Dr. Doris Day: EPISODE LINK

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TRANSCRIPT:

Colleen – Welcome back to Hot Flashes and Cool Topics Podcast, the voice for women in midlife and beyond at Hot Flashes and Cool Topics. We talk about anything and everything to do with midlife. My name is Colleen. My name is Bridgett.

And before we get started on today’s amazing guests and all this information we’re going to share with you, Bridgett and I just wanted to share one little piece of information, and that is last week’s episode, there was an error in the intro. We have a lot of people who jump on as soon as it uploads on Wednesday mornings and unfortunately, the name of our guest was edited out for the intro. It was corrected, so if you listen to it now, it’s perfectly fine. But we wanted to apologize to any of our listeners who are like, who am I listening to and what does she do? But we wanted to apologize to any of our listeners who are like, who am I listening to and what does she do?

Bridgett – I also wanna bring up to our listeners that listen on Apple Podcasts, that if you could download our podcast, because Apple has changed things around, in the past, if you were a follower of Hot Flashes and Cool Topics, it would automatically download our episodes. I also wanna bring up to our listeners that listen on Apple Podcasts, that if you could download our podcast, because Apple has changed things around, in the past, if you were a follower of Hot Flashes and Cool Topics, it would automatically download our episodes. But they’ve changed that. So if you could just hit download on it, and then you will be sure to not miss a single episode.

Colleen – With that, let’s talk about this week. We are talking to Dr. Doris Day. And Dr. Doris Day is a board certified dermatologist, medical educator, and clinical associate professor of dermatology at NYU’s Langone Medical Center.

She’s also an author. And let’s just say she is one of the top New York City dermatologists. Stars go to her. Like every time I mention her name there, oh, I’ve seen Dr. Day. And we were lucky enough to have her on the last conversations event in New York City. She was on the panel about health and longevity. And what we really liked about her was that she focused on skin longevity. It wasn’t just you need to have this procedure, that procedure, she wants you to look youthful, but not try to look younger than you are. And she also talks about what we need to be doing to protect our skin. So we have a really in-depth conversation about sunscreen, because of course it’s summertime, and we wanna make sure that we are protecting our skin. We also talk about collagen and retinol. I mean, we cross the gamut, but I just so enjoy listening to her speak because she looks beautiful, she looks authentic and she’s just a wealth of knowledge.

Bridgett – She is. And that’s the one thing at the last event that I noticed with her is she looks real. She looks beautiful, but she looks real. And so many times, procedures can make people not look real. We all know the different people that we’ve seen that have had different procedures done and they look very different. And I love the things that she says and things that I’m going to think about. I do Botox, I have injections, Botox. I’ve never had fillers before, and Colleen hasn’t, but it was interesting to hear where the fillers should go, what’s helpful, what’s not helpful, what’s going to actually make you look older, where certain procedures are taken. So you’ll need to listen to this podcast so you can find out what areas are being injected that might be making you look older, or like a Vulcan or something like that. And we’ll save that for the science fiction shows like Star Trek and things like that. I kind of want to look like a person, but-

Colleen – Don’t you feel like when dermatologists come on the screen, they immediately check our skin? Immediately I’m like, oh gosh, is it, okay, am I moisturized? Do I have my vitamin C serum on? She’s just wonderful.

Bridgett  – I know, as if they could even see a very clear, through the screen of what our skin is going like.

Colleen- And there’s a clip from the video interview that will be up on our YouTube channel that we actually had to edit out of this interview audio because she is pointing to different areas of our face. So if you’re watching it on YouTube, you’re getting the gist. If you’re listening to this audio on any podcast platform, just go over to our YouTube channel, Hot Flashes and Cool Topics, because there’s an extra little bit about actually injecting the forehead and how sometimes it actually will lower your brows and make you look older, which is the last thing.

Bridgett – Make your eyes look smaller. We kind of want our eyes to look bigger because a big thing I was told by my dermatologist was hooded eyelids, and that happens.

Colleen – Dr. Day is also very knowledgeable on menopausal skin, and she talks about that. So if you’re not following her on Instagram, you need to go over there, because she gets a lot of questions from people, and she answers them over there, and a lot of them deal with peri and postmenopause. She is so knowledgeable and shares the expertise that she has answering questions for people. So with that, let’s get started talking to Dr. Doris Day. We’ll talk to you after.

Colleen – Welcome back to Hot Flashes and Cool Topics. Today we have on Dr. Doris Day. Now Dr. Day was at our event in New York City, and one of the things that I loved about our conversation was that we talked about skin longevity. And for a lot of women, that’s more important than what procedures they may or may not be getting. So we would love to welcome you to the show, Dr. Day.

