Latest / Skin Anarchy / Vivian Bucay, MD, FAADDermatologist

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Vivian Bucay, MD, FAADDermatologist · Skin Anarchy

• 0:00
  SPEAKER_00: Is Dr.
• 0:00
  SPEAKER_00: Vivian Bukai, who is a dermatologist and was trained at the University of Miami and the Baylor College of Medicine.
• 0:07
  SPEAKER_00: She is a clinical assistant professor in the Department of Physician Assistant Studies at the University of Texas Health Science Center.
• 0:14
  SPEAKER_00: In addition, um, Dr.
• 0:15
  SPEAKER_00: Bukai is a nationally and internationally, you know, lecturing member of the medical community.
• 0:22
  SPEAKER_00: And she is also in the process of writing book chapters for dermatology textbooks.
• 0:26
  SPEAKER_00: So without further ado, welcome to the show, Dr.
• 0:29
  SPEAKER_00: Bukai.
• 0:30
  SPEAKER_00: I'm so excited that you are here with us.
• 0:32
  SPEAKER_01: Thank you so much.
• 0:33
  SPEAKER_01: I'm really honored to be here.
• 0:34
  SPEAKER_01: How much fun.
• 0:35
  SPEAKER_01: This is all new.
• 0:36
  SPEAKER_01: You know, I'm I'm a dinosaur in medicine.
• 0:38
  SPEAKER_01: And so all these technologies, technologies are uh sometimes, you know, they still manage to put a little fear in me, you know.
• 0:47
  SPEAKER_01: I feel much more comfortable talking about what I do than getting my message out there.
• 0:52
  SPEAKER_00: That's what I want to ask you, actually.
• 0:54
  SPEAKER_00: I want to I want to get started though first by you telling us a little bit about your um your journey in medicine and you know, just just the whole the whole, I guess, journey and and adventure of becoming a dermatologist.
• 1:06
  SPEAKER_01: So I'm I'm one of these people that I've always loved art and I've always loved detective, being a detective, very visually oriented.
• 1:14
  SPEAKER_01: I originally thought I was I was like the little girl that had a Barbie doll with her dream house, but I also had a chemistry set.
• 1:21
  SPEAKER_00: Oh my gosh, me too.
• 1:23
  SPEAKER_01: So that was that was like I was, you know, there was always this duality.
• 1:27
  SPEAKER_01: And I think I originally wanted to be an architect.
• 1:29
  SPEAKER_01: And then once I figured out that there wasn't that much autonomy in it, and it wasn't just about letting your creative energies flow, you know, unrestricted, that I thought I read the fountain head and I said, Oh no, I'm not going to be an architect.
• 1:40
  SPEAKER_01: And the chemistry got the best of me.
• 1:42
  SPEAKER_01: And I thought I was going to become a chemist, but I love people and science and biology, and so medicine was like a perfect fit.
• 1:50
  SPEAKER_01: I originally wanted to be a reconstructive plastic surgeon and you know, treat children with cleft lip, cleft palate, that type of thing.
• 1:57
  SPEAKER_01: But I was really hooked on dermatology at my first lecture in medical school.
• 2:03
  SPEAKER_01: And I it was this was way before before aesthetics was even on the radar, to be quite honest.
• 2:09
  SPEAKER_01: I mean, it was to me, it was interesting enough that acne, psoriasis, all the things that are so visible on the skin and can have such an impact on quality of life that that there was actually a whole specialty dedicated to skin diseases and skin wellness.
• 2:25
  SPEAKER_01: Well, and hair and nails, too, right?
• 2:27
  SPEAKER_01: Right, right.
• 2:28
  SPEAKER_01: Yeah.
• 2:28
  SPEAKER_01: So that's what that's what got me really interested.
• 2:31
  SPEAKER_01: I started my private practice in 1991.
• 2:34
  SPEAKER_01: My husband and I went to Mexico City, that's where he was born and raised, and that's where my parents come from originally.
• 2:40
  SPEAKER_01: Although my mom, when she got married, moved to the States and, you know, and stayed here.
• 2:44
  SPEAKER_01: So we had um so from 91 to 99, uh, I practiced there.
• 2:51
  SPEAKER_01: And you know, I'm luckily I'm completely fluent in Spanish.
• 2:55
  SPEAKER_01: And although I didn't attend medical school there, thankfully my studies were recognized and I was able to, you know, have my medical license and practice.
• 3:03
  SPEAKER_01: Wow, that's so cool.
• 3:04
  SPEAKER_01: So it was really fun.
• 3:05
  SPEAKER_01: And you know, the first thing to me that was very exciting was just skin care in the sense of like, you know, it wasn't too many years after uh Dr.
• 3:12
  SPEAKER_01: Klingman had pop, you know, published on uh the use of tretinoin to treat photoaging, right?
• 3:19
  SPEAKER_01: And uh and then glycolic acid and the alpha hydroxy acids came on the scene, and then patients would kind of push me.
• 3:26
  SPEAKER_01: They would drive, they would drive questions like, well, what else can I do?
• 3:29
  SPEAKER_01: What else can I do to make my skin look better?
• 3:32
  SPEAKER_01: And I was very much focused on how the skin could look better.
