← TheUPside Podcast
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- [00:01]
A
Today on the Upside Podcast, we're going to talk about being confident in your own skin. And I mean literally your own skin. I have a special guest with me today. Welcome to the Upside Podcast. I'm Teresa Flood, your host, and we help you get unstuck in life and business by elevating your thinking, provoking meaningful change from the inside out. My special guest today is my dermatologist, Dr. Mara Dasho. And. And I want to tell you all just a little bit about her resume. It's very impressive, but she is a cosmetic. And gentle. She is gentle, but general dermatologist. And she leads the aesthetics division at Innovative Dermatology in Plano, Texas. And you are also a clinical assistant professor of dermatology at UT Southwestern. That's very impressive. And this is exciting. You're the incoming president of the Texas Dermalogic Dermatological. I actually practiced that one. It's a mouthful. Dermatological Society. And she told me I don't have to call her Madam President. Yeah, you don't.
- [01:06]
B
Not yet.
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A
I am so happy to have you. We're have such a fun conversation today, but I want to tell everybody, too, that you have four children under the age of 10. So you are in the trenches, working full time at the practice, being a mom of four kids under 10, three of them boys. You sing, you do yoga. We're gonna talk about so much today. So first of all, just tell everybody your story.
- [01:32]
B
Well, tell something. So thank you so much. It is such a pleasure to be here. I love talking about this stuff. Yeah, this really is my. My passion. So my story. I started in dermatology kind of by chance. I wasn't sure what I was going to do. When I was in medical school, I kind of did everything. I did some women's health, I did some public health. I ended up in dermatology because I had an interest in a rare disease called leprosy. It's one thing I can tell you. No. So leprosy is one of those diseases that we don't see very often. Right. It's kind of a neglected disease. And what I found really fascinating about it was the fact that it is something that affects all of someone's being. So not just their skin, but also their nerves. Right. Because they can't necessarily feel very well, but also their perception of themselves and how others perceive them because it is stigmatized. So I kind of dove into that aspect of it. I did some research, but then I found that I loved skin disease. And. And so then I went back to I kind of went to my, my medical school and I did a bunch of electives. And I love that dermatology is where you can really impact someone's well being and you can impact their confidence. Right? At a very, very, very kind of micro level. Yes. Right. So I think that those things were really important to me. I also love that in dermatology you can do so many things. You can be a pathologist, which I also am. You can do procedures, you can do minor surgeries, you can do injectables, you can do aesthetics.
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A
Right.
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B
But there's just, there's so many options and the diversity and impacting so many lives in so many ways. I think that was really what, what got me going.
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A
It's really interesting. I think the last person that I have heard about having leprosy was the man from the Bible. I mean, I have not heard of anybody in the US or. And it still exists, it's free.
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B
Exists across the U.S. it exists in the U.S. it's rare. So there'll be 100 cases a year.
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A
But that's still a few hundred people. Right.
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B
But it's still, it's still there. And we still have a lot of people who come from in places where it's endemic. Right. Or they have leprosy in their communities. And so it's important for us to just recognize it's out there that it can be treated. Right. And I think it's still very important to be engaged in those types of very interesting skin conditions.
- [04:08]
A
So the phrase being comfortable in your own skin obviously has symbolic meaning, but I think it's because there is such a truth to having a literal meaning of being confident in your skin. And when your skin looks good or your skin doesn't look good, it definitely affects confidence. How do you think skin and confidence are tied together? How does that show up, do you think?
- [04:25]
B
I think they are so integrally related. They're very, very important kind of aspects of your own self. Right. So your skin really is, I mean, it's the window to your soul, right? That's the old saying.
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A
Yeah, but it really is.
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B
So it's the first thing that we kind of judge someone by. And as humans, that's just what we do, right? We get a first impression by looking at someone's skin. That's what we do. And it's our largest organ. So our confidence is so very much tied to that organ. Right. And how we're perceived. So I think that when we talk about confidence, we're talking about, we're talking about how to really kind of have someone feel really good about themselves. And our skin is gonna be that link.
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A
That link.
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B
Right? Yeah.
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A
Well, it's so visible.
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B
It's so visible. Right, right.
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A
We're never gonna cover it all up. You're not, at the end of the day, cover a lot of it up.
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B
Right. So impacting someone at that level is huge because then what can happen is that you can. Then that person can turn around and impact their whole world in a more positive way.
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A
Yeah. So what do you think people misunderstand the most about skincare?
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B
Oh, man. Skin care.
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A
Right.
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B
Such a big topic.
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A
Yeah.
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B
And it's a.
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A
Or about your skin, right? Yeah, general.
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B
I think that first of all, I mean, kind of looking at what are some of the myths out there, I think that's important to kind of debunk. And if you talk about skincare, we can start there. A lot of people think that you really have to have 12 to 20 different steps in your routine to be successful.
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A
Yeah.
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B
So you're gonna go online and you're gonna try to find all these different products. You're gonna be influenced, right?
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A
Yes. So I think shop now.
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B
Shop now. And I think that's such an important thing that I certainly encounter all the time that I try to demystify for my patients. And so you don't need a 12 step skincare routine. You don't.
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A
That's good news. Budget especially.
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B
Right, right. You really just need skincare that is tailored to your unique needs. Right. And so I think that's. That's the skincare aspect.
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A
Okay. So keep it simple.
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B
Keep it simple.
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A
So a cleanser.
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B
A cleanser. An antioxidant if you can, like a vitamin C product.
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A
Okay.
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B
And that acts as sort of like a barrier between your skin and the environment.
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A
Okay.
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B
An extra layer of protection. Okay.
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A
And then at night or in the morning.
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B
That's the morning.
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A
In the morning.
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B
That's the morning. And that goes underneath your skin. Sunscreen, which is actually the most important thing you can put on your skin.
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A
Can you combine it with your foundation or it's not enough?
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B
You mean the sunscreen? Can you have SPF in your foundation?
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A
Right.
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B
Is that the question?
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A
That's the question.
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B
My suggestion is. No, my suggestion is to have a standalone SPF to be taking notes. Take notes. I'll let you know about this.
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A
What is it?
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B
But really it's important. Why? Because your SPF is really the most powerful when it's by itself.
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A
Okay.
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B
So if you're mixing it with all these different things and Whatever products and lotions, you're kind of diluting the effect. That means really want the full benefit of your SPF and you want at least 30. So it's hard to find a product that you love that feels good. Right. But that you'll wear consistently.
