What Estrogen Does to Your Skin (And What Actually Works)

Because there was so much to cover with Dr. Tony Yoon, we have broken this episode into two parts. This is part one, and we will publish part two later this week. So in general, for a male, starting in your mid-20s, you do lose about 1% of the thickness of collagen in your skin every year, starting the mid-20s. Women, it's different. Okay, starting in mid-20s, same thing, about 1% a year. But once women go through menopause, their studies show that women lose 30% of the thickness of their collagen in the first five years after menopause. Wait, wait, Tony, wait. 30% of the thickness of collagen in the first five years after menopause. Now it also will increase by about, it increases the collagen loss to about 2% a year after that. So now you're doing 30% in the first five years and then about 2% every year thereafter versus men where it's about 1% a year. And so that is the effects of estrogen on your skin. And that's why you see women who maybe are in their 70s or 80s and some of them have literally tissue paper thin skin to where you scratch them and the skin tears. You don't see it quite as thin in men as they get older. And that's that estrogen effect. The views and opinions expressed on UNPOS 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. For years, I thought I had the menopause conversation covered. Hormones, bone density, cardiovascular risk, brain health. I was deep in the research and I thought I knew what my patients needed. And then women started coming into my office with something I kept dismissing as cosmetic. Their skin had changed dramatically almost overnight. The texture, the volume, the collagen. Women who had great skin in their 40s telling me their products had stopped working, that their face looked different in a way that they couldn't explain. And I was doing what every doctor does when a patient brings something outside of our specialty. I referred it out. It took me longer than I want to admit to connect what I knew about estrogen and what was happening to their skin. Estrogen receptors are in nearly every cell of the body. Of course they're in the skin. Of course declining estrogen changes everything about how skin ages, how it heals, how it responds to products and procedures. That's not just aging. That's biology. When I started actually studying the skin menopause connection, I found a physician who had been asking the same questions from opposite directions for decades. Dr. Tony Yoon is a board certified plastic surgeon, nationally recognized as one of the top plastic surgeons in the United States by Newsweek, Harper's Bazaar and U.S. News and World Report. He trained at Michigan State University College of Human Medicine, completed his plastic surgery residency at Grand Rapids, and went on to complete an aesthetic fellowship with a prominent Beverly Hills plastic surgeon before building one of the most respected practices in the country. He is the author of four books, including his most recent national bestseller, Younger for Life, a comprehensive guide to looking 10 years younger without surgery using the principles of what he calls autojuvenation. He has appeared on Good Morning America, Today, The Doctors, and dozens of other national programs. With more than 5 million YouTube subscribers and 8 million TikTok followers, he's the most followed plastic surgeon on social media. He built that platform on one thing, telling women the truth about their skin, even when the truth might cost him business. Dr. Yoon calls himself America's Holistic Plastic Surgeon for a reason. He has spent his career watching what happens to women's skin and midlife from the inside of an operating room and the consultation suite. He knows what works and what doesn't, what the beauty industry profits from selling and what it quietly buries. He sees the outcomes every single day. He is here because the truth about what happens to women's skin and menopause is not being told anywhere near clearly enough, and he is one of the few people on the planet actually qualified to tell it. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPause, where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. I've really been loving the idea of throwing on a cute casual outfit and then pairing it with just the right piece of jewelry to pull it all together. 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Get a free gift with your first Jenny Bird order when you shop at Jenny-Bird.com. Dr. Yoon, welcome to Unpause. Thank you. We have so much to talk about today because this is one of the biggest things my patients talk about and I can't really help them with, is their skin and what's happening with all these changes with menopause. What I didn't realize was what estrogen is actually doing in the skin at a cellular level. Can you walk our audience through that? Yes. Estrogen is something that honestly in medical school, in residency, and fellowship, we didn't talk about it all. As plastic surgeons, 70 to 90% of our patients are women, yet we don't learn anything about estrogen. It's crazy. It's crazy. Estrogen does actually interact with receptors on fibroblasts. Fibroblasts basically create the building blocks of our skin, which is collagen and elastin. We know that estrogen really has a profound impact on the creation of collagen and the maintenance of collagen and elastin in the skin, which collagen and elastin are the building blocks. The way I describe it to my patients is that it's like the logs of a log cabin. That's what the collagen fibers essentially are. When you're younger, those logs are nice and tight. The log cabin is nice and strong, but as you get older, they start to fray. They start to fall apart. They get weaker and that's part of the aging process. But it's more than just collagen and elastin. Estrogen also impacts hyaluronic acid. We think of hyaluronic acid now because we talk about fillers and all that, but hyaluronic acid actually is a naturally occurring moisturizer of our skin. It also creates some type of structure to our skin as well, but it's the hydration of it. It's essential to hydrating your skin and keeping your skin moist and hydrated and youthful. Also it impacts the sebaceous glands, which help to create oil. Without estrogen, then that can impact how the sebaceous glands are reacting. This is something that recently that we have learned about. Once again, shockingly, not shockingly to a lot of your audience, it really wasn't studied a whole lot other than the last probably 10 years. My patients describe it as their face literally deflates and it feels like it's overnight. I've experienced some of this myself. I had the normal aging stuff and when I look at pictures, but as I crossed that threshold into full menopause, it really felt like things accelerated, especially down here in the neck and chin area, if y'all can see me doing this on camera. It's not that bad. It's me and I'm on video all the time. My patients complain of it constantly. The crepey texture, is there a way to determine how much of this is estrogen and how much of this is actually just aging? Yes, there are studies that have looked at this. In general, for a male, starting in your mid-20s, you do lose about 1% of the thickness of collagen in your skin every year, starting the mid-20s. Women, it's different. Okay, starting in mid-20s, same thing, about 1% a year, but once women go through menopause, there are studies that show that women lose 30% of the thickness of their collagen in the first five years after menopause. Wait, wait, Tony, wait. 30% of the thickness of collagen in the first five years after menopause. Now, it also will increase by about, it increases the collagen loss to about 2% a year after that. Now, you're doing 30% in the first five years and then about 2% every year thereafter versus men, where it's about 1% a year. That is the effects of estrogen on your skin. That's why you see women who maybe are in their 70s or 80s, and some of them have literally tissue paper-thin skin to where you scratch them and the skin tears. Yeah. You don't see it quite as thin in men as they get older. Really? That's that estrogen effect. That's what it seems to be from what we're seeing in studies. Amazing. The internet's going crazy right now. Listening to this because women feel constantly, I hear in clinic, they feel like this is overnight. This very rapid change in- There is a biological basis and that is 100% real. So you're not imagining it. It is a real thing. But the good news is that there are a lot of things you can do about it. That's the good news. Okay. You don't have to worry that, hey, there's nothing you can do. There is a lot that you can do. So what effects do replacing estrogen have? Because we have systemic estrogen therapy. If you're looking at hormone replacement therapy. Systemic. Systemic, yeah. The studies show there was one study, a fairly good size study that showed after 12 months of HRT an increase about 30% of the collagen in the skin in literally 12 months. Okay, that was one study. Like with a biopsy. Yes, that was my understanding. Okay. But there was another study, six months showed about a 6% increase. So there's only a couple of studies out there. The studies are not very strong. 