Dr. Day –  It’s so good to be back. The event was amazing. I loved all the speakers. I learned so much. And it was really great to see the enthusiasm in the room. Everybody wanted the information that was there.And just the camaraderie, the networking, it was really a beautiful event. That was so honored to be included.

Colleen – Well, it was a magical day. It’s great. Afterwards, we always hear from attendees, the day was just magical. It was, that’s the word that keeps popping up. And we truly appreciate your time with that. And I wanted to start, I was gonna start one place, but you and Bridget started talking before we pressed record. And you were talking about the fact that doctors need to be cheerleaders for their patients. So I wanted to start there. What do you mean by that? And why is it so important?

Dr. Day – Well, I think it’s one of the most important things we do as doctors is cheerlead our patients’ health and look at what they have that’s good. Like I always say, if I look at my patients and I go, oh, all these things are wrong, I’m gonna take them from more wrong to less wrong. But everybody has beauty, everybody has good aspects of their health. If your cholesterol is a little bit high or you have a wrinkle, all those things are there, but you have energy, you have strength, you got up this morning, you showed up today. All of those things are things that we want to celebrate in our patients and encourage them more of that. Like we want more of this good health. We wanna take what we love about what you’re doing for yourself, what your genetics bring, and then say, this is what we’re gonna build on it to optimize your health and give you the greatest chance of having the best longevity, the best health span, so that every day of your life, you can reach the goals that you want to reach. But unfortunately, so much of medicine has become medicine where we just look at labs, look at data, look at problems, and then try to give you something to solve the problem, instead of saying that life is good today. And I always say, we’re all just gonna die of a side effect, because every drug has a side effect, and for every side effect, there’s a drug. And before we know it, you’re just on this roller coaster of medicines. But I want to optimize health, and that’s what longevity is, and longevity beauty is a step towards that, because we now know that your skin isn’t just reflecting your health, it’s affecting your health as well. And when you have beautiful, healthy skin, it’s making your other organs healthier, and it’s also reflecting the health of the rest of your body.

Bridgett – Can you talk a little bit about just keeping some things there that you can move for your face? You don’t want to freeze your forehead, how that you just really look authentic.

Dr. Day – Well, that’s so sweet, and thank you. I’ll always accept the compliment and say thank you. My philosophy is never to point out my own flaws, so I’ll just say thank you. I’ve tried to understand why we have this obsession with erasing all movement, and I think it really comes from the way the FDA trials are done. So when Botox or ZMN or any of the neuromodulators go for the FDA approval, we create scales. So let’s say we’re doing between the eyes, the lobella.  So it’s easy. You have a scale. No movement is zero to extreme movement is a four or a five on a scale. If you want an FDA approval, you want to take the ones who are at moderate to severe movement and take them down to mild or none. That’s how the FDA judges that it worked. But unfortunately, when you get an FDA approval saying you can go from severe movement to no movement, then that’s how the companies have to market the product. So they have to say that this is the on-label way to use it. They don’t say best real world use. They say this is the on-label way, and that’s how it has to be taught to people who are learning how to inject.  And now because these products are so commoditized, everybody and anybody is injecting. I go by hair salons, and there are people injecting in hair salons. Like, it’s crazy. Everywhere you go, these products are safe when used appropriately, but I’m not worried about safety necessarily. I don’t want to walk around with no movement or one brow off from another. So that’s part of the problem, is that a level of expectation is that I got my money’s worth or I got the best effect if I can’t move. But actually, the best effect is for me, when I look at somebody after doing a treatment, is one, what do they look like at rest? So if you see somebody that can’t move their forehead at all, at rest, I promise you, their brows are gonna be lower and flatter, and they’re gonna look older, and their forehead will look waxy smooth. That to me is a bad outcome. Then when they try to raise their brows, one of two things will happen. One is they can’t, which to me is horrifying. And two, which I think is also a big problem, is that any little bit of that muscle fiber that’s not knocked out is gonna hypermove because it’s the only part of the muscle that can move, because this is a really big muscle. So then you’re gonna see a line right there or a spot look because they’ve dropped here and they’ve raised there. The last point is about doing these products is that as we age and as we go through peri and post menopause is our anatomy changes and the forehead muscle, which is this massive muscle in the forehead and the only muscle that raises the brows, it slides down a bit. So when they do the injection here, if they’re too high up, they’re hitting the lower forehead muscle, which is going to drop you immediately. It’s going to drop you down here and then you’re naturally going to pull up here. And you see these women walking around thinking they got a brow raise, but meanwhile they’ve dropped here and they’ve raised here. And this is not a good luck, right? You want to have a natural arch or your natural arch or a little bit of a lift. So it is very technical, especially as you get older. And I don’t believe in preventative botox or preventative neuromodulators.

