Latest / Skin Anarchy / Regenerative Medicine Meets Aesthetic Surgery with Dr. Michelle Lee of Dr. 90210

Transcript

Regenerative Medicine Meets Aesthetic Surgery with Dr. Michelle Lee of Dr. 90210 · Skin Anarchy

• 0:00
  SPEAKER_00: Hey guys, welcome back to Skin Anarchy.
• 0:02
  SPEAKER_00: Today's episode is going to be very focused on aesthetics.
• 0:04
  SPEAKER_00: We're going to be learning from the best of the best.
• 0:06
  SPEAKER_00: I'm so honored to be hosting our guest today.
• 0:09
  SPEAKER_00: Many of you might recognize her from Dr.
• 0:11
  SPEAKER_00: 90210.
• 0:12
  SPEAKER_00: And so would love to go into her background.
• 0:15
  SPEAKER_00: She is a board-certified Ivy League trained plastic surgeon and the founder of Perk Plastic Surgery in Beverly Hills.
• 0:22
  SPEAKER_00: So without further ado, please welcome Dr.
• 0:24
  SPEAKER_00: Michelle Lee.
• 0:24
  SPEAKER_00: Welcome, Dr.
• 0:25
  SPEAKER_00: Lee.
• 0:25
  SPEAKER_00: I'm so excited to host you.
• 0:27
  SPEAKER_01: Thank you so much.
• 0:28
  SPEAKER_01: So excited to be here.
• 0:29
  SPEAKER_00: Yeah, I can't wait to dive in.
• 0:30
  SPEAKER_00: And you know, uh, Dr.
• 0:31
  SPEAKER_00: Lee, I always start medical focused interviews off by asking physicians like what really got you into medicine and where when was that moment in your life where you realized, like, I'm gonna go this route and I'm gonna commit to it?
• 0:43
  SPEAKER_00: If you could kind of walk us down memory lane.
• 0:46
  SPEAKER_01: Sure, absolutely.
• 0:47
  SPEAKER_01: So um, I never thought I was gonna be a doctor.
• 0:50
  SPEAKER_01: I'm just gonna come out and say that um as a human being, I was always told that I've always been obsessed with aesthetics and beauty ever since anyone has known me.
• 1:02
  SPEAKER_01: So the my story that my parents love to tell is that I was three years old and I loved this pair of shoes, and it was so pretty.
• 1:10
  SPEAKER_01: And I'm three, like I just know that this is a really beautiful pair of shoes.
• 1:13
  SPEAKER_01: It gave me blisters everywhere, but I refused to take it off because it was so pretty.
• 1:17
  SPEAKER_01: So as long as I can remember, I've always been so obsessed with beauty and aesthetics, and it's not just so much physical aesthetics, but everything like you know, beauty in music, beauty in um landscapes, furniture, fashion, or whatever.
• 1:33
  SPEAKER_01: So that actually led me to be a piano performance major um in college.
• 1:39
  SPEAKER_01: Yeah, so I really thought I was going to just be in this artistic world.
• 1:43
  SPEAKER_01: I graduated from UCLA, and um, my parents were like, We're so proud of you, great job.
• 1:50
  SPEAKER_01: Um uh we're going to like not fund you anymore.
• 1:53
  SPEAKER_01: So good luck being a piano major.
• 1:57
  SPEAKER_01: And all of a sudden it was kind of like a screeching halt, a reality hit.
• 2:00
  SPEAKER_01: Like, how am I gonna make this work?
• 2:02
  SPEAKER_01: Um, it's very challenging to be our artist, and I have so much respect for people who make it and can pursue art um as a living.
• 2:12
  SPEAKER_01: So I thought to myself, it's very expensive to live in Los Angeles without any source of income.
• 2:16
  SPEAKER_01: So I thought, you know what, I need to do something practical.
• 2:18
  SPEAKER_01: And coming from you know an immigrant family, you know, the the the practical job that always paid reasonably well medicine is one of them.
• 2:26
  SPEAKER_01: So I was like, you know what?
• 2:27
  SPEAKER_01: I need to do something stable.
• 2:29
  SPEAKER_01: So I hard pivoted left.
• 2:31
  SPEAKER_01: And you know, that's not a very, you know, aspirational story, but I was like, you know what, I need something practical, I need to be a doctor.
• 2:38
  SPEAKER_01: And so I applied for medical school and um I got in.
• 2:41
  SPEAKER_01: I went to University of Pennsylvania um for medicine, but this love for beauty has always just been inside of me.
• 2:49
  SPEAKER_01: You know, I I never I was really never drawn to the traditional aspects of medicine, such as you know, cardiology or whatnot.
• 2:56
  SPEAKER_01: I was immediately drawn to plastic surgery and dermatology because it's the most it combines aesthetics and science.
• 3:05
  SPEAKER_01: So I fell in love with plastics, and then from there on, I think I found myself the perfect field.
• 3:11
  SPEAKER_00: Yeah, no, that's I love that story.
• 3:14
  SPEAKER_00: Thank you for like sharing that because I feel like nobody talks about that.
• 3:17
  SPEAKER_00: Like enough doctors don't discuss like our other passions and like other things we did in life.
• 3:22
  SPEAKER_00: Like, I feel like every time I hear the story of how someone came into medicine, it's like, well, I just love science, you know, and I I wanted to go into science.
• 3:30
  SPEAKER_00: And it's like, I get that.
• 3:31
  SPEAKER_00: I was definitely in that boat, but I really love that you had this like, you know, other stuff that you're focused on and you appreciated beauty because that is such a huge player.
• 3:40
  SPEAKER_00: I feel like, especially right now, the way I, as a consumer, and when I'm looking out into the space, a lot of the times I think a lot of it is very like anatomy-led, you know, in terms of like the plastic surgery component and aesthetics and everything.
• 3:54
  SPEAKER_00: And everybody's so hyper focused on like, you know, what can we do to like modify ourselves?
• 4:00
  SPEAKER_00: And no one discusses like what does beauty actually mean, whether that's psychosocial, whether that's, you know, whatever that might be, we don't discuss it at large for some reason.
• 4:08
  SPEAKER_00: And it really bothers me, you know, when I see that.
• 4:10
  SPEAKER_00: So I that's actually my first question for you is this idea of like when you think about the world of aesthetics, the world of plastic surgery, dermatology, any of these fields that are so, you know, intersecting with how we view ourselves, what do you think is the most important thing for consumers to understand, for patients to understand um before even approaching any kind of thing, right?
• 4:31
  SPEAKER_00: Even skincare or topical solutions.
• 4:35
  SPEAKER_01: So um I I'm so I want to smack up a little bit.
• 4:37
  SPEAKER_01: I'm so glad you mentioned that because this is the thing I obsess about all the time.
• 4:41
  SPEAKER_01: So, for example, like right now, everyone's obsessed about jawlines, right?
• 4:45
  SPEAKER_01: But when I look at someone's face and they may have a perfectly smooth, perfectly sharp jawline, but then when you look at it, sometimes you look at the person, it's like, but is that aesthetically pleasing?
• 4:55
  SPEAKER_01: Like, do you want to have a jawline so sharp that it can, you know, open a can or whatever?
• 5:01
  SPEAKER_01: But it doesn't, it doesn't always translate to being beautiful, right?
• 5:05
  SPEAKER_01: And I think beauty is so much more than being wrinkle-free or having no pores or have a perfectly smooth skin.
• 5:12
  SPEAKER_01: It's there's an X factor to it, right?
• 5:15
  SPEAKER_01: And there's some people, I'm sure you've met many of them that they have wrinkles and they don't have perfect skin and they just radiate this beauty.
• 5:23
  SPEAKER_01: And we don't 100% know what it is because there beauty is about harmony, proportions, and uh inner radiance, right?
• 5:29
  SPEAKER_01: So I think right now um it's a challenge for the aesthetics field because you have to say, like, well, if you have hyper-focus on one thing, like, you know, I want to reduce wrinkles, I want the skin to be uh pigment-free or all my pores to be poreless, glass skin.
• 5:45
  SPEAKER_01: When you get so hyper-focused on one thing, sometimes that's a very slippery slope and a very dangerous slope because then you don't look human.
• 5:54
  SPEAKER_01: Um, I've seen, I mean, there are people with flawless skin, but then they just look, it's too flawless.
• 5:59
  SPEAKER_01: You look like you're you're you're waxy and glassy, and that's what that's what happens when you have too much of a good thing.
• 6:06
  SPEAKER_01: And I often see like there's so much information out here right now, and I'll often see patients who come in and they're just like there's something about it that just doesn't look right.
• 6:14
  SPEAKER_01: Does that make sense?
