unPAUSED with Dr. Mary Claire Haver - Menopause Skin Treatments: Botox, Lasers and Lifestyle

Starting point is 00:00:00 The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. So we'll get into skincare routine, but let's start with sunscreen. Okay. Is, you know, chemical, mineral, is it endocrine disrupting? Why are things banned in the U.S. and not in Europe? this is what fills my feed. Yes.

Starting point is 00:00:33 Okay. So, yes, this is truly my number one sunscreen, skin care ingredient. But sunscreen in general, there are chemical and physical sunscreens. Or you could call that organic and inorganic. And sometimes people call it the physical one mineral because they're titanium or zinc. But the way they work is chemical sunscreens absorb into the skin. And then they, you know, take ultraviolet radiation and convert it to heat. So that's the sunscreens that you need to apply 30 minutes before you go out because it has to penetrate and get into the skin to work.

Starting point is 00:01:09 The physical sunscreens are mineral sunscreens like zinc oxide, titanium dioxide. They basically lay on the surface. They lay on top and they scatter and reflect the ultraviolet light. The problem is chemical sunscreens are much more elegant. You know, they absorb, they feel better. They're not, you know, so white and sticky. But I think the physical sunscreens are getting a lot better.

Starting point is 00:01:34 They're more micronized. They're tented now, so they don't have such a white cast. And, you know, in general, the physical are just, they're better probably for sensitive skin. They're better for the environment. They have negligible percutaneous absorption, so absorption from the skin into the bloodstream.

Starting point is 00:01:51 So those are probably, you know, we recommend those more. But the bottom line is, I recommend the one you will use. So if I recommend some sticky sunscreen that you hate and you're not going to apply it, I'd much rather you apply one that you like and not burn, you know? So that's the main thing. That's my number one skin sunscreen tip is just, you know, use, wear the one that you will, you will wear. And then what about the

Starting point is 00:02:17 endocrine disruption worry? Is that real? So I don't know that that, I don't think that there's been studies that really elucidate that. There are studies that show we absorb the chemicals in our sunscreen, but there's studies that show we absorb the chemicals from everything. You know, we're just like, I mean, it's funny because it's hard to get some things through the skin that you want to get through, but those things seem to make it in, things in your shampoo and things in the environment. So I don't know that it's been that there is enough evidence to prove endocrine disruption, but what I always say is just cover what you can and apply the smallest amount of sunscreen.

Starting point is 00:02:55 And I usually use a physical on face, hands, and then I just cover everything else. Also, don't forget scalp. I think we see a lot of skin cancers on the scalp, a lot of skin canagers on the ears, the lower lip. Don't forget about these things. And one of the things,

Starting point is 00:03:10 if you're in a place where it's too windy, like here in Galveston, to keep on a hat, you can use a spray, or I actually have a translucent powder that I use on my part. So just don't forget. those areas. How can we convince our children to wear sunscreen? It's a good question. Mine were oh, so good until they became teenagers. But they're pretty good, again, I have to say.

Starting point is 00:03:35 The thing is, we don't want you to be a hermit. We want you to go out and be active and be in nature. You hike more than any human I've ever met my life. Yeah, you know, with my big hat, my long sleeves. But yes, I know. Your beekeeper outfit. Yes. But I feel like, you know, it's the evident. that ultraviolet light causes skin cancer is definitive. There's no arguing it. And ultraviolet light is officially classified as a carcinogen, so cancer causing. And, you know, it basically causes mutations in the DNA in our cells. There's a signature mutation you see, these permitting dimers, and it causes reactive oxygen species.

Starting point is 00:04:15 And I sometimes explain it this way. There is a genetic condition that these patients have one. mutation in one enzyme. And this is called zero dermopigmentosum. This one enzyme is the enzyme that repairs ultraviolet damage in our DNA. And they have a 10,000 fold increase in non-melanoma skin cancers and a 2,000 fold increase in melanoma with a one mutation. And so just to drive home to the point that we know it causes skin cancer and premature aging, but we don't want you to stay inside. You know, just don't get burned. Just go outside, you know, be active, but just don't get burned. Do we need sunscreen every day? I mean, I wear sunscreen every day. That's one of my tips is

