Well with Arielle Lorre - 384: Ask the Derm: All About Exosomes, PRF, Salmon Sperm, Face Taping & Procedures We Should Reconsider with Dr. Sheila Farhang, M.D.

Episode Date: April 16, 2025

Dr. Sheila Farhang is a board-certified dermatologist and double-fellowship trained cosmetic surgeon as well as a reconstructive Mohs micrographic (skin cancer) surgeon. She is also the host of the Derm Approved Podcast. She joins the show for an “ask the dermatologist” episode where she answers your most pressing beauty questions including what lasers to use when, the truth about tretinoin, whether we all need topical estrogen cream, how EZ gel works, whether exosomes are worth it, all about salmon sperm, and whether botox is the end all be all for anti aging. She also shares the surprising trends and procedures she does not support and we do some beauty myth busting.This episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.Visit openphone.com/BLONDE for 20% off 6 months. Visit masachips.com and use promo code BLONDE to get 20% off your first order.Go to prolonlife.com/BLONDE for 15% off their 5-day nutrition program. Visit oneskin.co/well and use code WELL for 15% off your first order.Go to nutrafol.com and enter BLONDEGIFT for $10 off and free shipping when you subscribe.Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So go to your Reisadviseur Orsonicars. The following podcast is A Dear Media Production In a world of ever-changing wellness trends and information, what does it mean to truly be well? I'm Ariel Lorry and I'm going to explore this with you. I am bringing you candid conversations that will equip you with everything

you need to live your best life and look good doing it. Think of well as your go-to resource for all of the latest in wellness and me as your internet bestie. Well, let's get into it. Hi, everybody, welcome to the show. I have such a fun episode today. because we are talking all things, beauty and aesthetics. So I am talking to Dr. Sheila Farhang. She is a board-certified dermatologist and double fellowship trained cosmetic surgeon, as well as a reconstructive mo's micrographic surgeon. That is skin cancer for those who don't know. She stands out in the dermatology space as she has expertise in both integrative skin care and cutting-edge procedures. She has authored numerous publications in top dermatology journals.

She's written textbook chapters. She has been invited to present her research internationally. She's also a principal investigator for dermatology clinical trials. She is a media expert. She is also the host of the Darm approved podcast here on Dear Media that I was on recently, so you can go back and listen to that. And we are talking all of the beauty and aesthetic things. And I had you guys send in questions for this episode.

It's basically an Ask the Dermatologist episode. But we cover so many different topics. So we discuss things like the trends that she is against. We do talk about Botox and what it can and can't do and who it's good for and who it's not good for. She has some hot takes about things like exosomes and salmon sperm and blephroplasties and all of these very trendy kind of buzzy keywords that you're hearing in the beauty and aesthetics industries. And her hot takes are definitely going to surprise you. We also it into lasers. So this is a huge area of interest for you guys. We talk about specific lasers for which concern. We talk things like easy gel, estrogen cream, trinone, trintonone alternatives. She has really great specific recommendations. So make sure to check the Well Instagram. It's at well.com. And we always put together collages and link everything that is discussed in the episode. And it's just such a fun episode for the girls and the guys. so please enjoy Dr. Sheila Barhang.

Welcome. Hi. I just did an episode on your show, so everybody can go check that out. I don't know if they're going to be coming around the same time, but I thought it would be really fun today to do an Ask the Durham episode. So my audience is very into skincare beauty, but they also like the science behind it, and you're the perfect person to talk to about all of this.

So before I get into listener questions, I just wanted to ask you if there are any skincare, dermatology, beauty myths that you see out there circulating that you want to debunk. Okay. So first, thanks for having me on. We just had a great session on Derm approved. So I know we're going to have some great little chat here. So as far as skincare, you know, as at Derm, I will say I'm not like a heavy skincare girly. I have like my basics. I know what works well from a scientific standpoint, but I think that, okay, skincare like one peptide over the other. I think everyone is so different.

And we were just saying like, you love the dewy look. I love the matte look. So just because one product works for one person doesn't mean that it works for the other. So as far as like skincare trends in general, people are going to come for me on this one. I love hypochloric acid spray, but it's like an SOS, right? So basically hyperchloric acid is like Tower 28, if the other brands have it. And everyone's going in and they're like dousing themselves with this hypochloric acid,

which is technically like diluted chlorine that decreases like bacteria, helps with redness from rosacea. But if you have like perfect skin, and I'm glad I didn't hear it in your skincare routine because you do right now, I think have very well balanced skin. You're not dealing with acne as much. You have decreased the redness. Your pores look great.

