Understanding Your Skin and How to Take Care of It
It’s the largest organ in our body and one of the most complicated parts to care for. Our skin changes from season to season and is the first to show our age. So, how can you be sure you’re making the best choices for your skin health? In this interview, Dr. Oz sits down with Plastic Surgeon Dr. Arthur Perry to reveal the vitamin everyone needs right now for a natural glow, and the everyday item that could be wreaking havoc on your skin! Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.
You know, I often laugh at these programs where I see, and I'm not going to name any names, but I see a six-step morning program and an eight-step evening program.
Who really does that?
Well, maybe a model like Lisa over here, maybe, or someone on television all the time.
But the average person can't do something like that, nor should they do something like that.
Skin care really can be easy.
Think of that person 10,000 years ago.
There was no skin care.
Hey everyone, I'm Dr. Oz and this is the Dr. Oz Podcast.
Dr.
So, Arthur Perry, our guest today, he's a plastic surgeon extraordinaire.
He's got his own skincare line.
He's written a book called Straight Talk About Cosmetic Surgery.
Just an incredibly bright man who's brought a lot of dignity to the discussion of cosmetics and plastic surgery and the like.
And I think reflective of what most of my brethren in that field actually do, but oftentimes they don't get the airtime, so we're honored to have him with us today.
I look like Casper de Ghost today.
Arthur, what's going on?
You look pretty good, man.
But because of our respect for Arthur and the wonderful work that he's done in Shedding Light, and I feel that's remarkably complex and confusing, we asked Arthur to join us as a co-author in our book.
It's called You Being Beautiful, The Owner's Manual to Inner and Outer Peace.
Let's start off by talking about skin, its structure, what makes it shiny and glow and give it the body you want.
And then I want to transition, once we understand a little bit about skin, how to take care of it, And then through the show, we're going to walk through some of the non-invasive plastic surgical procedures and finally culminate in something you do a lot of, which are the more invasive ones, just to give people a pretty good review of what their options are.
And along the way, by the way, we'll touch on things like hair and nails and other aspects of your external beauty that actually give us a lot of clues about our inner beauty.
One thing about you being beautiful, we wrote the book because we argue that beauty is not some issue of vanity.
Beauty is hardwired into us because at the end of the day, Our ancestors didn't have the access to blood tests and DNA profiles and MRI scans.
They had to decide in a quarter of the time whether you were a suitable mate for them.
So they looked for beauty.
So, in fact, beauty reflects health and, equally importantly, your ability to procreate, which is why we search for it all the time.
And any of you who think that beauty is some vanity issue don't recognize the fact that people who are deemed beautiful get paid more for what they do, they get promoted more often, they report themselves healthier in their relationships, even maybe happier about the relationships they And it seems unfair, except if you realize that not only are you looking for beauty, but your ancestors look for beauty, which means that you're beautiful by definition.
So all we've got to do if you don't think you're beautiful is to help figure out with you why that's so.
And to help you do that, we actually created a quiz.
It's called the You Quiz.
Take a look at it.
You can actually get your survey results back as you take the quiz.
It's also in the book, obviously.
But the UQ quiz is very simple.
It helps assess your perception of how beautiful you are today.
And compares it to what you want to be.
And the closer you are to where you want to be, the happier you're going to be in life.
And the further you are, the more work you've got to do.
And you can do two things.
You can change who you want to be, and you can change who you are today.
Both are doable.
Arthur Perry's here to help us on the first part of that.
So, Arthur.
Let's start off with the skin.
Walk us through sort of the ABCs of how you think about skin health and along the way maybe we can touch on some of the creams and the like that a woman faces as a purchase opportunity when she walks into the average store.
Well, Mehmet, the skin is our largest organ, right?
It weighs the most, more than any other organ in the body, other than maybe an omentum if you're really heavy.
But it's not just a container that holds us together.
We're not just people like a jellyfish with skin on it.
The skin is a very active organ.
Now, it's divided first into the epidermis.
That's the upper layer of skins.
That's what's our waterproofing layer.
It's our raincoat.
It keeps the water out and it keeps toxins out.
It keeps all the chemicals out so that when we walk through a farm that's just been sprayed by pesticide, we don't die like an insect.
