Transcription:
Carefully Considered Cosmetic Treatments Can Improve Your Confidence

Prakash Chandran: Welcome to another episode of Duly Noted, the official podcast of Duly Health and Care. I'm your host, Prakash Chandran. And today, we'll be talking with Duly Health and Care board-certified dermatologist, Dr. Alix Charles, to discuss the latest cosmetic techniques for enhancing appearance.

Dr. Charles, thank you so much for joining us today. I really appreciate your time. You know, as isolation starts to wind down and the weather warms, I imagine that there's a lot of people who want to step into summer looking refreshed. Can you talk about some of the most common treatments that people get to help their looks and boost their confidence?

Dr. Alix Charles: Sure thing, Prakash. So number one at the top of the list is still Botox and injectables like Botox. Botox has been what I'd call the king of the hill in terms of cosmetic procedures and treatments for a long time for many years now, primarily because it's so easy for somebody to find and have administered by a trained specialist. It wears off after a few months. So if you don't like it, that's okay, you don't have to do it again. I always tell people the downside of course is if you like it, it wears off and then you have to, you know, keep up with maintenance treatments. But it creates a nice effect in terms of relaxing lines and folds on the face that are caused by facial expression. And so a lot of people turn to Botox for a quick refresh to get ready for things that they're going to be doing in the summer.

Another injectable that's very popular is injectable dermal fillers. There are products that we can inject into the skin of the face and elsewhere that help to fill folds and lines that are present when a person's not expressing their face, when your poker faced or when your face is at rest. And so we can use these substances, many of which are very similar to things that you'll find native in the human body, such as collagen and hyaluronic acid, which is something that lubricates our joints. At any rate, we can inject these things and create a cosmetic or an aesthetic effect that's very pleasing. We can enhance lips. We can enhance cheeks, improve jawline, contours, and chin, fill hollows and temples. There's a lot of different things we can do. I even fill people's ear lobes when they're getting dehydrated and need to look refreshed.

Prakash Chandran: Wow. It's amazing there are so many things that you could do, and it feels like that the cosmetic technology has improved quite a bit, even within the Botoxing realm. Isn't that the case?

Dr. Alix Charles: Yes, that's correct. As a matter of fact, Botox is classified as a neuromodulator when it first came out as the only one on the market. And since it's been released, there have been some other newer neuromodulators that have come to the market as well such as Xeomin and Dysport, both of which are brand name products. And so we can use them in a lot of different ways as well. Dermatologists have always been at the kind of the cutting edge of innovating injectable and non-invasive or minimally invasive cosmetic procedures. And Botox is a classic example. It was developed by a dermatologist and their ophthalmologist spouse and popularized for cosmetic usage.

And now that we know so much about Botox, there's a lot of different effects and things that we can do with Botox. I can utilize Botox to inject into this superficial muscle of the neck so that people have wrinkles or bands across their neck, I can improve that. There's some individuals who have a naturally downturned kind of looking mouth, like they look sort of sad and like they're frowning because they have these muscles that are pulling down the corners of their mouth, I can use Botox to relax those muscles and sort of turn their frown upside down. There are individuals who, because of chewing gum or maybe clenching their jaw at night, they'll have big bulging muscles at the side of their jaw at the side of their face and kind of it gives them a squared off facial appearance, and I can use Botox to relax those muscles and soften and shrink them so that they can achieve a really nice tapered, beautiful triangular look to their face. So there's a lot of cool things that we can do now with injectables and neuromodulators like Botox and some of the other products like Botox, since we've done a lot of research on it and had a lot of time to learn and play around with the product.

Prakash Chandran: Yeah, it's pretty amazing to learn about all the different things that you can do. One of the things you also mentioned was skin contouring. Could you briefly describe what this is and some of the non-surgical procedures that are involved in skin contouring?

Dr. Alix Charles: Sure. And so when we talk about skin contouring and we talk about the beach body and how people wanna look, it's actually a pretty wide topic and there's a lot that we can discuss. There's not only improving the appearance of the skin, but also improving the appearance of the body. We have a lot of people who come in wanting to talk about body contouring, because they're going to be out at the beach or they're going to be out on the boat traveling maybe to Europe or wherever throughout the summer.

