DR. DORIS DAY: EPISODE LINK
DR. DORIS DAY: WEBSITE
TRANSCRIPT:
Bridgett: Welcome back to Hot Flashes and Cool Topics, everybody. We are having a return guest
on one of our favorite people, Dr. Doris Day, who is a board -certified
dermatologist, welcome back to Hot Flashes and Cool Topics.
Dr. Day: Thanks for having me
back. It’s so much fun to talk to you.
Bridgett: Yeah, it is great. And you have such great
advice on her website, Doris Day MD .com. You really need to subscribe to that,
follow that because it has great blogs, loads of information, great products, so you
really need to follow that as well. And I really love reading your blogs because
they’re so informative. And one of my favorite one of your blogs was
myth busting. It was just myth busting on things that you hear on the internet.
Do you mind sharing? I know one of them was that the myth that sunscreen’s bad for
you. Can you share why that’s not true?
Dr. Day: Well, sunscreens are regulated in the U .S.
as drugs. So they go through an approval process that is really very rigorous.
And hopefully the FDA will make some adjustments soon. There’s conversations about
that where they’re going to change the testing requirements because now there’s animal
testing required and a lot of European sunscreens have safety data, but they don’t
have quite the testing that the FDA wants because in Europe, sunscreens are regulated
as cosmetics. So there’s a lot of UV filters that are safe and effective that are
broader spectrum than what we have in the U.S. But we haven’t had new sunscreen
ingredients in 20 years. So one thing we know is that excessive exposure to UV rays
is carcinogenic. Anybody exposed to enough of it will ultimately develop skin cancer
and skin cancer can be deadly. So if you can be super sun smart where you can
minimize your exposure and the peak sun hours, not burn, not tan, and just, I mean,
sun exposure is actually good. It’s good for you. It’s good for your skin. It’s
good for your body. But what people don’t realize that you need very little of it.
And if you look back to in ancient times when we were hunter -gatherers, people didn’t
spend a lot of time outdoors. They spent most of their time in caves or undercover
and only went out when they had to for hunting and gathering. So we have,
the ozone layers of what it was, like the Earth’s environment isn’t what it
was, our skin tone isn’t what it was. So we need that UV protection. And if you
can’t do it with physical clothing and physically being not in the sun during those
hours, then you need to use sunscreen. And sunscreen ingredients have been around for
decades. The FDA still looks at them and they’re deemed safe. And you have to use
some standard to judge safety if you’re going to worry about things. So mineral
sunscreens, if they’re not micronized, even micronized ones, those are generally safe
because they’re absorbing the UV rays and reflecting them, but they’re not absorbed
into your skin so much. So if you really have a concern, look for the titanium and
zinc sunscreens, but the other ones, the avobenzone, the Helio, the Allantoin,
those ones are considered chemical. Everything’s a chemical, but there’s the one
people typically call chemical ones. They also have great data, great science, and a
great safety profile.
Bridgett: You know, it is so important. And I think the importance,
too, of getting checked up regularly. Like, I have a standing one -year appointment.
My husband, he goes twice a year because he did have something. Can you talk about
the importance of getting your check -ups?
Dr. Day: Right. So it is important to see a board
-certified dermatologist once a year for a once -over. I always say on your birthday,
get your birthday suit checked. It’s kind of an easy way to remember. And the thing
is, if you see something go sooner, but once a year, somebody should look you head
to toe from your scalp, you know, the belly button between your toes, everywhere in
between should be checked. And we use a special tool called a Dermatoscope. And that
helps us see a few layers into the skin. So if I see something that looks a
little bit odd. When I look with the Dermatoscope, it gives me more information of
whether that pattern is regular or irregular, what the network pattern is. We study
those patterns. And it helps us understand that we don’t need to remove everything,
but we can have diagnostic tools that are non -invasive, not painful, that we can
use to look at spots in the skin and help either remove them or reassure you that
they’re okay. But interestingly, most things that people come in and show me that
they’re worried about are nothing. But things that they don’t notice because they’re
flat, people think that things that are flat can’t be bad for you. But most
melanomas, that are the most deadly skin cancer from sun are flat, when they
start out at least. So when I look at something, I’m not looking at whether it’s
flat or raised. I’m looking at the color, the borders, the shades of color,
then I ask questions, are you familiar with this spot? How long has it been there?