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A
Okay, so cleanser, oil cleanser, regular cleanser, double cleanser.
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B
Good question. I think that honestly, a gentle cleanser is just fine. If you do wear a lot of makeup. Yeah. You need to probably consider double cleansing. You can do an oil based cleanser first and you can follow with the regular cleanser. Okay, that's fine. But if you don't wear a lot of makeup. No, you don't need anything really fancy. You can just do a gentle cleanser. And then we talked about the morning. So that's your, that's your, your antioxidant and the vitamin C, and there are different types of vitamin C, so I think that's probably a different conversation. But your vitamin C and then your SPF. Okay, okay. night. Right. Your cleanser.
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A
Right.
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B
And then you're active. Right. So what is it that you're really trying to achieve? And I think that especially for us, really, people of all ages can benefit from it. But a retinoid is really a good product to have because what is it doing? It's turning over your skin layers, it's revealing a more brightened complexion, it's reducing the size of your pores, it's helping with oil control pigmentation, and also preventing. We're learning this, you know, from our science. It helps to prevent pre cancers. So why not add that to your skincare regimen, which is, I think, for
- [09:00]
A
me personally, so hugely important, because I worry about skin cancer.
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B
Right.
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A
Because I'm a very freckly, moley person. I think I have a higher susceptibility to that. I have enjoyed the sun much of my life. Right. And so things like that are important to me personally. And you know, and I think we. How often should people be getting skin checks? Speaking of that, that's a really good
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B
question because, like, I see you at
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A
least twice a year.
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B
That's good. It really depends on your risk.
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A
Yeah.
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B
So there's no recipe book for how often you need to have a skin check. People who have more. A higher history of skin cancers or pre cancers or family history of skin cancer, they need to be coming in more frequently.
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A
Right?
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B
Right. And being monitored more frequently. Say you have a ton of moles. You have a ton of moles that need to be checked, need to be watched. Then you need to come in more frequently. But if you have never had a skin cancer in your life, there's no family history, you practice safe sun practices, then I think that you can probably get away with once every year or two.
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A
Okay.
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B
Right. Or come in when you need to.
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A
Yeah.
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B
When you stuff in.
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A
Right.
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B
Very important. Okay.
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A
So let's kind of go into talking. You talk about the pill, the wellness pillars.
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B
Yes.
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A
And how it relates to skin care. So I would love to hear more about that. Like what are really the main components besides product and procedures that we can do?
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B
Right.
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A
How do we give our skin the most opportunity to stay young, vibrant, healthy, radiant, the longest amount of time?
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B
I think that. So the wellness pillars and there's a lot of different camps and sort of what those are. The first one that I think about is self care. So these wellness pillars are really kind of the. Our well being sort of centers on these different aspects of our life. Right. That make us feel more alive, more vibrant. Right. And it kind of contribute to our well being in a nutshell. So the first one is self care. And that actually has become the top of my list.
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A
Okay.
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B
Okay. Because I do think that you're going to hear this a lot, this buzzword about inflammation and what it's doing to our bodies, what it's doing to our. Our organs, our skin. Right. How do we reduce inflammation? We're going to try to reduce stress. Okay. And self care is one of those very important aspects of our lives that we can control. Because we can. Yeah, we can control that. And that we can then impact our skin.
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A
Right.
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B
At a very kind of basic level. So self care, what does that look like? Yeah. What does it look like to you? What is your, what's your favorite woman's self care?
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A
Oh, good question. I think it composes a lot of things, but I think for me personally, when I think of self care, I think of relaxation and taking time to look and feel my best. I know when I feel like I look good, I feel more confident, I feel more energy. I mean, it definitely extends to that.
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B
Right.
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A
So you, you know, going to the spa or getting my nails done or those types of things, coming to see you, all of those laser, all of those things definitely do make it. And the older you get, the more you realize how key that is. It is.
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B
It is. Yeah. Because it's all point. Right.
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A
It is so hard to keep up with and also so much more opportunity, let's put it that way.
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B
Right. But everyone wants peace of you.
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A
Right.
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B
Especially as time goes on. So that self Care aspect, whether it's the spa, it's meditation, it's yoga, it's exercise, it's hair, it's nails, it's friends time with your friends or family, you need to fill your cup. And if you don't take a step back to fill your cup, what happens? Chronic stress, chronic inflammation. Right. Then what happens to our skin? Right. And I think this kind of, this is kind of trickle down to everything that we're talking about. But what happens to our skin? Well, more inflammation, more dull skin. Right. Potentially more breakouts. Because chronic stress then changes our hormones. It imbalance, it kind of puts us in more of an imbalanced state. So more breakouts, more, more textural issues, more redness. Right. More inflammation, potentially more rashes. I think that all of these things are, are important for us to take into consideration. Self care is not selfish. Yeah, it isn't. And when you're looking at your own health, Right. For me, it's dermatology, but our health in general, so important.
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A
Yeah. Well. And you know, the working out has been a part of my routine for, I mean, it's a habit now. I work out no four to five times a week typically. But my stress level is greatly different when I miss and whether I'm missing, you know, work trips or what have you, and I don't know a single person out there who's not stressed these days about something or doesn't have. Have a fair amount of pressure happening in their life, whether it's because of career or family or the combination of both, or just, you know, stressful relationships or what have you. I feel like everybody has a fair amount of stress that you're dealing with. And if you're not finding ways to healthy release those and have that kind of output, it does take the toll physically.
- [14:17]
B
Absolutely. Yeah, absolutely. So I think that's. Again, that's my top. And then there are several other pillars. I think they're important. So you talked about exercise and movement is important. Yeah. And if you go actually, and you look at the science, we even have studies that show us that aerobic activity leads to improvement in our skin quality.
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A
Oh, really?
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B
Yes.
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A
Is that because of the oxygen?
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B
It's oxygen. Right. But it's also kind of telling our cells, Right. Our cells that make up our, our skin, our dermis and our epidermis to, to kind of restructure and kind of to. To be reinforced. But more recently, we're seeing data that resistance training is actually even more important. Genetic level. Yes, at the genetic level, it's Telling our cells to kind of turn on. Right. Our fibroblasts, those are our collagen producing cells to turn on. Right. So resistance training is even potentially more important. They're both important, but I think that's important. Food for thought.
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A
Well, and there's so much conversation now about the importance of protein, our skeletal muscle. And as we age, adding skeletal muscle and all of that. And with so many people on weight loss, drugs, losing muscle, that becomes.