Starting point is 00:05:02 always, don't look at the weather, just make it a habit, put it on. I mean, I just put it on my face and neck every day. I really don't put it on my arms. I get it. It's sticky. It's gross. I don't like it either. But I keep a sunshirt in my car, and when I get in the car, I just slip on my shirt backwards and cover my hands and up to my neck. So I'm probably a little more cautious than most just because all day, every day, I'm finding skin cancer and, you know, looking at- On me. So, yeah, hello, here's my confession. I was recently diagnosed with squirtemusel carcinoma on my nose and you took it off for me and it's going to be fine. But yeah, I'm, so, I mean, it's just, I think I'm probably a little more, you know, conservative with sun exposure

Starting point is 00:05:46 than most. Okay. The skin cancer that I had was cumulative and mostly probably related to sun exposure I had years ago. Yes, that's true. It is. And the skin cancer I have at 80 is what I'm doing right now. Yes, or probably also still what you did. Because you're probably good now.

Starting point is 00:06:05 Yeah, very good. It still kind of catches up with you. I'm just hoping, you know, we've had more years where we're aware than not. I mean, my poor patients in their 80s and 90s, they didn't even have sunscreen when they were kids, you know. I mean, you know, we just see so many skin cancers. And, you know, here in the South and I have all these fishermen and golfers. And so it's just a big part of my practice. Well, let's go through a skincare routine. Let's do morning and let's do night. So what are the non-negotiables? I wake up in the morning. What's my morning skincare routine? So I think a basic skincare routine that everyone could be doing is in the morning you cleanse, then you apply your antioxidant serum, then you apply. apply your moisturizer and your sunscreen. And honestly, you could combine those. There's some great

Starting point is 00:06:52 sunscreens that are in moisturizer. And I kind of think of morning as more your protect. You know, you're protecting with your antioxidant and your sunscreen. So in the evening, I think of it more as your treat. So you start with a cleanser. You apply your retinoid or retinol or whichever active you're using. And then you put your moisturizer on top of that. So I think that's kind of a basic skincare regimen that just about anybody can be doing. So what do you do? So this is embarrassing. They want to know. They want to know. And don't be afraid. Look, Erica is purely academic. She does not support any brands. She has no affiliates. So like, and she has access to the best in the world. What do you use? And she tries everything. Yeah. So I'm, I always am generally a very

Starting point is 00:07:38 low maintenance person except for when it comes to skincare. I can pack for a two-week trip and a carry-on, but I have to decant all my lichens and potions into little jars. So currently what I'm doing in the morning cleanse. So I have a variety of, I don't know if, you know, I'm Saravei, LaRes Pose. You don't have to spend a ton of, that's what you taught me. You don't have to spend a lot of money on a cleanser. On a cleanser, for sure. Sometimes I just use the miscellar or mycelor water.

Starting point is 00:08:04 Then right now, currently I am using an exosome product in the morning called plated. So exosomes are little nano-sized. vesicles that basically all cells secrete and they're used for intracellular communication. And so there's been, there's small studies on this. I think the ones that have the most robust-ish are the platelet derived ones. And they've been shown to upregulate, you know, gene expression for collagen and elastin. So I'm currently using an exosome in the morning, let that dry. Then it's supposed to go first. So then I apply my, antioxidant serum. Then I apply my estriol. Then I use an anti-glication eye cream, age

Starting point is 00:08:54 interruptor by skinciticals. And then my lotion, right, depends. Moistriser often use Sarovay PM. Sometimes I use the TNS serumide lotion by SkinMedica. I really like that one, too. And then my sunscreen, which is my favorite is the Istinted. So I skip one step. because it's tinted, so it dubs as my makeup. So that's my morning right now. Then my evening, I currently am using a product very first thing after I cleanse called RECU. This is a brand new thing.

Starting point is 00:09:29 I don't even have much evidence. I don't have any of the white papers yet. But the way they market themselves is as a skin longevity topical. and it works somehow on the mTOR pathway, kind of like rapamycin, and it's supposed to like wake up your tired fibroblast. I don't even know if my fibroblasts are tired yet. I just went through my inopause last year, but I'm currently trying the recue. And then I use my tazeratine, which is my retinoid, every other night. So on the other night, I use the TNS advanced growth factor serum.