So I think that you wouldn't, someone that I would be like you need to like hypochlorous acid yourself so everyone's like so on this train of hypokloric acid but I think over time for perfect skin or like non-damaged skin it's gonna like mess up the pH decrease the good bacteria as well and just like set off the microbiome so I think that with anything good bad can come from it and we know that with skincare but I like don't love that everyone's using just hypochloric acid will and nilly yeah interesting yeah hot tip Yeah, I see it all over the viral four-second videos of spraying the hypoploric acid. Yeah, like after working out or if you have acne or rosacea, fine.

But if you have like no skin concerns and that Tower 28 does say like SOS, like save our skin, if you don't need skin saving, like why use it? I've only ever used it on my eyes or on my eyelids. Yeah. So after the whole Botox incident, I was super sensitive to certain things and I kept having this irritation where my eyelids were like really puffy, swollen, couldn't figure out if it was from my skincare or something was irritating it. So I would wipe with hypochloric acid every night. You know what? It might have been from that dry eye that you had. My sister's an eye doctor.

She's actually, if you know anyone with dry eye, she is like a celebrity practice here in Beverly Hills. Literally all they do is dry eye stuff. And they see so many patients like debilitated from like just like dry eye and they go through like radio frequency like all this stuff. But hypochloric acid is like huge inner practice. It was the most debilitating thing. I mean, that whole experience was debilitating each symptom in its own right. But I always heard about dry eye, never thought that it could be so incredibly painful, so debilitating. And I have so much compassion for people who deal with that chronically because it was like, and it's your eyes. There's no way to kind of mentally escape that. You know, it's just you're, you're consumed by it 24-7 and it was so hard. I couldn't work. I couldn't look at my phone. So, wow. If you have dry eyes, go see what's her name? Dr. Parissa Jalalot. Yeah. It's called the Beverly Hills Optometry Office. But yeah, it's insane how, I mean, you can get dry eye just like genetically. You can get it from Rosacea. You can get it from LASIC back in the day if you had it or just like anyone can get dry eye from LASIC. It's like in the fine print. I almost got LASIC and now I'm so glad that I didn't because I'm like,

Like, I would be that person. Oh, God. I am the side effects person where I can't do anything. And that would just be so difficult. Okay. So I asked my audience on Instagram questions for you. They are definitely all over the place. But I tried to compile the ones that we were seeing most frequently.

So I think it's only appropriate, given everything, to start with Botox. And I've seen your videos where you've said, like, not everybody needs Botox. And you have a little bit of a different approach to Botox. And you've even said it's not anti-aging, which I think is very shocking for some people to hear. So let's get into that first. And then we can talk about some alternatives. Totally. I love that you bring this up because, number one, you're right.

I do agree that. And I would say most dermatologists and ejectors would agree that it's not anti-aging. anti-aging in the sense that it's not actually reversing the lines. It's not going in like microneedling or lasers or your retinoid or peptides actually going and reversing those lines. What it is, it's preventative. So it's basically what neuromodulator. And we're going to call it Botox, but it's like Botoxium and all the things.

It decreases that channel, blocks that channel between your muscle and your nerve. So then your muscle is relaxed. It's not making that movement. So in that time, yes, it does help relax that muscle. so those fine lines do disappear. But what it also does, it helps decrease that movement. You already know this, I know, but decreases that movement. So you're not getting those dynamic lines where you see those lines when you're moving, turn into static lines where you see those lines when you're not moving. And that is usually the time when I tell people if you're interested in getting Botox done,

it's whenever you see those static lines. So those lines when you're not moving. So the thing about it is it's just preventative in that nature. I know you not having done it for like over a year. here now, you don't have a lot of set in lines. And it could be just because you're not expressive. And that way, I'm super expressive. But some people, I would say a lot of the reason why you don't have a lot of those lines is because you did do it for 10 years and those lines that haven't really set in. So I think that neuromodular like Botox is so great. It's great for lifting. It helps with fine lines. People feel good having it. And there's a lot of studies that people get more interviews. Not saying that you need this, but people just perception of you.

look better because you're not as mad or you look brighter and you like look how you feel. But I think it's not for everyone because number one, people like you, like I don't want you to feel like you are just like doomed and like you felt right after not being able to get it. Like, oh my God, I can't get my Botox. I'm like going to like age so rapidly because I think it's great. I think it's wonderful. But it's not like the only thing, right? I think the way it works is really interesting and there aren't that many things like it,

even if skincare products call it like Botox in a bottle. There's nothing truly like Botox, especially not in a bottle, at least not what we have now. The reason why I don't think it's for everyone is because my mature people who want that lift of their eyebrows, I will inject between their eyebrows to get that lift of their eyebrows because the counteracting muscle, which is in their forehead, will overcompensate and pull up. But a lot of people, if they're getting that muscle injected, they're going to feel heavy. And I'm sure a lot of, I don't know if you ever felt heavy from any neuromodulator like Botox injections, but most of the time when people have a bad experience, especially like mature.