So our epidermis, that's the important layer that really keeps us from the environment.
Underneath that is the dermis, and that's our collagen, and collagen is our leather.
That's what holds us together.
So that's our structure to our skin.
And with the epidermis and dermis, that's basically our skin.
You know, we hear all the time about the many layers of the skin, but we can keep it real simple.
There are two important layers.
But the skin does so many things, Besides holding us together and besides being our waterproofing layer, we make all sorts of hormones and chemicals and things and the skin interacts with our environment.
The simplest way to look at that is the production of melanin.
When we're exposed to ultraviolet light, the light of sun, we make brown pigment to protect us from that damage.
Well, Mehmet, 10,000 years ago, how did we take care of our skin?
Well, we never went into the water, ever.
When would a human go into the water 10,000 years ago?
Fishing.
Fishing.
That's about it.
If we saw something to eat, otherwise we would stay out of the water.
And our skin makes important chemicals, something called sebum.
Now, sebum is a fat-rich mixture of all sorts of things.
And sebum, it has a lot of functions.
And one of the most important functions is it kills bacteria.
So that when we have those oils on our skin, we're less likely to get infections.
And when we do things like what our modern society has told us to do, like wash our face repeatedly and use all sorts of skin creams and chemicals, well, we're disturbing the natural function of our skin, And that's why probably there's a lot of eczema and a lot of acne and things of that nature.
So some of the things that we teach in the book is what we should be doing to the skin, how we can take care of the skin in a more natural way.
And I'm a real proponent of natural ingredients with the skin.
So let me go back for a second because you mentioned two phrases, two terms that a lot of folks sort of know about but don't know much about.
So eczema.
If we're washing off that sebum all the time, our skin gets desiccated.
But what really is eczema?
What does it represent and what are the best ways to treat it?
Well, eczema really is an allergic reaction to something.
You know, it's very interesting.
When you look at fragrances, for instance, fragrances are very common ingredients in almost everything you put on your skin.
Well, 14% of the population is allergic to fragrance.
14% of the population is allergic to preservatives.
And preservatives are in everything except maybe a bar of soap.
Give us a couple names of preservatives that are commonly out there.
Anything off the top of your head?
Oh, well, triclosan is one of those.
Oh, there's fancy medical names, benzalkonium, things of that nature.
All these different preservatives.
Urea is a preservative.
Things like that.
And they sensitize the skin.
And they cause allergic reactions.
A lot of people tell me, as a plastic surgeon, that they have sensitive skin.
It's usually not sensitive skin.
Our skin is pretty durable.
What it is, is they are allergic to some component in something that they're putting on their body.
And that could be anything from their soap to their laundry detergent to their shampoo to their fingernail polish.
And we see it in their skin.
And the treatments, I know, because we struggle with this within our family, with one of our kids, we would give them omega-3 fats.
Yeah, because it's not just what you put on your skin that affects your skin.
It's what you put in your mouth, too.
Absolutely.
So what else do you tell folks when they have eczema besides omega-3 fats?
Well, the first thing I want people to do is to stop, take an inventory of what they're putting on their skin and try and reverse some of the allergens.
So, for instance, we'll go to a soap that has almost nothing in it.
And one of my favorites is Kiss Your Face soap.
It's got olive oil, water, and salt.
That's it.
Nothing else.
But you know, Mehmet, most soaps smell pretty bad because they're made of fat.
They're made of lard, and you can make soap.
It's one of the down-home things you can do.
You can take a Saturday afternoon and make some soap, and you can take any fat you want and make soap out of it, and it smells pretty bad.
The only fat that smells good, I don't want to say this in front of Mehmet Oz, but maybe fat on a grill smells good.
But not if it's on your face.
That's right.
But certainly any other fat doesn't smell particularly good, and that's why fragrance is put into every single soap for the most part.
If you take something like Kiss Your Face soap, it doesn't smell real good, but it's less likely to cause an allergic reaction than other soaps with an ingredient list that goes maybe 13, 14, or 15 long.
Acne, the other thing you mentioned besides eczema.
Well, acne is caused by a combination of factors.
It's caused by clogged up pores by our own skin.