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B
That's right.
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A
Even more important.
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B
Right. So that affection, Nutrition is another pillar of wellness. So how can we then harness our nutritional needs, Right. To or improve our nutritional supply or whatever we're giving to our bodies to improve our skin health? So you talked about protein. Yeah, skeletal muscle. But protein is so integral to our skin and our ability to get the building blocks right to produce healthy, healthy skin. Right. So protein, of course. But also we're kind of telling our skin when we're doing these treatments that we love to do, right? Lasers and injections and microneedling and all these things, we're like, come on, pump out all the collagen. Let's go. Let's go. We're telling our fibroblasts to do that. Well, our fibroblasts need nutrition, too.
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A
Yeah, Right.
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B
And if you're not replenishing that nutrition, then you are depriving your cells and you're pushing them to the limit and they're not able to produce. So we have to feed ourselves. So that's even more important.
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A
So collagen, do you recommend taking collagen supplements or using a collagen powder and it's additional, or should you be getting that out of nutrition?
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B
That's a great question. Honestly, I get asked this question all the time by my patients, and unfortunately for me, the jury is still out. Okay. I just need more data. Yeah, I just need.
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A
That's a fair answer.
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B
Collagen. There's so many brands out there, right? You go online, you can find a million collagen brands. Like, which one do I do? Does it even help? Do I spend my money here?
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A
Right.
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B
Well, collagen in. When it's ingested, how does it really know to go to your skin? Is it giving you what you really need?
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A
What can I tell you? When I was taking it, regular wear, meant to go all new. Gray hair.
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B
No, it wasn't just new hair.
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A
It was. Well, I think it's just. Yes, I do. I think it was that my hair started growing faster. It was like, are you kidding? So I quit taking it.
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B
Yeah.
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A
So I think My hair, my nails growing and. Yeah, so they're growing plenty compared to this and that in that pudding bag.
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B
Yeah. Right. So I think for some people, what it's probably doing is it's filling a nutritional gap that you had.
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A
Yeah.
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B
And so I think that's valuable. Right. What nutritional needs do you need, then the next person may not need.
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A
Right.
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B
So I think that I still support supplementing and collagen and getting good. Those amino acids is still important, but it's like, well, which one? I can't put my stamp of approval yet on one brand. But I still think that if it works for you and you see results, it would not hurt.
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A
There's no harm in it.
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B
No harm.
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A
No harm in it. Not a total waste. Okay, so talk a little bit about stress, about mental health, about community, about spirituality. Those are some of the pillars that you mentioned to me that show up in our skin almost as if our skin tells a story.
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B
That's exactly what it is. That's exactly. So I think that the. All of those aspects that you just mentioned really are the psychosocial underpinnings. Right. Of ourselves. Right. How we feel, how we interact with our communities and those around us.
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A
Right.
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B
So I think that those still tie in to that stress reduction and connection, which I do still think and believe that impacts our health of our skin. It really does. Because again, reduction of inflammation is so important. However you achieve that, whether you are religious and you go to church.
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A
Right.
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B
Or synagogue, or you're Buddhist or you do yoga.
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A
Right.
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B
Or you're an Ayurveda.
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A
Right.
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B
Those things are still all so valuable, and I think they really play a role in our ability to kind of affect healthy skin. It really is. I mean, if you ever notice, like, you know, after you've. You felt sort of connected, Right. With your community or with spirituality, you know, you kind of look at yourself in the mirror and you're like, man, actually, I kind of feel as good as I look or I look as good as I.
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A
Beauty and happiness. There's absolutely. And gratitude and contentment. There is something about that.
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B
And you can tell when you look at something. Yes. You're like, oh, that person have a soft center and they radiate that well being those around them.
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A
Right.
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B
Okay.
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A
So anything else on pillars?
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B
I think that's it. Okay. I was trying to think there's anything else that we missed. I don't think so. I think.
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A
Okay. I'm sure we could talk about it all day.
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B
Right.
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A
Okay. I want to chat just a bit about sun exposure. Because I love the sun and I
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B
know you will be out of the sun.
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A
Okay. So is there a healthy tan that's okay.
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B
That is such a great question. I'm so glad you asked that question, aren't you?
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A
I am going to be sad. I am. You're going to be pretty sad.
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B
You asked me.
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A
I know.
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B
You know, a tan is actually your skin's cry for help. I know. You know what I'm gonna say.
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A
I don't.
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B
It's the first sign. It's like a self defense mechanism that our skin is putting out. Oh, my goodness. I just got damaged. I need to put up my walls. That's what. It's tan.
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A
It's tan. We're not obviously a burn. That's the case. But you're saying that's the case with the tan.
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B
Tan means you've been damaged. Okay. Okay, Now. Now they're good. It's a really good question. Are there some people that can tolerate more than the next? Of course, yeah. Because none of us are the same. Right. Your background and my background are very different. Sure. And so I go out in the sun and I'm burned in 10 minutes. Right. You probably can last longer. Right. Because of your skin type and your ethnicity and your background and all these things play a role. So I think that you just need to kind of understand where you stand. And I tell people, you know, any sun exposure, I'm going to be exposed to the sun. But you just need to be cognizant. You need to protect yourself. Yeah. And if you are going to go out in the sun, just. Just protect. Right. Sunscreen.
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A
So do we have to use mineral sunscreen that makes us look bright white?
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B
No, you do not.
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A
Okay. I can just use my spray. So yes, you can use like boats.
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B
Use the spray. But the key is that you have to know how to apply it.
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A
Right.
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B
Which means you have to apply a good amount of it. It's not like I said this, it doesn't work.
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A
My husband says I really got none of the sunscreen actually. Right.
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B
You spray around you, but you have to literally put in your hand and not have to do this. Okay. And you have to do it every.
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A
Tommy's gonna feel so validated so much.
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B
Right. But I tell patients any sunscreen that you use is the best sunscreen for you.
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A
Okay.
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B
Using one.
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A
Got it.
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B
Right. Okay. But everyone is different. Yes. And their tolerance level and their risk for skin cancer.
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A
So I do love a great self tanner. And then sometimes I worry, am I just like putting toxic poison all over My body all the time.
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B
I don't. Am I okay? I think you're okay. I think you're okay. Honestly, I prefer self tanner.
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A
Okay.
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B
I do. I tell people, if you love the feel of being tanned or the look of being tanned, then go get a spray tan. Yeah, no problem with that. I'd much rather you get a spray tan than go out and get a bunch of sun. And of course, no to the tanning boots. I mean, that is just. That's a. No.