And I'm talking like, like 50 plus, they will come in and they're like, I, Botox is not for me because they had a bad experience. So I think number one, it's not the only thing. There are other things. There are other things. And then number two, just because someone got injected in their forehead doesn't mean that you need to get injected in your forehead because your goals are different. Your aging is different. Is there anything coming down the pipeline? I mean, there's got to be something that somebody, some scientist out there is working on that's like the same. Sure.

The same effect produced, but not bodulin toxin. I know that there are topicals and we talked about PTOx and that's supposed to have like wrinkle modulating peptides. obviously it's very different from something that's injected directly into the muscle. I know that there are ingredients supposed to inhibit movement, but that's how topical. So the amount that's actually getting in your muscle, who knows. Exactly. Even like injectables, I know you talked about the salmon sperm and I've talked about it a lot of times. It's the polydeoxy ribonucleotized, the PDRN, which very injected superficially, it's those building blocks of DNA, but is actually going in and decreasing that muscle.

No. there are new toxis coming out but they're all botulin toxin A Latibo or something Oh I don't know that one Yeah it's the biggest one in South Korea

I think it's approved in Europe and Canada right now The thing where I'm like I don't know about that It's gonna come out as like The most affordable Oh So it's gonna be like

$6.8 unit I don't know Yeah I know Versus that's like usually our cost For Botox It's like $6.8 So It's like are they cutting corners?

Yeah. Like, why is it less? Or is it just the technology is, it's like less? I don't know. Because technically Botox is the most, well, Daxify is the most expensive and then Botox and then some of the other ones. But there's myoblock, which is botulinum toxin B. Right.

But that's like for medical purposes. Yeah. Yeah. But I know that some people who have. I know. I know somebody in New York who does it. I obviously have not tried it. Right.

I'm like so trepidious. I mean, it's just. It's just the last thing I'm going to do right now. Yeah, yeah. But I know that it's only cleared for medical purposes, but I do know that people who have developed Botox resistance have used it. Sure. And it has worked.

So it seems to the antibodies react differently, maybe to that different protein. Yeah, exactly. And I think even before like going in the myoblock, trying a different neuromodulator, so changing from Botox to something like ZMN or Daxify, they don't have those accessory proteins, they're different, so your body isn't able to attack it and decrease the immunity is like a better first step. From the stress of life's changes to busy schedules, postpartum, or menopause, your hair goes with you through it all and hair thinning and shedding effects more than just our hair.

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Because it's just we don't know what we don't know. Another controversial topic is I'm like not pro exosomes. You know, it's not FDA approved. I still haven't found a really good product that I trust. So right now I'm like, let's use patients like stem cell and growth. factors and things like that before we go into like a lab-derived exosome. My opinion on that will change in the future. I just think it's so young right now that I don't trust any companies where I think it's like reproducible. I think that it's not FDA like approved. So it's in my head,

it's like crypto right now where it's like people are down with it, but it's not backed by government. It could be really amazing or it could be terrible. And that's exosomes or PDRN or both? Both, honestly. No, PDRRN is a skincare. It's fine. but like mostly exosomes. Hmm. Yeah. Even for things like microneedling and then putting exosomes. Yeah.

Because like is like what's the reaction? What are the preservatives in there? Like is that supposed to go really deep? I know some people do it and there are some germs that lecture on it. I just lectured at one of our derm conferences on liposuction and there was a whole lecture on exosomes. And sometimes there's like a debate too because one derm is like all for it and then the other one isn't. And then you are like, what if there's this like X factor because some people are like exosomes for hair regrowth? And I'm, I don't do that. I do PRP. But did it really help because of the exosomes or did it really help because you're doing like little micro injections to the scalp? And then there comes like a whole cascade of wound healing and growth factors to help from the injection. So it's like really hard to like causation versus correlation. Yeah. Interesting. Tell us about lipo. Oh, lipo. I love lipo.