Colleen –  You should definitely be following Dr. Doris Day on Instagram because the information that you share is amazing. It’s just so invaluable. And one of the things you’re talking about now is a series for menopause and perimenopause, which is great because we need this information. And I wanted to talk to you, like step one, someone comes in and they’re in perimenopause, and as you say, they say, my face is falling apart. What does that mean? What is that, because I know for me it’s dryness, lack of collagen, what does your face is falling apart mean?

Dr. Day – It’s exactly that. It’s that once you hit perimenopause, we already know collagen production starts declining as early as in your 30s. And then we’re just hoping to repair what we can and maintain what we have. But once you hit perimenopause and then post menopause, I mean, you lose 30% of your collagen in the first five years postmenopause. And the decline starts happening peri. It’s just more rapid at post menopause. So the best way to prevent collagen decline is estrogen. And I have a radio show on SiriusXM and I had a colleague who does a lot of hormone replacement. And he said something so interesting. He said that estrogen, and I never thought of it in this simple, simple way, but it’s true. Estrogen is not a carcinogen. Estrogen is a hormone that you really do need. Your brain has estrogen receptors, your skin has estrogen receptors, your joints do. So you need it for lots of things. And when you go through perimenopause and that estrogen starts to decline, your oil glands start to make less oil. And the further you go away from your face, the less you have anyway. So you really feel it in your legs first. And then it’s when women start coming in in their 50s or 40s, and they start noticing creepy skin on their arms or above their knee. So it’s not just the face that they start to complain about. It’s the neck and the chest and the other body parts that they’ve had chronic sun exposure that now all of a sudden, I think of that Bounty Paper Towel commercial where they’re holding the Bounty Paper Towel under water, and it’s holding, holding, and then it just falls apart. It’s kind of like what your skin is doing. It’s taking in all these insults of like stress and pollution and UV exposure and diet changes, and then hormone loss or depletion. And then all of a sudden, one day, it hits that tipping point and it just, you see the difference. One thing I’ve noticed is that the area around the mouth is a continuation of the neck in terms of how it ages. So I look at women and this part of their face that goes from the sides of the nose to the corners of the mouth and the chin, it ages about 10 to 20 years faster than the mid face and the cheeks. So the skin quality is completely different. And then the eyes are also the thinnest skin and that doesn’t age very well in a lot of people. But it’s really, I tell women in the summer, get a sunscreen stick to put it on the upper lip because you’re gonna sweat that off in an hour. And people don’t reapply their sunscreen. Actually, my Saturday post was if you didn’t reapply it, it’s like you didn’t apply it at all. And people were complaining saying, no, no, it’s better than nothing. And actually it’s really not better than nothing. It’s actually probably worse. Because what happens is people put on sunscreen first thing in the morning, and then they don’t even use enough. And then they go, well, I put sunscreen on. I am now exonerated from anything that happens to my skin hereafter. And they’ll go and spend the whole day out in the sun with this false sense of security that they have some sun protection. And they fry, they burn their skin, they age their skin. And if they didn’t use sunscreen, they might not feel that protected. And they might either apply it later when it really matters, or they might go inside or not spend as much time outdoors or do other things to protect their skin. So sunscreen really does have to be reapplied because even if it’s long lasting sunscreen, you literally wear it off as you’re out and about.

Bridgett – I’ve always heard if you get in the water, you get out, reapply. And is it every hour or every two hours? I couldn’t quite remember.

Dr. Day – Yeah, well, it depends. So there is no such thing as waterproof. There’s water resistant and very water resistant. So I think it goes like 60 minutes and 90 minutes is the amount of time that the saying goes by. But it also depends what you’re doing, how much you applied. And the way that I apply sunscreen is I always do the neck first before I get dressed. And I always go in an upward direction to make sure I get the bottom of the neck. Then I do the full face. Then I do it again. So I always do a double application first thing in the morning to make sure I get good coverage. And then when I’m out and about, if I have makeup, I’ll use a powder SPF. Otherwise, I’ll just keep re-applying the sunscreen every hour or so. Just because I really just don’t want the breakdown of collagen. And people talk about vitamin D or about how important the sun is. If you feel like you have to get sun, just look at the UV index. And if it’s at two or below, then it’s fine in my view. You don’t need to worry about sunscreen. And probably it’s fine. It’s actually probably a little bit good to be out. Like first thing in the morning, as the sun is coming up to get a little sun, sets your circadian rhythm. I mean, I think the sun is amazing. I’m in the sun all the time. I walk to and from work every day. It’s two and a half miles, but I’m just smart about it. But I think being outdoors, being in the sun, I’m never saying don’t do that. I’m just saying be smart about it.