And if someone has something in an area where they’re familiar with, and they don’t
remember something and it looks odd, then we need to either follow it or remove it.
But the earlier you diagnose things, I mean, the idea to me that people can have
things on their skin, that if I find it early and remove it, they have a 99 plus
percent chance of survival. And if I find it late, then that survival goes down
dramatically. And it’s on your skin. It’s visible. We can find it and remove it.
But you have to see somebody who knows how to evaluate spots and how to make sure
that we do the right thing for our patients. So once a year for once over, more
often if you see anything new are changing, and certainly more often, if you have a
family member or a personal history of melanoma. Once a first -degree relative has
had a melanoma, your risk goes up. So if you have a parent or a sibling,
grandparents, cousins, those are not first -degree relatives. It’s parents or siblings
who’ve had a melanoma, now your risk goes up. Melanoma can also occur in the
eyes. So if you have a personal or a family history, first degree relative of
melanoma, you should also get your eyes checked.
Bridgett: Wow, I mean, that is so important
too, because with the Dermatoscope. You know, when I go in, I feel
like it’s so fast. I’m like, how did she see anything? But because she has that
tool, she can see those layers.
Dr. Day: And also, if you don’t have spots, there is not a
lot to look at. Like, if you look at somebody who only has a few moles, it’s
going to be a fast visit. It doesn’t, it’s not necessarily a long,
is that something? So I just tell them, I’m having a conversation with this spot.
I’m trying to understand it. I’ll let you know what the outcome is. But it’s just
I need to, it takes time sometimes to really look at all the dimensions of specific
spots. And then most of the time they’re fine. But our goal is to make sure that
we don’t miss a melanoma and also to make sure that we don’t just take off
everything we see.
Bridgett: Right. Yeah. I mean, that is so important. Like I saw a tiny
little something and I’m going back in this Saturday. I just saw a red spot that just wouldn’t go away. And, you know,
with my husband, that was what he had was something we had never seen. And it was
on his arm and we never paid attention to it. So it is so important to do that.
And that was his first time to get a dermatologist once over. I talked him into it. I said
“you need to go once a year,” and they found something on him. So it is so
important. And another thing that I feel like so many women in our demographic talk
about skin aging, and they talk about what’s happening. So can you talk about what
happens to a woman’s skin as she ages?
Dr. Day: Once you hit about 40, you start to enter
this really interesting time in a woman’s life called perimenopause. And we’re
learning more and more about it. In the past, we kind of knew that women go
through it. Like, that’s not news. But we just sort of dismissed it and thought,
well, it’s a right of passage, right? Women just go through this. And (we were told) hormone
therapy is dangerous. So we’re not going to do that. That was the conversation. And
that’s what women were taught to believe. But what’s happened is that I would say
many of us, and I started this about 20 years ago in my studies, is I started
reading the data from the Women’s Health Initiative and all of the data that was
saying that hormone therapy isn’t safe and seeing that it was a lie. And then other
doctors started speaking up. And with the advent of social media, we all sort of
feed off each other and feel more confident sort of talking louder and louder, and
now it’s kind of a roar to the point where the FDA just took the black box
warning off of vaginal estrogen, which is such a gift to women and to doctors,
because people are litiginous, and a lot of doctors won’t prescribe things because
they don’t want to risk being sued if something goes wrong, even though it’s
completely unrelated to the treatment. So we now know definitively that estrogen is
not a carcinogen, but people who, whether or not they do hormone therapy, may get
breast cancer. The facts are that the long -term survival of women who do hormone
therapy and who get breast cancer is no different than women who don’t do hormone
therapy and get breast cancer. And we just have so much more data. We also have
bioidentical hormones and we have ways of measuring and we have symptoms we can go
- So there’s really very little excuse for the women who are suffering today with
menopause to continue to suffer without being properly treated. And more and more
doctors are starting to come on board and feel comfortable. And I believe, and many
smart doctors believe that every doctor, whether you’re a dermatologist, psychiatrist,
GYN, surgeon, whatever, should be able to do hormone therapy assessment and a
prescription for patients because many GYNs won’t do it. Right. Because they’re
afraid of their malpractice. So it’s something that I’ve been sort of trying to
raise awareness about and certainly I’ve been doing it myself for almost 15 years
for me because it’s changed, you know, it’s been life -saving. But I think the
conversation should be that women should be more afraid not to do it than to do it
because of the risk of heart disease and osteoporosis and dementia and then aging up
the skin. So a lot of times women come in their 40s and they tell me, you know,
I’m using the same skincare, but now I’m breaking out like a teenager, or my skin
is dry, or my skin is itchy, or my ears are itchy, or my hair is thinning, or I
feel like my face just fell apart. All these things are signs of perimenopause. And
I’m often the one who tells them that they’re in perimenopause. Now, in early
perimenopause, you have regular periods, and they’ll say, I get my period every
month, but their periods are different every month. Sometimes it’s lighter, sometimes
it’s heavier. That’s a sign of early perimenopause. In later perimenopause, then you
start missing periods or having heavier periods, because now you might have no eggs
drop one month or two eggs another month, and that’s going to change. So your
estrogen is going like all over the place, and that’s affecting your mood and your
skin and your sleep and your fat distribution and your energy level and everything
else. So we kind of put it together. But the problem with perimenopause is that
you’re still fertile in many cases, maybe not as fertile as your 30s, but you’re
still potentially fertile. And you have symptoms that are so nonspecific.