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A
No.
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B
It really is. And I know a lot of people do it still and did it, but I mean, linked melanoma to tanning boots and that would be the last thing I would want. Right. You know, for those that I, I meet or I care about.
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A
So, vitamin D from the sun. What. What is the best way to get vitamin D besides the sun? Supplement.
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B
Supplement.
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A
Morning sun.
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B
People ask me, well, I. Why can't I go in the sun? I need my vitamin D. Right. I need to get my, my, you know, oily.
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A
It's not really what we want. We really can. We're just saying it feels good.
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B
No, but I, I tell people, just supplement. It really is the same. You're going to get what you need from a supplement. And the risk of skin cancer and that sun damage, which we all hate. Right. Is so much greater. Right. Then your risk of not getting enough vitamin D. So just supplement. It's easy enough.
- [23:52]
A
Okay. And I do do that. It's a very tiny little, tiny little supplement. Chat a little bit because we didn't kind of touch on this with nutrition or wellness, but talk a little bit about alcohol in the skin and hydration. You don't really talk about water. How important is that? How much of a, how, how damaging is alcohol
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B
over time? I think alcohol is. Listen, it's totally fine to indulge in alcohol. It's part of our, it's in our society. It's something we do socially.
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A
Right?
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B
Right. I think that it is. If too much of anything is not good for us. Right. We know that alcohol still can contribute to toxicity, free radicals, which. Free radicals are kind of those and, you know, kind of signals in our skin that our bodies. That something's wrong. Right. And so we have cells that sort of scavenge those and kind of neutralize those. Right.
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A
Okay.
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B
We have too many free radicals. Then what? It's burdening our system. Okay. So. Yes. Too much of a good thing.
- [24:56]
A
Right? Yeah. So you're telling me I can have a margarita in the shade? Yeah.
- [25:01]
B
Yes. I love that.
- [25:02]
A
All right, ladies and gentlemen, get the cabana. Dr. Dasha says you can have your. And I will rejoin you in the cavan.
- [25:10]
B
Okay, perfect.
- [25:11]
A
I love it.
- [25:12]
B
But so. And then you mentioned hydration. Yeah, that's also such a common question. I get, oh, I'm. I'm drinking all this water, but my. But my skin is still dry. Why I've been drinking. Well, the truth is it doesn't translate apples to apples. Hydration, drinking does not always translate to dryness or hydration in our skin. It does not. So. And there's a lot of reasons for that. Right? It could be environmental. It could be the fact that you might have a little rosacea or you have a skin type that is just one way or another just because of the way you're made. That means that you have to look at other avenues to hydrate your skin, whether that's stronger or not stronger, but a thicker moisturizer, hyaluronic acid, something to help bring water into your skin more effectively.
- [25:58]
A
Okay. Okay, Great. All right, so let's talk about skincare by the decade.
- [26:04]
B
Okay.
- [26:05]
A
And we'll start with the teen years. Unless you had something specific for the. For the littles. For parents raising kids, you're.
- [26:12]
B
You might feel kids 10.
- [26:14]
A
Is there kid advice? Definitely.
- [26:16]
B
Yes, of course. And honestly, coverage is best. Just, just get them used to wearing the. The sleeves.
- [26:22]
A
Yeah. And.
- [26:22]
B
And actually my kids don't know how to go swimming without the sleeves. Like they'll end up in like my son went to epic waters and she's. Dory's wearing his sleeves.
- [26:29]
A
Yeah.
- [26:30]
B
Because that's what they do. Right? That's just what they do. So if you start them early, it becomes a habit.
- [26:34]
A
Okay.
- [26:34]
B
And that's just what they know as for skin checks. Because I have patients that come in with their kids. They're like, how early? How should I, how soon should I get their moles checked? And I know. So it's never too early.
- [26:46]
A
Should I be getting them checked?
- [26:47]
B
Not necessarily. Oh, well, listen, I think that, I think that that's actually a good age to introduce to a dermatologist. Why? Because it's an opportunity to have that discussion, talk about skin cancer, safe sun practices. Right. Because they'll understand.
- [27:01]
A
Yeah.
- [27:01]
B
And it's really.
- [27:02]
A
My 14 year old girls are very. They're well versed concerned about skin care. So yes.
- [27:07]
B
That's a really. So they're so they're. They're investing at that very younger. If they have moles that need to be checked or spot you're concerned about, then maybe bring Them in.
- [27:15]
A
Okay.
- [27:15]
B
But as for the teen years.
- [27:17]
A
Yes. So I think Sephora craze.
- [27:20]
B
The Sephora craze. So I think it's. It's good and bad. Right. Because we're seeing kids who are interested, but we're also seeing kids who are highly influenced by social media, by what's around them, by friends. It's really important that that's where you engage with, for example, a dermatologist to get really customized information and to educate. What does your skin really need right now? And for the teen years, a lot of times they're dealing with acne. Right, Right.
- [27:50]
A
Which is a huge shock to confidence.
- [27:52]
B
Huge shock to confidence.
- [27:54]
A
As if it's not hard enough being 13, 14, 16, 17. I mean.
- [27:58]
B
Right. And so one of the things that I struggle with with teenagers is, first of all, making sure that we, like, we see each other early enough. Right. It's early in the game where the acne is not as severe as it could be. Okay, Right. So. And. And there are lots of different forms of acne, but if it's early in the game, you can start with, okay, here's your routine. We're gonna start you off on X, Y and Z. And it's important to be, et cetera. But if you get a teen and they already have cystic scarring acne, and it's time to start something stronger. Right. Like a hormonal treatment or Accutane. God forbid we talk, say Accutane.
- [28:36]
A
Yeah.
- [28:36]
B
So that's the other thing. Right. So when, at what point do we start a medicine like that? And a lot of the times I see patients, I see teenagers, and it's late in the game.
- [28:47]
A
Got it.
- [28:47]
B
And then I gotta talk to the parents about it. And some parents are not feeling it.
- [28:51]
A
Right.
- [28:52]
B
Because of what's out there on media. Right. So I think the best thing you can do is make sure you see a dermatologist, get educated on the real data.
- [29:02]
A
Right.
- [29:02]
B
The real risks and the real information so that you're not fishing around on Google trying to put it together for yourself. That's scary. It's scary.