So the epidermis is an actively growing part of our body, and we're continually shedding skin.
And that's why everybody exfoliates.
We do that in the shower.
We do that with all sorts of methods.
But if we don't exfoliate, and that means if we don't get rid of that dead layer of skin that's constantly growing, it can clog the pores.
So the combination of clogged pores, the oils in our skin, and bacteria can cause acne.
And we know that the oils have a real good purpose.
There's all sorts of reasons for it.
We talked about the antibacterial properties of oils.
But you know what else oils do?
Oils attract mates.
And it's interesting that the skin has an acidic pH.
So it's around 5.5.
I don't want to bore the listeners, but remember that hydrochloric acid is zero and lye is 14 and water is 7. So when we have a 5.5, we've got an acidic skin.
Well, in two areas of the body, Mehmet, we have a more alkaline skin, and that's our underarms and the vulva of women.
And the reason it's alkaline is because it allows the proliferation of bacteria in those locations.
And why do we have bacteria in those locations?
Because the bacteria act on the oils of the skin and they create a very characteristic smell.
We all know that when you go into an elevator with someone who hasn't bathed.
But they send signals to our mates, our potential mates.
And we talk a little more about that in the book, about these things called pheromones, which are acted on their oils that are acted on by bacteria to create these smells that attract a mate.
I love this stuff.
It's so cool, isn't it?
And by the way, we do talk a little bit about the fact that pubic hair and axillary hair has two primary functions.
One is to trap these smells so it gives you a bigger surface area so people around you can smell it because some people who love you want to have that scent near them.
It reminds them of you and they're attracted to it biologically.
And the other reason is it probably prevents chafing.
But I didn't realize that the pH was different there.
It's a very cool insight.
We have a lot more to talk about, but first, let's take a quick break.
So you've got the epidermis, this sort of shield on the outside, keeps things out.
The dermis being our leather, sort of keeps us in.
If you had to give me sort of the ABCs of how to take care of the skin.
And this is a complicated area that, you know, if you walk into any store in America, they'll give you their perspective on it, but you probably won't walk out with a lot more clarity than when you walked in.
And you've written a great book, Straight Talk About Cosmetic Surgery, which sort of reviews these, but we did our best in you being beautiful to knock this out of the park as well.
So walk us through how you explain this to people.
Well, skin care doesn't have to be a difficult concept.
And, you know, I often laugh at these programs where I see, and I'm not going to name any names, but I see a six-step morning program and an eight-step evening program.
Who really does that?
Well, maybe a model like Lisa over here, maybe.
No.
Or someone on television all the time.
But the average person can't do something like that.
Nor should they do something like that.
Skin care really can be easy.
Think of that person 10,000 years ago.
There was no skin care.
And for the most part, they got along just fine.
I'm not sure we'd want to be in an elevator with that person now.
Yeah, and they probably looked like they were 75 when they were 24. Well, remember, 10,000 years ago, our life expectancy was 20 years old.
And in fact, skin, if you were 20 years old, your skin, if you survived to that age, would have been pockmarked because the only people that survived to age 20 were people that already survived smallpox or milkmaids, right?
Yeah.
Milkmaids were the people that actually got naturally inoculated against smallpox.
So we look very different.
The movies don't depict people from 10,000 years ago as what they really were like, but they weren't pretty as we know them now.
But they had skin that was protected by the sebum, as you mentioned, and the epidermis and dermis.
So if you were to give someone a five-step program, and that's what we do in the book, and it was thanks to you that we sort of designed it along these lines, walk them through it.
Okay, well, skin care requires three things.
A bar of soap and a morning protector cream.
And if you were to ask me what the single most important skin care ingredient really is, it's sunscreen.
It's sunscreen.
Because the number one determinant of our aging, other than our genes, and if you smoke, of course, it's all out the window, but the number one determinant is sun exposure.
So ultraviolet light will prematurely age our skin.
So number one, if you're going to buy one product, just one product to take care of your skin, other than that bar of soap, then it's sunscreen.
And everybody should have sunscreen on.
And it's a level of about 15 that you should be wearing.
Pretty much day in and day out.
Because, Mamet, you go skiing in Vail, and what happens when the sun hits the snow and comes at you at an oblique angle?