30% sounds pretty aggressive to me. So I question whether that's truly accurate. Even 6 months, 6% at 6 months, still that too seems pretty aggressive. But we do know that it definitely helps. So we know that there is just the quantification we're still figuring out. There aren't a lot of studies. So you know that taking HRT can definitely help because you're getting that estrogen and it can definitely help to thicken the collagen of your skin. We have lots of studies where we looked at women on HRT, not on HRT. Has anybody done a comparison of like? Not that I know of. The studies are really, really limited. So there's HRT and then there's, as you mentioned, topical. Okay. Now people started applying topical by actually taking their vaginal estrogen and putting it on their face. Yeah, I read that. And that's typically been estradiol. And there are a handful of studies showing significant improvements in the collagen of your skin with estradiol on the skin. Estriol, there's only a couple of really small studies and they may even be industry funded. And so there's not a lot of science there for estradiol at this moment, but it's really early. I mean, really, I think I didn't hear about people applying estrogen to their skin probably up until last maybe years when I just started hearing about it, which when you think about it, it's just crazy that this is that it's taken that long for us to even to consider it. So the studies are very limited. They're very early. And then the question then comes is if you are on systemic HRT, is there any benefit to topical? And there are some studies that do seem to show that if you're taking HRT systemically and you add topical HRT, let's say to your face, that it still does create a positive effect. But once again, really the science is very limited. You have to keep in mind that these are not FDA approved indications. Right. You are treating it off the label, which doesn't mean it's not safe. It just means that the FDA hasn't approved it for that purpose. So it's really something to talk with your physician about. Estriol, as you know, and as you've taught is a weaker form of estrogen. You know, I think that it may be a safer option for people, although we do know that you get very minimal systemic absorption for topicals. So you'd have to assume that that's probably won't be a big impact. But right now the science is very early. And I think it's a very interesting thing to look at. Do you prescribe it? I do not. Just because I feel myself that I'm not an expert at it. Yeah. You know, I'm not a hormone expert. I know enough about it. I think to be able to educate in general and form, but not necessarily to I think prescribe. And that's where I really would leave it up to my dermatology colleagues, my gynecology colleagues to consider doing that. What does help then? Everyone's asking. So, and that's where the big question comes is, is it more, you know, if you were to put your resources or your time into applying topical estrogen or some of these other types of things, what would be better? And that's what we don't know. Like there would, it would be great to have a head to head on the impacts of topical estrogen to the collagen of your skin versus let's say Tritonin or Retinol. There's nothing like that out there. These are studies that I think would be really fascinating. And so there are a lot of things you can do from skincare. I fully believe in certain supplements I think can help. And there's also a lot of treatments out there that we can talk about that can really improve collagen. A lot of patients will come in and say, hey, you know, I was really happy with my skin. You know, they've seen me talk about topical estrogen. And then I just feel like my skincare stopped working. You know, is this real or is it psychological? Or I look at it the same way as when people had a system to maintain their weight, right? And then menopause hits and suddenly they're not able to maintain anymore because all this hormonal stuff's going on, the environment changes. Is the skin the same way you think? It is. And you are really fighting against the current with this. You know, so once again, you know, when you're talking about 30% of loss of collagen in five years, you know, that's something that all of a sudden it just revs up. That loss of estrogen really, really is a pretty big impact. And so when people say, yeah, you know, I'm doing the same thing that I did with my skin before. Why is it not helping? It's the same issue that you have with weight where it's like you're fighting against a current because your body has now changed. If you want to, and you don't have to, you know, there's, we can talk about, I've got a kind of an idea, a way of thinking about it. You don't have to do anything if you don't want to. But if you do, then yes, there are a lot of things that you can, you can do about it. So if you, what works, what moves the needle? If you had to organize everything into like three tiers, let's start with topicals. What can I put on my skin that might actually fight some of these changes? What I try to do is encourage people to separate to morning and evening. Okay. Okay. So morning and evening skincare routine. In the morning, the most important thing other than cleansing your skin, and I do recommend sunscreen, is to apply a vitamin C serum. Okay. Okay. So vitamin C, we know it's an antioxidant, antioxidant fights free radicals, fights oxidation. Oxidation is a huge part of the aging process. But what a lot of people forget is that vitamin C also is a cofactor for the production of collagen. And it's not developed about collagen. And so, you know, this goes back to our like high school biology, where we learned that these sailors, you know, a long time ago would set off onto the Atlantic Ocean with all these fresh fruits and vegetables, and then they'd be out on the ocean for three weeks, and they would run out of fresh fruits and vegetables, and they would develop scurvy. And they would, their mucus membranes would start having lesions, and their skin would break down, and some people would even die from it because they didn't get vitamin C. So vitamin C is an antioxidant, it's a vitamin, but also is so important in production of collagen, you need it to get collagen. And so applying it in the morning, super important, like ingestion of vitamin C, you know, it's something that you do want to do every single day, it's not like you do it once and it works for weeks on end or anything like that. So applying vitamin C serum every morning will protect your skin, but also help for production of collagen. And that's the most important step in the morning. So cleansing of vitamin C serum, and then I do recommend a sunscreen, we can talk about that. Okay. At night, that's when your skin is really going to get ideally six to eight hours of just uninterrupted treatment time, essentially. And so that's when you want to 100% you start by cleansing your skin, you're going to get rid of the days worth of dirt and grime and oil and makeup and all that. And then I do recommend applying some type of a treatment. Now the first one we usually recommend is a retinoid. Retinoid is basically, well, it's the most proven and scientifically studied anti-aging ingredient for skincare. It comes in prescription strength, which is tritinoin or retinae and non-prescription strength, which is retinol. That really, if you ask dermatologists and plastic surgeons, that's going to be the jack of all trades, the number one most studied and probably most effective anti-aging skincare ingredient. But it also can be irritating to the skin for some people. And so for people who, let's say, have really sensitive skin, retinoids may not work as well for them because they may find it makes their skin red and dry and irritated. For those people, then you may want to look more at bakuchiao. Bakuchiao is kind of like a plant-based alternative to retinol, very well tolerated. That's been used in Ayurveda and ancient Chinese medicine for hundreds of years. And there was a small study that compared bakuchiao to retinol head-to-head for anti-aging effects and found very similar effects between the two. You can also look at growth factors and peptides. Those are also ingredients in skincare, or you can do all of them. It just depends on how much you want to do. But that, when you're looking at skincare, is anti-aging skincare in a nutshell. Let's go back to