- [29:11]
A
Well, and I think that's great advice, just to come early before it's absolutely necessary. Because I think as parents, you know, my girls are starting to deal with just a few random breakouts every now and then, but it's overwhelming what products to use, how often they should be, you know, you don't want to. And Jillian, one of my girls, has a little bit of eczema at times. It'll flare up. Not every Day, not regularly. So that makes it more complicated. Right. So, yes, I think it's probably time to bring them in. Thank you for that. All right. That on my. Any of my little show notes of to do lists. Okay. So then in your 20s.
- [29:46]
B
Yes. What? So your 20s, actually, that's an interesting time because you kind of had the best skin you're ever gonna have in your life. Yes. You no wrinkles. You don't have sun damage. Usually. Usually you're. You're feeling good. Right.
- [30:05]
A
So much acne and pimples.
- [30:06]
B
That's. And that actually is the most vulnerable time of your life, because that is when the damage is done. Oh.
- [30:17]
A
Because you feel great about it.
- [30:19]
B
You're like, I don't have a line on my face.
- [30:20]
A
Right. That's it.
- [30:21]
B
Odd is really when the damage is done. And so when I did it. Right. And so we didn't know. We didn't know.
- [30:27]
A
But I mean, my mom tell me she's gonna listen to this podcast. She's gonna be like, teresa, I told you, hold yourself.
- [30:33]
B
But that is really the most that actually, if you can kind of get in, then like when I see my 20 something year olds for skin checks or for consultations, I just thank my lucky stars because for them, that is gonna set them up for success if they have that knowledge.
- [30:48]
A
And what do you think about Botox in your 20s? I mean, so many young women, especially men too.
- [30:53]
B
I think that first of all, there's the question of a preventive aspect of Botox, Right. Are you preventing lines if you don't have lines yet? There's. There are two camps, right? There's two camps. One camp says, yes, you can do baby Botox. That just a little bit here and there, that's going to keep you from etching in those lines. And there's another camp that says, no, if there are no lines, then you don't need to be treating. Okay. I actually do think that there's a preventive aspect to Botox or Dysport or any of the other neuromodulators on the market. So I actually do think that it's fine to do. And in your 20s, you may actually start seeing these changes. So I'm a little bit more okay with it.
- [31:37]
A
I remember the first time I noticed the.
- [31:40]
B
Oh, the lines. Yeah. Smile line.
- [31:42]
A
Yes. And I got myself in the mirror kind of at a corner and I
- [31:46]
B
thought, what was that?
- [31:47]
A
And it was in my 20s.
- [31:49]
B
Yes. Yeah.
- [31:50]
A
And it was, it was a moment, though. But I saw myself age for the first time in A way that. Yeah. Now it's, you know, every other day.
- [31:58]
B
All right, 30s, 30s, so 30s, a lot of times that is actually one of the first times that you can see some of the changes. Yeah, a little bit.
- [32:07]
A
Just a little bit.
- [32:08]
B
Yeah. And you look at yourself like it's a little bit different now. I think I need to start doing something. And that's really when you can start engaging in what I call, or what is called prejuvenation.
- [32:19]
A
Okay.
- [32:20]
B
Okay. Even in your 20s, you could be doing this, but you're starting to add products, you're starting to add treatments that help to target your skin health. Okay, Right. And so I think that the 30s really are. You're very powerful. You know, you really start at that time. You can really set your up yourself. Yourself up for success moving forward. So, anyways, I think the 30s are a great time. But the other thing that can happen, as you mentioned, when you say, oh, I start to see these lines, is you're going to go overboard. Yeah. You ever seen that?
- [32:53]
A
Sometimes they look older.
- [32:54]
B
They look older.
- [32:55]
A
Yeah.
- [32:55]
B
And people can look unnatural. And so there's actually a condition out there, it's called overfilled face syndrome, because you go out and you say, I gotta fix this. And someone goes, who doesn't have a stop sign?
- [33:11]
A
Right.
- [33:12]
B
And says, no problem, let me fill it for you. And then you end up looking unnatural. You look not like yourself. And I think that's one of the things that I really try to emphasize to my patients is that you should be looking like you. Just the best version of you.
- [33:29]
A
Yes.
- [33:30]
B
Right. So the little tweaks that you can do in different ways, that can really help you and set you up for success? Yeah.
- [33:36]
A
And do you think it's true that once you start doing things like, let's just say, injectables, more Botox, dysport, that kind of thing, it's sometimes hard to. It's easy to go too far. Meaning, is it addictive?
- [33:48]
B
That's a really good question, because I think it depends on, number one, the patient, but number two, the practitioner. Who is holding the needle. Yeah. Who is holding the needle and what is their kind of litmus? What is their gauge for what is enough and what is successful for that person. So I think that that requires some investment on the patient's side. You need to be doing some research. Who's really. Who's treating me and what does that person look like? What does the staff look like? I think all those things are really important.
- [34:21]
A
So I do look at that. That's important, I think, because. Right.
- [34:25]
B
Because you are trusting your face with someone else. Sure. So I think that, yes, it's easy to go overboard. You need to have some. You need to be seeing a practitioner who has restraint and can say no. Right. No, I'm not going to fill your lips. It's already been, you know, it's been within a year. You're not going to do it. Yeah, but, yeah. And then you talk about being addictive. I think that, gosh, addictive, it's not,
- [34:52]
A
It's a strong word. Yeah.
- [34:54]
B
I don't know. It's truly an addiction. I will tell you that neuromodulators like Botox and Dysport are just challenging because you start seeing the lines come back, you're like, oh, it's time, it's time for me to get some more. Okay, well then, you know, it's worn off after three to four months. You plan, you budget for that.
- [35:08]
A
Right.
- [35:09]
B
There actually is also something that was coined called perception drift. So I think that's a really important, important concept.
- [35:17]
A
Okay, I haven't heard that.
- [35:18]
B
Tell me. Yeah, so that's a. A very well known cosmetic dermatologist in California named Sabrina Fabi. Okay. Coined this term, it's called perception drift, where we end up laser focusing on one aspect of our face. And we focus and we focus on it. We want to improve it. We want to improve it. We lose that full perception of ourselves and our whole image. Right. Because we're so laser focused and we move to something else. Like, oh, it's the lines here. Oh, it's the lips. Oh, it's the cheeks. And then you lose sight of what you really want to look like.
- [35:50]
A
Yeah.
- [35:51]
B
And so I think that we can fall into that trap really easily. And then you may take a step back and say, oh, gosh, now I need someone to dissolve all of this.
- [35:59]
A
Right.