That means it hits you right in the face.
And here it is three months after your tan has disappeared, so you can get a real sunburn in the winter.
So it's sunscreen year-round.
So that's what you need in the morning.
In the evening, I like a vitamin A-type cream.
Now, vitamin A, we know it as Retin-A. That's the prescription form.
But there are other forms of vitamin A that are almost as good, probably as good, such as retinol, which is in a lot of Johnson& Johnson type products.
There's retinylpropionate, which is a storage type of vitamin A. There's retinaldehyde.
There's all sorts of different vitamin A's, and our skin has the ability to turn one into the other.
So we have the enzymes in our skin.
So it really probably doesn't matter which form of vitamin A you put on your skin.
Now, vitamin A is a wonderful drug.
It's really the only thing that can reverse some of the signs of aging.
Other things kind of hold it at bay.
Can you cut open a vitamin capsule and rub it on your face?
Probably not.
Probably not because, well, those are usually in the vitamin A capsules.
Those are ester forms.
I mean, you might get some absorption.
Now, I'm intrigued that vitamin A is so popular, but the most common antioxidants in our skin are actually vitamin C and E. So why is it that putting a cream on with C and E is not smarter than putting a cream on with A? Well, I think C is probably the number two ingredient.
Vitamin A is the most well-studied cream ingredient.
It's been around for over 30 years now.
And we know that it does all sorts of things.
It's a first-line drug for acne because it decreases oil production in the skin.
It decreases that dead layer of cells on the surface of the skin.
It fades brown spots.
Overall, it just makes your skin look better.
But it's interesting, Mehmet, because if you look at the data behind even Retin-A, only 21% of people that use Retin-A daily see in the mirror a decrease in their wrinkles.
Now, everybody, if you take a biopsy of their skin, their skin will look better and younger under a microscope.
But the gold standard to you is not what it looks like under a microscope.
It's what it looks like when you look in the mirror.
And the skin creams that all say, well, you know, this helps wrinkles and this does this and that, many of those are not backed by real studies in scientific journals.
Right.
But again, why would you support vitamin A over C and E if C and E is a more common antioxidant than A is?
Why do we even start looking at A more than C and E? Well, A does more.
It's more than just an antioxidant.
It really reprograms the cells to do things differently and to look better.
Now, vitamin C is great because it stimulates collagen formation of the skin.
And collagen, as we said earlier, is that structural layer of the skin that thins as you get older.
So the child has really thick, nice skin, and the 70-year-old has almost translucent skin.
That's because collagen has declined.
Well, vitamin C will not only protect your skin as an antioxidant, but it will also directly stimulate the formation of collagen, and it does that actually better than vitamin A. So I'm not saying one over the other, but if I were to choose one,
you know, vitamin A. Are there creams with all three, with A, C, and E? Well, E is something that we probably don't have to put into our skin creams because the body is very efficient at taking oral vitamin E, vitamin E that we eat in our foods, and it sends it right up through the sebum.
And that's one of the problems with overwashing your skin because when you wash your skin, you're removing the natural oils of the skin.
And that means you're removing the vitamin E that your body has placed in the skin.
Vitamin C is so light-sensitive that we can't get very high levels of vitamin C in our skin even by eating it.
And it's destroyed probably within an hour or two of going out into the sun.
So that's why in my skin care program, we put vitamin C on at night.
And when we see vitamin C in skin creams in the morning, it doesn't make much sense.
It's destroyed.
Vitamin E is also destroyed by light, but it takes longer.
So once you've sort of gotten your basic program down, you have antioxidants on the skin at night, you have a moisturizer with SPF 15 or greater, usually titanium or zinc oxide, right?
Because then it's not being absorbed by your skin.
Absolutely.
Very important, Mehmet.
And something that's not been, there's not been enough publicity about maybe the dangers of the chemical sunscreen.
So I like a physical sunscreen that does not get absorbed into your body.
Alright, so you have your own cosmetic line.
Is it for sale, this stuff, yet?
Do you know?
Yes, I have Night Skin, which is an evening program.
Thanks for the plug.
Day Skin, which is the morning skin protector, and a sunscreen.