What do you love lipo for? So the cemental area. Okay. Yeah, I think it's perfect for people who genetically hold a little bit of adipose tissue there, so like a little fat there. Genetically, they just have a weaker chin and jawline. I think it's like the biggest, it could be, it's like low risk. Of course, we don't want to, I don't want to do it on someone who's like a facelift

candidate, so a little bit more mature, but I'll still go in and liposuction their jails, and then I go in and I tighten the skin afterwards. So I will do it on like people in their 40s and 50s as well. But I think for my patients in their like 30s, 40s, it's like perfect, perfect, even in their 20s. And I have a lot of the non-surgical things too. So there's injectables like Kebela, which love, hate relationship with that. Tell us why. Well, with something like Kybella, number one, the downtime rate.

You're like bullfrog for at least a week. I don't think it gets rid of that much fat. I think in male patients, we see a little bit more result. And I think you have to look into, is it causing skin laxity there? Is there enough inflammation there to actually tighten the skin? And I don't think it does. And it's so expensive. So like a lot of our injectables, lasers, they cost us a lot of money.

So we have to charge a lot of money. So, you know, one vial of Kipella can cost $700. And if you get two, that's $1,600. If you do two sessions of that, that's a lip-case. Right? So why not just go in there and suck the fat out? downtime is like a day, although you do have to wear the wrap and you're like good to go. So I think that's why I'm like a huge advocate for life.

Of course, it's still a procedure. It's sterile setting. Someone has to drop you off, pick you up. But it's very similar to a bluff, which I know everyone's talking about now. And it's like super trendy. She made a face. Why don't you like a bluff? I think that people are like going into it sooner and not giving it a second thought because it can

change your, and I'm like trained on doing blefts in my cosmetic surgery fellowship. I just don't do them enough. And so I don't offer them because if I'm going to do something, I want to be like the best at it. And same with like if you're going to go and get a bluff, make sure. Really, it's an oculoplastic surgeon. So that's like a specialist in eye surgery. Or you can see a plastic surgeon who does them all the time, like every day or at least a few a week because you don't want to go to a plastic surgeon who does them once a month. Yeah. So that's, and you wouldn't know that because they'll have a few before and after it's up there and what are you going to do? Like, how many of these do you do? Like, it's kind of intimidating asking your surgeon that, but, you know, they should be their own advocate.

And if someone looks like they're the eyelid surgeon, so blephroplasty for people who don't know is like when you take the extra skin above the eyelid usually. And that's genetically, you can get somtosis there, which is drooping or just over time people are just like a little bit more hooded and then if they age and they're well into their 20s, 30s, 40s, it can look a little bit more. I think that it's just becoming so trendy that people are going in there first and if they're not going to the right person because you had one, right? Okay. And we'll chat and I think yours looks great. Thank you. I think that people are do agree like people are kind of like rushing into it. I think. I feel like it's the trendy surgery right now. I feel like every year there's something different. Yeah.

I mean rhinoplasties, I know there's still very popular but lip-lift that was a thing yeah like every year it just seems like there's something very trendy and like sculptra is super trendy and that's not to say that they're not good but it's like are you the appropriate candidate that's what i think you're saying like people are just rushing into it because it's like oh everybody's doing it and it is as far as like invasive procedures go a blephroplasty like it can be a little bit less invasive it has a pretty quick recovery time but it's also your freaking eyelid right like you can your eye shape can change. Yeah, you can scar really badly. Which that's usually when I see patients is like dealing with

their scars because you have to go to someone really good. But if you're not a good, you know, say you just don't heal well, there's going to be some visible scars. And depending on your eye shape, it could be really visible. It could look really bad. Do you need like muscle removed there also? And then also with lower bluffs, which I don't think people are talking about as much. Like if they're going in removing the fat pads, are they repositioning them or removing them completely where you need to like add fat? or you have hollowness now after that. So it's like so important. The two biggest reasons why I see people after Bluff who like didn't end up liking it,

most people like it. And most people, if you go to a good solid ocuropastic surgeon who thinks you need it, will recommend that. Well, number one, obviously they can take too much if you don't go to someone good. And then you'll get chronic dry eye because your eyes aren't closing when you're sleeping. Number two, that gnarly scar. And number three, they feel like their eye shape is different. They almost look like a different ethnicity.