vitamin C. Everyone's taking notes right now. How do you choose a vitamin C product? Because I've heard, read, it's very unstable. You have to have in a certain type of bottle. Like walk me through choosing a vitamin C product. What are you looking for? So the most important thing is you want to make sure that it is stabilized. Just because, like you said, the way I would talk about vitamin C, think about it, it's like if you have an apple, okay? And you cut an apple and you put it out into... It turns brown. It turns brown. And so it is actually oxidizing. It turns brown. Well, vitamin C serums do the same thing. They can oxidize, meaning that they can do this. It's a fact, essentially neutralizing free radicals when it's not necessarily on your skin. And so you want to make sure that the bottle is opaque, meaning that either it is a dark amber color, so it doesn't allow the light in that way, or it's completely colored so that nothing gets in. So like we have our own, you know, I have my brand, beauty. Our bottle is white. So you know, then that doesn't get in. And if you're not sure when you pull it out, oftentimes vitamin C will either have a clearish color or a bit of a yellow tint, and that should be fine. Even if it has a slight brownish tint, that should be fine as well. Studies do show that if it's mildly oxidized, it still should work fine. But if it's brown, then it may have oxidized too much and it may not be effective. The other thing you want to consider with vitamin C is that there are studies that do show that if you combine vitamin C and vitamin E together, they can be synergistic together. There's a company called Skin Suiticles. I don't have any, you know, relationship with them, but they have a serum called CE Ferulic, which is legendary. I've seen it. I think I've tried it back in the past. It's like $180 for like a half ounce or one ounce. And so we kind of created my own version of CE Antioxin Serum because I know, I mean, it's such a great idea because we know it's synergistic, it works best, and now you're getting actually the benefits of vitamin C and E, and we know that that can even work together to give even a better result. In your professional opinion, since we're on the subject, why are you can look at two bottles of vitamin C and one is $5 and one is $180? Like what are you paying for? What is the difference? You're paying for the brand name, you're paying for the packaging. You may be paying for, you know, the company to get a bit of a higher return on their investment. But I think really one, a very important thing to realize with skincare is just because it's more expensive doesn't mean it's going to work better. Now, if you like how the product smells and how it feels on your skin and you want to spend the extra money for that, that's fine. But there are a lot of honestly drugstore brand skincare products that work great. I really think it's important for people to realize that cost does not determine the value of a product. And if a big celebrity endorses it, that doesn't mean anything other. Either it just means that they got paid to endorse a product. And so really you want to look for the active ingredients, make sure it actually has, you know, like elascorbic acid in it, make sure that once again, that when you apply it, that it isn't brown. And then really it's just going to be a personal preference in a lot of ways. You know, even when you look at percentages with a lot of skincare products, like let's say retinol, you know, there's some that are 1%, some that are 0.5%, it's not an even playing field across. So you may find a quote unquote medical grade 1% retinol that can be very aggressive on your skin. Yet another one you could buy at the drugstore that says 1% retinol and it's not nearly as aggressive. And so unlike, let's say prescription medications, where we know that the amounts that they say are going to have to be very, very accurate with skincare, it's not the same. Many of you know, I've spent my career pushing for better medical standards for women. MidiHealth is on that same mission, delivering the kind of care women have always deserved. For too long, women have been told to just deal with perimenopause and menopause symptoms. Your labs are normal. This is just a part of aging. Eat less, work out more. That approach failed us. And it's exactly why both my work and Midi's exist. 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There's 0.1%, which is the strongest, 0.05%, which is the most commonly prescribed and 0.025%, which is obviously the weakest. It's really important to keep in mind that not everybody can tolerate Trentinoin. It's strong. What does it do? The easiest way to describe it, it creates an acute inflammation to eventually reduce chronic inflammation. Okay, so an acute inflammation to eventually reduce chronic. And there's a little bit of hormesis idea to it as well. Why does it work for acne? Like my kids have been prescribed it for their acne. So it will help to increase cellular turnover. And that can help with clearing out pores. It can help to regulate, let's say oil content in the skin. It can help to reduce fine lines and wrinkles. It can help to support collagen production. There's an anti-inflammatory effect to it. There are some studies that show that let's say if you have a history of base sulcarcinomas on your face that I recommend all my patients who have a history of skin cancer to apply then Trentinoin afterwards, you're not going to know what it prevents because it may take some cells that are maybe a little dysplastic and essentially slough them off before they become cancer. They just never show up that way. So really it's a jack of all trades when you're talking about truly anti-aging. The problem with Trentinoin, as I mentioned, is that it can be very strong. When I was in medical school, my wife and I were having issues with acne. And back then, I didn't think about what was the cause of it. What was probably being up at night taking call, eating the fry bar at the hospital at night, the deep fried apple wedges and all that type of stuff. And God knows what my microbiome was doing at that time. There's so many factors. But I saw my family doctor and she said, oh, let me prescribe you Trentinoin. It worked for me. So I was like, okay, so she prescribed me 0.1% Trentinoin. She said, apply it every night. And at the time, I'm like, okay, I'll have her prescribed for my wife too. So we both started taking it. And I didn't see her for about a week and a half. We had a bunch of call nights and stuff. And it was hilarious because we finally started to have about a week and a half. And we both broke out laughing because we both, our faces were bright red. They were on fire. They were peeling and flaking. It was hilarious. But in the end, when I think about it now, my family doc, she was female, but she had really thick oily skin. And so for her 0.1% Trentinoin was great. Like she tolerated just fine. For me and my wife, that's not our skin. And it was, it was a very big lesson. So I actually don't tolerate Trentinoin. I only tolerate retinol because it's too strong for me. And I find that I get some too much skin irritation from it. That being said, we do know that the studies are very, very strong in its overall benefits and so many different things. So if you can tolerate Trentinoin, and if you have a dermatologist that's willing to prescribe it for you, even if you just buy it over the counter, because technically you can only prescribe it for acne. That's a great anti-aging cream. So if someone was going to try to pick, like walk me through like you did for vitamin C, how do you pick a good retinol product? What do you look for in the bottle? So what you want to look for, ideally a couple of things. Like if you have thick oily skin and you want to be more aggressive, then I would go the Trentinoin route. No question. If you don't, if you have more sensitive skin, or let's say you don't have access to a doctor, then there's a lot of different retinols out there. Pretty much every big skincare company has a retinol. And once again, percentages don't seem to matter, unfortunately. So you can't necessarily look for a percentage. There are certain things that I do recommend that you look for overall with skin care products. The first thing is ideally you want to avoid fragrance, because that can be very irritating to the skin. So there are some companies where the fragrances are really strong and that's something I in general don't recommend. But there are good retinols that are from drug store brands like Rock ROC, like that's just a drug store brand. They've got a really nice retinol. There are brands that are going to be more expensive, but what you really are paying for isn't necessarily a better quality of the retinol. You're just paying for the brand and the brand name. What