And so the first thing I'd like to say though, before we even get into that, I always tell people, we always have limits in what we can do with minimal to non-invasive technology. We're really good with different things, but it's not always perfect. So I always concede that for some patients you do still need to turn to plastic surgery, liposuction, things like that that's still necessary. But for the right person who is relatively fit, they're eating right, they've hit their ideal body weight, they have realistic body expectations, there's quite a lot that we can do. We have devices such as CoolSculpt and truSculpt that are designed to target fat, subcutaneous fat and shrink it without having to use liposuction. We have treatments like the s-Sculpt, which is a novel device that uses magnetic energy to cause super contractions of muscles of the abdomen and the arms and even the buttocks so that you can get toning and tightening beyond what you could get normally just by exercising in the gym.

There's a brand new device that we have called Avéli. It's got some pretty limited use across the country because the company selected just less than a hundred physicians throughout the country who could begin to premiere and use this technology. And luckily at Duly, there is myself and two other dermatology colleagues of mine are also using Avéli. And it's a probe that you can use to visualize cellulite bands underneath the skin and it has a hook and sort of a retractable edge, sharpened edge, so that you can visually remove cellulitic bands and get dimples of cellulite in the buttocks and the sides to pop up. And so that's a really cool thing that we've been able to premiere just even this year to offer to our patients who want to look toned and want to look better.

There's a lot of people who also just have skin that's sort of sagging and they want their skin to not be as saggy. We have special injectables that we've learned how to mix and use so that we can get the patient's own body to stimulate collagen and elastin to tighten the skin of the arms and of the neck and of the face. I've used it to tighten people's knees and to tighten people's abdomens. And we have other devices that are minimally invasive, such as what I call, what I term hot microneedling, the Profound radiofrequency, which uses microneedling with these radiofrequency energy that passes between the microneedles and causes an increased amount of collagen and elastin beyond what you would normally expect with, say, microneedling rollers.

And so we have a lot of different technologies that we can use now to help even tighten people's skin. And it's really cool to be able to offer this to people. It is best to start these things before the summer. We tell patients to start on their journey in the winter or even in the spring so that they can be ready for the summer. But even if somebody missed the boat and it's the summertime, now's the perfect time to start planning. So that for next year, they'll be ready.

Prakash Chandran: Yeah. So just expanding on that a little bit. I imagine that when you're thinking about getting whether it be injectables or some of the skin contouring things we're talking about, there are important considerations that people should think through. So could you speak broadly to what they are?

Dr. Alix Charles: Well, regardless, we want to make sure that we pick the appropriate person and that's our job as a physician. But I do tell consumers, or I tell patients, they want to pick the right person as well to be doing these procedures. And the field is rather crowded now. There's a lot of individuals who claim out there and say that they can perform aesthetic procedures and cosmetic procedures. And because of that, there's a proliferation of people out there, unfortunately, probably doing bad or subpar work. And if you watch enough reality TV, you might have seen the show Botched

Prakash Chandran: Oh,

Dr. Alix Charles: some people who have had some bad work done.

And so the first thing I try to tell patients, people who are considering cosmetic procedures, I tell them, "Look, I've met all sorts of different people who are trained. I've met physicians. I've met nurse practitioners, nurses, physician assistants. And I would say that you can't look at an individual and say, 'Oh, my gosh. That person's a PA or that person's a physician. They're going to be excellent.'" I've met practitioners who are good at aesthetics and practitioners who are bad at aesthetics. Ultimately, it comes down to their talent, their training, their expertise, their desire to keep up with the knowledge and to learn. And so those are the sorts of things that a patient needs to question and ask somebody if they're thinking about undergoing a cosmetic procedure. They need to be asking them, what they trained in and how they learned, you know, how they keep up. Are they members of societies that hold regular meetings or publish journals that these individuals review and keep up with the knowledge and learn?