Starting point is 00:10:06 And then I cut then my eye cream and then my moisturizer. And sometimes I use a thicker moisturizer at night and something really thick on my lips. Do you take any supplements specifically for skin? I take a ton of supplements. I'm not really taking any of them specifically for my skin, I guess. But there's definitely evidence that, well, we need vitamin C. That is a co-factor in the production of collagen. So we do need vitamin C.

Starting point is 00:10:34 The studies have shown you actually get higher concentrations of it topically. also omega-3s have been shown to help with, you know, inflammatory skin conditions, inflammation in the skin, and also help with hydration. So, yes, I... What about collagen? So collagen, I... This is one thing that I think I have changed my mind on over the past couple years. So I used to be like, I mean, it's a huge molecule.

Starting point is 00:10:59 It's not going to make it across the stomach and get to your skin and or it's going to be broken into just all of its amino acids. So you might as well just eat protein. but it turns out that there are studies that show benefit, like significant improvement. And it turns out that there are dye and tripeptides that do make it across the gut. And that have been found in the skin. So, you know, there was a large meta-analysis in- Came out this week.

Starting point is 00:11:25 Oh, really? I didn't see that one. Yeah. I'll send it to you. Okay. But one in 2023, kind of when I, you know, first really started to say, hmm, I should probably be doing this. But that was a meta-analysis of like 26 different randomized controlled trials, like over 700 women. And no, that was more than that.

Starting point is 00:11:44 It was like 1,700 that, you know, basically showed significant, statistically significant improvements in all parameters, mostly hydration and collagen. This study showed the same exact thing. And it was like 16, but they had like 7,000 patients. Yes. So. You know, then there was a. another meta-analysis in 2025 that sort of questioned some of the studies that were included. So were though, you know, they considered some lower quality or industry funded.

Starting point is 00:12:16 And so they said when they removed those, that the improvement was removed. I think overall, I mean, I can't say definitively with the evidence we have now, but I think that the body of evidence we have does trend towards benefits. Okay. You know, my thing is that I only drink water. And like anything in it, no flavorings whatsoever. So I'm like, somebody please put it in a capsule. It'd probably be 15 capsules, but I'm okay with that.

Starting point is 00:12:43 I've seen your supplements, Jack. Yes. We travel together. But yeah, you have thyroid and other stuff. Okay, let's talk about treatments. Lots of questions coming in from my followers wanting to know about professional treatments versus using just skin care. So I think it depends on your concerns.

Starting point is 00:13:02 You know, it depends on your concerns. It depends on your appetite for downtime or your tolerance of downtime. Costs. And finances because, I mean, a lot of this stuff is expensive. So I think everyone could be using at least a good skin care regimen. And then we just kind of take it on a case-by-case basis, you know, from there. So say someone comes in for an aesthetic consultation. One of the first things I do is just to hand her a mirror and say, what's bothering you?

Starting point is 00:13:30 What do you notice? So we start there. And then we talk about the, I would say the four R's. So that's relax like you would do with a neuromodulator like Botox for, you know, muscle, you know, overactive contractions of muscles. Refill. So that's when you have volume loss and we're using fillers. Then there's resurface. So that's kind of more superficial on the skin surface like that could be anywhere from skin care to maybe peals, lasers, microneedaling.

Starting point is 00:14:00 and then there's re-drape, and that's surgical. So that's when I refer to my plastic surgery colleagues. Where do lasers fit into all this? So say someone comes in and their main complaint is superficial discoloration, unevenness. They're getting brown spots or getting dilated blood vessels. That's sort of a perfect scenario for maybe a package of IPLs or BBLs. And we can talk about laser types or someone comes in more with etched-end lines. on the surface, you might want to use a resurfacing laser, or you may come in with volume loss,

Starting point is 00:14:35 and then we talk about fillers, or some of my, you know, darker skin types that may hyperpigment from energy-based devices, then we can offer microneedling. Or, you know, if it's muscles of facial expression that are causing the dynamic lines, then we talk about neuromodulators, Botox. So you can think about lasers in kind of maybe simplistically like three broad categories. How aggressive can can you be in menopause with these things? So a couple of things I adjust in menopause. One would be, since we're talking about lasers, one would be the depth of penetration of the laser.