- [36:00]
B
So I think one of the most important things that you can do is again, do your research. Focusing also on things that improve your skin health. Not just filling. Right. Don't just fill. We want to kind of tell our skin how to regenerate and rejuvenate from within. There's a lot of technologies that can do that now.
- [36:20]
A
So I've been doing the, I've told you the laser Fraxel 1550. So big shout out to Donna who has done my laser. And that has been one of the best gifts that I have given my skin.
- [36:29]
B
And your skin does look really good
- [36:31]
A
because it does improve it. It's not just a surface treatment. Right, right. So you could explain that better. And you told me, I didn't realize that it's skin cancer preventative as well.
- [36:41]
B
It is. Actually. There are studies showing us that these, that these particular lasers, these fractional lasers, and what they do is it's kind of controlled injury to the skin. Very controlled. So you're kind of damaging the skin in a certain way to stimulate renewal of hair. But in doing that, you're also kind of improving the turnover of the skin size and you're kind of getting rid of those atypical cells that set up in the skin.
- [37:08]
A
Interesting. And I can tell my skin is thicker, like in a good way.
- [37:12]
B
Right. It's.
- [37:12]
A
It's firmer. Yes, I am about. Well, by the time this episode airs, I will be 46. And I think there is some ways I think I look older than I do did when I was 40. But I think the quality of my skin is better because I've been doing this now for, I don't know, probably three or four years.
- [37:31]
B
Yeah.
- [37:32]
A
So long enough to where, you know, I do. I definitely see signs of aging in my face. But. But the quality of the skin.
- [37:38]
B
Right.
- [37:38]
A
And laser is. Is amazing.
- [37:40]
B
Yes. And I think you have to address skin quality before you can start doing other things. So you are ahead of the curve. Right. When it comes to other things, you're good to go. Yeah.
- [37:50]
A
Okay. So that's a little bit on the 40s, but anything else in the 40s, that's about it.
- [37:55]
B
I think in 40s is about the same. Okay. But you know, as you kind of near the fourth and fifth decade, then you're really starting to see those changes.
- [38:03]
A
We're feeling it.
- [38:03]
B
We're feeling it.
- [38:04]
A
Yep.
- [38:05]
B
As women, our hormones are shifting. When those hormones shift, our estrogen starts to dip down.
- [38:12]
A
We are.
- [38:13]
B
Collagen is already going down since we were in our 20s and 30s, unfortunately.
- [38:17]
A
Yeah.
- [38:18]
B
But once you start that estrogen dip, it's going to be more drastic and you're going to start seeing those facial changes. So I see my patients all the time come in for consultations. I'm just seeing everything kind of fall. Everything is like this. Can you get rid of this? And it's hard because those are things that all of a sudden you see it. They actually have been happening slowly over time, and that's why we talked about the decades. But certainly in your fifth decade, you're feeling those changes as a woman. Men are dealing with their own changes. Right. And so. But women, specifically for peri and perimenopause, and menopause. That's so important. So what can we do about that? Right. Yes. All the skin care. Right. We talked about the wellness aspect. Really focusing on the nutritional aspect, too. If you need to be supplementing, supplement, that's okay. Get your protein. So those are. I think you're. I think you're doing all the right things, but. But you kind of focusing on that restorative and regenerative and not just the augmentation or the filling.
- [39:30]
A
Yeah.
- [39:30]
B
Is so important because we want to be ourselves. Right. We just want to look good for ourselves. Right. Yeah.
- [39:36]
A
Well. And I just. We talk about. On this podcast all the time, and I'm just a firm believer that it is always inside to outside.
- [39:45]
B
Yeah.
- [39:46]
A
Like, we want to achieve great things. We want to have success. We want to be. It is inside to outside. That is just the. The beauty of greatness in life comes inside to outside. So we can do all the things externally to mask it or to fix it. Try to focus on changing behavior and that type of thing. But really so much of it is mindset. It is spirit. It is. You do that, what you put into your body. I mean, all of that. But of course, the external matters. But it starts internally.
- [40:18]
B
It does start internally. Yeah. I think that we're. And we're programmed. Right. To just look in the mirror and say, I gotta fix. I gotta fix this.
- [40:26]
A
What's. As opposed to the journey.
- [40:29]
B
Right. Which is longer haul. And I love that. Inside to outside.
- [40:32]
A
Yeah.
- [40:33]
B
It's so important for your skin, too.
- [40:34]
A
Yeah. Okay. So I want to give you a lightning round.
- [40:40]
B
Okay. Okay.
- [40:41]
A
So I'm just going to throw some things out. Scale of 1 to 10, with 1 being a hard. No, never, never, ever. And 10 being 100%. Everybody should do this. Okay.
- [40:53]
B
Injectables, 10. 10.
- [40:57]
A
Sorry, everyone.
- [40:59]
B
I don't know about everyone, but, I mean, I practice cosmetic dermatology, so it's just. It is a. It's a passion of mine. I think that. I think that you shouldn't shy away from them, but I also think you need to be able to see someone that will choose the right one for you. Yeah. And it doesn't mean that you're filling. Yeah, no. We're doing treatments that are regenerating. Right. Bio stimulators are stimulating. Right. Nutrients. We're injecting collagen boosters and things that are kind of priming our skin. So I think there's so much on the horizon. I love injectables.
- [41:33]
A
I really do.
- [41:33]
B
I think they're. They're so versatile.
- [41:35]
A
Red light therapy.
- [41:37]
B
Ooh, four. Four. Yeah. Okay.
- [41:41]
A
Do what you want. I got masks, girl.
- [41:44]
B
I have a mask. Not saying it's not.
- [41:46]
A
I actually find it quite soothing.
- [41:48]
B
Well, that's fine too.
- [41:49]
A
That's good.
- [41:49]
B
That's positive. Yeah. How much is it really doing for your skin?
- [41:53]
A
I have no idea.
- [41:54]
B
Well, I don't know. I think that we still need more, we need more data. I do, I think that there is a benefit post procedure, like post laser for inflammation reduction maybe to sort of lock in some of those, those, those results. But as for like a regular. Oh, I gotta put on my mask tonight. I think that there's still a lot of question marks. But it hurt you.
- [42:18]
A
Yeah.
- [42:19]
B
So if you like it and you're seeing those changes on your skin, then go for it.
- [42:22]
A
Okay. So it also has a click, another button. We can do blue light therapy. What's the value of blue light therapy, Vinny? One to ten.