Colleen – Do you have any recommendations for sunscreen? Some of the best ones?

Dr. Day – Oh yeah, there’s so many great ones. I mean, I think La Roche-Posay is probably one of the best brands out there. They have pure mineral ones. They have ones that are absorbed and not absorbed. I don’t call them chemical because everything’s a chemical, but there’s ones that are absorbed, like the Helioplex. Let’s see, they have the Antelios. The Helioplex is the Neutrogena one. That’s also good, but they all have mineral-based ones as well. And now the mineral ones come with natural tints to them that go across a broad range of skin tones. And so, Neutrogena, I think for children, I like Blue Lizard, that’s a nice brand. And what else do I like? Super Group seems popular with a lot of people that if you like it and you’ll use it, I’m happy. When I go to Europe, I do buy sunscreen there because they have a lot of UV filters that we don’t have here. So unfortunately, in the US, well, fortunately or unfortunately, the sunscreen ingredients are FDA drugs. So in order to get something that you can label as a sunscreen, you have to go to the FDA and show all the safety data. So we haven’t had a new sunscreen ingredient, I think in 20 years in the US, but in Europe, they’re only regulated as cosmetics. And the reason why they don’t come here is because they don’t have the safety data that the FDA requires. And so for all the people in all these advocacy groups who complain about our sunscreens, these are ones that the FDA allows. And to get those studies, to get that data, you have to prove a good amount of safety. So I’m okay with the sunscreens we have until the FDA says otherwise. But so far, the FDA has asked for more information on some of the absorbed ones, but hasn’t taken anything off the market. So I don’t believe sunscreens cause cancer. I believe that skin cancer is increasing. We have two people dying in this country every hour of skin cancer, something to take very seriously plus skin aging. And sunscreen is our best defense, but the UV filters in Europe go to some levels of blue light and visible light even. So they have broader protection than we do here. They just don’t have the safety data. So if you believe that they’re okay, then when you go to Europe, buy sunscreen. Elastin has a good sunscreen that people really like in terms of the tone. Who else? There’s just so many, but I really think that the drugstore brands, La Roche-Posay and Neutrogena are probably my two favorites. Aven has a really nice one for more sensitive skin. Aveeno, like all the simple brands in the drugstore, I usually stick to the big names because their money goes into research and development, not into packaging and marketing, because they are just such big companies. And actually, I’ve been to all their labs, met with their PhDs, and they’re really quite serious scientists looking for the best ways to bring products that are safe and effective to the market at accessible prices. So I really respect that.

Bridgett- What about the sprays? What do you feel about the sprays?

Dr. Doris Day – I like the sprays. I think they’re fine, but it depends. So there’s a continuous spray and there’s a mist. So if you have a continuous spray, that means that when you’re spraying, you’re getting a continuous product coming out. In a mist, you’re only getting a misting of it. So you’re not getting the same coverage. So you have to mix that in. And I would rather do it outdoors because I don’t want you inhaling the sunscreen. And I don’t like it for the face. I would spray it on your hands and then wipe it on your face. So if you’re doing the back or areas away from the face or outdoors where you’re not going to inhale it, I don’t think inhaling sunscreen is a good idea. And I think it’s hard to not inhale it. And then of course, there’s the way that it comes out of the bottle. If it’s aerosol, there’s problems with aerosol. So, but if it’s like my kids will use a spray, so I’m going to get a spray. They’ll use it. That’s always what we run out of first on vacation is the spray.

Colleen – Can we go back to collagen? Because this is like, because it’s all kind of interconnected for your body. If you’re not on estrogen, how can you get, like, you know, people drink collagen protein powders and does any of that really work?