• 6:15
  SPEAKER_00: Yeah, yeah, absolutely.
• 6:16
  SPEAKER_00: And I I'm so glad you said that because body dysmorphia is also a real thing.
• 6:21
  SPEAKER_00: Like I and I think nobody discusses that at all.
• 6:23
  SPEAKER_00: Like it's not even about like and you know what's crazy is like I feel like when we bring up the term body dysmorphia, everybody freaks out.
• 6:30
  SPEAKER_00: And it's like you're calling me anorexic, you're calling me bulimic, you know, and it's like, no, it's a real conversation.
• 6:36
  SPEAKER_00: I'm pretty sure I went through it a many, many, many times in my own life, you know.
• 6:40
  SPEAKER_00: So it's like I I love that you are pointing this out because I think sometimes we just have to check ourselves and be like, I'm looking in the mirror and seeing something.
• 6:49
  SPEAKER_00: Now I need to go to somebody who's a professional that is going to actually give me a pragmatic view of this.
• 6:55
  SPEAKER_00: And not saying that, you know, like I'm sure like you don't when a patient comes to you, you're not gonna automatically just be like, yeah, okay, I'm gonna do it.
• 7:01
  SPEAKER_00: You have consultation with them, you discuss things with them.
• 7:04
  SPEAKER_00: Like, and I feel like that's what I think consumers, we want to jump that.
• 7:08
  SPEAKER_00: You know, we want to jump over the fence with that instead of just relying on our on our professionals to be like, let's have a conversation and let's open this up and like pry it open and figure out what is it that's bothering you at the end of the day, you know?
• 7:21
  SPEAKER_00: So I I just I would love for you to speak on that a little bit in terms of like where do you think that checks and balances needs to begin for people?
• 7:29
  SPEAKER_00: Like, do you think it begins in the in the clinician's office, or do you think we can do things before we even go to a doctor, you know, about this?
• 7:37
  SPEAKER_01: I think the the primary responsibility first lies in the clinician, who, whichever provider is treating the patient, it is your responsibility to say no when you don't see and be able to identify BDD.
• 7:50
  SPEAKER_01: And it's so important.
• 7:52
  SPEAKER_01: Um, I often find that some of my most beautiful patients are the most self-critical, and they point out something to me, and I'm like, I don't even see what you're talking about.
• 8:02
  SPEAKER_01: You know, yeah.
• 8:03
  SPEAKER_01: And and it's and we say no all the time, and that's so important because you know, everyone has a tendency to fixate on something that they dislike, and then your algorithm all of a sudden populates you with the procedure or the skincare cream that you absolutely need to fix that one thing.
• 8:20
  SPEAKER_01: And and I think you know, media companies like and social media platforms also has a responsibility not to create BDD and unrealistic um images for the population, but the primary responsibility is the person who's providing the treatment and aesthetics, it's a tricky field.
• 8:38
  SPEAKER_01: I love this field, but it's ripe with misinformation, it's ripe with people who can really take advantage of the consumer because there's a lot of money in it.
• 8:48
  SPEAKER_01: Yeah, yeah.
• 8:49
  SPEAKER_00: No, that's that's very, very true.
• 8:50
  SPEAKER_00: And you know, I agree.
• 8:52
  SPEAKER_00: And I and you know what really bothers me is that we, I don't know, for some reason the last few years, we've diverged from this idea of, you know, because when I was growing up, I'll just use that as an example.
• 9:02
  SPEAKER_00: When I was growing up, it was a norm.
• 9:04
  SPEAKER_00: You went to a board-certified specialist in a field, whether that was endocrinology, whether it was dermatology, whatever.
• 9:11
  SPEAKER_00: You know, we didn't go to like hole-in-the-wall practices that popped up, you know what I mean, asking for a prescription for whatever, like, you know, whatever we needed.
• 9:20
  SPEAKER_00: And nowadays, I feel like in the last few years, we've kind of seen this culture shift where people are now relying on people that don't have the credentials.
• 9:28
  SPEAKER_00: They can't guide you.
• 9:29
  SPEAKER_00: And so I know what you mean about that, where it's like it's on the clinicians, but I also feel so bad sometimes because in the field of aesthetics, I feel like there gets there's so much critique here because doctors simply can't control sometimes who you went to first.
• 9:44
  SPEAKER_00: You know, like somebody might have got, like you were talking about jawlines earlier, right?
• 9:48
  SPEAKER_00: Like if somebody goes to like a whack job somewhere, right, who has no credentials and they're being told this, like it's being reinforced in their mind, and then they come to your office, you're gonna be like, What are you talking about?
• 10:00
  SPEAKER_00: You know, like from my medical expertise, I'm not seeing what you're talking.
• 10:03
  SPEAKER_00: And so I think that's also a big thing that I see a lot from, you know, just having this podcast and seeing the industry now, like that people are falling for these like pseudoscience explanations, whether it's on social media, whether it's like, you know, non-credentialed individuals, and then they're holding the aesthetic community responsible for the spread of body dysmorphia.
• 10:23
  SPEAKER_00: And I just simply disagree with that, you know, where it's like, I don't think that's really what it is.
• 10:27
  SPEAKER_01: So and I think what's um also interesting is that you know everyone wants a simple answer, right?
• 10:33
  SPEAKER_01: So right now we're seeing a shift and all filler is bad.
• 10:36
  SPEAKER_01: You get one drop of filler, you've ruined your face forever.
• 10:39
  SPEAKER_01: Let's all go to biostimulation.
• 10:42
  SPEAKER_01: But then in reality, biostimulation is not the same as regeneration, right?
• 10:47
  SPEAKER_01: So we when we when you think about things that's biostimulatory, it creates a lot of fibrosis.
• 10:52
  SPEAKER_01: Regeneration is actually replacing like with like.
• 10:55
  SPEAKER_01: So you see the same amount of problems with biostimulatory.
• 10:59
  SPEAKER_01: So when I'm doing facelifts, when we open up all the planes of the face, I've seen scarred in planes from biosimulation, from fillers, from threads, from energy-based devices, all kinds of crazy things.
• 11:12
  SPEAKER_01: It's kind of like a I don't know what to see.
• 11:14
  SPEAKER_01: So then, like, you know, whenever I talk to someone about a facelift, I list like this laundry list of have you had this, this, this, this, this, this, and they think I'm trying to quiz them, but because you never know what you're gonna find in surgery.
• 11:25
  SPEAKER_01: But the the interesting part is that sometimes when you have a bad surgery, that creates more scar tissue than anything you've talked about before.
• 11:33
  SPEAKER_01: So, you know, this field kind of has this yo-yo effect where it's like, oh, filler is bad.
• 11:38
  SPEAKER_01: Let's go to biostimulation, but I've also seen really bad biostimulation.
• 11:43
  SPEAKER_01: Then, oh, let's all get a facelift when you're 30.
• 11:45
  SPEAKER_01: But you can't have an unlimited number of facelifts that creates scar tissue too.
• 11:49
  SPEAKER_01: So you have to be very nuanced.
• 11:50
  SPEAKER_01: And you know, people don't like to say, like, you can use this for this, this for this, this for this.
• 11:55
  SPEAKER_01: So it's um it's it's important for us to educate the the public about this.
• 12:00
  SPEAKER_01: No, I completely agree.
• 12:01
  SPEAKER_01: Not simplify everything, yeah.
• 12:03
  SPEAKER_00: Exactly.
• 12:03
  SPEAKER_00: You can't simplify everything.
• 12:05
  SPEAKER_00: And just to like, you know, build on your point, I would love to get your opinion here is this idea of like, you know, I talk a lot about skincare on this podcast.
• 12:13
  SPEAKER_00: And one of the big concerns with anybody using skincare, people usually use skincare when they have like texture issues, for example, you know, um, or like, you know, hydration or like the overall tone of their skin.
• 12:24
  SPEAKER_00: And I'd love for you to kind of dive into this with us in terms of like what is that line between what we can do with skincare and then when you should actually be considering an aesthetic procedure um for something like texture.
• 12:37
  SPEAKER_00: Okay.
• 12:38
  SPEAKER_01: So I think for skincare is the basis of everything.
• 12:42
  SPEAKER_01: So whenever I get really excited about a facelift, is because the patient has great bone structure and great skin.
• 12:48
  SPEAKER_01: So I know, wow, this is a great canvas that I get to work with.
• 12:51
  SPEAKER_01: Whenever someone has, you know, thin skin, I'm always a little bit uh hesitant because I don't know how good of a result you're going to get just because you don't have the skin quality to support it.
• 13:01
  SPEAKER_01: So when I think about skin can, you have to have the basis.
• 13:04
  SPEAKER_01: You clean your face every single day, make sure you wash away your the day.
