more than 15 years

167
00:11:03,090 --> 00:11:06,080
in the United States, like
Restylane and Juvederm,

168
00:11:06,081 --> 00:11:09,760
the initial products that were
introduced. And increasingly,

169
00:11:09,761 --> 00:11:14,280
we've gotten specialized fillers
that are designed for cheeks or lips

170
00:11:14,490 --> 00:11:16,200
or jawline line.

171
00:11:17,660 --> 00:11:22,080
but the unmet need up till

172
00:11:22,640 --> 00:11:26,200
recently was a superficial
filler that, again,

173
00:11:26,201 --> 00:11:28,000
plums the surface of the skin.

174
00:11:28,050 --> 00:11:32,360
So fine wrinkling and
roughness in texture are

175
00:11:33,270 --> 00:11:34,103
a faced,

176
00:11:34,820 --> 00:11:38,800
and within the past few
months in the United States,

177
00:11:38,801 --> 00:11:42,960
we've seen the introduction of one or more

178
00:11:43,730 --> 00:11:44,563
fillers,

179
00:11:44,820 --> 00:11:49,680
FDA approved specifically to
chase these more superficial kinds

180
00:11:49,681 --> 00:11:50,514
of issues.

181
00:11:51,530 --> 00:11:56,320
Another example is
biological injectables in the

182
00:11:56,321 --> 00:11:59,560
United States. That's
principally platelet rich plasma.

183
00:12:01,040 --> 00:12:02,800
other countries in the world,

184
00:12:03,130 --> 00:12:07,640
in Europe and elsewhere
are using other biological

185
00:12:07,710 --> 00:12:12,160
things stem cells and

186
00:12:13,070 --> 00:12:13,761
exosomes,

187
00:12:13,761 --> 00:12:18,680
which are subunits out of cells and

188
00:12:18,681 --> 00:12:22,480
other kinds of things to try to
biologically modulate the skin.

189
00:12:22,481 --> 00:12:23,600
Now we don't know

190
00:12:25,460 --> 00:12:28,670
what will come to the United
States and when that will happen,

191
00:12:29,690 --> 00:12:34,430
but we know that's a lot of interesting

192
00:12:35,570 --> 00:12:40,390
development and clinical
application taking place elsewhere

193
00:12:40,391 --> 00:12:44,630
that gives us a glimpse of what might
be in our future in the United States.

194
00:12:45,540 --> 00:12:47,550
Lastly, before we close Dr. Bass,

195
00:12:47,740 --> 00:12:50,790
what should our listeners take away
from today's episode about skin?

196
00:12:52,170 --> 00:12:56,050
First, there's categories of skin quality.

197
00:12:56,770 --> 00:13:01,250
Skin quality is not a single
attribute. It's classes of attributes,

198
00:13:02,570 --> 00:13:07,050
texture, glow, turgor or fullness,

199
00:13:08,650 --> 00:13:12,530
pigment issues, and redness
issues, just to put it in simple

200
00:13:14,410 --> 00:13:15,243
terms.

201
00:13:15,690 --> 00:13:20,570
It's worth working on to maximize your
appearance in youth and to prevent and

202
00:13:21,610 --> 00:13:24,370
maintain the skin in
the early aging process.

203
00:13:26,290 --> 00:13:29,250
It's a key additional
component of facial aging.

204
00:13:30,170 --> 00:13:34,370
So correcting the skin itself
separate from shape restoration or

205
00:13:35,250 --> 00:13:40,050
laxity correction has a major impact on

206
00:13:41,090 --> 00:13:42,690
how aged you look.

207
00:13:46,530 --> 00:13:50,600
Understand that this is some ongoing work.

208
00:13:51,560 --> 00:13:52,393
It's a maintenance process,

209
00:13:53,680 --> 00:13:56,960
and we need to take multiple small steps

210
00:13:58,760 --> 00:14:03,200
on a fairly frequent basis to
help our skin stay healthy and

211
00:14:03,920 --> 00:14:08,520
to restore it to its youthful
appearance so you look your best.

212
00:14:09,150 --> 00:14:12,470
Thank you, Dr. Bass for sharing your
knowledge and expertise with us.

213
00:14:12,471 --> 00:14:16,430
And thank you to our listeners for joining
us today to hear about how your skin

214
00:14:16,431 --> 00:14:19,830
changes with aging and what can be
done to maintain a youthful appearance.

215
00:14:20,100 --> 00:14:23,390
I hope you found this episode as
fascinating and informative as I did.

216
00:14:23,880 --> 00:14:27,390
If you think of other exciting
developments or trends
in plastic surgery that

217
00:14:27,391 --> 00:14:29,590
you would like us to discuss
in an upcoming episode,

218
00:14:29,591 --> 00:14:32,910
please reach out by email or
Instagram. We'll see you next time.

219
00:14:33,900 --> 00:14:38,030
This is Doreen Wu thanking you for joining
Dr. Bass and me for this discussion

220
00:14:38,031 --> 00:14:41,630
of skin quality and aging.
Be sure to tune in next time,

221
00:14:41,631 --> 00:14:45,270
and don't forget to subscribe to our
podcast to stay up to date with all of the

222
00:14:45,390 --> 00:14:47,070
exciting content that is coming your way.

223
00:14:48,110 --> 00:14:52,360
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

224
00:14:52,361 --> 00:14:57,040
Class podcast with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

225
00:14:57,840 --> 00:14:59,720
educator, and technology innovator.

226
00:14:59,860 --> 00:15:02,520
The commentary in this
podcast represents opinion.

227
00:15:02,521 --> 00:15:05,040
This podcast does not
present medical advice,

228
00:15:05,220 --> 00:15:09,320
but rather general information about
plastic surgery that does not necessarily

229
00:15:09,600 --> 00:15:12,640
relate to the specific conditions
of any individual patient.

230
00:15:12,970 --> 00:15:17,800
No doctor patient relationship
is established by listening
to or participating

231
00:15:17,810 --> 00:15:18,643
in this podcast.

232
00:15:18,850 --> 00:15:23,000
Consult your physician to advise you
about your individual healthcare.

233
00:15:23,090 --> 00:15:24,600
If you enjoyed this episode,

234
00:15:24,630 --> 00:15:28,800
please share it with your friends and
be sure to subscribe to our podcast on

235
00:15:28,801 --> 00:15:32,960
Apple Podcasts, Google, Spotify, Stitcher,

236
00:15:33,170 --> 00:15:35,520
or wherever you listen to podcasts.