did you put in yours and why? So ours is Stabilize Retinol Liposomes, because we know that by putting it in the liposome, it's a bit less irritating to the skin. Also, we have a bunch of moisturizers in it with antioxidants. We have a bunch of good fatty acids in it, so it's very moisturizing. What I like about ours is that virtually everybody can tolerate it unless you're super, super sensitive. But that being said, if you have really, really sun damaged skin, you've got a lot of spots and you want to change very quickly, then my Youn Beauty Retinol Moisturizer may not be the best option for you. That's where I would go more towards a trinol. If you want to be more aggressive. If you're looking for something that's kind of long term that you can tolerate that's very stable, that feels good, it's moisturizing, then I think for me, it's a cornerstone. I use it, my wife use it, my mom use it. We send it to them every month. Talk to me about sunscreen. How many people are actually using it the way they should? About 15% of the population in the US wears sunscreen every day. I can't get my 22-year-old to wear it. She's still tanning. Still tanning? Yes. Oh, that's not even, yeah. That's a whole lot of you. And they're bikinis in the backyard. Yeah. My daughter, she likes getting color in her skin too, but it's tough because in general, yes, I'm not a dermatologist. If I was, I'd say you have to apply it every day and reapply every two hours. You have applied at lunchtime and all that. And even if you're in a dark room, you should have it on. Realistically, I'm going to be honest with you, I don't apply sunscreen every day. I'm in the OR two days a week. And if I'm in the OR, where literally, I live in Michigan, where it's dark when you leave in the morning, it's dark when you come back sometimes. I don't necessarily put it on. It is very important if you're going to be out in the sun, you do want to wear it. No question. At least SPF 30, make sure it's broad spectrum. If you have issues like, let's say melasma, especially melasma that's hormone-mediated, a lot of times an SPF 50 is going to be better for you. And that's where usually people stick with 30 or more. 50 to 60 can be very helpful in certain issues like I said, like with melasma. Does it matter if it's chemical sunscreen versus mineral? I see a lot of debate on the internet. Okay. So there's no question that a mineral-based sunscreen is safe because essentially it sits on the surface of your skin and reflects the sun's rays. The problem with mineral-based sunscreens is they can be very thick and kind of tacky on your skin. Yeah. And very white. Especially if you're a person of color, then it can really change the color of your skin. Even if they micronize it, meaning that they make it much smaller particles, it can still change the color of your skin. And that can be an issue. The problem with chemical sunscreens is that there is a concern that some people have that certain ones, oxybenzone and octanoxate could be potential hormone disruptors. And there are studies that show that the vast majority of Americans, it's like almost 100%, literally have it in their urine when they have tested people. It's like crazy how much people have it. And then there's a concern with coral reefs, if you're, let's say, out on vacation of those disrupting the coral reefs. So there are concerns with it. I think number one is if all you have access to is a chemical-based sunscreen, then still use it. Okay. Cause you do not want to get skin cancer. That's, you know, I'm a plastic surgeon. I can't tell you how many people that I've seen in my office, they get skin cancer on their face and it's disfiguring. You do not want skin cancer. I would be much more afraid of skin cancer than a hormone disruption from a use of a sunscreen on your face if you're on vacation. That being said, you know, there are certain filters that I think have not been concerning. Avo-benzone is one. McZorrell, XL is another one. These are filters that nobody would argue are, you know, potentially harmful. The only two that I've seen any data for is Oxybenzone and Octanoxate. And a lot of sunscreen companies now are excluding those ingredients in their sunscreen products anyway. So I wouldn't be all that worried at this point. You really want to protect your skin. If you are really fortunate though, the problem in the U.S. is the FDA has not approved a new filter since 1999, since the 1900s. Wow. The 1900s was the last time they approved a new sunscreen filter. And there are other countries around the world that do have much more advanced filters than us. A couple of years ago, I went to Korea with my family and we bought a ton of sunscreens. And it's, you know, it's like you put a moisturizer on your skin in the morning and you'd forget that you have it on. It's just comfortable. You don't feel greasy. That's how these sunscreens feel on your skin. Just like you're putting your moisturizer on. Yeah. Yeah. It just, it feels like that. Yet the ones that we have here in the United States, they're old, you know, they're, yeah, they're effective and they work, but they're not as comfortable. And that's where really the hope is that the FDA does start approving. They just made a recommendation to potentially approve a new one this past November. And like I said, be the first one since the 1900s that one is potentially going to get approved. I see a lot of sunscreen being added to like makeup. Did those work? I mean, or should you really just have your sunscreen separate? So they work, but usually there's not enough in it to truly protect your skin. And what about my dermatologist friend gave me, because we hike a lot together. Yeah. And she puts the powder one on, you know, and swears that it works. Yeah. I mean, however you like it, I think the powder is going to be a mineral base. She hikes in full makeup. I do not. You know, that's right. Yeah. So I mean, those, those work as well. I mean, even there are people using the sticks now, roll on sticks with it. Whatever works for you and it's comfortable and you will keep with, that's the important thing. Because really like I said, you know, if you're going to be out in the sun, it's so important to wear it. You know, I did a podcast interview, really nice guy and he said, you know, Tony, I don't, I don't wear sunscreen. I just put lard on my face. He's like, what do you think about that? And I'm like, oh, okay. That's, I, you know, and I think what I've seen like I said is too many people who you get premature aging from it in addition to the potential risk of skin cancer. And with the premature aging, you know, we're talking a lot about that here. All you have to do is compare the skin of your butt to the skin of your face and your neck and your hands. And you know that sun can really cause premature aging. And so really applying it is super important. And whatever it takes for you to be compliant, you know, if it's the powder, then violence and use it. Then use it. Let's talk about some other products, lots of chatter on the internet about peptides. What is a peptide and why would you put it on your skin? Okay. So we got to look at peptides in two different manners. So peptides essentially are short chains of proteins, you know, amino acids. So for our audience, if you don't know, like insulin is a peptide, GLP ones are peptides, but that's not what we're talking about here. So essentially, they are small proteins that cause the body to react in a certain way. Now, when you put them in skincare, they do what we ideally want. Like we just talked about what happens with menopause, what happens with aging, you lose collagen in your skin. So peptides essentially are cellular messengers to message your skin cells to create more collagen. That's essentially what they do. The good thing about peptides is that they're in general relatively inexpensive. So if you go to, let's say a drug store and you look for an antigen cream, and they claim to improve wrinkles and all that, oftentimes they'll have peptides in it. And they usually are well tolerated, they're not that expensive, and they're a very good budget option. Studies when you compare, let's say retinol to peptides, most of those studies will show, and most dermatologists will tell you that they would prefer retinol over peptides in general for efficacy. The other group are growth factors. Growth factors, very prominent, you know, we can get them through PRP, but there are growth factor serums out there that are being sold, and some of them are being sold for a lot of money. That too, their science behind those, the same thing, they promote the skin cells to create more collagen. Those are going to be more expensive. Is this the like salmon sperm stuff that have been seen? Salmon DNA is polyribonucleotides. That's PDRN, polydeoxyribonucleotides technically. Let's go