You’re a little irritable. You’re a little bit more tired. But, you know, you’re
also working really hard. Or you have kids or parents or things going on. You have
everything to explain away what these symptoms are. And you’re seeing all different
doctors for each symptom and nobody’s putting it together. So often, me as a
dermatologist will sit there and say, also, do you feel like maybe are you a little
more bitchy or are people more stupid? You’re in peri menopause. Yeah, people who
get that are in peri menopause. So it’s a whole bunch of things.
And the earlier you start, the better the results, the better the protective
effects of it against osteoporosis, dementia, heart disease, collagen breakdown. So now
in the office, what we do around that, so now we understand here we are in
perimenopause. We have a great treatment that addresses it at its root cause with
hormone therapy. But that doesn’t stop you from aging. That just slows things down
and makes you feel better and can mitigate a lot of the side effects, but we still
have to treat the cumulative damage of years and then the genetic creep of what
happens in the aging process. So there’s a couple of things. One is the
neuromodulator. It’s like now we have five. We have Botox, Dysport, Daxxify, Xeomin,
and Jeuveau. And they’re all a little bit different. They all have unique properties.
So we’ll select the right one for the patient. We’ll do broader areas. and then we
do it differently. The forehead muscle drops a little bit, so you inject a little
differently in the midface. You have to be more careful in the forehead because your
brows are a little heavy because of your eyelids. So you can’t do as much in your
forehead, and we have to balance against that and look at other ways of lifting the
brows. We have to think about combining it with devices, and I’ll get to Sofwave
for that, CO2 laser to erase some sun damage and some of the more superficial
etched in lines from decades of sun. And, um,
ones because this is a device that uses ultrasound energy, and it’s not the only
one that uses that energy, but it’s the only one that uses it in synchronous
parallel layers of ultrasound energy, which doesn’t go deeper than the skin,
which is perfect. So it’s not going to melt fat or cause fibrosis or scarring in
the skin, but it improves the skin texture and quality. And that gives a tightening
and lifting effect. So people consistently come back after having their Sofwave and
they say the same three words. This really works. They’re just so happy. And when
patients in their 30s do it once a year and their 40s twice a year, their 50s,
I have them still do it twice a year, but continuously twice a year. And their
40s, twice a year for like four times and then every 10 months or so. But once
you hit your 50s and up, then I just have them do it twice a year as their
maintenance. And then with skincare, and it’s for the full face and neck. So it
tightens, it lifts, and you can do it any time of year and there’s no downtime.
But I would say it’s consistently a treatment where people come back and will say,
not only this really works, but I get so many compliments. And they come back for
more and they send in their friends for more. It just grows itself because people
are so happy with what it does. Now, there’s always that person who’s either not a
good candidate but tries to do it anyway or who has expectations that are a
facelift, which this is not, and it’s not meant to be, who will feel like they
didn’t see enough. And, you know, I always say it’s what your body will give. It’s
like the device is a device. The technique is a technique, but the body will do
what the body does. So some people take more treatments, but I will say that over
90 % of patients are super thrilled with the treatment and the results.