And people can buy it in stores?
I get it free from you, so I've never actually gone and gotten it.
I keep you supplied.
They can go to nightskin.com.
Perfect.
And they've used a cleanser.
Just to be clear, you prefer the bars because there's less chemicals in them?
And something like Kiss Your Face is nice because it's only olive oil, water, and that's it, I guess.
That's it.
Water, salt, and olive oil.
So it's very, very simple.
No preservatives.
All right.
The last part of the program then is exfoliation.
Exfoliation is important.
Otherwise, those of you who have had a cast on know what exfoliation is all about.
If you have a cast on for six weeks, you take it off of your leg, and you have got that filmy extra skin that just washes off the first time you get in the shower.
Well, every single day we exfoliate, and we exfoliate for a reason.
We look better.
Our skin looks smoother.
And exfoliation is an important part of a good skin care program, and it will decrease acne.
And you do it once a day, once a week?
Well, once a day with a washcloth.
That's all you need.
A lufa pad, a washcloth.
Some people like glycolic acid, which is a wonderful chemical exfoliant.
It doesn't really matter which way you do it.
The issue I keep hearing women complain about, and when I walk into stores, by the way, and try to figure out what the advisors are telling people, it always seems that the advice depends on what kind of skin you have.
So it's very difficult to generalize.
And so someone, for example, has oily skin versus dry skin.
The amount that they would exfoliate would vary.
Perhaps the kind of moisturizer they would use would vary.
Is it really possible to create a cookie-cutter model for this, or is it too complicated?
Well, I think most people's skin are fairly similar.
Sure, there are differences in oil production of the skin and different people have acne and other problems such as rosacea.
But for the most part, skin care doesn't need to be difficult.
And a lot of what we learn about skin care is incorrect and pushed by an industry that makes an awful lot of money.
And one of those topics is moisturizers.
Why do we use moisturizers?
You know, 10,000 years ago, we didn't need a moisturizer.
And, you know, most men don't use moisturizer now.
And most women, certainly when they're children, they don't use moisturizers.
Why do we use moisturizer?
Because in 1870, Vaseline was invented.
It became the biggest-selling moisturizer in the world in 1870 and continued for many, many decades.
and people are programmed by the media, by a lot of outside influences, that they need a moisturizer.
Well, the fact is you don't need a moisturizer in most cases unless the humidity is very low, under 20%.
And interestingly, by the way, if the humidity is under 20%, like in Phoenix, the oil content of your skin actually is increased as compared to someone who lives in New York and then moves to Phoenix the next week They have very dry skin, they feel.
Because we adapt, we acclimate.
Our skin is very good at doing that.
So why do we want to put moisturizer on?
I don't think it's necessary in most cases.
Alright, so we're beating this into the ground, but again, one more time.
So you use a cleansing agent that doesn't have a lot of chemicals in it.
Then you use some type of a cream that has antioxidants in it at night, some type of a cream that has sunblock in it during the day, at morning, and then you use some kind of an exfoliation, it could be chemical, mechanical, whatever, in the evening.
Do you exfoliate every day or once a week, or does that vary based on your type of skin?
I think exfoliation daily is probably appropriate and keeps your skin looking good, but it can be done as simple as a washcloth and soap.
It doesn't have to be fancy.
Okay, so we're doing all this stuff, and father time is still creeping up, and your skin doesn't look like it did when you were 16, and it's starting to hang off your bones a little differently.
Then we call you up, and what do you get us to do?
That's what I'm interested in.
You know, plastic surgery has really been revolutionized in the last decade.
When I trained at the University of Chicago way back in the dark ages a couple decades ago, plastic surgery was really surgical, and we've evolved now.
So operations like facelifts are actually going down in relative numbers compared to tummy tucks, for instance.
Facelifts are less popular now than they were 10 years ago because of things like Botox and things, wrinkle fillers like hyaluronic acid, Restylane, for instance.
Those type of less invasive, I hate to call them non-invasive, but because if someone sticks a needle in your skin, is that really non-invasive?
No, it is.
But those type of things like Botox and Restylane will really buy a number of years for you and the facelift is being put off later and later.
I like doing liposuction on necks.