Starting point is 00:15:12 So for instance, if you're using a non-ablative laser like fractal, the fluence, basically, the joules per centimeter squared is what dictates the depth of penetration. So I may just dial that down a bit because the skin is thinner and I want to target like the upper and mid-dermis. that's one thing I adjust. One of the important things to adjust in postmenopause is the delivery of toxins or neuromodulators. Oh, really? Yes. So you only have one, this is the main thing, I think, you only have one muscle, the frontalis muscle here in your forehead, that elevate your brows.

Starting point is 00:15:50 So as we age, we get a little lexity, you know, there's a little, the brows get a little lower, the upper lids get a little lower. You only have that one muscle that raises your brows. So this is also a time period where people will start to notice more of these horizontal lines on the forehead. And it's for a reason. It's so you can see better. So you're trying to open up your eyes more and you're activating that frontalis muscle. If you walk into the van that's doing Botox, they'll Botox it for you, but then you won't

Starting point is 00:16:20 be able to see for a while. So you have to be very careful with the forehead. It can be done by very advanced injectors. you have to be very conservative. What I do like to make sure I include are all the brow depressors. So the proseris and the corrugators and the depressor superciliae. And then over here, I guess people can't really, some people can see, but over here, the crow's feet area, that's cervicalis oculi. All of those muscles pull the brows down. So I do like to weaken those. So they basically kind of float up a little bit. I use the analogy of like a helium balloon. I just let out a couple millimeters and they float up. So I, I, I, I think you have to adjust your Botox with time. So you mentioned that the Botox in a van. You know, if someone is listening to this and interested in these procedures or the lasers, what should they look for? Like, you know, do you want to go to the guy on the corner who has one laser?

Starting point is 00:17:14 You know, do you want to go to a big multi-specialty practice that has 10 lasers? Like, like, how do you ensure that you're going to have the best results possible as safely as possible? Right. I think that's really hard to figure out. I feel like it ends up being word of mouth more than. than anything, like people that have had, you know, successful treatments. What are red flags to look for? Well, I think it's, you know, most of these are best done in the hands of dermatologists and

Starting point is 00:17:41 plastic surgeons, you know, I know that some plastic surgeons, maybe even some germs delegate, but as long as they're, you know, supervised by a physician, I think a lot of, you know, med spas, there's no one, there's no one on site. And even if they have a physician's supervisor, or it might not even be a specialty that is trained in these things, you know. Yeah, I think it's tough. It's really tough for the consumer because it's kind of the Wild West out there. Like anybody can do a weekend course and then buy a device and it's hard to know, you know. So what are big red flags, though?

Starting point is 00:18:17 I mean, I think a red flag is if you have no physician involved, you know, I would want to know credentials. I would want to know numbers. And, you know, do they know what to do? there is an adverse effect, you know, because we get all of those. Yes. So how often do you see complications from other people's procedures? We do a bit. I mean, you know, Galveston's a small area, probably not as many, you know, places around here.

Starting point is 00:18:40 But within our dermatology groups, you know, we all see a lot of these adverse effects. I mean, the worst thing that can happen with Botox, you know, you might make someone look funny for a bit. You know, they'll have the spocked brows or, you know, heavy lids or something that looks unnatural. what I really worry about are fillers. Because fillers, I mean, there are deleterious effects. If you don't know anatomy and what you're doing, I mean, the worst possible outcome with a filler is you get an arterial occlusion. So that I worry much more about. I'm like, definitely do fillers with, you know, in a qualified practice with board certified dermatologist or plastic surgeon. Let's talk about Botox. When is the right time to start? So what is baby Botox? So if you're going to start at all, I think the right time is probably before you have the etched in lines. I think you can have some depressions. Like sometimes in between the brows, you know, people will start to develop a little bit of a little gully.

Starting point is 00:19:38 That can go away, you know, when you start to do Botox on a regular basis because that's more, you know, muscle hypertrophy. And as it atrophies, that can smooth out. But it's much harder to get those little etched in on the surface lines once they're etched. So I would say before that is probably a good time. Baby Botox, I don't like to call it that because it sounds like we're doing Botox on babies. But I call it micro-Botox. But it's honestly how I do mine. This is a couple of different things.