So which some people want. But again, it's like if it's trendy right now, try to fast forward a few years. Trends come and go. And I mean, you look at like the Bella Hadid eyes, that super, super snatched thing. I think that that was in for a while. And now we're kind of going towards this more natural look, which is good. Yes. Yeah. But, you know, when you're doing these changes to your face that are permanent and you're doing it based on a trend, that's not going to age well either necessarily. Like do what fits your face. And I know that everybody has something in their mind, usually of what they want. And at least in my experience, whenever I've done a procedure, I go in and I have something in mind.

And then the doctor tells me what's possible and what's natural, you know? And those have to be aligned. So I think if somebody's going in to, you know, some of these doctors and they're saying, I want Bella Hadid snatched eyes. And they're like, okay. You know, and it doesn't necessarily like fit their face. That's a big red flag. And from what I know, you've gone to like really credible plastic surgeon here in L.A.

That they have reputation as well. I mean, one is like ethics. You want to do the right thing. But two, it's like you want to make sure your patients look okay. Yeah. And I've actually gone back to him and been like, do I need to like do that. And he's like, no. Good.

Yeah. Tellay. No. Yeah. I don't know how it is like in Tucson, but you come here a lot as well. But you see really bad work. And it's like, who is doing this? Tucson?

I'm like in the suburbs, but I see some of the really crazy things where I'm like fixing things. And it's crazy what people go through to like get something for like a lower cost. Or sometimes they just don't know. So I've seen some wild things. Especially I trained in Miami. Oh. And that is when we saw some wild things like injections into the butt. And it ended up being like cement basically.

Yeah. So crazy. I was going to say I'm sure you saw some crazy body. Yeah. modification stuff there. Yeah. Everywhere has like a different aesthetic. So it's kind of interesting. And I always say whenever I'm in New York, I just feel more free because they have a totally different approach in general. It's kind of a generalization. But to aging and two aesthetics, it's a much more natural approach than it is here in L.A. And I think the tide is turning a little bit

overall. But I feel like women embrace aging a little more there. Yeah. And embrace like the They're natural. It's almost like a 90s supermodel vibe where there's a lot of individuality versus like this cookie cutter kind of one look for everybody here in L.A. 100% agree. And it's really interesting because I lecture a lot of these meetings and there are some fantastic derms in L.A. And there are some really fantastic germs in New York. And the approach, even like the attitude towards patients are so different. Like the ones in York are like, I'm not going to. No, like, not even a question.

And the ones in L.A. are kind of like a little bit more. Suggestable? Yeah. Like, you know. Cavalier. Exactly. So not saying that they're always like that, but I think that there's a look. Like you said, there's a look in each place.

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these classic tortilla chips. I first saw them posted about by Leanna from Forma Pilates, whose recommendations I trust. And guys, they are incredible. They have only three ingredients. So it's only organic corn, grass-fed beef tallow, and sea salt. So it's basically like skin care for your gut. It has clean, high-quality ingredients that support how you feel and how you look. We all know that our external appearance is basically a reflection of what is going on inside and what goes into our body shows up on the outside. So grass-fed tallow is one of the best things that you can put into your body for your skin. It's so much better than seed oils. We just should not be consuming these at this point ever. So just tallow from grass-fed. So just tallow from grass-fed. And,

beef, which is better for your hormones, your skin, and your metabolism. You would be surprised by how much better you feel just switching your snacks. I don't feel bloated or sluggish after eating these. Like I usually do after eating chips. I just feel light, satisfied, and nourished. And they just have the best flavor. I cannot even describe it to you, but it's the perfect crunch. It's the perfect amount of saltiness, but it has that kind of umami flavor from the tallow. They are the Chips that you will ever have. They're perfect for on the go. Airport travel after Pilates in your tote bag. Masa is proof that healthy eating can be delicious too. They do not taste like health food. They taste like what chips should taste like. So think of it as your new non-negotiable pantry

staple. Visit Masa chips.com and use the promo code blonde to get 20% off your first order. That's M-A-Chips.com and the code is blonde. Okay, I want to talk about lasers. Everybody is always asking, what laser do I use for XYZ? And I think it's so different depending on the person, their skin type, what the concern is. But I think the two big areas are sun damage and wrinkles. Yeah. So what are your favorites when it comes to that?

So I literally last week did a full solo episode on lasers and energy beings. devices. So definitely check that out because I talk about lasers literally for an hour by myself. And I try to create a guide. But in short, you're right, I don't expect people to know the technology or the name brands or the way lasers work because you mentioned FRAXL the other day. That's like a brand or the other day like an hour ago. It's been a long day. And so I don't expect people to even know fractal, but I like that you know that brand name because it is a type of fractionated CO2 laser that resurfaces the skin. And so I think that when people want to really short, when people want to look for lasers, are you resurfacing the skin? So that means you can go super ablative and go like CO2 or BM.