Dr. Day: I think so. I remember having a conversation. I made a show with a couple of friends called The Gist. It was like the dermatologist. We were The Gist Five. So it was, and I started talking about collagen supplements, and they were all like, no, this is horrible. Bad for your kidneys. It doesn’t do anything. There’s no data. But the reality is that any supplement is going to be a little tricky because it’s not an FDA product. They’re not going to do FDA trials. You’re never going to have the amount of data you want. That’s going to say definitively that it does anything. But the way I look at it is one, it’s a protein. That’s not bad. You’re getting protein, so that’s fine. And the second is that enough of the companies made enough of a least theoretical set of information that made me believe I could see how it could work, and it makes sense to me. So this is the problem. And if you think about cholesterol, we’re all saying don’t eat foods high in cholesterol because your cholesterol will go up. When in reality, cholesterol is a massive molecule. You don’t eat it, it doesn’t go through and stay as cholesterol, right? It gets digested. Same with collagen. Of course, when you eat collagen, they’re all saying, well, you’re not gonna get collagen if you eat collagen because it’s gonna get metabolized and broken down. But what I’ve seen is that if you have good hydrolyzed collagen, and I think that the marine source, which is really from fish scales, so if you think about it, it’s sustainability, right? You’re not killing anything to get it. If you’re vegan, it’s a problem, I guess, but if you can get yourself past that, it’s fish scales. And so now you’re using all the fish, that’s not bad. And when it gets broken down, it gets broken down into basic building blocks of collagen, which is the step ahead towards collagen production. And there is some good data for joints that it has shown some benefit that seemed like it was from the product. Again, it’s not a placebo-controlled blinded trial with enough people to really show that much, but if you have normal function kidneys, you don’t overdo it, you’re getting a protein and you may be helping your skin. And I think that there’s enough, at least theoretical data to make me think that it’s safe when done properly, doesn’t do harm and could benefit that I’m on board with it. So the three brands that I’ve seen that I think have the best data and the best science behind them and are the most serious, I think SkinAde was the first, that’s SkinADE, and then the second was LiquidBioCell, and the third is Nutrofol. And they’re all either drinkable or they’re powders. I don’t like the gummies or the pills because that’s too dense a protein. You should have it in a liquid. So ultimately, it either comes already liquefied or it’s a powder that’s gonna go in a smoothie or something else, and certainly follow the directions on the bottle and give it time. And it’s one thing. No one thing is gonna replace your need for sunscreen or otherwise good healthy habits. It’s just one more thing.

So that, you know what? I realize there’s two different things. There’s evidence-based medicine where you do the clinical trials and you have the placebo control with enough people and they’re well done. But that’s always gonna be driven by big pharma, right? Somebody who has big money to make is gonna do those big trials. But these companies are never that. So I think there’s evidence-based medicine and then there’s called something else called evidence-informed medicine, where you may not have the big trial with all the evidence, but there’s something to clinical experience that says, in my experience, looking at the data, studying and analyzing with the history of everything I’ve done over the past 25 years, this is why this makes sense. That to me, it also has value. And that’s what I’m going with here.

Bridgett – You were talking about this, and then also, when I’m getting back to skincare, what can we do about damage that has already occurred?

Dr. Day – That’s such a great question. Well, one is if you’re a good candidate for hormone replacement, then that’s one thing that does help. I’ll just say one quick thing, and I’ll go back to this about hormone replacement. I know not everyone’s a good candidate for it because some people have had breast cancer and whether or not it’s estrogen receptor positive, and they just cannot do it. But my concern is that too many women will not do it because doctors won’t prescribe it for them because it’s easier not to than to have the discussion. And so part of why I drive this conversation so hard is because it’s so important, and so many women are given bad data or just discouraged or they’re just afraid because breast cancer, but the benefits outweigh the risk for most people. And too many people who would benefit are just not given enough information, so I drive it there. But so that aside now, just putting out there that it’s good for most people, but if you can’t, then here’s the other thing, or if you can, but here’s other things you can do as well. One is retinol. I think retinol is really important because retinol is what’s called an abundance mimetic, meaning that retinol makes your skin think that it has everything under control. So now we can do housekeeping, we can build collagen, we can repair, we can help even out skin tone, do all these great things. But my worry about retinol and chronic use is that my dad used to have a saying that, I don’t know if it was his or not, but he said, toujours plaisir n’est pas plaisir. Always pleasure is not pleasure. So an abundance, my medic may be good sometimes, but what happens when you have overabundance? You get chaos.

So I started to pulse my retinols a little bit, and I don’t know what the pulsing is, but my informed evidence decision is to pulse it five days a week. Do I tell my patients to use a retinol five days a week, but is it a month on, a month off? Don’t know. We have to sort of figure this out, but I think that’s where we’re getting with retinol is figuring out how to pulse it. And I’m hopeful that we’ll come up to some data that we can say makes sense of how it should be pulsed. But retinol is one, things like vitamin C are another. And just to understand and to put out there that I heard everything you said about past sun exposure, but it’s never too late to start. So people will come in and go, oh, I’ve had all this sun exposure. I’ve had, it’s like my lifetime sun exposure is done. It doesn’t matter what I do now, but it does matter. So whatever you do from this day forward is what you have. So one is getting to a good sun protection routine. Two is add retinol at night, vitamin C in the morning, peptides, exosomes, I think have come a very long way. Lasers really do help stimulate collagen. They don’t thin your skin. They actually thicken your skin. Retinol doesn’t thin your skin. It thickens your skin. It makes the collagen layer thicker. So people have a misconception about retinol and thinning the skin and lasers and thinning your skin, but neither of them do that. Retinol makes the outer layer sit more compact, which is the stratum corneum, which is why your skin looks smoother. So that’s flattening it, but it makes the collagen layer thicker. So all together, your skin is thicker and firmer and more resilient.