there. So that's a whole other thing too. So right now what's really one of the newest topics in antigen medicine and plastic surgery are bio stimulators. These are substances that you can inject underneath the skin. So they're injectable. To help in general, to help cause your skin to rejuvenate. Now, once again, we look at increased production of collagen, but it may also help reduce inflammation. There are other potential effects that they may create. And there, once again, bio stimulators is the name of it. PDRN is really popular in Korea. And there's this, it's basically salmon DNA, or people call it salmon sperm, a salmon DNA, whatever. I don't know how you actually get it out of the salmon, but people have made funny memes about it. But you take the DNA from the salmon, and it's actually very similar to human DNA, believe it or not. And they create then these bio stimulating products, one of them is called regeron. And in Korea, they will actually inject it underneath the skin, literally like dozens of injections throughout the face. And they say it's one of the most painful, non surgical treatments because you're having like, I've seen the videos from Korea. Yeah. Here in the US, it's not FD approved for that. It is illegal to do it that way. But it's not illegal to use the product as a topical. And so there are places who are doing, let's say, micro needling, where you're making tiny little pokes on the skin. And then they're applying the PDRN, the salmon DNA, like regeron on top of it. And then the idea there is that it seeps into those tiny little holes made by the micro needling, and it rejuvenates the skin from the inside out. So that is legal to do. Wow. I would expect that the salmon DNA, the PDRN is probably going to get FD approved sometime the next year or two, hopefully. I mean, we don't have a lot of studies on it. But what you hear is a lot of anecdotal reports that are pretty impressive. Have you ever gone to Korea for any of this or checked out? I have not. I mean, you see these women flying over there and they're getting eight, nine, 10 procedures all in the same week. Is that safe? I mean, It depends on what it is. So they do a lot of stacking treatments and that is popular here in the US as well. But when you see who's going over there, I see influencers going there where they're getting the treatments comped for them because they're going to post on it. I think it's really important for people to realize that this is a small, tiny group of people who are going there. And to afford that is so unusual. Yes, if you have the ability to do it and you want to do it by all means, go ahead. But I also think it's important for real people to realize that you don't need to do that and that it's, yes, they will stack treatments. I'll do micro needling. They'll do, let's say, IPL with it. Yeah. They may do lasers. Yeah. High frequency ultrasound. They'll inject some Botox. They may do a little bit of filler and they're doing these stacking treatments that you can do in the US, but it does get very, very expensive and you don't have to do all that stuff. Start with the base stuff that we'll talk about with diet supplements, with skincare, and then there's even at home treatments that work really great. And for the vast majority of people who can't spend 20 grand going to Korea, I don't want to spend that myself. Yeah. There's so much you can do. Okay. Nice and amide. Talk to me more about topicals. So a couple of things to consider. Nice and amide is nice. So if you do look at drugstore brand products and you're especially, if you're looking for a sunspot reducing product, like a brightening, nice and amide is very common in brightening products. It is a form of vitamin B3, very well tolerated. It's kind of like a jack of all trades for anti-aging skincare. So it does have some antioxidant effects. It definitely can be very moisturizing for the skin. It has some anti-inflammatory effects, can help with fine lines and wrinkles, but mostly what people use that for are spots. And that's one thing we haven't mentioned yet too, is with actual menopause, there is an increase in people who do get hyperpigmentation of the skin. It could be melasma or it just could be the sunspots and age spots. That does seem to become a more of an issue as women go through menopause. Nice and amide, very nice ingredient in over the counter brightening creams. So if you're on a budget and you're going to your local drugstore, that could be one of the products that you see. Very safe, moderately effective. Not the most, but moderately effective and good for somebody who's on a budget. Instagram teen accounts with automatic protections on who can contact teenagers and the content they can see. Instagram teen accounts have contact limits on by default, so teenagers get messages from people they know, not strangers, and default content settings. Plus teenagers under 16 can't change these default settings without parental approval. So parents can help teenagers connect safely. Learn more at instagram.com. Slash teen accounts. Summer smells like fresh fruit and backyard evenings. Now is the perfect time to bring that feeling indoors. Pura makes it effortless to sent your home with clean, premium fragrances controlled right from your phone. And right now, it's easier than ever to get started. Subscribe to two fragrances for six months and get a free Pura for Diffuser. Don't miss this limited time offer. Visit Pura.com. What do you see on, at least on topical products that women are spending money on that you're like, no, you know, that you wish they wouldn't? Yeah. So where you can save money, number one is, let's say on a cleanser. Okay. So there are cleansers out there. I don't need a hundred dollar cleanser. You don't need a hundred dollar cleanser because it's just cleansing your skin. And it doesn't stay on. And if your cleanser has all these fancy things, they say it doesn't matter. Wash it off. Wash it off. Now you don't want to use bar soap because bar soap can leave a film on your skin. You do want to use a facial cleanser. And ideally you want to use a cleanser appropriate for your skin type. So for example, if you have oily skin, then a foaming cleanser will help with controlling that oil a little bit better. If you have more sensitive or drier skin, which is often the case with women who've got menopause, you're going to want more of a milky or hydrating or gentle type of cleanser. But that's where you can really save money. You get something that's a large amount because once again, it shouldn't be that expensive. And as long as you're tolerating it, what you want after you cleanse your skin and you gently dry it off is you don't want your skin to feel tight. Okay. If it feels tight, then it's probably too dry into your skin. If you give it a minute or two and it feels comfortable, then that's when you know it's doing fine. Okay. So save money there. Another place you can save money is toners. What is a toner? I never understood what a toner was. Okay. So back... I mean, I felt like sea breeze when I was a kid. Back when we grew up, the belief was that you would cleanse your skin, then you would apply an astringent or a toner that had alcohol in it, and then you would apply it with a cotton ball and your skin would feel nice and cold and like it felt great and then your skin would dry. And what we've determined now is that those astringents filled with alcohol actually would disrupt the skin's microbiome. And so that's the first thing is we have a microbiome on the surface of our skin, kind of like the microbiome inside our gut, trillions of bacteria that live there that help with skin homeostasis and it helps with keeping your skin healthy. And when you're using an astringent like sea breeze that people used to use, you basically kill off all of that bacteria. So that's the first problem with the toners back then. The other thing is people would use them because they were having, let's say oil problems. Yeah. Yeah. And so people would say, Hey, I've got a lot of acne. I'm going to use these toners and I'm going to get rid of that oil. But what would happen is you would get rid of it initially, but then the skin cells would say, Hey, what happened to the oil? And it would cause the skin cells to actually create this cycle of creating even more oil. So it would backfire because you would get rid of it. Then your skin would be so oil free that your body would create even more oil to compensate for it. So eventually people realize, Hey, this isn't working. And so then they switch toners over to balance the pH of the skin. That was how it was marketed. And yes, there is some truth to that. If you have a real harsh cleanser, then applying a good toner that's a closer to the pH of your skin may help with it, but a lot of cleansers nowadays, especially gentle cleansers, aren't