I will say that at least as far as medicine goes, there are four specialties, we call them the core four specialties that we buy in residency. These specialties get a lot of facial and body anatomy that's integrated into their residency training and aesthetic procedures are part of the residency training. Dermatology is one of them, plastic surgery another; ear, nose, and throat oftentimes can do a lot of facial plastic procedures as well. And lastly, ophthalmology, there are a lot of ophthalmologists who will get subspecialty training in plastic surgery. And so, if you can find an individual, who's one of the core four specialists and they've kept up with their training, then that might be a really good place to start your cosmetic journey.

Prakash Chandran: Yeah, that's fantastic advice and very actionable for people to consider as they're making a decision around who's going to be doing their cosmetic work. The other thing that I wanted to discuss with you is that it feels like people are getting cosmetic procedures done earlier and earlier. So I guess the question is should age be a consideration these days?

Dr. Alix Charles: That's a complicated answer. But I'm glad you asked that. And actually, this is something that I encounter more and more every day. The bottom line, in my personal opinion, I really do think that a person should wait until they have a well and fully formed self-image and body awareness before they make important decisions about how they want to alter their appearance. So in general, people should wait, I believe, until at least adulthood, so beyond the age of 18 and probably beyond their early to mid-20s. That being said, people who are younger can still make good decisions. Obviously, if they're below the age of consent, that decision has to be made with their parents. And hopefully, they're speaking with their parents and their parents are levelheaded enough to try to help ground that individual.

Beyond that though, there is definitely a trend toward what we now call pre-juvenation instead of rejuvenation. For many years, people were coming in having not really taking care of their skin or taking care of their body throughout their lifetimes. They hadn't done very much and they finally present to one of our offices and they're asking us to fix and correct things that have changed over time, over their entire lifetime, and we specialize in doing that. I do that all the time, and I love taking care of people that way and transforming people and showing them the sorts of changes I can make. But there's definitely a trend toward pre-juvenation where younger individuals are trying to take care of their skin early. They're taking a look at their mom or their dad or their aunts or their uncles, seeing the way that their face and their bodies are changing and they're like, "Hey, I share those genetics" or "I share that their lifestyle and I want to do something to prevent some of the changes, some of the wrinkles and some of the sun damage or the skin damage or the body changes that I see may be coming down the pike for me." So individuals will start now at an earlier age trying to address these issues with injectables, with proper skincare, even with nutrition. I think the same trend, you can see it in fitness, and even when it comes to dietary habits, I think the earlier you establish those habit, the longer you'll be able to enjoy the benefits and the results. And the same thing is happening in the aesthetic and cosmetic industry with people in their early to mid 20s or late 20s or 30s coming in and doing procedures that allow them to prolong and maintain their appearance so that they don't have to do as much work down the road repairing and rejuvenating.

Prakash Chandran: Wow. That makes a lot of sense, so pre-juvenation. When you mention, you know, skin care and proper fitness, what are some of those techniques that people are doing? Like specifically, what are they putting on their skin and what types of exercises can they do to stay looking young and healthy?

Dr. Alix Charles: Great question. And before I even begin with somebody, if somebody comes in and they are saying to me that, "Hey, I want my appearance to look better. Can we talk about injectables? Can we talk about lasers?" I oftentimes tell them, "Let's stop and take a step back. And let's talk about your basic skincare first and make sure that you're doing all of the right things at home." And the analogy that I like to use, I tell people, you know, Coming into the doctor and wanting to get Botox, fillers, things like that, that's sort of like going to the Dentist and maybe getting your teeth cleaned or getting work done. You would probably go to the dentist and get your teeth cleaned, but then you wouldn't go home and never brush your teeth. You wouldn't do that. But some people in their minds, they're they want to come to see us for a procedure, see us for a treatment, for injectables, and then they don't want to necessarily do things at home and it doesn't make any more sense, the not brushing your teeth at home. So I tell them, "You really do need to have the proper skincare regimen at home to take care of your skin."

Just like there's four core residency specialties I told you about it, there just so happened to be four core products that I teach patients about and say, "Hey, if you can incorporate the core four products into your regimen on a regular basis, you're going to lay down a foundation that will be excellent to build upon to take better care of your skin." Those four products are sunscreen, vitamin A product, antioxidants and growth serums.