And there is some discomfort in some of the spots, but there’s no lingering
discomfort. And meaning that once the zap is done, sort of the energy sort of
builds, and then it drops. So you feel that build. And then that peak, you’re like,
woof, and then it goes away. And it’s done. And some spots are nothing and some
are a little bit spicy is what I call it, but it passes. And then we have
something called Pronox that really helps as well. But there’s another thing in skin
care that I’m really excited about, and it’s a novel molecule called RLX 201.
So RLX201 is an analog of a drug called Rapamycin. Rapamycin is big in the
longevity space. And what Rapamycin has been shown to help with is collagen
production. And what it blocks is this pathway called mTOR. And mTOR is in every
cell. And it’s essential for life. If you look at size or yeast or any creature on
this earth, they all have that protein kinase called mTOR. And it does the same
thing in all of us. So something that’s that evolutionarily preserved, and that
consistent across species across time is essential for life. So this mTOR is
essential for life. Now mTOR has two pathways, torque one, torque two. One is for
cell turnover. One is more for repair as a simple way to think about it. But with
age and with perimenopause, mTOR becomes dysfunctional. So those fibroblasts, the cells
that are making collagen and elastin get exhausted. You can promote turnover,
which we do with all of the treatments, whether it’s retinolic acid or retinone or
retinol, or it’s laser resurfacing or even Sofwave, all these treatments we do,
they’re telling those fibroblasts, those cells that are making collagen and elastin,
work harder produce. It’s like asking them to continually run marathons.
But they don’t get recovery. As you get older, when that mTOR is dysfunctional,
they and their mitochondria get exhausted. And when they get exhausted, they go into
cell senescence, where they become like zombie cells that are useless. And if you
look at collagen in somebody who’s older and has sun damage, their collagen isn’t
these beautiful waves. It’s these purple clumps and unhealthy, useless collagen that’s
not supporting your skin. So you can do all these treatments, not so much Sofwave.
Sofwave seems to hold through because of the way that it works, but even CO2
lasers and retinoic acid, the skin doesn’t get the same benefits because those
fibroblasts are kaput. They’re exhausted and your stem cell reserves are depleted. So
RLX 201 helps with recovery of those fibroblasts. And in their studies, they took
what are called skin xplays. So skin that had been removed, treated it with RLX201
and retinolic acid, and they found that 56 -year -old fibroblasts reverted to 23 -year
-old fibroblasts.
Bridgett: Wow.
Dr. Day: I know. They aged that much younger,
which is amazing. Then they said, okay, well, maybe it’s the retinol that’s doing
- So they tweeted the same skin explants with just retinol, and they found the
fibroblasts were hyper -stimulated, and they made collagen, but they went into cells
in essence. They aged and they became exhausted. So that’s why I don’t use retinoic
acid. The prescription form in my women in their 40s and 50s, I switch to retinol,
and I always combine it with RLX 201. So I’m not hyper -stimulating those fibroblasts
and exhausting them and depleting them. I’m supporting their recovery. So I’m saying,
yep, I want you to run marathons, but I’m going to help you recover in between.
And now I do RLX 201. It’s a product called Re-Q and it’s a face serum. So it’s
a pro longevity serum and it’s the first pro longevity serum that is in this space.
So there’s a lot of longevity products that are making skin claims. This is a skin
product that promotes longevity and there’s nothing else that does what this does.
And you can’t use topical rapamycin because rapamycin blocks both pathways, which we
don’t want. We only want to block the one that’s driving turnover, not the one
that’s driving repair. So this is what’s called a selective torque one inhibitor and
rapamycin blocks, torque one and two. So that’s the process.
So that’s Re-Q. And it’s a super exciting new product. So I combine it with
retinol. And so someone who’s having a CO2 laser or using retinoles or vitamin C or
just getting sun exposure or doing other things, I always have them use Re-Q at
night because that’s when you repair to help support and protect those fibroblasts so
that they age better and they can stay younger for longer. So I always say whatever
you do, just start with Re-Q.
Bridgett: And do you have that on your website or do you
have that for sale?
Dr. Day: It’s on the website in the office and dermatologists are
carrying it. It’s going to be through your dermatologist. So more offices are
starting to carry it. We have it. Dr. Sewell and Cox has it. Mitch Goldman has it
in California. So there’s offices that have it, but it’s certainly on our website.