• 13:09
  SPEAKER_01: Um, you're using um sun protection, whichever you know, the whole thing about sunscreen is toxic, just drives me insane.
• 13:17
  SPEAKER_01: Um, and if you have texture issues, it really depends on what exactly is the texture issue.
• 13:24
  SPEAKER_01: Do you need some kind of retinoids to help the skin to turn over or some kind of exfoliation?
• 13:29
  SPEAKER_01: And that's you have to have a consistent routine, but consistent routine, and then you have uh skincare um procedures in a dermatology or plastic surgeon's office to kind of boost that.
• 13:40
  SPEAKER_01: But you can't you can't just do a procedure and expect that to do be miracles without the baseline skincare every single day.
• 13:49
  SPEAKER_00: Yeah, no, that makes a lot of sense.
• 13:51
  SPEAKER_00: And you know, I'm glad you brought up retinoids because I think that's a hot topic right now, retinoids and understanding like what they can realistically do for your skin, because I've seen all sorts of stuff online, you know?
• 14:00
  SPEAKER_00: And um, I would love to kind of debunk this a little bit with you, where it's like retinoids, I know they do so much for the architecture of our skin, you know, like if you're consistent with them, if you're sticking to them.
• 14:10
  SPEAKER_00: But then like if you're say you're like in your 40s, right?
• 14:14
  SPEAKER_00: And you've been relatively consistent with your retinoids, what are some like aesthetic procedures that you think would be, I mean, I know this is individual, but just to give a little bit of general, generalized, you know, nature to this, what are some aesthetic procedures people could think about?
• 14:29
  SPEAKER_00: You know, if they're reaching that 40, 50 year mark and they're like, hey, I've been doing my skincare, but I don't know, I might want to get something.
• 14:36
  SPEAKER_00: And is there anything that you kind of go to um immediately in your mind when someone approaches you like that?
• 14:42
  SPEAKER_01: So this is very boring, but I love good old micronealing, not radio frequency micronealing, but just the needles are vibrating, and there's very good science that backs this up.
• 14:53
  SPEAKER_01: They show that after you've had micronealing after five or six times and they biopsy the skin, the skin collagen thickness increased by over 400%.
• 15:02
  SPEAKER_01: Uh, and this is well documented.
• 15:04
  SPEAKER_01: I actually love broadband light, uh BBL, not Brazilian buttliff, but broadband light.
• 15:11
  SPEAKER_01: Yeah, chloride.
• 15:14
  SPEAKER_01: Um, broadband light basically helps even skin tone with you know browns and then reds and it improves skin texture.
• 15:20
  SPEAKER_01: And there are studies coming out of Stanford that basically show that people who whose skin has been treated with BBL over 10 years behave younger than if they've never had a treatment before.
• 15:30
  SPEAKER_01: They looked at before and afters 10 years apart, and they thought that was a before and after of before the treatment.
• 15:36
  SPEAKER_01: So they're very well documented studies.
• 15:38
  SPEAKER_01: So there's so much devices that come out all the time that claims it does this and this and this and this.
• 15:44
  SPEAKER_01: But I think supporting skin's health from you know microneedling causing controlled stress to the skin so it can regenerate and create collagen is very good.
• 15:54
  SPEAKER_00: That yeah, it makes sense.
• 15:55
  SPEAKER_00: I mean, I've heard great things about microneedling.
• 15:58
  SPEAKER_00: I'm like, I've always been too scared to do microneedling, but I've heard such great things.
• 16:01
  SPEAKER_00: So I'm I'm actually gonna look into it more now that you've uh mentioned that, because yeah, I I that's it's not boring, to be honest.
• 16:08
  SPEAKER_00: I'm glad you said that because I think sometimes we're expecting this like incredible, like the newest technique, the newest device that just came out.
• 16:16
  SPEAKER_00: You know, we're always expecting practitioners to tell us about that, but it's just like we can't always rely on that, you know.
• 16:21
  SPEAKER_00: That's uh but is there anything right now that you're really interested in?
• 16:24
  SPEAKER_00: Like, is are there any devices or new techniques that have come to market that you're like, I I like this, there's a lot of promise here, you know.
• 16:30
  SPEAKER_01: You know, I someone who I'm always suspicious of new devices at all times.
• 16:35
  unknown: Yes.
• 16:37
  SPEAKER_01: I think it takes time for you to see what's going on and what what's the long-term effect.
• 16:42
  SPEAKER_01: You know, everyone wants to see an immediate before and after, an amazing transformation.
• 16:46
  SPEAKER_01: But I really think about aesthetics in the long term.
• 16:50
  SPEAKER_01: What is this gonna do in tiny years and in 20s?
• 16:52
  SPEAKER_01: And we're seeing this with radio frequency micronealing.
• 16:54
  SPEAKER_01: When that came out, it was the hottest, greatest thing.
• 16:57
  SPEAKER_01: It's jazzed up micronealing, it's radio frequency and micronealing.
• 17:00
  SPEAKER_01: It tightens, it lifts, it's all of the things.
• 17:02
  SPEAKER_01: And then now five years later, you're seeing, oh, it's melting the fat in your face.
• 17:06
  SPEAKER_01: You need to preserve all the fat in your face so you don't get a worse skin quality.
• 17:12
  SPEAKER_01: We see so many patients who come in and say, you know what, I did, you know, radio frequency micronealing, and my skin is now crepey.
• 17:18
  SPEAKER_01: It looks far worse because it melted all the fat underneath.
• 17:21
  SPEAKER_01: So you have this thin, crepey skin, and you can't really go back on that.
• 17:25
  SPEAKER_01: So I like things with long-term data that is like, I know what this is gonna do now, what is this gonna do in five years, in tiny years, there's no question because I don't want to do something and say, like, oh, it looked great right now, but tiny years down the line.
• 17:39
  SPEAKER_01: This is you only have one face, you know.
• 17:42
  SPEAKER_01: Like if you want to think in the long term, you you don't want to think like, hey, I want to do this right now.
• 17:47
  SPEAKER_01: Like skincare when there's so many things and like aesthetics, there's so many things, but when you really boil it down to there's only a couple of things, it's not that fun and that sexy and all the newest and greatest things.
• 17:59
  SPEAKER_01: I know everyone's talking about Zerf right now, and everyone's like, it's painless, there's no downtime.
• 18:04
  SPEAKER_01: Great, like, but I want to wait until I see the long-term data before recommending it to my patients.
• 18:10
  SPEAKER_01: Maybe that makes me very um boring and conservative.
• 18:14
  SPEAKER_00: No, I think you're you're playing the smart long-term game, like you said, because that's really what I mean.
• 18:19
  SPEAKER_00: I would I want that from my physician, you know.
• 18:22
  SPEAKER_00: It's like I don't want to be recommended things that there isn't robust data around.
• 18:26
  SPEAKER_00: That's actually why I brought retinoids up to you from the skincare side, because people love talking crap about retinoids, but it's like that's the most studied skincare, you know, even though it's a drug, that's the most studied.
• 18:37
  SPEAKER_00: Like you can't refute the evidence.
• 18:38
  SPEAKER_00: So I completely hear you.
• 18:40
  SPEAKER_00: And I and I love that you're so focused on what's tried and true and proven to work.
• 18:44
  SPEAKER_00: And speaking of, you know, I want to actually ask you about like skin laxity issues because I know we're seeing that a lot lately.
• 18:50
  SPEAKER_00: A lot of people are on GLP ones.
• 18:52
  SPEAKER_00: I'm sure you say it a lot in your practice.
• 18:54
  SPEAKER_00: What are things that actually work for skin laxity versus maybe some of the hype that you've seen like on social media or you know, maybe even heard from your patients?
• 19:02
  SPEAKER_01: So, you know, I personally really love Softwave.
• 19:05
  SPEAKER_01: Um, you know, I'm not affiliated.
• 19:07
  SPEAKER_01: I mean, we have a softwave device, but the company doesn't pay me for anything for it for this reason.
• 19:12
  SPEAKER_01: Softwave's ultrasound and it stimulates the skin to produce collagen and elastin.
• 19:18
  SPEAKER_01: And I do see that it helps with skin elastic.
• 19:21
  SPEAKER_01: Um, that's in the same category as alt therapy, but it really depends on how deep the alt therapy is going.
• 19:27
  SPEAKER_01: Um when I really think about laxity, we have to really back up and say, like, why do you have laxity, right?
• 19:33
  SPEAKER_01: It's as we get older, we're gonna lose collagen and elastin.
• 19:38
  SPEAKER_01: When you're in your for a woman, when you're in the perimenopause um era, you lose 30% of your collagen within the first five years of um perimenopause or menopause.