- [42:29]
B
I'm gonna say two.
- [42:30]
A
Okay.
- [42:31]
B
Just because I, I don't, I don't see much of it in literature. I don't really see anyone doing it kind of in offices. If you're getting blue light therapy, the question is why? What are they kind of promoting it for?
- [42:46]
A
Okay, what about acne? Because I have that in mind. So I wonder, should my girls use it for acne?
- [42:51]
B
That's a good question.
- [42:52]
A
They have just mild like anti inflammatory.
- [42:55]
B
Again, I don't want it hurt. They're actually, it's interesting you mentioned that there used to be a mask out there by one of the big kind of cosmetic companies. They had a mask that was specifically for acne, but it didn't make it, it didn't survive.
- [43:09]
A
Right.
- [43:09]
B
And so we don't necessarily recommend blue light for acne because there's just nothing backing it. We're not seeing. But there is, by the way, there are some lasers which target the oil gland. And so I think that if you think about light and you're thinking about energy devices, then there are some lasers that I do think are beneficial for acne.
- [43:31]
A
Okay. Ice rollers.
- [43:36]
B
Zero.
- [43:38]
A
Sorry, it's not going to depuff.
- [43:40]
B
I say one, I'll say one. Okay, okay, I'll give you, I'll give it a two. Because I do think that if you're rolling, you are giving and I think there.
- [43:52]
A
So let's say Gua Sha Shaw.
- [43:54]
B
Okay, fine. Two. You are, you are, you are kind of contributing to that lymphatic. You're getting almost like a lymphatic massage. So if you tend to run puffy.
- [44:04]
A
Yes.
- [44:05]
B
If you tend to, you know, you, you swell, maybe doing a little bit of a lymphatic massage won't hurt. But don't expect groundbreaking results. Okay, is my, my 2 cents there?
- [44:15]
A
So and is the results then from something like that just the immediate movement of the fluid out of your face, it's not really helping you tomorrow to move that today?
- [44:23]
B
I don't think so.
- [44:24]
A
Okay.
- [44:24]
B
I don't think so.
- [44:24]
A
Got it. Chemical peels.
- [44:28]
B
Ooh, eight.
- [44:32]
A
Eight.
- [44:33]
B
Yeah.
- [44:36]
A
I could not tell what direction you with that at all.
- [44:38]
B
I love. No. So the reason I chose 8 and not 9 or 10.
- [44:42]
A
Yes. Okay.
- [44:43]
B
First of all, chemical peel has been around forever.
- [44:44]
A
Yeah.
- [44:45]
B
And I mean dermatologists kind of for
- [44:47]
A
me, I've not done that. A lot of this I haven't done yet.
- [44:49]
B
Chemical peels are great because they do, they're, they're often very, very safe for all skin types. Which I think is important for your procedures. Right. You want something that's sort of a, you know, everyone can engage but chemical peels are, they can be limited.
- [45:04]
A
Right.
- [45:04]
B
You need to make sure your practitioner knows exactly what they're doing and knows what the kind of outcome that they're, they're, they're reaching for, what they want to affect in the skin and when to, you know, to stop the peel, stop the process and, and how to counsel. There's a lot of handholding, there's a lot of post procedure care and I also find that depending on the peel that you're doing and a lot of people are doing light peels, you're not going to get a very well result.
- [45:29]
A
Okay.
- [45:30]
B
So I think that they're beneficial. You have to do multiple but you just keeping in mind it's operator dependent. It's also the aftercare is important and there's some downtime associated.
- [45:43]
A
So laser maybe over chemical peel.
- [45:46]
B
Depends. I think lasers also you can have some downtime associated and I think it just the, it's just a different treatment. And for lasers you're targeting something, you're targeting either pigmentation or redness or skin texture. Right. For acne, scarring, that sort of thing. Chemical peels are just kind of turning over your layers of skin.
- [46:06]
A
Okay.
- [46:07]
B
And simply be exfiliating. I think exfoliating is great if you need it.
- [46:12]
A
Okay.
- [46:13]
B
If you need it. Yeah. So if you tend to run oily, if you have blackheads, if you, if you need some help with brightening. Right. Or you have pigmentation issues, I think exfoliating is a great move. Right. But which exfoliant are you going to use? Right. I think that's always a big question.
- [46:30]
A
But anyways, do you have an answer for that?
- [46:32]
B
The best exfoliant, I think that. Combinations to look for. Yeah. So there are several different types of. They're called. Aha. Bha.
- [46:45]
A
Okay.
- [46:45]
B
Alpha hydroxy acids. Right. Beta hydroxy acids. So alpha hydroxy acids are like the glycolic acid. You may. What about betas? Like, it's like salicylic acid. Okay. They both affect turnover of the skin, and they're both great. So I actually think that depending on your knee, if you run more oily, you may benefit more from a salicylic acid. For example. Okay. If you want to do more brightening and you're. You want something that's sort of for pigmentation, I may choose something with glycolic.
- [47:14]
A
Okay. Microneedling
- [47:18]
B
10. I love microneedling. I love microneedling. Scares me. Why? I don't know. But you'll do the fraxel.
- [47:26]
A
The dot.
- [47:26]
B
That's what fraxel is. Yeah.
- [47:28]
A
But I walk in there and I. It's. There's no downtime.
- [47:31]
B
I mean, I just look. That's interesting. Bright.
- [47:34]
A
I mean, so it needs a little bit of redness. I mean, there's. But the next day, I'm not hiding in a cave, so.
- [47:41]
B
You shouldn't be hiding in a cave after microneedling.
- [47:44]
A
Oh, now maybe I'm thinking of something else.
- [47:46]
B
You might be thinking of something else that. Like a CO2 laser, which is significant downtime.
- [47:52]
A
Okay.
- [47:53]
B
But microneedling is a device that we use that basically it's controlled injury. Right. It's a device that pokes these very, very tiny, tiny, tiny holes, minor channels. Right. This device called a skin pen, is called tight. Okay. And different depths on the skin, on the face, depending on where you're treating it is one of the oldest treatments we have. It's a great way also to deliver different products into the skin. Okay. Lasers are too. But microneedling doesn't require the heat.
- [48:27]
A
Okay.
- [48:28]
B
So for people that may not be able to deal with the downtime or they have a skin type that you don't want to use the thermal type of energy. Right, Right. Like a laser has. Because maybe it's going to worsen your melasma or maybe for whatever reason.
- [48:43]
A
Okay.