Bridgett: And do you need a prescription for it or no?
Dr. Day: No, we’ll be our prescription version
in like three or four years. So it’ll be over the counter in prescription, but this
is over the counter. But the amount of basic science data behind this molecule is
there’s nothing that I’ve seen that has this quality of basic science research of
looking at what this molecule does, how it works. It doesn’t go through the skin.
It goes into the skin. So there’s no systemic effect. So the safety profile of it
is incredible. And the data on its efficacy, both in humans and in vitro in the
lab, and they’re all done by third party. So nothing is done just by the company.
Bridgett: Right. And, you know, another thing that you have on your website that I love is
the body retinal body serum. I, that’s one of the few places I’ve seen that is
through you and your website.
Dr. Day: Yeah. That’s mine. Yeah,
that’s through me. My product. So the Body Retinol is very, very special. It’s not
silicone base, which I really like. It’s a different emollient, which is super, super
hydrating. but it also has peptides. It has a great retinol one retinoate,
which is HPR, a high -powered retinol. And it has some vitamin C and peptides and a
little bit of salicylic acid, which helps gently exfoliate, and that’s also a
humectant. So it’s so good for the skin. I have people do it on their neck, their
declotte, their arms. And the RE-Q is also good for the inside of the arms where
it gets crepey, mixed with that body retinol. So I have people put that on their
face and the inside of their forearms, and you see a dramatic difference there. But
the body retinol is probably,
if not the best, selling product that I have. It’s up there at the top. And it’s
a huge bottle. So it goes a very, very long way. But the quality of those
ingredients and the combination of the C, the peptides, the retinol,
the hydration, it sinks in quickly and it has, it’s not greasy at all. And you can
moisturize over it too.
Bridgett: Yeah, that’s exactly what I do. That’s exactly what I do
because it is so smooth. Sometimes you forget that you haven’t put your moisturizer
on after it. And I was like, I forgot to do that. But it’s very smooth.
Dr. Day: It has a good moisturizer in it.
Bridgett: Yes, it does. It’s really great. And, you know,
back the Sofwave. So you were saying, how long does the session last when you go
to that?
Dr. Day: For a full, like, the neck, it takes about 40 minutes. And we can do
body now as well. And the device has another component. So we have two Sofwaves
because there’s such a high demand. But there’s a, they also have a component called
Pure Impact. And Pure Impact is like doing plyometric exercise for the body. So
while you’re doing Sofwave of the face and neck, you could actually be exercising
your abs. And what’s great is that when you do plyometrics, you build muscle and
muscle is metabolic. Muscle is endocrine. Like I think of muscle as currency.
Muscle is truly the fountain of youth. So the better muscle you have and the
stronger your core is especially, the better workouts you can have. But because of
the way the plyometric exercise is delivered, you don’t build lactic acid.
And so you’re not sore afterwards. So it also makes the Sofwave go faster and you
can be multitasking. So we have a lot of patients who are doing Sofwave for the
body with the plyometrics, the pure impact, and they’re doing the Sofwave tightening
skin treatment for their face and neck. But Sofwave also now has body handpieces.
So what I do a lot of times for people who have like the crepiness above their
knee is I’ll use Sculptra, and I’ll add more Lidocaine for numbing and then we’ll do
the Sofwave directly on top. So Sculptra is a biostimulator and Sofwave is a
biostimulator. So this way we get more out of each treatment with fewer sessions to
smooth that.
You could do the arms as well and even the abdomen for people who’ve had kids or
who’ve lost, or doing a GLP1, and they have some saggy skin, but they don’t
quite need a tummy tuck. You can do a sculptor, which we just hyper dilute, meaning
we add more water to it. So it’s bio stimulatory, but it’s not a filler. And we add
more lidocaine. So you get that numbing effect. And then we do the Sofwave directly
on top. And it’s really quite nice. So there’s a lot of treatments we can do now
to combine to help tighten and lift on the body as well as the face. Without doing
a surgery, which I mean, probably cost effective.
Bridgett: Yeah, cost effective and probably
not quite as, well, not invasive and less risk. Is that the case?