Starting point is 00:20:06 It's either just lower doses or some people call micro-Botox when you're just doing really diffuse, like intradermal injections for skin, you know, texture and oil production. And that's not a very common way to do it. I think usually what people are talking about is lower doses. So where you still have movement in your face and you have facial expressions, but, you know, you're not, I think when we very first started doing Botox, like back in the, you know, in 2000, it was higher doses. And, you know, people looked more frozen. And I think we've really, you know, our technique has really come a long way in the past, you know, 26 years. You Must Remember this presents The Bisexuals. Libby Holman was a sexually fluid blues singer who became famous in the 1920s, and then infamous

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Starting point is 00:21:25 There probably is a time that's too late. I'm picturing, I'm picturing some consultations. I mean, if you have a lot of laxity, you know, sometimes there's just so much laxity that the skin just sort of bunches up here, you know, in the crow's feet area and in the glabella area, that area between your brows. And you're not going to get enough lift from the Botoxy. to make that much of a difference. So I do think there is a time period that sometimes it just doesn't really do very much for you anymore.

Starting point is 00:21:56 But you kind of have to take it on a case-by-case basis. I mean, I have some patients that, you know, they're in their 80s and they look like they're 60 or, you know. So it just depends on each individual patient. That's actually saying that reminded me. One thing that I notice in my practice, and this is just anecdotally what I notice in my practice, if I have a woman that comes in to see me who is in their 70s, 80s, 90s, that looks, her skin looks really good for her age and there's like not a lot of sagging, I always ask and usually discover that she was placed on hormones at menopause, and I can notice a difference

Starting point is 00:22:33 and then maintain them or at least was on them for years. And, you know, you notice a difference in clinical practice between, because I see a lot of patients that went through menopause, pause before 2002 when, you know, prescriptions really drop the prescription percentages off. With everything we've talked about, does this apply to the body as well? All of these same things are happening. I think with the body, the difference is the photo protected sites often show a more pure, like intrinsic aging pattern, like the thinness, kind of the crepey tissue paper, the easy tearing, easy bruising, dryness, as opposed to.

Starting point is 00:23:14 to the exposed sites that also have all the dyschromia, so the brown spots and the deeper wrinkles and the pebbly elastosis that you see kind of on the photo-damaged skin of the face. But it's happening everywhere, and it's most pronounced, actually, in the vulva vaginal area. Yeah, that was my next question. You use a lot of topical estrogen. Thank you for your service, by the way. You're not scared to look at the vagina, the vulva. No, no.

Starting point is 00:23:41 What about high ironic acid, moisturizers? Do you ever recommend those, prescribe those? So this, the vaginal moisturizers were new to me. I don't know if you remember earlier this year. I listened to a podcast on female sexual health. And then I text you, you know, I was like, wait, are we supposed to be moisturizing or vaginas? I'm like, no idea. I think this is not on most dermatologist radars.

Starting point is 00:24:05 I mean, I texted all the females in my department, and they were like, what? So this is not something that we learn. Do you think that you should? So I, you know, vaginal estrogen first and foremost, right? But I think every woman should consider a lubricant in menopause, even with vaginal estrogen. You know, vaginal estrogen is not a lubricant. And like, it's just the friction coefficient just changes so much. And there's, you can never replace your 25-year-old vagina.

Starting point is 00:24:32 You're still aging, right? So I love a lubricant. Lubricants are oil or silicone-based and just just are thickness for friction. to decrease friction with activity, okay, whatever that is for you. But a moisturizer is basically high ironic acid for the vagina that just pulls water in. And, you know, for patients who are just chronically dry outside of intercourse or with, you know, but for that everyday dryness, and it lasts a long time. So you can put a moisturizer, you know, high erronic acid in whatever form in,

Starting point is 00:25:02 and you will get protection like for 24 hours. And so they just are much more comfortable. they have less chafing. And so, you know, if that's what your patient's complaining of, I am recommending it. Okay. Good to know. Good to know. So, yeah.

Starting point is 00:25:16 I'll share it. So lubricant's different than a moisturizer. Yeah. Okay. Is it ever too late to start protecting your skin? No, I said it's never too late. I mean, you might not be able to reverse the damage you already have, but you can at least stop accumulating more. Because that's the problem is the accumulation.