• 19:47
  SPEAKER_01: So you really have to find the root cause.
• 19:49
  SPEAKER_01: If you're just trying to address laxity, but really where you need hormone replacement therapy with a device, that's never going to work.
• 19:56
  SPEAKER_01: So you really have to look at what is it that's causing the laxity.
• 19:59
  SPEAKER_01: And genetics also plays a huge role.
• 20:01
  SPEAKER_01: There, you everyone knows that grandma who looks like she's 50 years old and only like, you know, washes her face with soap, she has no laxity because she has great genes.
• 20:10
  SPEAKER_01: She stays out of the sun, you know.
• 20:12
  SPEAKER_00: So yeah, yeah.
• 20:14
  SPEAKER_00: No, that makes a lot of sense.
• 20:15
  SPEAKER_00: And I know I uh actually had a grandmother like that.
• 20:19
  SPEAKER_00: I used to I still think about her, and uh, you know, I was like, wow, she was looking damn good for 90 years old, you know.
• 20:25
  SPEAKER_00: Like uh so it, yeah, I know what you mean with the genetics part, but I think this also feeds into one of the questions I had for you was this idea of like longevity aesthetics keeps coming up now.
• 20:34
  SPEAKER_00: You know, I think more than ever.
• 20:36
  SPEAKER_00: I love longevity medicine.
• 20:37
  SPEAKER_00: I think there's a lot of potential there, you know.
• 20:39
  SPEAKER_00: Myself, I'm very interested on the research side, you know, the regenerative medicine side of it.
• 20:43
  SPEAKER_00: But I would love to get your take on longevity aesthetics.
• 20:46
  SPEAKER_00: Like, what do you think that actually means in terms of like, you know, whether that's procedures, whether it's mindset?
• 20:52
  SPEAKER_00: I mean, what are your what's your take on longevity in general?
• 20:55
  SPEAKER_01: Both.
• 20:55
  SPEAKER_01: So, you know, for the mindset uh part is that I want, I hope that every single patient evaluates all the procedures that come up and all the things that they get bombarded with, saying, like, hey, like what I just said, you know, is this gonna how is this gonna affect my face 10 years from now?
• 21:10
  SPEAKER_01: Am I gonna look lumpy bumpy, or am I just gonna do am I gonna look youthful in 10 years?
• 21:14
  SPEAKER_01: And the goal is not to look youthful, but just to look, you know, refreshed and like yourself, or am I just gonna look like I'm done and everything just looks a little bit off because the human brain, the human eye can catch millimeter differences.
• 21:26
  SPEAKER_01: You know, sometimes when I go to these aesthetics meetings, I look around and I'm just like everyone just looks like they're a little bit dumb, but no one looks quite right of the practitioners, and I'm so horrified of that in in many ways.
• 21:40
  SPEAKER_01: Now, regeneration, that's the the holy grail.
• 21:43
  SPEAKER_01: We've been chasing this fountain of youth regeneration since I don't know, in the beginning of time.
• 21:47
  SPEAKER_01: Like, you know, when you look in history books, people are looking for the fountain of youth.
• 21:51
  SPEAKER_01: I personally, as a certain, I'm the most excited about fact.
• 21:55
  SPEAKER_01: Fat is unbelievable, and we don't this is the part where the science.
• 22:00
  SPEAKER_01: Doesn't hasn't quite caught up.
• 22:01
  SPEAKER_01: Like we don't really know how fat is doing this.
• 22:04
  SPEAKER_01: So we've been fat grafting people's faces for decades now.
• 22:09
  SPEAKER_01: And then we're seeing a change on the skin from the fat grafting.
• 22:12
  SPEAKER_01: Wherever you're fat grafting, you're seeing skin changes.
• 22:15
  SPEAKER_01: So this was seen in breast reconstruction that has nothing to do with facial aesthetics.
• 22:19
  SPEAKER_01: So people who've had mastectomies for breast cancer and radiation, when you fat graft the area to give you more tissue thickness, there's something the fat is doing to the overlying skin that's reversing the radiation damage.
• 22:33
  SPEAKER_01: And we don't know how it's doing that right now.
• 22:37
  SPEAKER_01: So the same thing is happening with facial uh skin, that the fat somehow is rejuvenating this skin.
• 22:44
  SPEAKER_01: And I think this is the frontier of where we're gonna go.
• 22:48
  SPEAKER_01: It's like, how is the fat doing it?
• 22:50
  SPEAKER_01: Is it the macro fat?
• 22:51
  SPEAKER_01: Is it the nano fat?
• 22:52
  SPEAKER_01: Is it the the growth factors and the stromovascular fraction from the fat that's doing this?
• 22:57
  SPEAKER_01: Um I really love a nano fat um rejuvenation of the skin where we break down the fat to just the stromovascular fraction and the growth factors and all the goodies and get stamped into the skin.
• 23:09
  SPEAKER_01: I, you know, I just want to be super honest.
• 23:11
  SPEAKER_01: I don't 100% know how it's doing this.
• 23:14
  SPEAKER_01: Um I think, you know, I need the biologists to tell me, but the skin looks youthful and there's data that's been tracked, you know, 10, 20 years, how fat crafting just somehow is regenerating the skin.
• 23:26
  SPEAKER_00: Wow.
• 23:27
  SPEAKER_00: Yeah, I'm so glad you brought up fat because I've always been intrigued, like from the research side about the P per gamma pathway, because I feel like it's one of the most like understudied pathways in skin rejuvenation.
• 23:39
  SPEAKER_00: Like I know we know a lot about it from just like hard science, you know, like learning about it in terms of like differentiation of fat cells, but I feel like there's a huge like, and this is one of the topics I feel like longevity can really hit on.
• 23:50
  SPEAKER_00: And I'm glad you're talking about this because if there's any longevity physicians in the, you know, in the audience, let we need to dig into these pathways because some of them are such like upstream targets that we don't know what's going on.
• 24:03
  SPEAKER_00: Like we saw that with like mTOR, I feel like mTOR was one of them, right?
• 24:06
  SPEAKER_00: Where everybody was like really excited about mTOR inhibitors and longevity.
• 24:10
  SPEAKER_00: And it's like, yeah, because it's like one of the biggest anti-inflammatory pathways.
• 24:13
  SPEAKER_00: And so we don't know what that's gonna do when you actually tweak it a little bit and what that means downstream.
• 24:19
  SPEAKER_00: And so I think that's that's huge.
• 24:21
  SPEAKER_00: I mean, it's really interesting to hear that you see such instant results and you're seeing that overtime result as well, you know, where it's like signaling combined with aesthetics.
• 24:29
  SPEAKER_00: I mean, that's the holy grail, I feel like, that you can expect.
• 24:33
  SPEAKER_01: So yes, and I'm excited to see how we incorporate that, you know.
• 24:37
  SPEAKER_01: Like, I don't think everyone wants to just go to the surgery and you know, harvest fat from one area and put it in another area, but we have to really see like how is the body regenerating this?
• 24:47
  SPEAKER_01: Because I think the main thing is that regeneration is not fibrosis, and right now all the things that we're doing is creating fibrosis and not true regeneration.
• 24:57
  SPEAKER_00: That's right, that's right.
• 24:58
  SPEAKER_00: No, I want to ask you.
• 25:00
  SPEAKER_00: Um, you had mentioned, like, you know, you can always kind of tell when someone's done, and that's a really powerful statement and a good way for me to hear that because I've always felt that way.
• 25:09
  SPEAKER_00: I'm like, is something wrong with me?
• 25:11
  SPEAKER_00: Like, I just like clock people's faces.
• 25:13
  SPEAKER_00: Like, I'm just like always like, but I really feel like it's a conversation to have, you know what I mean?
• 25:18
  SPEAKER_00: In terms of what do you think it is, or like where do you think that line is where someone gets work done and then you can tell somebody else can tell that you had work done versus like small incremental changes that you might want to opt in for, you know, from the aesthetic side.
• 25:33
  SPEAKER_00: What do you think that that balances before so it becomes very obvious, you know?
• 25:38
  SPEAKER_01: I think um when something when someone when work can be detected, it's there's a disharmony because everything should go together.
• 25:48
  SPEAKER_01: And then the human eye is very good at detecting.
• 25:51
  SPEAKER_01: So for example, if your jaw is super, super snatched or you know, tight, but then your skin quality is not great, and then you have um very wrinkly a forehead, like if something's not in balance, your your your head, like you know, your your mind says, you know, something's wrong.
• 26:10
  SPEAKER_01: Or if there's obvious signals, for example, you look very natural everywhere else and your lips are overfilled, then immediately you know, oh, that looks done, and they can't focus on anything else except that you're overfilled lips.