Dr. Day: Totally. Yeah, It’s not invasive. It’s much less and less, no recovery time. So it’s the
downtime is nothing. Recovering from a tummy tuck is probably the hardest recovery of
surgery that there is in terms of surgery that’s done. And sometimes you need a
tummy tuck. If somebody’s lost 50 to 60 pounds and they’ve had a few kids, that
we’re not going to fix that with pure impact and softwave. You’re going to, that’s
a tummy tuck. But there are people who are really fit, but just have some loose
skin. So it’s always the right candidate.
Bridgett: Oh, yes. I mean, it’s funny when you
mentioned above the knees, because that is the one place I noticed on my legs. And
I thought, oh, I’m out there in tennis skirts. And so it’s (the sun) hitting right here.
It’s in that spot where the tennis skirt doesn’t quite reach above the knee. And
that is one place that I’ve noticed it.
Dr. Day: So it’s funny about how many people that bothers.
I don’t get it because I don’t think it’s a big deal at all, but it just really
bothers people. And also the inner thighs bothers people.
Bridgett: You said two times a year about to do the Sofwave?
Dr. Day: Two times a year.
And yes, and you can push it out longer. But I think that every six months is a
reasonable amount of time because there’s no downtime and it’s not a surface
treatment. It’s a deeper treatment. We wait in between to allow it to do its job
and then we build on it.
Bridgett: Yeah. Now, how expensive is it? Because I know that
that’s a big thing with women, too? Or does it just depend?
Dr. Day: It does depend. But
the one good thing in my office is I don’t know the price of anything.
Bridgett: Oh, okay. It sounds like it’s definitely less expensive
than surgery.
Dr. Day: Yeah. And also, surgery, you have to wait to get to where you’re bad enough
for surgery. With this, my hope is, like, I don’t know, I’ve done it eight times
so far from me, and I’m in my 60s, and my hope is I won’t ever have surgery. So
even if the cost add up to what a surgery would be, I got the benefits of being
happy without surgery. So I didn’t have to wait to fall behind and then go get
surgery. And the whole idea of people doing surgery in their 40s to me is silly. I
mean, surgery has risks. It’s not a walk in the park.
And yes, surgical techniques are good, but I think if you can avoid surgery,
the idea is to avoid surgery. So I’m not one to, I mean,
I’m still thinking I hope to never want or need a facelift and just be happy with
what I can do non -surgically and then just aids a way that I age. But certainly
the investment is there. And I, you know, I think now I don’t, I don’t compare the
cost of surgical and non -surgical, because if you add up all the things we do, it
does add up. But the idea is, as long as you don’t have a facelift in mind, only
a facelift is a facelift. So if somebody, I always ask my patients, would you have
a facelift? Because if they’re thinking facelift results, it’s not what I do. I’m
not trying to be that for them or even put it off for them or anything. I just
have non -surgical approaches. I look to create balance. I look to even out skin
tone, to support skin structure and function. And I send people out to plastic
surgeons every day for at least evaluation because sometimes people are happier with
that. And then I tell them on the other side, you’re still going to need all these
things because surgery doesn’t fix skin structure. Surgery doesn’t do what Sofwave
does. So it doesn’t make your skin firmer itself. It pulls it.
And if you have thin, unhealthy skin and you pull it, you’re going to look pulled,
but you’re not going to look younger, right? You’ll just have less sagging, less, I
mean, you can pull some wrinkles tighter, but you’re still going to see them on the
surface. They’re still going to need CO2 and Sofwave and maybe even some fillers
because it doesn’t even do volume loss. Even fat transfer doesn’t always last, often
doesn’t last. So I always tell patients who get a facelift, you’re still going to
need me on the other side because I’m going to help finesse what’s left and help
make sure that I can preserve the facelift work and help it look its best. But one
doesn’t necessarily replace the other.
Yep. So if you start at a young age with sun protection as where our conversation
started, right, And then you add in good skin care, like with RE-Q and retinol and
being physically sun smart. Then you do Sofwave intermittently,
you can help make sure that a facelift will look even better. Because when you do
Sofwave and then you have a facelift, now you have better skin that you’re working
with. Sofwave doesn’t make a facelift harder. It’s not causing any scarring. It’s
not frying underneath the skin. It’s not burning. It’s heating up to stimulate
collagen production, but it’s not causing any damage to the fat or the nerves or
the muscles or the fibrous tissue behind it. So your skin will sit better
afterwards. So I always think of these things as compliments, not instead of.