Lasers can help. I love SoftWave. SoftWave is a lifting device that actually helps build collagen as well. It doesn’t melt fat. It doesn’t affect nerves. And I actually think that’s a better preventative for young people than a neuromodulator would be. And when you’re younger, you’ll do it once a year. As you get older, you might do it a few times and then maintenance every 10 months or so.

Colleen – That’s external. So that’s not

Dr. Day – Yeah, SoftWave is external and has no downtime. So it’s on the skin and you could do it in the summer even, doesn’t even matter. So that’s a nice treatment that I’ve been happy with. I’ve had four or five of them myself. So it just keeps everything up and helps with evening out the brows. There’s a lot you can do with it. It’s uncomfortable. But as women we know, beauty is pain, pain is beauty, don’t hate it. Just give me results. Hurt me, but give me results. And then other topical things, I think even just a simple good moisturizer is really helpful. Things with hyaluronic acid that are going to help the natural hyaluronic acid in your skin is really helpful. Hyaluronic acid fillers, done very carefully. And that’s another area where, I mean, I’ve had fillers, I’ve had all this stuff. Maybe you could tell, maybe you can’t, but it’s the idea for me is not to get rid of every line and wrinkle. I get the whole lecture called, don’t chase the lines, treat the source. And the idea is to not be offended by a line, but to understand it. So what I’ve seen is that people who grind their teeth, their maceters get overgrown. So this muscle that’s here, they’ve used for chewing, it’s called the macetor because use it for mastication, for chewing. So you have it here and you have it here. So when this muscle overgrows, then your face gets shorter because this muscle will now be the end of your face instead of that your chin or your jawline. So when you smile, instead of going all the energy going across the whole face, it stops where that muscle starts because it’s like a wall. So it pushes forward from there and back from here, and then you get this line that comes down here. So when people have this line behind the marionette line, this line that comes down, usually it’s because they’re grinding. So if I can relax that grinding and then put a little bit of filler behind it to extend the jaw, that line will go away without putting anything in it. The marionette lines are also not from loss here. It’s from loss behind and under. So if I put the filler along the jawline under and behind and a little bit up, I’ve already made that line better without putting anything in it. So the mistake people make is they say, I see a line, I’m going to fill the line. And then you look like you have a ball there. The line is gone, but you look better. Not usually. So then you have ligaments and we’re starting to pay more attention to the ligaments. So you have a ligament that comes down the side called the lateral retaining ligament. If you fill with a filler in front of that line, it’s going to make a big ball. And then you see these people with these big cheeks and has nowhere to go. So it pushes up. So makes your eyes smaller from below. If you put it behind, it’s going to give you more of a lift or lifting effect. So you see these people, right? They get the filler here and then their eye goes up from below. Then they get the botox from above and their eye drops from above. They have low brow, small squinty eyes and big cheeks. And we wonder why people start looking unnatural. So it’s really understanding anatomy and understanding that you’ll never make a 40 or 50 year old look 20, nor should you, but you cannot because your bone structure has changed, right? The skeleton shrinks and the rate limiting factor is always going to be your eyes. Because when this bone that surrounds the eye shrinks, that means the hole gets bigger. And for some people, the eyes will sink in a bit. So if you try to fill, you’re gonna make the eye further away from the surface, which makes you look older. And if you try to fill underneath, you’re gonna puff it out more, which again has the same problem. So the eyes are always going to be what limits how much you can put in the face and where you put it.

But what we’ve learned is if you go back into the hairline a little bit, you can sort of start to share the space. My dad, I don’t know what he thought I could be when I grew up, but he sent me to sonography class for secretaries and to sewing classes for housewives. So it helped me take great notes in med school, and it also helped me learn to suture and to share energy. Because when you sew and you have one side that’s longer than another, you have to make them match, right? So you do that by learning to divide the space into smaller and smaller units till you make everything work out. And sort of when I looked at the face, it’s kind of like that. I go, what’s happening? And where can I put a product so that you don’t see the product, but it can share the energy to give you the effect of a lift or a smoothening? And when is it that I can’t do that anymore? So I do it with a combination of fillers, neuromodulators, devices, and skincare. And that combination is never meant to replace a facelift or look like a facelift. It’s meant to look authentic, natural, mobile, and beautiful for any age. But at some point, if there’s way too much laxity, usually in the neck, then at that point, if it bothers someone up, then it’s a facelift. I’d rather get old. You look amazing. There’s just no reason why you really need one.

Colleen – But this information you’re giving us is why it’s so important that women just not walk into a nail salon and ask for Botox or filler. Because there’s so much information that you need to have in order to do this correctly. So you do look the best that you want to look.