People in their 40s can have liposuction as opposed to a facelift and the skin retracts and the neck looks more youthful just from removal of fat.
So that's a nice way to do it as opposed to a facelift.
I think in 10 years we're not going to be doing too many facelifts.
Alright, before we get into Lisa's favorite topic, there's one last thing.
I'm washing my face once a day.
I'm putting sunscreen on it, and I'm using antioxidants.
Believe me, I get asked this question.
But you still start to age.
Rosacea.
Ugh.
And then we're going to go to Botox.
I promise you.
Just wait.
It's coming.
Tell me what rosacea is about and what are the best ways to treat it.
Because there are a lot of folks that have rosacea, and the treatments, you know, there are 15 of them, which means none of them are perfect.
Well, rosacea is characterized early on by kind of a blush, a red blush on your cheeks and nose.
It's in what's called a butterfly pattern on your face.
And in the beginning, it's usually just that blush.
As it progresses, acne forms in that area.
So the real name of rosacea is acne rosacea.
And as it gets even more developed, when we get into our 50s and 60s, the skin begins to thicken and And it can create...
Remember Jimmy Durante?
Remember that guy in Hollywood?
Well, he had acne rosacea and something called rhinophyma, which is the extreme of that where the skin really thickens.
You know, I've actually removed thickness of skin as much as a half an inch Are you kidding me?
It's amazing.
We shave that off, but we want to prevent that from happening.
So in the early stages of rosacea, where it's really just a red blush, things like vitamin A, you asked me about retin-A and vitamin A. Well, that's one of the things that can help rosacea, and vitamin C can also help rosacea, and niacin, vitamin B3, can remove some of the blush from rosacea.
Is it a bacteria?
Well, bacteria are part of it, and so as the disease develops, a dermatologist, usually not a plastic surgeon, will prescribe something like metrogel, which is a very common antibacterial, and it's a combination of factors that contributes to rosacea.
So we want to head it off.
When I get involved, often besides the skin creams, is to laser those red blood vessels.
Is it contagious?
No, no, not at all.
So you can't catch it from somebody else.
But what's the difference between acne and acne rosacea?
So acne, if I understand correctly, is when the pores get blocked off by oil secretion.
And again, the reason is probably because you're making a lot more oil and unable to clear it like you should.
So when does it become actually a rosacea?
Well, acne can occur anywhere on the body.
Acne rosacea is classically on the face.
And it's characterized by those red blood vessels.
Often, by the way, those red blood vessels really stand out with spicy foods and alcohol and cigarette smoke and things like that.
So those dietary things and behavioral things contribute to acne rosacea, whereas with normal acne, usually they are not.
Not to leave this question about Botox.
Asking about Botox.
No.
I'm interested in any kind of plastic surgical intervention.
Botox in the eye of the beholder, if you think you need it, you can get it.
It's pretty straightforward.
You taught us also when we were writing, you being beautiful, that the skin is attached to the muscles, so the more you bend it like a cardboard, it forms a crease.
Botox helps stop that bending process, so it actually allows creases in the forehead, for example, between the eyes to resolve.
Yeah, Botox is wonderful.
I like men with wrinkles.
I think it's distinguished.
Well, see, the art of good Botox, though, Lisa, is to leave some lines and leave some animation of the face and not make it...
So the art of good Botox is not making you look like you've really been paralyzed, but reducing the wrinkles without making you look funny.
Well, your eyebrows are going up and down, like, very animatedly, which means you probably haven't had it yourself.
It's very difficult to do in the mirror, that's right.
Arthur Perry, our guest today, is a very animated person.
He's a co-author with us on You Being Beautiful.
There's less more to come after the break.
We're not talking just about external beauty, about inner beauty as well.
Because it turns out that your outer beauty is in many ways reflective of your inner beauty.
So pain and depression and relationship problems, financial headaches, these are all part of the inner pain you may feel that hinders your external beauty.
Creates wrinkles.
And creates worry wrinkles, worry lines, and the names of those lines, by the way, between your eyes.
So Lisa's been torturing you in the break about Botox.
So give us a quick walkthrough about the non-invasive plastic surgery procedures.
So Botox, wrinkle fillers, peels, and lasers.