You can go fractionated, which is a small portion of that and that's fractal. But even with phraxel, you have like fractal repair and frexel dual. So I don't remember. I don't know like dual. Dual. Exactly. So that's the one where I had a few like a week. Technically if they did it full force, you would have like a two week downtime.

You had like a three day downtime. So you should definitely do it again. Or did you do it around your eyes or they did like a very late. No, the CO2 that I did around my eyes. I didn't really have much of a cool peel or something. I'm not sure. I think we were just so like. So yeah.

We're also not sure how my body was going to react to things after what I went through. whatever, yeah. But Faxil, usually when I do dual, it's like 10 days. Okay. Yeah, that makes sense. I'm like, let's hit it. And that is so great. Yeah, that's good for fine lines, resurfacing. It only helps pigment. It's not targeting pigment, but it's actually, I mean, it's actually targeting water, which is like the skin. But you get that resurfacing. You get those little flakies coming off, and that's why sunspots go away. So that's resurfacing. And then with that, you have something like cool peel, which is like minimal, minimum downtime. It's like super popular here in L.A. I have it at my Beverly Hills office. I think I have something like clear and brilliant, which is a little bit more

downtime than the cool peel, but it's also like a fractionated resurfacing, very good for like people getting into lasers. And then you have like pigment stuff, a really important one that I think everyone should like at least kind of know about is IPL. Intensible Slides. So good. Very similar to BBL. BBL is just a good brand name. That's a little bit wider wavelength. This is actually not a laser. it's the energy-based device. It's a light-based device that can target reds and browns. And that's why it's so great. Great as a first-timer. It's also called photophacial. It doesn't really like rejuvenate the skin as much, but you get flakies and you feel really good afterwards. And then with that, you can get into pigment-type lasers and you have like something called Halo that can help with a little

bit of that. And then you have skin tightening devices, which I don't know if I've ever heard you talk about this, and I'm really interested to see your input on it, but you have energy-based devices that actually go in and contract the tissue and stimulate collagen such as Morpheus, radio frequency, microRNA, which I'm a huge proponent for. As with anything, it could be done wrong, wrong settings, wrong energy settings, wrong provider, anything, and it can be targeted. fat where you don't want it to target fat. They can target fat, but only when you need it to, such as like the submental area. But I think in general, people are so worried about something like Morpheus when it's so great at the raid settings, because fat starts at around like two,

three millimeters. So if you're at like half a millimeter, one millimeter, low energy settings going in and out really quickly, that contraction of the skin is just so great. And the cascade can really tighten the skin, especially around the eye. So that's actually one thing that I think would be so good. For you, though, you being worried about hollowness and things like that, we would have to go so, so light, so light that I would do like the CO2 before the actual like radio frequency microline. But I think that done like half millimeter depth where it's like not even focusing on the fat at all, it would be really, really nice to help tighten because that's, I think, at the end of the day, what it also needs around your eyes is a little bit of skin tightening in addition to helping

with those wrinkles by stimulating collagen and, like, helping resurface the top layer of the skin. And so another energy-based device that also tightens skin is oltherapy. So that is ultrasound technology. And you also have to be careful with that because if you go really strong, yes, it can melt fat. I think people have had really bad experiences. I think Amy Chang talked about her experience on your show. And but I think that if the settings are done correctly, almost like less is more. We need this type of technology there because you can only do so much with injectables.

You can only do so much with skin care. You can only do so much with even like things like biosimitory things like Sculptra and hyperdilute radias. And you can only do so much with a facelift because I've seen facelifts where people don't have black skin, but they have terrible skin quality. And it's like saggy. There's no collagen. And they need lasers.

Thank you for saying that. because so many people say, like, on my skincare videos and everything, like, oh, well, you've had all this work done. And I always say, please tell me the surgery that changes your skin. Right. They're two completely separate things. And I see people all over L.A., usually older women, but some younger women who have very obviously had work done and don't have good skin. And it's like there's only so much that you can do. Like the skin is your canvas.