Starting point is 00:25:32 So whenever you can stop, and you may be able to reverse some, but at least stop accumulating more. Does what you eat, impact your skin? Yes, and unfortunately sugar is a big one because you know how I love it. So sugars, refined sugars can cause glycation. So they will bind to the proteins in our skin and make them more stiff. That's the Mayard reaction. That's like when you brown a piece of meat or when you apply yourself tanner and it turns brown, it's that same reaction. And it makes the collagen fibroids more stiff so they can't, you know, form their triple helix like they should. And so it stiffens elastin and collagen and it kind of causes a yellowing of the skin and just kind of more that

Starting point is 00:26:15 salowness. And, you know, diabetics are sort of the prototype of this. In fact, for years, the skin aging model in studies was to use diabetics. Although my mom looks fantastic and she's done. But anyway. So, yes, for sure sugars can. What's the best diet for your skin? I mean, you know, just in general, a healthy life. I don't know if there's a best diet, but I think, you know, exercise and prioritizing sleep and eating right and whatever simple limits you may need do show through on the surface. But I don't know that there's a specific diet. How important is sleep? Sleep is very important.

Starting point is 00:26:54 I mean, sleep is important for so many reasons, but even for the skin. So probably one of the most obvious reasons is when your sleep is disrupted, your cortisol increases. And when cortisol increases, you produce less collagen, you have more inflammation in the skin, and actually can alter your barrier. So I think that's probably the most obvious. There's also less well-known, but we actually have a circadian rhythm in our skin. Really? Yeah. So they've recently discovered opson cells in our skin, which are like the ones in our retina that set our circadian rhythm.

Starting point is 00:27:26 I don't think we know yet exactly what they do, but it's pretty fascinating. Well, on that topic, do you think there's any benefit? of red light therapy for skin? I think so. I think that there is benefit there. The most benefit is for hair growth, actually. Really? Yeah.

Starting point is 00:27:42 So there's a most, there's a lot of studies for hair growth and more and more that come out all the time. So I actually do recommend that on a regular basis for people with endergenetic alopecia, which was the female pattern hair loss. And I think that, you know, there's also pretty good evidence for wound healing and a little bit less so but still so for kind of skin rejuvenation and somewhat for acne. It's a little more short-lived for acne because it targets the bacteria and they just come right back. But there's science behind it. I mean, it's called photobiomodulation. And what happens is light in the red wavelength

Starting point is 00:28:19 and the near infrared wavelength stimulates the cytochrome C oxidase and the mitochondria and just basically makes you produce more ATP. So I think I think about it like adds a little energy to your cell's battery. Also causes vasodilation, so brings more blood flow to the area and decreases inflammation, too. So sometimes people use red light after another laser that causes a lot of inflammation that you can kind of calm it down faster with red light. Do you have red light at home? I don't.

Starting point is 00:28:51 You know, I probably will get one, but I do have one. I have the HairMax laser band from my hair, and I've had that for years. What do you do for your hair? I think a lot of questions on hair loss. Yes, we see a lot of hair loss. Just happens, you know, it can happen way before menopause, but accelerates after menopause. In fact, after menopause, so at 50, studies show that 50% of women have some degree of antigenetic alopecia.

Starting point is 00:29:19 At 70, 70%, and over 80 virtually everyone. So, you know, we don't die with the same amount of hair we had when we were 20. No one does. But, you know, what I do typically you can use. So one of the reasons for that is estrogen stimulates aromatase activity in the hair follicle. And that converts testosterone to estradiol. Well, when there's estrogen's not there anymore, there's more testosterone available to be converted to DHT, which is the stronger testosterone. And that DHT causes miniaturization of the follicles.

Starting point is 00:29:56 So there's three growth phases of hair. The antigen phase is the one you want to prolong because it's the growth phase. So hair grows longer and of a bigger diameter. And testosterone shortens anogen phase. So that's one of the reasons this is happening. So one of the ways you can treat it is with a 5 alpha reductase inhibitor, which is like finasteride or dutasteride. But really what's becoming the favorite is low-dose oral monoxidil. I'm taking it.

Starting point is 00:30:25 I'm taking it too. So it's basically this was an antihepretensive, a medicine for blood pressure, and, you know, at a lot higher doses. And everyone who was taking it was getting really hairy. And so some smart person said, hey, why do we put this in a liquid and apply it to the scalp? And that's how Rogaine was born. Which Rogain works if you apply it. So it's effective. And the hair math is a lot. Yes. Yes. So it's effective in studies, but the efficacy is not as good because in the real world people, aren't applying it twice a day. I played it one day and I was like, no, that's it. So I think that it can work, but we have come full circle, basically, and now we use monoxidil orally again in low doses, enough to stimulate hair production, but not so much to lower your blood pressure and make you really hair. Now, you will get some unwanted hair that shows you what's working. You get a couple on the chin around the hairline or eyebrows. People notice, yeah, nose, forearms. So you do get some unwanted hair growth, but you just have to be okay with that and just pluck them. And, you know, you will get a shed.