Bridgett: Right.
And another thing that I always liked, like last time we spoke to you, that you
want people to look natural.
Dr. Day: Yes.
Brigett: You’re very careful about where you place what you
do on people’s faces. Can you talk a little bit again about that, about how you’re
very careful about where you place.
Dr. Day: Sure. I think one of the most important things
is the assessment. It’s looking at somebody’s face, looking at their particular
anatomy, how they’re aging. We often ask patients to bring in pictures from when
they were in their 20s and 30s and 40s, depending on how old they are. And then I
just get to see the trajectory of how they’ve aged so I could see what their
balance is, and then understanding the difference in the left and right side of the
face. Once I can watch them naturally animate and then watch their natural resting
expression, it’s more important than asking them to make a face. So if I ask
someone to raise their brows, they may move it more evenly, but if they naturally
animate, they’ll move differently. So just having the conversation with
them tells me about how they’re aging and how they’re going to age.
You blend around the nasal labial folds and the upper lip and the chin. All of us
as women, when we age, our mandible, this bone, it shrinks and recedes. So if you
didn’t have a strong chin as a kid, that chin shrinking and receding is going to
make your upper lip and your teeth seem to hang over your lower lip. And that is
going to make you every time you close your mouth, pucker a little bit and make
upper lip lines. So now it’s not filling the upper lip. That’s the answer. It’s
reshaping the chin and the lower lip to bring it back forward and reposition it.
And now you can put a very little bit in the upper lip and you’ll have a much
more natural authentic outcome. So it’s not necessarily using less filler, but it’s
being precise in understanding where the loss is coming from and tweeting the source
rather than just chasing the lines.
Bridgett: Right. And I think that’s such an important part
because you see people where they’ve had the injections done or they’ve had,
I mean, I see women a lot younger than me where it just, it’s almost as if
they’re speaking and their mouth’s not moving.
Dr. Day: Right. That’s a big problem too. Or
they don’t have any lines, but they enter what we call the uncanny valley where
They look,
you know who it is, but they look so often, it’s uncomfortable. They don’t have
lines and everything should be right, but it’s just uncomfortable. And that’s the
uncanny valley where they kind of look human and that you kind of know that this
is that person, but you’re taken aback by it and it’s not pleasing.
And that can be not necessarily from too much filler, but it’s misplacement of the
filler and somebody who goes into the doctor and says, I don’t like this line. And
the doctor’s like, well, I can get rid of the line. Well, you can. You achieve the
goal. The line’s gone. But you defeat the purpose because they don’t look better. So
the goal for me is not to erase the line. The goal is to achieve the goal,
which is to look balanced and look more youthful and to age better. So you combine
it with skin care, with devices, with neuromodulators, with fillers,
and sometimes with surgery as needed. And that combination is a conversation. We make
our patients a calendar for the year and we say, okay, we’re going to do this
today. You’ll come back for this. And then we make a calendar over the next six
months to a year, what they should come in for when. And then they
out of the way as well, and if they come in and they don’t need it, we don’t do
it, or if they need something different, we do it. It’s a general plan of what we
think they’ll need to help them reach their goals and maintain it. And I think
there’s something comforting in knowing what to expect and why, as opposed to like
waiting until something bothers you. And I asked somebody once who was really
overfilled, why she kept on getting more. And she said, well, she wasn’t sure when
she could go back to that doctor and she was afraid it would all go away. And I
think it becomes addictive. And people just keep doing more because they do more and
they don’t even see that it’s there. They just keep looking for flaws. And I always
try to start with what I think are people’s best features. So if you have like
your beautiful cheekbones, we point out all your best features and we say we want
you to go from beautiful to more beautiful and to enhance your best features. We
don’t want to just like look at flaws and try to keep fixing flaws because those
are endless we can always pick it ourselves there’s always another flaw to find.
Bridgett: yes there is, absolutely! Sometimes the magnifying mirror isn’t your friend.
Well thank you so much for coming back on Hot Flashes and Cool Topics. You always have such
great information and listeners you really should go to to Dorisdaymd.com because
there are fabulous blogs, fabulous products. I’m telling you, I love the Body Retinol.
I mean, it is so great. And I’ve got to check out the other products as well. And
thank you again so much for coming on.
Dr. Day: Thanks for having me. Take care.