really all that harsh on your skin anyway. So it's not all that necessary. But that's where you can save money. Okay. And then the final thing I would say saving money, and maybe you don't need to, is there are moisturizers out there that smell nice. They feel nice on your skin, but they don't do squat. Okay. Cause they don't have those active ingredients. They don't have peptides. They don't have growth factors. They don't have retinol. They don't have Bacuchia or any of that stuff. The old cold creams. Okay. Same thing. My grandmother swore by cold cream. Cold creams are also, she gave me my first jar of St. Ives. Oh, there you go. We'll talk about exfoliants. Ground up apricot. Yeah, exactly. So really careful. I mean, you can apply cold cream if you want. And if you love it, biome and stew it, you know, but if you want to save money, combine a moisturizer that has active ingredients into one step. You don't have to if you don't want to, but that's where you can definitely save if you want. There are fancy moisturizers out there that cost a ton of money by big names, and they have absolutely nothing in there that's going to actually fight the aging process or make your skin healthier, other than just moisturizing. And if you want to spend the money, you can, but if you want to save it, then buy those moisturizers that have actual active ingredients like we've talked about. So go back. Do we need to exfoliate? Is that a thing? Yes. So exfoliation is a thing. So our skin, when we're young, exfoliate turns over every about six to eight weeks. Okay. And this so I think of it for our listeners who don't understand skin. It's like a conveyor belt. Yeah. So it's like our skin, essentially it's made at the base of the skin where the skin actually meets with the fat. And then as the skin sells age, they go towards the top and eventually they're at the top and then they slough off. And that whole process takes about six to eight weeks. That's one reason why too, if let's say you're using certain types of creams, sometimes it takes a couple of months, six to eight weeks for you to start seeing the benefits of it because you are waiting for that skin to turn over and those older, you know, let's say more age skin cells, more damaged skin cells to eventually slough off. As we get older, like everything, that process, that sloughing exfoliation process slows down. It starts taking 10 weeks, 12 weeks, maybe even longer for those skin cells to slough off. And that's one reason why our skin feels rougher in texture as we get older. When you exfoliate your skin, you can do it in one of two ways. You can do it with mechanical exfoliation, like with a gentle scrub, or you can do it with a harsh scrub, like you mentioned, or you can do it chemically with acids like glycolic acids and hydroxy acids, that type of thing. What that does actually is that that will then get rid of that upper layer of dead skin cells, but that will actually send a cellular signal to deeper layers of skin cells to start turning over more quickly. And so you can start revving that process up. So I usually recommend to exfoliate your skin. If you have quote unquote normal skin, maybe two to three times a week. If you're sensitive, maybe once a week, you'll know your over exfoliating. If you find that your skin is irritated, if it's kind of red and inflamed, then you're overdoing it. And if it's not, then it may be a reasonable amount. Let's move on to procedures. Everybody wants to know we're getting closer and closer to surgery. So we're going to get there. Yeah. But so walk me through the case for starting a neurotoxin, like Botox, Disport, and what's the difference between those two? There's Botox, there's Disport, there's one more, right? There's Ziumen, there's Jivoh, and there's Daxify. So there's five that are FDA approved in the US. Botox obviously is a gold standard that's been used for the longest time and all the other ones are essentially competitors. Essentially, it's their neurotoxins and what they do is they prevent the transmission of nerve impulses to muscles. And there's certain muscles that create wrinkles. They're called dynamic wrinkles. When the muscle contracts, it causes the skin to wrinkle in a certain way. And so yeah, just like you're doing. So in the upper face of- My forehead is Botox. Three main areas. You helped me. So the first area is right between the eyebrows. Actually, my Botox is worn off, so I don't have any. It's right between the eyebrows, most common. Second are the crows feet. This is from the orbicularis muscle. And then the third is the forehead or the frontalis muscle that creates the vertical lines. These are the three most common areas that you Botox. Obviously, their injections results last about three to four months and then it wears off. Disport is a brand that's been around the longest as a competitor. There is a belief that in some people, it's a little bit of a softer result. So if you Botox somebody, if you inject it, you know exactly what you're going to get. It's pretty strong. Things don't move. The idea behind Disport is that it spreads just a touch more. And for some people, it gets a little bit of a softer result. So some people like that. Xeoman, it has like peptides in it that the idea is that it's a little more pure, but I don't see any true benefit from it. They've tried to advertise it. Oh, it's got peptides to improve the skin quality, but I don't use it. Jivoh actually is from a company that I was one of the founding investors in called Avelis. And I'll be honest with you. And thank you for your transparency. I'll be honest with you. They had the studies actually looked really good for it and comparable to Botox. So I was really excited when it came out. And when we started injecting patients, didn't seem to last as long and patients weren't as happy with it. So I stopped using it. And I don't think the people in the company are that happy with me because as an investor, I'm like, yeah, I don't use it anymore because I don't, for me, I don't find, but there are some people who love it. It's just, I haven't found great results. And then Daxify is the newest one that came out as a longer lasting compared to Botox claiming a six month duration. We do see that in some patients, but not everybody. Okay. And so that has been walked back a bit. I do think that one works really well. I've used that myself. So comparable to Botox. Yeah. And like I said, I think in some people, it may last a little bit longer, but it doesn't appear to be in everybody. So I think Daxify, so my office, we use Botox, Disport and Daxify. I think I love all three of them. I think they're great. I don't have anything much to say about Xeaman. And then my experience with Javau wasn't great, but there are some people who love it. So I see a lot of, you know, it's so funny what our algorithms show us. And I see a lot of injectors injecting all over, platysmal bands, the nefertiti lift. What are those? Cause people are wondering. So the three traditional areas to inject or the three I mentioned earlier, in general, when you, when you inject below the crow's feet area or the cheeks on down, you are going to create potentially more of an effect. You have to be more careful, I guess, because these are areas where the dynamic wrinkles are caused by muscles that also move your mouth. Okay. And so we will inject a tiny bit of Botox, let's say under the corners of the mouth and the depressor, Anguli or DiAO. This is kind of the permafrown muscle. And I've had that injected in myself and you, it's a muscle that does this. And if you inject right here and here, a tiny amount, it will weaken that muscle and it lifts the corners of the mouth. So it's kind of turns a permafrown upside down. You can inject it in the platysmal bands. Those are the platysma, is the sheet like muscle, it comes up the neck and when it gets droopy, yep, you can get little bands here. So if you inject it, it basically weakens those bands. And in some people, if they don't have a bunch of loose skin, that can smooth that area out a bit. The nefertiti lift is injections of Botox right underneath the jawline. And the idea is that it weakens the muscles that may pull down and that can create a mild upward lifting effect, which you don't see that a whole lot in people. And then there are other areas you can do, like you can do it for the gummy smile. So people do a lip flip, or you put a tiny bit right here, which just causes the lip to avert just a touch. So there's a lot of these little types of things that you can do with Botox, but you have to be careful because it really, these doses in the lower face and the neck are on in general smaller doses because if you do too much, no, you can't. Yeah, your mouth doesn't move right and stuff like that. What is baby Botox? So there is, it's this idea of prejuvenation. So baby