• 26:23
  SPEAKER_01: Yeah, yeah.
• 26:23
  SPEAKER_01: So it's all about proportion and harmony.
• 26:27
  SPEAKER_01: And when something looks off in me that immediately clocks that before the human eye, and you can't even explain it at that point.
• 26:34
  SPEAKER_01: What is done?
• 26:35
  SPEAKER_00: Does that make sense?
• 26:36
  SPEAKER_00: Yeah, it does make sense, yeah, absolutely.
• 26:38
  SPEAKER_00: And I think that's that's a really, really important topic.
• 26:40
  SPEAKER_00: I know, like in the past, I've heard other physicians talk a lot about things like the golden ratio, you know, that comes up a lot in terms of like trying to understand the geometry of all of this, and like, and I I get that, but I think for the average consumer, that's really helpful to hear what you said because we don't really think about proportions, especially going back to what we were talking about.
• 27:00
  SPEAKER_00: If you have a little bit of body dysmorphia going on, you know, where you're kind of hyper-fixated.
• 27:05
  SPEAKER_00: I mean, five years down the line, you might be noticing that, you know, like, oh, I overdid it, you know, with my lips or I overdid it with my nose.
• 27:13
  SPEAKER_00: Um, and you know, this leads me to ask you.
• 27:15
  SPEAKER_00: I recently I've I've seen a lot of this where um surgeons and and you know, aesthetic providers, they're able to do a lot now with um like fillers and injectables that can really kind of transform the anatomy of the face and just even like the the optics of how things look.
• 27:30
  SPEAKER_00: I mean, I'd love for you to kind of dive into that in terms of like, is there like a is there a safety difference or like a like a uh longevity of results different between like truly like non-invasive kind of treatments versus the more invasive surge full-blown surgery treatments?
• 27:47
  SPEAKER_00: I mean, what what's your take on that?
• 27:49
  SPEAKER_01: I think ultimately you have to think about surgery and non-surgical treatments as just tools in a toolkit, right?
• 27:55
  SPEAKER_01: You can't expect surgery, a facelift that restores laxity and restores tissue to where it's supposed to be, to also um help with volume deficiency.
• 28:07
  SPEAKER_01: That's really either you're doing fat grafting or using fillers or whatnot.
• 28:11
  SPEAKER_01: And you can't expect using fillers and fat grafting to replace volume to lift sagging tissue, right?
• 28:17
  SPEAKER_01: So you have to use the appropriate tool for the problem at hand.
• 28:21
  SPEAKER_01: I think the problem becomes of when you think that you're only gonna use one tool to solve all of your problems.
• 28:27
  SPEAKER_01: That's how you get overfilled faces.
• 28:29
  SPEAKER_01: That's how you get, if you really are volume deficient and you're just trying to pull your face as tight as possible, you're still just gonna look volume deficient.
• 28:36
  SPEAKER_01: Yeah.
• 28:36
  SPEAKER_01: So it's really about, I think um, the aesthetic industry cannot be so segmented and saying, like, you know, you can't have plastic surgeon that says, you know what, facelift is the only thing that can solve all of your problems.
• 28:47
  SPEAKER_01: You can even do a great facelift, and the person that has poor skin quality, it's not gonna look right.
• 28:52
  SPEAKER_01: You can have, you know, the best skin quality, but everything is sagging, you have volume loss.
• 28:57
  SPEAKER_01: Just doing skincare is not gonna cut it either.
• 28:59
  SPEAKER_01: You have, I think the aesthetic community has to come together and not say, like, you know, it's either surgery at 30 years old or you know, non-invasive stuff at 30 years old or whatnot, like whatever you want to pick, but say, like, look, we are all team members on this team so that we can make our patients present like the best self and we have to work together.
• 29:19
  SPEAKER_01: It's not one tool versus another.
• 29:22
  SPEAKER_01: And then I and I want to make one more point about this is that I think some of my happiest patients, they are happy before their surgery.
• 29:31
  SPEAKER_01: And that's not how I can tell that they're gonna do well before surgery, because I'm very worried that we're gonna enter an era when people are so hyperface of looks maxing or whatever it is that they're doing to get to their ideal self.
• 29:44
  SPEAKER_01: So they're constantly picking and picking and picking to so they can optimize their looks.
• 29:49
  SPEAKER_01: That is not good for your mental health, that is not the right attitude to go into any kind of aesthetics procedure or skincare.
• 29:57
  SPEAKER_00: No, that's a really, really good point.
• 29:59
  SPEAKER_00: I'm glad you mentioned that.
• 29:59
  SPEAKER_00: Yeah, looks maxing is everywhere right now.
• 30:01
  SPEAKER_00: I don't know why we're so and we keep pushing it.
• 30:04
  SPEAKER_00: Like this is it blows my mind.
• 30:06
  SPEAKER_00: It's like social media keeps pushing it over and over again.
• 30:08
  SPEAKER_00: And it's like we have to come to a place of society, I think.
• 30:12
  SPEAKER_00: I I completely agree with you where it's like there needs to be something, right?
• 30:16
  SPEAKER_00: Like a barrier.
• 30:17
  SPEAKER_00: I don't want to stop anybody from you know doing what they love or they want to do.
• 30:20
  SPEAKER_00: Like, and this was actually one of the questions I had for you.
• 30:23
  SPEAKER_00: Like, for example, like the 28-year-olds that are like, I want to get a facelift.
• 30:26
  SPEAKER_00: I feel like I need to get a facelift.
• 30:28
  SPEAKER_00: And you look at them, right?
• 30:29
  SPEAKER_00: And you're looking at, what are you lifting?
• 30:32
  SPEAKER_00: Like, you are fully lifted, my friend.
• 30:35
  SPEAKER_00: You know, like your face looks great.
• 30:37
  SPEAKER_00: I mean, what what are your thoughts on that?
• 30:39
  SPEAKER_00: Like, because I feel like now, more than ever, we see this younger generation that's just like ready to go.
• 30:45
  SPEAKER_00: They're like, skip the skincare.
• 30:47
  SPEAKER_00: I'm ready to go see a surgeon.
• 30:48
  SPEAKER_00: Like, I gotta get something done.
• 30:49
  SPEAKER_00: Like, what are your thoughts on that?
• 30:51
  SPEAKER_01: It all comes down to education, right?
• 30:53
  SPEAKER_01: I um very naively at the very beginning of my career believes that you can have an unlimited number of face-ups.
• 30:58
  SPEAKER_01: You do you cannot have an unlimited number of face-ups.
• 31:00
  SPEAKER_01: Every time you touch the tissue, there's gonna be a scar that's formed.
• 31:05
  SPEAKER_01: We are not in an era where you have scarless healing.
• 31:08
  SPEAKER_01: Um, the tissue, if you one thing has a weird tension line, you're gonna look odd.
• 31:12
  SPEAKER_01: When you're 20 and you have no laxity, it is the provider and the surgeon's responsibility.
• 31:17
  SPEAKER_01: And I actually think it's malpractice if you say, like, hey, yes, you can do a facelift when you have nothing to lift.
• 31:25
  SPEAKER_01: Because it's your responsibility as a physician to do no harm at that point.
• 31:30
  SPEAKER_01: Um, does that make sense?
• 31:31
  SPEAKER_00: Yes, yes.
• 31:32
  SPEAKER_00: And I love that you said that.
• 31:33
  SPEAKER_00: Yes, do no harm.
• 31:34
  SPEAKER_00: And I also like it's like educate, right?
• 31:36
  SPEAKER_00: Like you had talked about this earlier, is like just educate people, you know, like that's and I think a lot of times, like that's what I was trying to tell you earlier, where it was like when I was growing up, like you went to the doctor.
• 31:47
  SPEAKER_00: You actually went to your doctor and said, I don't know what's going on, help me, you know?
• 31:51
  SPEAKER_00: And you allowed them to educate you and and share information with you and and things you didn't know about.
• 31:57
  SPEAKER_00: I mean, this was like pre-googling things and AIing everything, you know.
• 32:01
  SPEAKER_00: So I don't know.
• 32:02
  SPEAKER_00: I worry about the youth a lot because I think that they get so sucked into this, you know.
• 32:06
  SPEAKER_00: Another thing I really want to ask you about this, as we know, clinical grade skincare is not a thing.
• 32:12
  SPEAKER_00: Neither is medical grade, neither is any of the other BS terminologies on the market.
• 32:17
  SPEAKER_00: Do you think there's a difference if somebody gets an actual surgical procedure done, something like a facelift, and then they are asking, like if they're asking for skincare, like what do I do to maintain my results?
• 32:28
  SPEAKER_00: Or like, you know, just good skincare habits.