Dr. Day – Not necessarily like you said, younger, because this is just not part of the growing up. But more youthful. So I separated out between younger and more youthful. And I think there is a difference between that. Looking younger is where I see people getting into trouble. Because they think if they get rid of all their lines, they’re going to look younger, then they can compete in whatever world, whether it’s the job market, dating field or whatever. But the reality is if you look more youthful, it’s a good thing. There’s something to the thinking fast and slow kind of idea. Instinctually, we think of younger people as being fertile. We can’t help it. It’s hardwired into our DNA. We’re a species that if we want to survive, we have to propagate. So we’re going to be turned on by certain features that imply fertility. A full head of hair, a certain curve of the back, a certain youthful features that we see as like, actually fertility is like the best for having and carrying a baby. But we don’t think of that in an overt way. It’s just our instinct to see that. As we get older and we’re not fertile, what happens is we become invisible to people looking for that, but become more beautiful to people who get over that. So your instinct will be to look in the mirror and go, oh, I have these lines, I’m showing signs of aging. But okay, that’s your instinct, but we’re evolved. So we can get over that and go, ah, but I have a life I’ve lived, I’ve accomplished, I’ve survived all of my bad days and I’m still here happy today. So all of those things are really, really important. You can have health and energy and be productive and contribute and do all those things at peri and post menopause. If you do things to support that, right? Like the stuff we’re talking about, which also goes to nutrition and exercise and sleep and sex and all those things that are great for your skin. I mean, there’s data now that shows that both aerobic and resistance exercise is directly impacting your skin health. So it’s one more reason to get out there and do some strength training and get on your bike or walk or run or do whatever. Maybe not run too far because then you get running face. But to do your exercise.

Bridgett – What’s running face? I used to run. What’s running face? I don’t run anymore.

Dr. Day – People who run a lot, you can see their face. It does show all that pounding isn’t great for your face. So run like five miles, not 25 miles. Older is better.

Colleen – Exactly. Oh, I love that. Older is better. You know, I wanted to just follow up on the retinol. Does it have to be prescribed retinol? Or is there so many over-the-counters now that have retinol added?

Dr. Day – I almost never use a prescription retinol for anti-aging. And for two reasons. One is you don’t need it because we have so many molecules that are not prescription that work as well for the wrinkle component of it. And also, when you’re a prescription product, if you want to change the formula in any way, you have to do a whole new FDA trial. Whereas in an over-the-counter formula, you can add in peptides and growth factors and vitamin C and other supporting ingredients that make the retinol better that you couldn’t in a prescription product. So there’s a lot that you can do with retinols that are over-the-counter, but they’re not all the same. And you can’t go by the percentage of retinol, like a 0.1 of one retinol versus another. It doesn’t mean anything. It’s the formulation that matters.

Bridgett – That’s one thing I really like about your Instagram page, that you will put products up there. There are all kinds of price ranges that someone could get at the drugstore or someone could get a really high-end one. And I think we hear from a lot of people that I just don’t have the money to pay for a really expensive product.

Dr. Day – And you don’t have to. You know, another great brand is Laneige. It’s at Target. It’s an Amore Pacific line and it’s their Target brand. And I love those products. So there’s so many great brands out there. But again, these are the big name brands over the small kitchen ones because they really do have the quality control.

Colleen – One of the questions we got asked by a listener is that they have acne now showing up that they never had before. And then to the opposite end, the dryness that they’ve never experienced. Can you talk about both ends of that spectrum?

Dr. Day – Well, one is that I’m not sure that it’s acne, right? It could be rosacea and acne and rosacea can look alike because rosacea can have pimples. So one is I would see a dermatologist to make sure it is what you think it is. And two hormone fluctuations can cause you to break out, whether it’s with acne or rosacea. And when people come in and I tell them they have rosacea, they go, but I didn’t have this before. I’m like, okay, well, some things you don’t have before.

Some things you grow into and some things you grow out of. But rosacea is unfortunately one of those things you grow into. And also you didn’t have it before probably because you weren’t drinking alcohol and you weren’t stressing the same way. So rosacea is triggered by environmental things. And one of the big differences between acne and rosacea is acne is more bacterial driven and rosacea is not. So actually, the book I just wrote, my most recent book is called Rebooting the Biome and it’s about the skin biome, the microbes that live in the skin, which are really bugs. And when those bugs get off kilter, then you have overgrowth of ones that are bad or strains of ones that, well, actually in the book, we make a point of saying that bugs are nearly, neither good bacteria, neither good nor bad. It’s the environment they’re in that can make them behave badly. So when you have a good biome balance, then they tend to behave less pathologically and you tend to have better strains because they keep each other in check. And it’s really changed the way I practice medicine because I use almost no antibiotics anymore. I really work on balancing the skin biome as much as I can, whether it’s with topical probiotics that are designed for the skin, or if it’s with ingredients like salicylic acid that are more biome friendly. But if you think about rosacea, there’s a my theory of rosacea where Demodex mites overgrow.