He had a good way of doing Botox that a lot of people don't do that.
I wanted to hear about.
Okay.
Well, the first time I do Botox on a patient, I like to see them two weeks later, and I'll adjust the Botox.
Because everyone does react a little bit differently to the Botox.
And if you've chronically lifted your brows, then what happens after the Botox, since it's been a habit, often you will lift the outer portion of your brows and you'll have the joker type appearance.
Oh yeah, that's scary, right?
The Jack Nicholson look.
So what I do is that first time I'll go a little further out with the Botox.
We'll touch up with just a little bit to relax that so you don't look funny.
And then after time your brain retrains itself and usually the second time I do Botox you don't get that reaction.
So you've got to wait six months before you look good?
No, no.
We're going to fix it with our touch-up Botox at two weeks.
Wrinkle fillers.
Tell us about them.
Well, wrinkle fillers.
We're in a new generation of wrinkle fillers.
You know, we had collagen since 1978, I believe.
But collagen wasn't that good because our bodies made antibodies against collagen.
That means we attacked it.
And you know, there are...
Probably hundreds of cases of rheumatoid arthritis.
Are you kidding?
Yeah, from people who have gotten lots and lots of collagen.
I'm not talking about one or five or ten injections.
I'm talking about the people that have had hundreds of collagen injections over the years.
So about five years ago now...
Hyaluronic acid was introduced.
Now, that's a much more natural type of substance that we inject into wrinkles.
It's a sugar, and it's identical in the test tube to what's in our body, so we don't make antibodies against hyaluronic acid.
The most common form is Restylane, and it really revolutionized the treatment of wrinkles because before that, I would try and dissuade my patients from having collagen.
I really didn't think it was a good idea.
Why would you do Botox in your forehead instead of injecting something like Restylane in those wrinkles?
That's a great question, and it's that pesky little complication of blindness that I just hate.
Oh my gosh!
So, what happens is there have been at least 50 cases of blindness from injecting all sorts of things, from collagen and fat and pretty much any...
That is a solid or a gel.
If it's injected around the eyes, it can connect with what's called the retinal blood vessels.
Those are the blood vessels that go behind the eye.
And a lot of people think, well, the blood vessels around the eye just run with the skin.
That's wrong.
And if you study anatomy, those blood vessels that come right up to the skin go into the skull and connect with the eye.
And that's why there can be cases of blindness.
So I don't inject...
Anything like Restylane or Juvederm or anything around the eyes.
We had dinner with a woman who was not actually blind but could not focus because of Botox so that she couldn't constrict her pupils.
Her eyes were actually paralyzed.
And she was an older woman, but her children who were our age had to lead her around because she couldn't see for however long the Botox was going to work.
Well, the nice thing about Botox is if you don't get a perfect result or you get blurred vision, which is a known complication of Botox, well, it does go away relatively soon.
Like four months.
I mean, it's not that soon.
Usually those things go away sooner than the long-term effect of Botox, which is at the maximum six months.
This is very interesting.
Peels, finally, peels.
Okay, well, there are all sorts of peels.
There are different peels.
There's a lunch hour peel.
You could go today down on Fifth Avenue and get your glycolic acid peel, but you're really not going to see too much.
And it takes six glycolic peels spaced about three or four weeks apart to even see any sort of result.
But it's good for people who have no downtime.
They can't take time off of work, so it's better than nothing.
Glycolic acid is a nice exfoliant and will help fade the skin and even out the skin tone.
So what is an effective peel then?
If that's not really going to do anything, if you really wanted to lighten your skin and get rid of fine lines, what peel would you do?
The TCA peel is a great peel.
What's that mean?
Trichloroacetic acid, and that's a chemical that we put on the skin.
It's also called the Obagi peel out in California after a dermatologist who popularized it.
But it's a great mid-level peel.
And what it does is it removes the upper layer of skin, and with it, it removes the pigment.
So if you've got melasma, which is the mask of pregnancy, or if you've got freckles of your face, you know, when you're a child, freckles are cute, but they're age spots when you become an adult.
And so if you've got those things, the TCA peel is the quick way to get rid of those.
And I'm a big fan of that.