Starting point is 00:31:33 This concerns people a lot of times. In the first couple months, you will shed hair excessively. And that's actually a good sign. So wait it out because that means it is transitioning the hair to the antigen cycle. So the tealogen hairs are the resting phase. It's going to kind of fall out. The tealogen and then transition over to anogen. So wait and, you know, don't stop.

Starting point is 00:31:55 It's going to stop after about two months or so. And then you'll start to notice some improvement maybe around six months or so. Okay. So you have to be in it for the long game. You do. Anything that you do for hair, you have to do forever. I'm like, do it as long as you care. And so back to what do I do?

Starting point is 00:32:10 I have the laser helmet. It's not a helmet. It's really a band that has teeth in it. So it kind of gets through your hair. And then I'm taking oral monoxidil. And I occasionally inject two testosterone. Okay. Oh, I didn't know you could do that.

Starting point is 00:32:25 I know they have it topically. You had actually like tried something and like gave it to me. Yes. And it was monocidyl deer phanasteride in one other ingredient. Yes, because I don't like applying anything to my scalp. No, I couldn't stand the stickiness and whatever. I would rather have 50 shots. Injections.

Starting point is 00:32:45 Okay. So what is the number one thing we should all start doing for our skin? I mean, if I can only pick one, I have to go with sunscreen. Okay. Nothing touches that. What's the number one thing? we really should avoid for our skin. I mean, keeping in the vein of sun protection, I would probably say, you know, unprotected sun.

Starting point is 00:33:05 You know, we want you to get sun, but just don't burn, you know, just kind of maybe avoid the hottest times of the day or when your shadow is shorter than you are and just throw on a hat. But it's okay to get a little bit of sun. Just don't burn. All right. Walk me through the Walgreens here in Galveston. Like what products would you pick out? Like what would be a good cleanser? your vitamin C, like in your regimen.

Starting point is 00:33:31 So what do I recommend the most? And I write things down all day every day. So I oftentimes start with a cleanser. I recommend Sarave. I love Saravei in general. You know, the face products, the body products. I love La Roche Pose. By the way, there's even better La Roche Pose.

Starting point is 00:33:46 You know, sunscreens in Europe when you're there and pick up some of those. But so often, you know, either of those cleanser, sometimes just the miscellar water, I use the Saravee PM for my moisturizer. Nutrugina makes a lot of great sunscreens. I often recommend to my dry patients that just sort of aren't, the skin's not turning over well anymore. They're super scaly and dry. I recommend a lotion called amylactin that has lactic acid in it. That is basically helps to chemically exfoliate those cells.

Starting point is 00:34:20 But I usually want you to apply that and then apply another moisturizer on top as your barrier that will kind of, you know, create, reseal that brick wall. So oftentimes I'll have patients do two steps when it comes to that. Another thing I recommend a lot for the body, you know, all day, every day. I have patients asking me about bruising. Everyone starts to bruise so easily. And usually, you know, there's not a ton you can do, but what I typically recommend is either a retinal body cream so you can kind of start to try to build some collagen there. and one I typically recommend is Dermand Fragile Skin Formula. There's a couple of others that have retinels in or maybe Bucciol or something.

Starting point is 00:35:05 And then another thing I recommend to those patients is there's a supplement, back on supplements or a couple of other niche ones that I recommend. And one is citrus bioflavenoids. So specifically the rutan in citrus bioflavenoids has been shown to strengthen your capillary walls. So a combination of maybe using a retinal. and, you know, the oral citrus bioflaminoids can help with the bruising summit. Well, Dr. Kelly, thank you so much for coming out on Paused. Thanks for having me. I've enjoyed it. I love the new studio. You can watch full episodes of this podcast on YouTube at Dr. Mary Claire.

Starting point is 00:35:43 You can also find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com. Unpaused is presented by Odyssey in conjunction with good roommate media and long wave digital.

unPAUSED with Dr. Mary Claire Haver - Menopause Skin Treatments: Botox, Lasers and Lifestyle

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