And when you go through perimenopause, you have a lot of estrogen receptors in your skin of your face. Actually, it’s one of the areas of your body you have the highest level of estrogen receptors. And so when you start to get estrogen depleted, that affects your skin biome, it loses some of its diversity. And then you can have overgrowth of other things like mites that can trigger rosacea. So balancing your skin biome becomes really important. Some of that’s through looking at the gut, some of it’s through looking at the skin and or a combination of those.

Colleen – And what about the dry skin? Is it the same that the-

Dr. Day – Yeah, it’s the same because your oil producing glands are driven also by some of that estrogen. So your oil producing glands become less productive, and they make ingredients that are food for the microbes. So now these microbes don’t have their normal food supply, and some do better with that than others. So yeah, you’re losing the nutrition for those microbes and also your oil glands or the moisturize, the oil lines in your face make something called natural moisturizing factor, and you’re losing all of that. So you’re gonna get drier. And it is kind of an insult that you’re getting wrinkles, pimples and dry skin all at once. Like that’s just morally wrong. I mean, it makes no sense.

Bridgett – It is. It is. So true.

Dr. Day – Yeah, it is. There’s so much that I know we don’t have time to touch on that I know that, you know, hair loss, well, you’re getting hair on your face where you don’t want it, and then the hair loss is happening on your scalp as well. Yeah, so hair loss, so hair does naturally age. Your hair on your head, the scalp gets naturally thinner each strand changes and hair that’s curly can become frizzy or straighter. Your hair texture changes, the density changes, even if you have no genetic female hair pattern of hair loss, then you add on top of it that plus genetic hair loss, which is a female pattern where you tend to maintain the frontal hairline and kind of lose right behind it. Men just lose in the temples and then they lose in the crown and then they lose all of it. We kind of keep this and lose behind it. But women do thin out in the temples too and it really offends all women. So minoxidil at 5% once a day is the only FDA approved treatment for female hair loss. But there’s a lot of other things. PRP can help, which is where we take your blood, spin it down, add it back. And the reason why you get the hair growth on your face is again, the hormonal imbalance. Your estrogen to testosterone balances off and the hair starts growing. And to get rid of that, if the hair is black, and you have a lot of it, laser hair removal is great, although you have to do it for longer because it’s so hormonally driven that it’s not just a few times and you’re done. Don’t do it if you have a tan. Make sure a doctor sees you before anybody else does it for you so you know that you’re a good candidate for it. And the hair should be present but short. If you’re going to do electrolysis, that also helps if you don’t have too many hairs. Make sure you have somebody good who does that. Waxing can help, plucking, dermaplaning.

Shaving it doesn’t make it grow back thicker, it just makes it grow back. So those are all things you can do. And PRP is good. Topical exosomes actually just help co-found a new company. And we’re working on a novel molecule for skin and hair. We’re going to have both over-the-counter and prescription products. So the first product should be out in about a year and a half. I used to work in a research lab and I’m a little bit of a lab rat wannabe because I love the lab side of it and developing products, but there’s a lot coming for skin and hair to help with skin longevity that are novel molecules. So I’m one of many coming up with things, but I think it’s going to be, I mean, I’m doing it, so I think it’s going to be revolutionary, but it’s really very, very exciting. So it’s a good time to be getting older because we’re taking the aging process to a new level. We’re looking at rejuvenating the immune system and sort of trying to help us in a more holistic way rather than just appearance. And it’s working, we’re figuring it out. It’s been decades of it, but we’re getting there. It’s really, truly so exciting.

Colleen – Well, I know you have a skincare line, which I’m about ready after this conversation, even after the conversation we had at the event, to go purchase. So everybody can check that out too on your website. But first and foremost, I would tell people to please follow you on Instagram. There’s so much information out there. And women have questions. They email us all the time with these questions. And I’m like, follow this person, check out that. And so again, you have two books. The most recent one is Rebooting the Biome, and then you have Beyond Beautiful as well. Like Bridget said, we could talk to you all day, but we know you have patience to see. So we thank you so much. We hope you come back and talk about this new exciting products that are going to be coming out. And thank you for everything you’re doing for women in our demographic. We really appreciate it.

Dr. Day – Thanks for having me. This was so much fun. I know I went on and on, but I love talking to you. And it’s just been great.  Thank you for having me.