- [48:43]
B
Microneedling is a great option. Now, it's for a different result.
- [48:47]
A
Right.
- [48:47]
B
For microneedling, yes, you can help with acne scarring. Yes. You can do skin texture, but you can also do Pigmentation.
- [48:54]
A
Okay.
- [48:55]
B
Okay. So I think that again, it's really, it is operator dependent. It's important to note that. So when you see those pictures of like the bloody face walking out of the office.
- [49:07]
A
Right.
- [49:08]
B
Kardashian, bloody vampire facial, I think that there's you know, there's probably some. Yeah. Education there.
- [49:16]
A
So would you say that there's a big difference in practitioners?
- [49:21]
B
Absolutely. Yeah, absolutely.
- [49:23]
A
How do you know besides going to you.
- [49:25]
B
Yeah.
- [49:25]
A
Where you can just know. All our listeners can know. They can come see you and be in great hands. But maybe they're out of state and they're listening and so they say, how do I know that I'm going to a good practitioner?
- [49:35]
B
I think it's so important that you not just rely on word of mouth. You need to do your research, you need to go to the website, you need to look at the credentials, you need to know who the supervising physician is. Right. Unfortunately, in Texas it's a little bit loosey goosey. You can go to a med spa and the supervising physician may be across the state. And God forbid, what if something happens?
- [50:07]
A
Right.
- [50:07]
B
What if someone's injecting something into you and God forbid they have a vascular occlusion or, you know, they get into a vessel. Right. And I mean those are the worst case scenarios, but they can happen. And so I think it's important that you do your research, you do your due diligence when you're seeking out these procedures and make sure that your practitioner has credentials and is trained not just in a hotel room.
- [50:32]
A
What the, the special of the week is no Botox.
- [50:37]
B
You are offered a price that seems too good to be true. It probably is fair. Right. And I do think that you, you have to decide. It's a personal decision. Yeah. If you want someone doing that that may have a, you know, a good rate, it's may not be good in the long run because of the risks.
- [50:56]
A
Yeah. Peptides. That's the last one I'm going to ask you about. Oh, peptides, like, peptides are all of a sudden, all the peptides are great.
- [51:02]
B
I would probably give peptides a strong seven to eight. Okay. I like peptides. Peptides are kind of also like a signal Right. To your proteins to start sort of kind of creating those building blocks to just sort of generate and, and, and build collagen and elastic tissue and all that good stuff. So peptides are great. And then there's also, I'm sure you've heard about this, growth factors and exosomes is another buzzword. But Yeah, I do think peptides are great. Now, when you're talking about topical versus injectable, I think that's also important.
- [51:37]
A
Okay.
- [51:37]
B
Because there are some that will inject these products that are not FDA approved necessarily, or regulated. So be very cautious. If someone says, oh, let me just do some little injections of this product I got from wherever, and you're like, oh, no problem. Go for it. Right? No, no. Make sure. That's what I'm saying. Practitioner matters. And so you need to know the safety profile of what you are putting in yourself is right.
- [52:13]
A
And that's really on us as the patient, to do our due diligence and
- [52:17]
B
make sure that we're being smart.
- [52:18]
A
This whole is smart.
- [52:18]
B
It really is up to the practitioner. But yet there's just too much. I mean, there's just too many cowboys out there.
- [52:24]
A
Yeah. So, okay.
- [52:26]
B
I got off my high horse.
- [52:27]
A
I love it.
- [52:28]
B
I was in the head.
- [52:31]
A
I feel like I learned so much. Thank you for this.
- [52:34]
B
Oh, it's a pleasure.
- [52:35]
A
Okay. So if somebody would just. Whatever decade they're in, what, you know, wherever they're at in their skincare journey, what advice would you give to somebody to be more comfortable in their skin? Just be big picture, I think. Would you want somebody to hear?
- [52:52]
B
I think it's important that you understand that you do not have to do this alone in a vacuum. Because as we know, there's so much stimulus coming at you at all times from all directions, whether it's a friend, whether it's social media, whether it's something that you read about. There's just so much data. And you're like, how do I even start? Well, the first place to start is to seek an expert.
- [53:19]
A
Yeah.
- [53:20]
B
Someone who did a full training in hair, skin and nails, and who knows how to guide you and advocate for you at any decade of your life.
- [53:29]
A
Cut through all the noise.
- [53:30]
B
Cut through the noise and. And. But be able to customize it for you, because that's really important.
- [53:35]
A
And I did that. I came in just. Actually, that's how we had this conversation. I know, is we did a consultation and a skin check. Cause I always do those. And I said, yeah, I'm seeing myself on video a lot because I do this podcast. And that's how this whole conversation started.
- [53:50]
B
Right.
- [53:51]
A
But you do that for your patients of just saying, let's talk about what your options are. You may choose to do this, you may not choose to do it.
- [53:59]
B
Right.
- [53:59]
A
But this is what it is. This is what it'll cost. This is what the side effects would be, or then downtime, if you will, and what your opportunities are.
- [54:06]
B
And I also think it's important that. That you understand you as everyone understands that this is a journey, this is a relationship. It's not a. Okay, I'm going to do your injections. Bye. Bye. Yeah, no, I want you to come back in a few months. I want to assess you. I want to look at the before and afters, really detect those changes and show you where you started and where you are now.
- [54:30]
A
Yeah.
- [54:31]
B
So I think that's all very important.
- [54:32]
A
You are a professional. You are so good at what you do. I don't know how I think I was referred to you, actually. I'm trying to remember who referred me. I got to put some thought into that.
- [54:43]
B
But anyways, the finest compliments. So thank you.
- [54:46]
A
Absolutely. And hopefully all of our listeners here locally will come check you out at Innovative Dermatology. But how can they connect with you? Personally, I know you're on Instagram.
- [54:56]
B
My Instagram is actually the best way. So my Instagram is @drmaraderm, d r m A R A Durham. And I'm in the process of revamping it. Yes, it's exciting, but I do respond to DMs and just requests, so that's a great way to connect.
- [55:13]
A
That's perfect. Yeah.
- [55:15]
B
Okay.
- [55:15]
A
Well, thank you for coming on, for having me.
- [55:17]
B
I forgot.
- [55:18]
A
Wonderful.
- [55:18]
B
You're wonderful. Thank you, Theresa.
- [55:20]
A
Awesome. Well, thank you, everybody, for tuning into the Upside, because when you invest in yourself every single day, it's going to yield you great returns. As always. Keep living on the Upside.