And so that's like first and foremost before you're doing anything. anything, in my opinion, my completely non-professional opinions. I am not a practitioner, but I think it's so important. And I think like maintaining the quality of your skin, like you just get so much longevity out of that. And then you can do little tweaks and things like that. And they look really beautiful and you can age gracefully without just like some people just let the wheels fall off. And then they're like, oh, I get a facelift when I'm 70. Or get a facelift when I'm like 55. And again, there's skin quality. And by skin quality, you really mean like that, of course, pigment, of course, but it's maintaining that collagen, which gives our skin that structure. So collagen is so, so important. Not saying that you need to ingest it, but saying that you really need to incorporate it in your skincare routine where the ingredients are actually, like, I'm a huge retinoid, like, person. I think I saw it on your one of your episodes where you're like, retinal has a great PR team. Yeah, yeah. And I'm like, it doesn't. It's just like the gold standard has so much study, so many studies behind it. But I think that one thing that's coming in the future and peptides are so expensive, but I think peptides are going to be really on par with retinodes. I personally like to see them, you know, I like the products that have both of them in there.

So topical peptides, not like injectable peptides. I mean, those are kind of off the table at the moment anyway. Yeah. Okay. estrogen cream. Let's talk about that for a second. Yeah. So this is like a buzzy thing right now. I think that number one, people are talking about perimenopausal state a lot more, which is great. Estrogen and HRT hormone replacement therapy is still considered a little alternative. Not that it's bad, but we are noticing that it's a lot safer now. There was a really bad, you know, there was a study that came out a while ago that said it increases your risk for breast cancer, which it can insert in people, and that's why you have to really, really be careful and screen and make sure you don't have those risks. But guess what like perimenopause also can contribute to

is like cardiovascular disease and things like that. So when it comes down to topical, there's two main types. There's estradiol, which that's the vaginal cream or that's the cream people use that actually goes in systemically that's a little bit stronger and can affect your like systemic estrogen levels. And then there's estriol. Estriol is more like, let's help find lines. Let's help with like the skin looks. And I think it really depends on your goals. Are you going in wanting like more estrogen because you have other symptoms or are you going in wanting like more skin hydration and things like that? Again, I don't think like estrogen cream's going to like replace all these other skincare items. But I think if you are low on your estrogen, if you truly are in that like perimenopausal

or postmenopausal state, I think that we're learning so much more about. about it and I think most germs are team yes interesting what about volume filine oh wait what is that what I'm talking about it's supposed to increase fat that is hold on renewva no no no it's not injectable it's just a cream yeah people use it under their eyes and they say it's like a game changer yeah I think I would know about it I'm gonna tell me more where can people buy it I'm looking it up right now Volufoline serum. It says helps to gather and save more fat. That's Amazon.

Let's find a more legitimate. I'd say no. Allegedly creates or builds fat under the skin. I wonder how. Let me see. You have to send me the link later. Yeah. Natural plant extract prays for its potential to mimic the effects of injectables like

Botox and filler. We'll do a little, we'll do a deep dive on this. I want to say hard no, but because there's an injectable, I think it's called Renuva. Yeah. You know what I mean? Yep, I know Renuva. Yeah.

So it's an injectable. Yeah, yeah. So it's supposed to increase fat. I mean, there's a reason why it's not a hit. But you know what does increase fat? Sculptra. So everyone says it's to me this collagen, but like if you think about it, I do like non-surgical bLs or what we know about sculpture.

And I know some plastic surgeons are like, don't do sculpture. It's going to mess up your facelift. But any great plastic surgeon is going to look beyond that. And that's why you need to do these energy-based devices. You should be able to do so. It's a red, I mean, it will be really weird if you went straight to a facelift without doing anything. So get your sculptor.

Get your injectables. Obviously, there's a balance to it. Get your energy-based devices. That's okay if it's going to make your facelift a little bit more difficult. I notice that when I'm doing submental lipo, if some patient went in and they did coal sculpting, if they went into Kaibela, if they went into radio frequency microding. that my canula which I'm supposed to suck fat out is supposed to like glide like butter it is hard there there is scar tissue there there is inflammation there that's like tightening the skin and what your body's

reacting to so is that a bad thing no it makes my job a lot harder and it could potentially result in a poor outcome but they'll still get a good outcome and then it may potentially lead to like more bruising and inflammation because I'm going in there like jamming this cannula in there when it's really supposed to glide really nicely. So that's just all I'm saying with a lot of these things. Don't be so scared to do them because they could potentially make other things in the future harder. Got it.

Okay. Let's do some Derm approved or not approved. Ooh, I love it. Some rapid fire. You can do like one sentence to explain. Snail Mucin. Oh, Snail Mucin. Yes.