Botox basically are small injections of Botox. You can look at it two different ways. So some people refer to baby Botox as, Hey, I'm just doing little bits of Botox and you could be 40, 50, 60 years old, but you just are doing little bits to make tiny changes. And that's fine. There's no issue with that. Other people refer to baby Botox as doing Botox for prejuvenation, where you inject areas to prevent wrinkles from happening. That I'm not a big fan of. There are people in their 20s getting Botox injected and they have smooth faces before Botox and they have smooth faces after. I mean, Botox in general is a very safe treatment unless you have it done, God forbid, in a black market Botox or something like that. But in general, it's very, very safe. But we also know that there are people who eventually develop antibodies to Botox and that don't tolerate it after a while. Like they get injected and it just doesn't work. Nothing happens. And for me, I think two things. Number one, it still is a medical procedure and I'm not a fan of doing medical procedures that are not necessary, period. If you don't need it, then why inject it? Because there are potential risks of complications. They're pretty rare, but there still is a potential. And the second thing is, are you using Botox now and then when you actually need it in the future, it doesn't work anymore? There's a lot of people who are in their 20s that think, I can't imagine what it's going to be like when I'm 50. I thought that. I'm like, can I even make it there for God's sakes? And when I do, it's funny because you'll hear people say, oh, I'm 40 now. When I'm 50, I'm not going to care how I look. Or when I'm 60, I'm not going to care how I look. My patients tell me this all the time. Every decade, they always will say that you will care. Like we do, and it's okay. But don't assume that you're not going to because you probably will. And that's where I'm not a fan of that. I think that some people are doing it just to make money. And I just feel like you're not really doing the right thing for these patients. So what would be a good age or time or who should start Botox or consider it? Like when is the right time? When you start seeing those wrinkles and they're starting to bother you. Okay. Yeah, that's you don't want to wait too long because there are wrinkles that can get inset and they can get deep. And no matter what you do with them, you Botox them, you fill them, and they're just not going to go away. And the way I describe to my patients is like the wrinkles in my hand. Okay, I can Botox all the muscles on my forearm. I can inject filler into the wrinkles in my hand. They're never going to go away. They've been there way too long. And the same thing can happen with wrinkles of the face. If you wait too, too long, then you Botox them and it's not going to work. So the best time to do it is when you start seeing those wrinkles come by and they start bothering you. Then that's a good time to start. Welcome back to another MIDI Paws. I'm Dr. Mary Claire Haver, host of UnPaws. As we move through midlife, our healthcare needs change and often women are left without the right support. That's where MIDI Health comes in. From your first virtual visit, their clinicians deliver convenient, compassionate care that is covered by insurance and tailored to meet your unique needs. Midlife is a journey and MIDI is your map. Wherever you are in your journey, it's not too early or too late to start finding real solutions. When you address the root cause of your symptoms, not just the symptoms themselves, you can start to feel better with more energy, more clarity, and more confidence. One of the biggest challenges for so many women is knowing how to prepare ahead of time to get the most out of an upcoming appointment. So here's three simple ways to make sure you're ready for your virtual visit. First, write down your family health history, what conditions run in your family, who had them, and at what age. This can help your clinician determine whether certain treatments, like hormone therapy, may be right for you. Second, keep a symptom journal. Track any changes to your health since your last visit. Symptoms like fatigue, sleep issues, hair loss, weight changes, brain fog, or mood shifts. The more specific you are, the more helpful it is. And third, consider your treatment preferences, whether you're interested in hormone therapy, a more natural approach, or lifestyle changes. It's important to go in knowing what feels right for you and to ask your clinician for guidance based on your personal health history. If you want a little extra support, you can check out my menopause empowerment guide in the show notes to help you feel even more prepared for your next visit. Progress starts with a personal plan, because there's no one-size-fits-all approach to midlife care. That's why the MIDI approach centers around a holistic combination of solutions, from medications like weight loss medications and hormone therapy to lifestyle changes with a care plan that works for your body and your needs. MIDI Health is setting a new standard for health care. As the nation's fastest growing women's telehealth company, MIDI provides accessible insurance-covered services. MIDI fills the critical health gaps women face, building on its leadership in perimenopause and menopause. If you want a clinician in your corner who truly understands what your body and brain need, MIDI is there for you. Go to joinmidi.com, joinmidi.com, and connect with one of their clinicians today. Moving on to more injectables. What is a filler? What are we filling? The majority of fillers are made with hyaluronic acid. As I mentioned earlier, that's a naturally occurring moisturizer of our skin. The original filler was collagen. You may remember, you and I remember the show Beaches, the movie where Barbara Hershey got a lot of flak for saying that, oh, she had filler injected in her lips before. The problem with collagen is it only lasted a couple months. And so hyaluronic acid fillers came around after that, and that's still what we use primarily. Now there are so many different types of hyaluronic acids. Some of them are really thin and they're used for areas, let's say, like in the lips where you don't want something that's real thick. And then other ones that are thicker, let's say that you can use like in the cheeks or in the chin to even simulate bone, essentially. The way I describe fillers to my patients is it's like liquid skin. You inject it and it provides structure. It could be soft structure, like I said in the lips, or it could be something firmer. Usually they last anywhere from six months at the absolute least to a couple of years. And there are some reports now that we know of where it can last even longer than that. And some fillers because hyaluronic acid is a moisturizer, it actually is a humectant, so it actually will draw moisture to it. There are some reports that it can actually increase in size to a mild extent. I think fillers are great for the right people, but they're also much more risky than Botox. The reason why I'm talking about hyaluronic acid fillers are other fillers out there that I don't recommend. Such as? There's ones made of calcium hydroxyl appetite. Others ones made of just plain silicone. There's another one. There's permanent fillers out there. Well, we've all seen some people in Hollywood who've had the permanent fillers done. The problem with permanent fillers is that they're permanent problems. And the worst thing that can happen with a filler, we can talk about people get overdone, but even worse than that is what's called intravascular injection or intravascular occlusion, where you inject a filler and it goes into a blood vessel. And if it clogs that blood vessel up, then the tissue that's supplied blood from that can actually necroser die. People even got blind from filler injections. And so you do want to be careful. The reason why I recommend an HA filler like Restylane or Juvederm or the two big brands is because there is an antidote to them. We can inject hyaluronidase that can actually melt it away in worst case scenarios. Whereas some of the other fillers that are not HA fillers, you get an intravascular injection and you know. That's it. Yeah, there's not much you can do. You go to hyperbaric oxygen, you put warm compresses and you pray to God that somehow it's going to be okay. So I don't recommend the other ones. Who should be doing these injections? Obviously, the top of the line is going to be Placidurans and Dermatologists. But I do think, I do believe in general it's safe for physician extenders, nurse practitioners, RNs, PA's to be doing it as well. You know, I actually have four injectors in my practice because I can't treat everybody myself. But they're all trained by me. Yeah, like, we're, how do you check