And in order, sunscreens of course are great to prevent damage from ultraviolet light, which is the number one thing that will make you look more aged and wrinkled over time. So you should be using sunscreen every day. Vitamin A products or tretinoin, retinoin, retinoic acid, retinol, people have heard of those. And there's some derivatives and some some things that are similar to them that are natural derivatives, the natural products. But vitamin A derived products, when you apply to the skin regularly, help your body to create more collagen, helps smooth out the pores and refine the skin and even help with a little bit with pigmentation, evening out pigmentation. Topical antioxidants are the third of the core four. And antioxidants like furoic acid and vitamin C when applied regularly to the skin, it acts as sort of a sponge to absorb some of the damaging elements that the sun will impart as well as environmental pollutants and things like that. So it reverses, it kind of helps to reverse some of the damage. So while sunscreen's blocking damage, antioxidants are reversing the damage that still manages to get through.

And the last of the four is the trickiest of them, all growth serums and growth peptides. There's only a few companies that have gotten it right in terms of how to utilize these and how to formulate them so that patients can derive a really good benefit. But when you find a really good growth serum or growth peptide, and you apply it regularly, Kind of forces your, some of your skin cells to perform at a level that they would not normally want to do at your given decade of life. And so utilizing that, it's a very powerful tool for getting your skin to create more collagen, other proteins that make your skin look better. So utilizing the core four is something that I preach to all of my patients on a daily basis. And it's the foundation upon which I build a transformative cosmetic regimen for my patients.

Prakash Chandran: Amazing. So what I wanted to end on is something that I was reading that just kind of like struck me and that is that cosmetic procedures aren't just superficial, they're an extension of self-care. And I think that societally, sometimes people look at people getting cosmetic procedures. And I don't know that they're judging them, but they don't realize the impact that it might have on a person's life. Can you speak broadly to this?

Dr. Alix Charles: Sure. I'd love to. What I say to everybody is, look, the majority of the world really does care about how they look and how they present themselves to the rest of the world. Because the way that you look and the way you present yourself, when you're looking at yourself, it forms your own image of yourself, of course. But, you know, the way that we live in the world, people do look and they do formulate opinions based upon what they see. And everybody cares about how they look. I don't care who you are. The proof is just in fashion and just in dressing and before you leave the home. For all of us, it would be far cheaper if we all just wore white t-shirts or maybe if we all just dressed in potato sacks, because those are really inexpensive. But instead, people take the time to pick out fashion, to coordinate colors, to accessorize, to do all of these things. And that's completely accepted by society. People don't mind that. But then, when people start talking about making just little minor changes to their actual appearance, sometimes there's this stigma that's attached.

Now, I think that stigma's softening, it's becoming less and less because people do realize that wanting to look your best and wanting to feel your best, there's nothing wrong with that. That's just proper self-care. We all want to make sure that the external appearance matches the way we look and feel inside. And so I'm glad that some of that stigma is starting to fade and that more and more people are embracing that, more and more men are embracing that, it isn't just women. You know, I think traditionally when people think about cosmetic and anesthetic procedure, they think about women coming in to get themselves taken care of. But thankfully enough, men are finally becoming brave enough or the stigma's fading enough that men are now coming in and saying, "Hey, I care about how I look too. And I want to do something for myself to make myself feel better and look better," and it certainly can also have fringe benefit, such as helping them in terms of if they're out in the world dating, or if they're in a competitive sort of business field where they need to look their best and looking just a little bit better, has a subtle subconscious effect on landing that deal or making that sale. And so I think it's great that people are realizing that making yourself look better, making minor changes and taking care of yourself and wanting to look better, that there's nothing wrong with it. It's becoming more accepted and I embrace that.

Prakash Chandran: Well, Dr. Charles, this has been a fascinating conversation. Thank you so much for the education and your time today.

Dr. Alix Charles: You're very welcome. Thanks.

Prakash Chandran: That was Dr. Alex Charles, a board certified dermatologist at Dooly health and care to learn more, you can visit Dooly aesthetics.com. My name is PKA Chandrin. Thanks so much for listening and be well.