Yes. Approved. One sentence. Snail Mucin is a yes. I don't think it's the end-all, be-all, but I think that there's some merit to some of the, like, benefits, and I think it's fine. Okay. Threads. Threads. Love-hate relationship, but I would say mostly no, and I do offer them, but it's a no for most of my patients. Eye cream. Eye cream is a must. You must use an eye cream for your eyes and not just your skin care for your face for your eyes.

Spirnalactone. Spirnalactone is definitely a yes. I think that it does wonder. for hormonal acne, although there are some alternatives such as dim that we can get into. Yeah. Okay. You can tell us real quick. Yeah. We can open it up for that way.

Dim, I'm not saying is like completely comparable to, and dim is like a supplement from like cruciferous vegetables. And I find it for my patients that don't want to be on spiro lactone or we're just trying to find an end date because that's the toughest part with my spiro patients. I'm like, when do we get off of it? Mm-hmm. You know, and oftentimes I will like wean them off or they're on like 50 instead of 100 or 25, which is like not even therapeutic dose.

But dim is really interesting because I have this whole protocol that we can talk about at some point on supplements because they love supplements. And I think it's a good like introductory way to treat some of this hormonal acne or Nutraful women's balance has some things in there to really balance that estrogen and testosterone without changing your hormones. So that's a good pick. Dim is a good pick, which has like very similar ingredients. in there. So I say try that out first. And then if it doesn't work, see your Dermphospero.

Amazing. Easy gel. I love Easy gel. We talked about that. I think it's great. It doesn't add volume, but I think it's great for skin quality. This is kind of interesting. Self-tanner. People were worried about glycation. Oh, interesting. I think you should worry about glycation for like eating smoked foods and all that, like the ages. Smoked foods, all of that. So I think self-taining is like great. Okay. Yeah. Non-professional grade skincare. Mm. Non-professional great skin care. Like Sephora.

Yeah. I think that there are great skincare ingredients out there. Like it doesn't need to be half-studies on it. I think that be really careful about what you're buying. That's like super crazy on TikTok,

on TikTok shop, or on Amazon because that's where we get into a lot of issues. But I think Sephora really vets their products. Trenton Owen. So that's the prescription strength. I don't think everyone can tolerate it.

I myself can't tolerate it. There's things like Altrina, which is prescription strength. But I think that if you can use a retinol every day, the effects can be very similar. Like over the counter. Yeah, retinol is like way less of a strength and prescription strength of retinoid. What do you like? Do you like like Alpharet?

Alpharet's good. I think revision has a really great one. Rock has a great introductory one. So, yeah, there's so many brands can be drugstore or whatever. Sunscreen. Sunscreen and must. If you're at all worried about sunscreen in general, use a physical sunscreen, such as zinc or titanium based.

I think that if anything, wearing a hat, protecting your body when you're out, hiking or doing something is like really important. Face taping. Well, after talking to you, I love that you use it for a specific reason. That's correct. So if done correctly, I'm pro. Dermaproved. I have to say, I have this girl who listens to my Patreon. I've had a few of these who said, I'm 38.

Someone said I'm 40. I've never had Botox. I was thinking about doing it. And I did the face tape instead. And it looks like I have Botox. So I'm like, amazing. Yeah, whatever. Like, if it works, fine.

Yeah. I'm not going to like bash things, you know? If it works for someone and, you know, it's not doing harm, go for it. I think like, and I'm not affiliated in any way. Yeah. And I'm not benefiting off of these rolls of tape in any way. Yeah. But I think if people are on the fence for whatever reason or if somebody's like pregnant or

Or they have autoimmune issues. They're not sure. They just don't want to be injecting something or they can't afford it. There are so many things that, you know, constraints that people have where they can't get like traditional neurotoxins. Yeah. It's like, why not try it? It's 20 bucks, you know, for like a whole role. And you might be surprised.

Exactly. Yeah. As long as it's not damaging the skin or anything like that, I think I'm all for it. Yeah. Amazing. Well, tell everybody where they can find you and listen to your podcast. All right. So Durham approved.

I am on Spotify and Apple Podcasts. We'll be putting it on YouTube. And then my Instagram will have some clips on there, which is Dr. Sheila Durham or Durham approved podcast. And thanks so much for having me. Thanks for coming. I hope you enjoyed that episode. If you liked the episode and if you like the show in general, please take a second to rate, review, and subscribe.

It goes such a long way in supporting the show. Follow the show over on Instagram at well. You can also follow my personal Instagram at Ariel Lori. I'm always sharing great clips from the episodes. And we also have full episodes on YouTube as well if you want to watch in entirety. Thanks for listening. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.