• 32:30
  SPEAKER_00: Do you think there's a difference what when you look at the products that are on the market in terms of the categories they might sit in, you know, hypothetical categories, or do you think it's really, I mean, what what is it that you would think is the main thing we should be looking at as consumers for like post-procedure care?
• 32:48
  SPEAKER_01: So I tell all of my patients this after face, like, you know, we we basically, you know, tucked everything back into where it's supposed to be, but you have to take care of your skin.
• 32:57
  SPEAKER_01: And I really divide everything into four main categories: a good cleanser, um, you need something that keeps your skin turning over, some kind of a retinoid, you need some kind of antioxidant, and then a sunscreen.
• 33:09
  SPEAKER_01: I don't like multi-step skincare because I think people cannot stick with it.
• 33:14
  SPEAKER_01: If you cannot be consistent with your skincare, it's it doesn't matter if you have XYZ, the next greatest thing, if you don't use it, right?
• 33:22
  SPEAKER_01: So if I can get a patient to put on sunscreen consistently every single day, it doesn't matter if it's sunny or cloudy outside, that they can wash their face and put on retinol and an antioxidant.
• 33:34
  SPEAKER_01: I think you're 95% of the way there.
• 33:37
  SPEAKER_00: Don't you agree?
• 33:38
  SPEAKER_00: Yeah, I would agree.
• 33:39
  SPEAKER_00: And I that's really great.
• 33:40
  SPEAKER_00: I'm glad you you really simplified that because I love, like, I won't lie to you, I love all of the stuff we're doing in skincare.
• 33:47
  SPEAKER_00: I, you know, I love research.
• 33:49
  SPEAKER_00: So I come from the research side and I always feel like like, oh, this is so exciting.
• 33:53
  SPEAKER_00: You know, it's exciting to see research being translated, right, in a meaningful space.
• 33:58
  SPEAKER_00: But we do put the cart before the horse and we do start making a ton of claims around skincare that are just simply not viable, you know, at the time that we're making them.
• 34:06
  SPEAKER_00: And I think a lot of times it really helps to have that clarity what you just provided, because you can get so sucked in, you know, you before you know it, you've spent$5,000 on a skincare routine.
• 34:15
  SPEAKER_00: That's like 10 steps, and it's like you don't even know anymore what's working, like you know.
• 34:20
  SPEAKER_00: So um, I I think it's it's a really interesting area right now in that in that sense, especially as we approach like regenerative skincare, for example.
• 34:28
  SPEAKER_00: You know, there's so many products now on the market.
• 34:30
  SPEAKER_00: So no, I absolutely agree.
• 34:33
  SPEAKER_00: Yeah.
• 34:33
  SPEAKER_00: Um, you know, from the side though, I I do want to ask you about something because um when it comes to like multi-skin routines, one of the biggest categories that stands out to me is K Beauty.
• 34:43
  SPEAKER_00: And don't get me wrong, I love Korean beauty.
• 34:46
  SPEAKER_00: I think it's one of the biggest drivers of innovation in skincare.
• 34:50
  SPEAKER_00: I mean, I think the way Korea comes out with new gradients and the the, you know what I mean?
• 34:54
  SPEAKER_00: Like the um the pace at which they're constantly coming out.
• 34:57
  SPEAKER_00: I think there's a lot of like scientific vigor there, but it's also led to a lot of damage to people's barriers, I think, in some ways, you know.
• 35:05
  SPEAKER_00: Also, one of my big questions is I know overseas you can get like multiple procedures done in one session.
• 35:11
  SPEAKER_00: What is your thought on that?
• 35:12
  SPEAKER_00: Like, is that something we should even be doing?
• 35:14
  SPEAKER_00: Or I mean, what is what's the deal with that?
• 35:18
  SPEAKER_00: People getting like 10 procedures in one sitting.
• 35:21
  SPEAKER_01: I think, you know, with KB, like I have friends who go to Korea and then they send me a list and say, look, I got kybella, uh, neurotoxin, I got, you know, softwave, like salmon, like DNA, all injected all at once, and it's only like$20, you know?
• 35:37
  SPEAKER_01: So I, you know, I'm really hesitant about stacking so many procedures um at once.
• 35:43
  SPEAKER_01: Um, K Beauty, you know, I think they have a lot of scientific rigor behind their skincare, especially their sunscreen.
• 35:50
  SPEAKER_01: They have filters that we we we don't even have.
• 35:52
  SPEAKER_01: They're years ahead in terms of sunscreen.
• 35:55
  SPEAKER_01: But I think, I think doing so much to your face, I kind of paused at that.
• 35:59
  SPEAKER_01: Um, and I'll share this story.
• 36:01
  SPEAKER_01: I probably get in trouble for saying this, but um I I was at a a conference and I was talking to a Korean dermatologist, and I was like, man, this is years ago.
• 36:10
  SPEAKER_01: This is probably like 10, 15 years ago.
• 36:11
  SPEAKER_01: And I was like, man, like this, what do you think about the 20-step like you know, K beauty things?
• 36:17
  SPEAKER_01: And she's like, Yeah, like it may work, it may not work, but you know what?
• 36:21
  SPEAKER_01: I think like everybody's just on microdosing accutane.
• 36:24
  SPEAKER_01: This was like years ago.
• 36:27
  SPEAKER_02: And I was like, oh microdosing accutane.
• 36:36
  SPEAKER_01: But you know, like accutane is a very well-regulated uh drug in the United States.
• 36:41
  SPEAKER_01: You can't just, you know, get access to it.
• 36:43
  SPEAKER_01: But that's I mean, that really, I mean, I don't know if that's true or not, but that that was just an off-handed remark that this career dermatologist made.
• 36:51
  SPEAKER_01: And I think like, you know, but you have to think about something like, you know, maybe there's okay, like me, there's you know, I think it's really good to have a routine that's very meditative, you know, it's it relaxes me to have like, you know, a 10-step skincare routine at the night just you know, to set the tone for bedtime or a bedtime routine.
• 37:09
  SPEAKER_01: That's great.
• 37:09
  SPEAKER_01: Yeah, but I think once you start making claims that, you know, all of these things is the reason why you have flawless skin, but like, is it those skincare ingredients or is it the microdosing accutane?
• 37:20
  SPEAKER_00: That's right.
• 37:20
  SPEAKER_00: That's right.
• 37:21
  SPEAKER_00: No, I mean, I mean, I'm I'm still laughing about the microdose because I have to look into this now, by the way.
• 37:26
  SPEAKER_00: Like, I need to figure out if microdosing accutane works.
• 37:30
  SPEAKER_01: It does help 100%.
• 37:31
  SPEAKER_01: It does help.
• 37:31
  SPEAKER_01: The microdosing accutane um has been shown to improve colony, it does help, but you know, accutane has lots of side effects, and it's it's not that easy to obtain the United States.
• 37:42
  SPEAKER_00: No, but I mean, at the same time, though, like that's really fascinating to hear that because yeah, like you know what's crazy?
• 37:48
  SPEAKER_00: The other day I saw like someone's social media, I forget who the creator was, and I saw the post.
• 37:53
  SPEAKER_00: It was a man, and he was like, Yeah, so I went to Korea and I got the 10 procedures done in one sitting, and he's like, I still look the same.
• 38:02
  SPEAKER_00: Like it was like three weeks later, and he's like, I don't think my face changed at all.
• 38:06
  SPEAKER_00: My friends think it did, I don't think it did at all.
• 38:08
  SPEAKER_00: Like, and he had gone through, he's like, I didn't get any of the numbing done or anything for the PDRN injections or anything.
• 38:14
  SPEAKER_00: He was like squirming in pain, and uh, it was like, I don't know why I did that to my body.
• 38:18
  SPEAKER_00: Like, I I feel the same.
• 38:20
  SPEAKER_00: So, I mean, it's it just that's why I asked you because I'm like, does it matter?
• 38:24
  SPEAKER_00: Like, you know, that you went and you got all these like different freaking injections and you know, whatever.
• 38:29
  SPEAKER_00: I don't know, it's interesting.
• 38:30
  SPEAKER_00: I'd love for somebody to do a few studies on this so we can get some data on you know what's the skin quality like?
• 38:36
  SPEAKER_01: Well, I think that the taking care of your skin is culturally so inherent in Korean culture, and that's you know, there's something to be said for that.
• 38:43
  SPEAKER_01: I think when they're religious about staying outside of the sun, so of course that helps, you know.
• 38:49
  SPEAKER_01: So if you look at, you know, you don't have collagen breakdown from sun damage, and that's really important, you know.
• 38:54
  SPEAKER_01: So, how what percentage of it is it the snail mucin versus staying out of the sun?