their training? So if you're going to a physician extender, how would you know how they were trained? You probably don't. But what you want to make sure is that they're, that they're working with either a Plastic Surgeon or a Dermatologist. That is the key. Okay, because anybody can get you potentially a good result. And we know that as surgeons, that the true mark of how good a surgeon is, is not how many good results they get. But what happens when somebody has a complication or a bad result? Can they take care of that patient? That's, that's number one. And so if you're going to get any type of injection or any type of cosmetic treatment period, you want to make sure if that's not the actual doctor doing it, which once again, can be acceptable if it's not surgery, that they have either a Dermatologist or a Plastic Surgeon that they work underneath. Because right now, it's legal for injectors to inject patients and have a doctor who has an MD by their name or a DO, but maybe they're a family doc, maybe they're an ER doctor, or who knows what they are who don't know anything about complications. I've had patients come to me with complications from injections, and I tell them who injected you. They say, oh, this nurse at this center. And I said, well, who's our medical director? And the patient's like, I don't know. It's some doctor that I've never seen before. I think he is a family doc. And it's like, well, they don't have training and anatomy and how to treat these complications. That's why these patients end up at our door like, help concerned. Yeah, because like, nobody's here to help me. So that's why I would make sure, you know, if you're going to get these injections, once again, I do think it's safe to have an extender do it like a PA or a nurse or a nurse practitioner, but just make sure that that they're under the care of a Dermatologist or a Plastic Surgeon. So I see a lot of before and afters on social media as well. And I think that's how a lot of patients out there are picking their injectors. But I also see things that I would consider to be overfilling that are so obvious and not a natural result. What would you go into say to your injector? So a very simple rule, if you're thinking about filler, okay, is not to inject more than about two to three syringes. Give me the numbers. So if you see somebody in Hollywood, like on a Real Housewife type of show and they look overly filled, you're not talking two or three syringes. You're talking six, eight syringes, maybe even more. Okay. Cause the volume is the key. We are in, unfortunately, an era right now where there's a lot of filler fear because people think, oh, I'm going to go get filler and I'm going to look like this person on TV. And what I try to explain to patients is, is that there is a lot between where you are and what that person is. And to get to that point, number one, you have to sign on on getting a crap ton of syringes. And number two, you're going to be spending a crap ton of money to get there. You know, it's not like you're going to have it done in like one minute, you're going to look like yourself. And then 10 minutes later, you're going to look like a Real Housewife. It doesn't, it's not that quick. And if you're not sure, then start maybe with a maximum of two to three syringes max. Okay. So lips are very popular. I've had my lips done and very happy with the result. I kind of look like my lips at 30. Instead of 57. So, you know, honestly, I look at you and I didn't realize that. Yeah. If you were going in like, I'm curious about this, I want to learn more how like for lips, what would you say would be a reasonable amount to start with? One syringe. One syringe. Okay. Yeah. Yeah. One syringe is usually enough to get a nice modest change. Now, initially keep in mind that the lips swell a lot and they'll swell for the first couple hours and then they really come down if you're icing them. So if you initially go in, you have a syringe done and you're like, oh my gosh, my lips are huge and you're nervous. Don't worry, it's going to settle down. And usually you get a mild to moderate change with one syringe. Okay. If you were doing other parts of the face. So cheeks are popular. Yeah. So cheeks, I would say I would max out. If you're, if you really want a significant change in one and a half to two syringes on each side at the most to start out with, even one is typically sufficient to see a modest, nice improvement for most people. Okay. So I will max out and with my patients at maybe four at the most in somebody who really knows what they're looking for and we're studying it together. That's probably the most that I've done in a patient is four syringes at one time. Most commonly I'll do two and occasionally three. And that's for the cheeks. And the lips typically will do one syringe for most patients with a lip. It's rare that they'll do more than one syringe at a time. Okay. And then you let it wear off and then you know when things are getting thin. Now, there are even some, you can do a half syringes occasionally. There's not a lot of brands that sell them in half, but there's a couple. So that's another option, let's say with the lips. And what about under the eyes? That's also another really popular area. Under the eyes, you have to be really cautious. And really what you're looking at is about half the syringe on each side. Okay. So one syringe for a total of both is typically sufficient for most people. If you're doing more, if you're doing a syringe on each side, that's typically considered a lot. It migrates a lot, right? I think the migration is overstated. It depends on where you inject it. So the idea is that, you know, there are people who online will say, oh, if you, and I've seen this video once, a guy said, oh, if you inject it in your forehead, it could end up in your chin. And like there's absolutely no chance that that happens. But we do know that if you're injecting a filler in and around, let's say muscles, and those muscles are constantly contracting, can it move that filler a millimeter or two potentially? I think it's definitely possible. But is it going to move all around your face? No. There definitely is some migration of filler, but once again, I don't think that's going to be more than a millimeter or two because there's tissue planes. You know, your stuff just doesn't move around in your face that easily. Botox can also migrate, but that's not something that happens later on. It happens within a week or two. And the worst thing that happens with that is you can get a droopy eyelid for a couple of months. And if that happens, there's actually an eye drop that can help counteract that. What about the fat transfers? What is that? Fat's great. You know, I actually trained with one of the top fat transfer surgeons back when I did my fellowship in Beverly Hills many years ago. And really what it is, is it's the original filler. So we use like a small liposuction type cannula. We remove fat from the abdomen or the hips, purify the fat by spinning it down, and then literally just inject it. So I do a little incision each corner of the mouth, inject it under the eyes, in the cheekbones, put some in the lips. And the good thing with fat is it's your own tissue, and some of it will last a really long time. You know, I've had patients 15 years later that still have some of that fat there. The bad thing about fat is it's unpredictable. Anywhere from 30 to 50% of that fat will stay. And sometimes even a little bit less, you can't really predict it. In the lips, like 10% will stay very little. And so what I usually tell my patients is that I will over correct them by maybe 20%, knowing that at least 50% is going to go away. And I tell them, you're going to be under done in the end. Okay. But I don't want to risk overdoing you. And now having to try to liposuck some of the fat back out. And so a lot of times, I'll, you know, like I said, people will say, Hey, look, what I tell them is at one week, you're going to get buyer's remorse. You're going to be like, Oh my gosh, you put too much fat in my face. It's too puffy. At three weeks, you're going to say, it looks really good. Is more of it going to go away? And then at eight weeks, you'll say, you know what, it looks better than it started, but I wish you would have put more fat in my face. And aging process, not so much menopause, but aging in general, we lose fat in our face, right? We do. Yeah. Yeah, we lose volume. And the volume is fat. It's also bone. There are studies showing that you actually, the bony structure changes as we get older and that contributes to it as well. 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. Tony. 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. We would be so grateful. You can also find full episodes on YouTube. On Paws, 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.