A lot of people like to use the lasers now, and I know why they're using the lasers for that.
It's a higher fee.
Yeah, yeah.
It really is.
But the TCA is as effective as a laser, for example?
Usually it is.
It's certainly my first line.
Sometimes there are some refractory, some very difficult brown spots that we then go to the laser.
I'm going to spill the beans here on my wife.
I did a TCA peel on my wife, and we went up to Montreal the next day because we figured no one would see us.
And, of course, we ran into neighbors in Montreal.
Next door neighbors.
I had to tell them that she didn't have smallpox at the time.
Yeah.
But usually you hide for five to six days after a TCA peel.
Everything has downsides.
What are the big downsides of these peels?
If you get this done, can you do it again in five years?
Well, TCA peels we used to think were kind of one shot or maybe every couple years, but the trend now is to do them more often.
I do repeated peels now.
We can begin to treat wrinkles with TCA peels, whereas 20 years ago, we were taught we had to go to those deeper peels, phenol peels or laser peels, which are very invasive, require general anesthesia, and they're good, they're effective, but how many people really want to take two weeks off and have a weeping face that looks like a pumpkin?
So we're going into more, or rather less invasive peels like a TCA peel and repeating them.
The question that I think a lot of America is wondering though is if I have one of these peels done and let's say I'm 50. And I'm thinking about having it at 45 versus waiting to 55. Is it like a facelift where you sort of got one or two in your system?
Or do you think you can repeat these peels every five years?
Oh, even more often than that, Mem.
Most people really do get a TCA peel at one to two years, every one to two years, depending on what you do to your skin.
So if you use sunscreen and you have a good skin care program, you'll probably get more out of the peel and it'll last longer.
But certainly they're repeatable.
Now let's go to hair.
So the problems with not enough hair, problems with too much hair.
For the folks that have a lot of hair, you know, they're going through menopause, perhaps they're getting more facial hair.
What are the kinds of therapies that are practical to offer these women?
Okay.
Well, the first thing for a woman who is growing hair, let's say, on their face, first step is to see an endocrinologist because one of the most common problems is called polycystic ovary disease.
Or Stein-Leventhal disease.
And it's very important.
I have lots of patients that come in for laser hair removal.
And if they've got a little hair around the mustache area or on the chin, well, that's okay.
But if they've got a full beard, an endocrinologist really needs to examine them.
Once they've been cleared by an endocrinologist, the best way in 2008 to take care of hair on the face for a woman is laser hair removal.
It's wonderfully effective.
I've seen so many women...
Women who have had electrolysis and have had scarring from electrolysis.
And I've had women come into my office who have literally been doing electrolysis for five years.
You know, it's a weekly visit.
Their electrologist is their best friend.
Unfortunately, electrolygy is now in the realm of electric typewriters because...
Laser hair removal is very effective, so that's a great way to get rid of hair.
But aren't there problems with laser hair removal if you've got very light hair or if you're a dark-skinned individual?
Absolutely.
The laser is just a tool, and it needs to see dark hair.
And it does it best by looking at a contrast between the dark hair and the light skin.
So I always say, remember the phrase, get them while they're hot, you know, for the hot dogs?
Well, get them while they're black, because that's when you have to get the hairs.
If the hairs turn white, I can't get it with a laser.
And that's when we go to electrolysis.
Got it.
And how about these other chemical peels, Nair, shaving?
I mean, how do they all compare?
You're talking to the Nair expert of the world.
I did more Nair on rats than anyone else when I was at Columbia 20-something years ago.
Nair works wonderfully.
These rats are vain.
Yeah, they are.
That was in the skin grafting experiments, but...
We have to remove hair from rats, and we can remove it very effectively, but it's an irritant to a lot of people.
Many people get kind of red skin after using Nair, so I think it's much less popular than it was back in the rat era 20 years ago.
How does it remove the hair, by the way?
It dissolves it.
It physically dissolves the hair.
Oh, I like that.
No, that's creepy.
We were talking to Arthur Perry today.
Obviously, he knows everything, certainly about the skin and a lot of other things.
He's a co-author with us on You Being Beautiful.
Has his own book as well called Straight Talk About Cosmetic Surgery and his own cosmetics line even.