• 38:59
  SPEAKER_00: Since I'm on this, I I want to ask you about like a realistic aesthetic plan for people in the long term.
• 39:06
  SPEAKER_00: Like, how do you think, like I myself am 39 years old, very excited to turn 40, uh, you know, and I I've never actually gotten much done, you know, and it's it's not because I I look down on or anything.
• 39:19
  SPEAKER_00: I've just frankly I'm scared and I've never, you know, I've always had so many questions for my providers.
• 39:24
  SPEAKER_00: And but the point is, like, I've never had a plan in place where it's like, well, when I'm at when I am ready, you know what I mean, to get anything uh surgically done.
• 39:32
  SPEAKER_00: I mean, what is something that you think is like a good guiding principle or good guiding plan for people, maybe like myself, that are open to things, but we might not know where to begin and you know where to like kind of prep ourselves before going in and seeing a professional.
• 39:49
  SPEAKER_01: So I think what's really important to keep in mind is that you want to preserve what's what you have right now.
• 39:56
  SPEAKER_01: And so coming from that mindset, when you're in your 20s and your 30s, it should really be about skincare, right?
• 40:03
  SPEAKER_01: Taking care of your skin, staying out of the sun, you know, make sure you get sun protection and whatnot.
• 40:08
  SPEAKER_01: You don't really need anything more than that.
• 40:09
  SPEAKER_01: Your collagen is at its best, right?
• 40:12
  SPEAKER_01: So you don't need to like mess with it that much.
• 40:15
  SPEAKER_01: As you get older, we lose collagen every single year, then every single day you're losing collagen.
• 40:20
  SPEAKER_01: So you can think about some things that protect the collagen, collagen in your skin, you know, things like little a bit of microneedling.
• 40:26
  SPEAKER_01: Um, but that's really pretty much all you need.
• 40:28
  SPEAKER_01: If you start experiencing significant volume loss, that's when you can think about very strategically placed fillers, not to transform your face, but to replace the volume that you have lost.
• 40:39
  SPEAKER_01: I don't think filler is as bad as everyone makes it out to be.
• 40:42
  SPEAKER_01: I think strategically well-placed fillers are great.
• 40:45
  SPEAKER_01: And I also think it's very important not to do things that would damage the surgical plane if you want to have surgery in the future.
• 40:52
  SPEAKER_01: So things that's like, you know, really like cooking your face and you know, frying everything.
• 40:57
  SPEAKER_01: Sometimes I hear some claims saying like this is going to tighten your smaz.
• 41:01
  SPEAKER_01: And I'm like, no, leave my smazz alone.
• 41:03
  SPEAKER_01: I don't want everything like frying my smaz.
• 41:06
  SPEAKER_01: I need that to me.
• 41:06
  SPEAKER_00: But you put that on a t-shirt, leave my smaz alone.
• 41:11
  SPEAKER_00: Right, exactly.
• 41:12
  SPEAKER_01: But then, you know, if you consistently maintain your skin, um, strategically place fillers when you need it, but nothing crazy, and then you know, doing some micronealing to support your skin.
• 41:23
  SPEAKER_01: If you have pigmentation issues, doing some BBL to you know help with the pigmentation, and then I don't think you need to do that much.
• 41:30
  SPEAKER_01: And by the time you need surgical intervention, which is for most people, late 40s, early 50s to 60s decade, your skin, your your face is not this hodgepodge of things that has happened to it, and then you have to, you're like going through a minefield as a surgeon so you can have a nice result.
• 41:48
  SPEAKER_01: Does that make sense?
• 41:49
  SPEAKER_00: Yeah, yeah.
• 41:50
  SPEAKER_00: No, that's really, really good advice too.
• 41:52
  SPEAKER_00: I I like that you brought up that we have to keep the surgical planes, you know, free of all this like fibrosis and all of the different things that can result from like just you know overdone stuff and you know, maybe even premature, who knows?
• 42:03
  SPEAKER_00: I mean, I I I think that's interesting that you're saying that because I've never been able to get a surgeon to tell us that, you know, because this is the idea that I feel like if we put the information out there, like a plan, you know, people will have something, like a roadmap.
• 42:19
  SPEAKER_00: Because I think some sometimes people wake up in the morning and they're like, oh my God, I need to go get something done.
• 42:24
  SPEAKER_00: You know, like I just I can't believe I've gotten nothing.
• 42:26
  SPEAKER_00: And I I know I've had that feeling myself, you know, where it's like, I gotta go see somebody, I gotta, you know, and and to avoid that, I just feel like when you have something in your mind that's like a like a roadmap, like you it avoids that like impulsive nature, you know, that we often see in aesthetic medicine with with patients.
• 42:43
  SPEAKER_00: So that's really helpful.
• 42:45
  SPEAKER_00: I'd love to actually kind of like go back to the philosophy of of stuff a little bit with you know with you, because I I think that there's a lot to learn here in terms of like beauty.
• 42:54
  SPEAKER_00: You know, you said you started the interview with with explaining how you really love the idea of beauty.
• 42:59
  SPEAKER_00: I mean, what do you think in today's age, right?
• 43:02
  SPEAKER_00: What do you think contributes the most to like our perception of what beauty is?
• 43:06
  SPEAKER_00: And like, and how do you analyze that maybe in your patients or even just in general, you know, knowing what you know, you have so much knowledge, you know, from the aesthetic side.
• 43:14
  SPEAKER_00: So looking through that lens, when you look at beauty at large, what are some things that really stand out to you as driving forces behind that concept?
• 43:22
  SPEAKER_01: You know, um, for me, this is maybe a little counterintuitive because I'm in plastic surgery and not I am a plastic surgeon, but I actually think the some of the most beautiful people that I see, they have a true internal radiance.
• 43:36
  SPEAKER_01: And it has nothing to do with what's on the outside.
• 43:39
  SPEAKER_01: And and I I I believe that a hundred percent.
• 43:41
  SPEAKER_01: They're they're smiling, and I I actually think when you're smiling, that's the best mid face lift you can get than like any other mid face lift.
• 43:49
  SPEAKER_01: That's right, that's right.
• 43:50
  SPEAKER_01: I love that.
• 43:51
  SPEAKER_01: Yeah, so you know, I'm naturally a very happy person, so I I love being uh around people who are happy, who are radiant, and uh I That's the foundation of beauty for people who are not picking themselves apart but accept themselves at whichever age they're at.
• 44:08
  SPEAKER_01: Now, sometimes I have patients who say they're happy people, but saying, you know, when I look in the mirror, I don't even recognize myself.
• 44:15
  SPEAKER_01: You know, I I feel so much older, I look tired, and people always think I am angry, like you know, like everything is is sagging, but I don't feel that way inside.
• 44:25
  SPEAKER_01: I think when you match what you feel on the inside with the outside, um, and everything's in harmony, and you're not doing all these crazy things trying to transform yourself.
• 44:33
  SPEAKER_01: I think that's when true beauty shines through.
• 44:36
  SPEAKER_00: Yeah, I love that.
• 44:38
  SPEAKER_00: I love that.
• 44:38
  SPEAKER_00: And I'm so glad you said the happiness part because I think we really all just need to be happier, you know.
• 44:44
  SPEAKER_00: And I know it can be tough.
• 44:45
  SPEAKER_00: It can be tough.
• 44:46
  SPEAKER_00: We're going through a lot right now, you know, with the economy and a lot of things, but I love that you said that, you know, I don't see a lot of people smiling like all the time.
• 44:54
  SPEAKER_00: It's like just like I think like when we were growing up, people said that, right?
• 44:57
  SPEAKER_00: It's like smile more, like it's actually, you know, it's really good for your face to smile a lot.
• 45:02
  SPEAKER_00: And um, I just I don't know, I wish we'd hear that more often um for everybody.
• 45:06
  SPEAKER_00: It's just you know, just be happy.
• 45:09
  SPEAKER_01: That kind of well, I mean, like it's a very like it's almost like like I reduced to something so simple, but at the same time, I you know, there's a lot of things that we have to be.
• 45:18
  SPEAKER_01: I mean, there's a lot of assault in the world right now on our psyche and everything.
• 45:23
  SPEAKER_01: But at the same time, you know, there's so much beauty around us in terms of our community, in terms of aesthetic experiences, and I think also being kind to yourself and not picking yourself apart and a constant chase of perfection is not it, and that's actually going to distort you more than anything else.
• 45:40
  SPEAKER_00: Yeah, no, I absolutely agree with you.
• 45:42
  SPEAKER_00: And I also like there's just so much like comparison now, too.
• 45:46
  SPEAKER_00: Like, that's a big component of it.
• 45:47
  SPEAKER_00: I feel like I just wish people like, I mean, I'm guilty of this.
• 45:50
  SPEAKER_00: I'm not trying to like talk at anybody, but it's like put our phones down, you know, and just be like, be present for a minute, you know.
• 45:56
  SPEAKER_00: And I think a lot of times I've done that a lot, and I'm just like, it's it'll shock you how much happier you feel.
• 46:02
  SPEAKER_00: Like it shocked me, you know.
• 46:03
  SPEAKER_00: When I stopped like looking at social media, I think at this point I don't even really look at it like that.
• 46:08
  SPEAKER_00: It really shocked me because sometimes like I feel like we're internally comparing ourselves, even though we don't realize we're doing it, you know.
• 46:14
  SPEAKER_00: So we're scrolling, we're scrolling, and we're looking at whatever, and we're like, oh, I need that, you know.
• 46:20
  SPEAKER_00: It's uh and I think a lot of times like that's been such a driver, I feel like, with plastic surgery, especially is that sometimes you look at somebody else, like you look at a celebrity that got a boob job, you know, and you're like, I need my breasts to look exactly like that.
• 46:33
  SPEAKER_00: And it's like, how do you know that?
• 46:35
  SPEAKER_00: How do you know?
• 46:36
  SPEAKER_00: You know, you're you're comparing apples to oranges.
• 46:39
  SPEAKER_00: I mean, no pun intended, but you know what I mean?
• 46:41
  SPEAKER_00: Like you're you're like, you don't know what's gonna look good on your body.
• 46:44
  SPEAKER_00: That's my point.
• 46:45
  SPEAKER_00: So I think people need to like take a step back, you know, and just think.
• 46:48
  SPEAKER_01: Yeah, and but yeah, I I am very optimistic because I think people are, I think the the current generation of people are very uh smart, and then you know, they understand like what's a filter and like this is not realistic, like normal skin doesn't look like that.
• 47:01
  SPEAKER_01: And then there are a lot of creators who point that out and say, like, you know, like this transformation, like it's because of the lighting and one so people understand that these are unrealistic expectations that's put out there.
• 47:12
  SPEAKER_01: So I am very hopeful um in that way, and I think we are approaching, you know, an era where patients are very well educated.
• 47:20
  SPEAKER_01: You know, when I see patients coming into my office, they're not a blank of canvas of like, oh, I don't know anything, they know a lot of things, and that's really good.
• 47:29
  SPEAKER_01: I think it holds the professional community accountable, and it's good to you know democratize information.
• 47:36
  SPEAKER_00: I agree.
• 47:36
  SPEAKER_00: No, I completely agree.
• 47:37
  SPEAKER_00: Now, I do have one like random question for you, and I'd love to get your take on this.
• 47:41
  SPEAKER_00: Is like, I feel like doctors get criticized a lot.
• 47:44
  SPEAKER_00: We get a lot of critique for like accepting brand deals or accepting, like, you know what I mean, like anything from that, even celebrities.
• 47:50
  SPEAKER_00: Like, I'm sure you've had a lot of celebrity clients and stuff, and we get dragged, I feel like, on the internet.
• 47:55
  SPEAKER_00: Like, what is your take on that?
• 47:56
  SPEAKER_00: Because like, I just feel like if you've gone to school for 20, 30 years, like you have every freaking, you know, right to be like, if I want to take a brand deal, I'm gonna take a freaking brand deal.
• 48:07
  SPEAKER_00: I mean, what are your thoughts on that?
• 48:09
  SPEAKER_01: Well, my thoughts that you have to take the brand deal that you truly believe in, not just for the money, right?
• 48:14
  SPEAKER_01: So I actually think doctors should be uh very present in the conversation in social media, like the things that you know, like you do, because if we're not the voice of reason and science and evidence-backed evidence, that vacuum is gonna be filled with misinformation, you know, and we you cannot, and that's that hurts public safety.
• 48:33
  SPEAKER_01: And you know, in terms of brand deals, you know, I think you have to you can take brand deals if you really believe in the product, but not just some, you know, XYZ skincare cream that you're trying to sell.
• 48:45
  SPEAKER_00: Yeah, and no, that makes a lot of sense.
• 48:46
  SPEAKER_00: I agree with you.
• 48:47
  SPEAKER_00: I think that's but you know, that's the thing is like I feel like a a lot of doctors do do that too.
• 48:52
  SPEAKER_00: And it's like we I've just I asked you because I've I recently saw a lot of critique about this online.
• 48:57
  SPEAKER_00: It kind of like irked me because I'm like, I knew the doctor, right?
• 49:00
  SPEAKER_00: Like in this specific city, I was like, I know that person, I've interviewed them, but he's brilliant, you know what I mean?
• 49:04
  SPEAKER_00: And I feel like the product he chose is also brilliant, but it's like you get dragged, and practitioners nowadays, I feel like are I mean, it's good to hold doctors to high regards, you know what I mean?
• 49:14
  SPEAKER_00: You do have to hold us accountable, but it's like just go easy, man.
• 49:17
  SPEAKER_00: You know, like you're seeing influencers, you see influencers, right, with like two million followers, and they're out here like selling you garbage, like it's not even like science, you know.
• 49:27
  SPEAKER_00: Uh so if you see a doctor, like maybe just pause for a minute and be like, why would they why do you think they picked that brand deal?
• 49:33
  SPEAKER_00: You know, yeah, like that kind of thing.
• 49:35
  SPEAKER_00: So I agree.
• 49:36
  SPEAKER_00: No, but um, just to close out, I'd love to get your your words of wisdom for anybody who's listening that maybe has a child or is somebody looking to go into medicine, like you know, just some words of wisdom on like what it takes to get to the point, like your career.
• 49:49
  SPEAKER_00: You know, you've got you've done so much, you've accomplished so much.
• 49:52
  SPEAKER_00: Like, what do you think it really takes to get to that point in your career?
• 49:55
  SPEAKER_00: And and maybe just a guiding light for anybody that might be interested in medicine.
• 49:59
  SPEAKER_01: You know, when I look back, I I see that my journey to medicine is not a linear and that people go into medicine for all kinds of reasons, but ultimately you have to be authentic to yourself, right?
• 50:09
  SPEAKER_01: I've always been obsessed and loved beauty and anything that's a beautiful experience.
• 50:15
  SPEAKER_01: And in medicine, I still found that.
• 50:17
  SPEAKER_01: And in medicine, it's hard, it's the long journey.
• 50:20
  SPEAKER_01: It was four years of medical school, six years of residency, one year of fellowship.
• 50:24
  SPEAKER_01: That's 11 years of your life that you give up so many holidays, events, because that's the sacrifice that's needed.
• 50:32
  SPEAKER_01: But we are designed to do hard things, and there's so many aspects to medicine that you can find whatever that fills your satisfaction and what it drives you and your desires.
• 50:44
  SPEAKER_01: So I think you have to love the field.
• 50:47
  SPEAKER_01: It's not, you know, originally I went into medicine because I'm like, oh, it's practical, like, you know, I can get a paycheck.
• 50:52
  SPEAKER_01: So, you know, I'm not a starving artist.
• 50:55
  SPEAKER_01: But to really succeed, you have to love it.
• 50:58
  SPEAKER_01: You know, I love plastic surgery.
• 51:00
  SPEAKER_01: This is like I feel like this was my calling at the end of the day, even though I went about it in a very roundabout way.
• 51:05
  SPEAKER_00: Yeah, no, I love that.
• 51:06
  SPEAKER_00: That's great advice.
• 51:07
  SPEAKER_00: And thank you so much for that.
• 51:09
  SPEAKER_00: And I I really hope I I love you know seeing people get curious about medicine.
• 51:13
  SPEAKER_00: That's why I asked you because I see a lot of youth, you know, um on social media and they're like, oh, you know, what did it take and whatnot.
• 51:19
  SPEAKER_00: So I love getting this kind of advice from professionals um just to to help them out.
• 51:24
  SPEAKER_00: But thank you so much.
• 51:24
  SPEAKER_00: That was amazing.
• 51:25
  SPEAKER_00: Um thank you so much.
• 51:27
  SPEAKER_00: It was really fun talking to you.
• 51:28
  SPEAKER_00: I love this conversation.
• 51:29
  SPEAKER_00: And for everyone tuning in, if you guys have any questions about aesthetics, please chime in, let us know.
• 51:33
  SPEAKER_00: Maybe we can have Dr.
• 51:34
  SPEAKER_00: Lee come back for a part two if she has time and answer some questions.
• 51:37
  SPEAKER_00: But uh, this has been wonderful.
• 51:39
  SPEAKER_00: Thank you.