• 3:35
  SPEAKER_01: And in fact, I brought the CO2, the first CO2 resurfacing laser into Mexico.
• 3:40
  SPEAKER_01: I brought it in 1995, wow, and started doing treatments, you know, of all different skin types so that I wouldn't necessarily, you know, hyperpigment somebody or do that.
• 3:51
  SPEAKER_01: But you know, a year after I started doing that, people's wrinkles were starting to come back, and so and and it they looked tighter and smoother, but not necessarily more youthful.
• 4:01
  SPEAKER_01: Yeah so very organically grew into that combination treatments with um with fillers, botulinotoxin, um, or neuromodulators.
• 4:09
  SPEAKER_01: And then we came back to the states in '99 because of all the kidnappings, and my husband just really felt like with three little girls that that we would be.
• 4:18
  SPEAKER_01: So we removed to San Antonio, which is where I was born, but didn't really have any family there.
• 4:23
  SPEAKER_01: And I started private practice all over again.
• 4:27
  SPEAKER_01: And it was a personal experience with melanoma that I had.
• 4:30
  SPEAKER_01: I had a stage four melanoma.
• 4:31
  SPEAKER_01: I've been very public about it.
• 4:33
  SPEAKER_01: Uh, this was in 2006 and 2007, but it really made me think about what I was putting on my skin.
• 4:40
  SPEAKER_01: And even though my skin looked good and I didn't have wrinkles and so on, my skin clearly wasn't healthy.
• 4:47
  SPEAKER_01: So that's how I got really interested in skincare, DNA repair, started thinking about growth factors, about a lot of different things, and also realized that skincare can achieve things that devices cannot.
• 5:00
  SPEAKER_01: So, devices, if you remember what I said, how to make things look better.
• 5:04
  SPEAKER_01: Yeah.
• 5:04
  SPEAKER_01: Devices, and we do need them, we definitely do need that in-office technology, they can really help with wrinkles and scars and textural changes and discoloration and redness and broken capillaries and all of those things, right?
• 5:19
  SPEAKER_01: Really change what are the effects of you know, free radical damage on the skin of oxidative stress.
• 5:25
  SPEAKER_01: Can they do DNA repair?
• 5:27
  SPEAKER_01: And they actually do not for the most part.
• 5:30
  SPEAKER_01: Wow.
• 5:31
  SPEAKER_01: Yeah.
• 5:31
  SPEAKER_01: Skincare is really what becomes the most interesting, you know, to me now, as a way to enhance what we do and also protect what it is that we're doing, or for somebody who doesn't want to have an in-office treatment, and a lot of that, you know, during the pandemic, people were staying home more.
• 5:47
  SPEAKER_01: That's where skincare, I think, really, really, really had a chance to shine.
• 5:52
  SPEAKER_01: And so that's really interesting.
• 5:53
  SPEAKER_01: So I've been really interested right now in using autologous, you know, using platelet-rich plasma for skincare.
• 6:01
  SPEAKER_01: And so there is a method, you know, there is a way to do that.
• 6:05
  SPEAKER_01: And so that's just kind of next level in terms of what does that provide?
• 6:08
  SPEAKER_00: What like what does that do for us?
• 6:10
  SPEAKER_01: Like, can you can you tell us about the technology and the and the science behind that?
• 6:13
  SPEAKER_01: Yeah, yeah.
• 6:14
  SPEAKER_01: So the science, and this has been studied, Dr.
• 6:16
  SPEAKER_01: Zoe Dreilos has actually done uh blinded studies and and vehicle controlled studies.
• 6:20
  SPEAKER_01: So it's basically it's a serum that is that that creates an environment to protect and preserve the activity of the platelets, which are loaded with growth factors.
• 6:32
  SPEAKER_01: So, in very much the same way when anybody's had a platelet-rich plasma done, whether for hair loss or for uh after a laser resurfacing, you know, for wound healing or injected, this is now done where it's the platelet-rich plasma.
• 6:46
  SPEAKER_01: And then it's it's it's you know, it's so it's the patient's own platelets.
• 6:52
  SPEAKER_01: And then those actually those are added to a serum that it's actually refrigerated.
• 6:57
  SPEAKER_01: So you have like a one-month supply of each.
• 6:59
  SPEAKER_01: So every three months, yes, the downside is every three months you have to go in and get your PRP done.
• 7:04
  SPEAKER_01: But the real upside is that you're using your own growth factors, it's not derived from anybody else.
• 7:10
  SPEAKER_00: Yeah.
• 7:11
  SPEAKER_01: It's and the and the serum does not allow the growth of any viruses, any bacteria.
• 7:16
  SPEAKER_01: That's also been studied.
• 7:18
  SPEAKER_01: There is no, God forbid, there was a mistake, and somebody, you know, was the accidentally had transmitted an infected plasma, you know.
• 7:25
  SPEAKER_01: I don't know, it won't grow in that.
• 7:28
  SPEAKER_01: It will not.
• 7:29
  SPEAKER_01: So it's another level safety, but at the same time, the growth factors can then target our own cells to do what they normally do, but do it better.
• 7:38
  SPEAKER_01: And you know, everything slows down as we get older.
• 7:41
  SPEAKER_01: So I think it's kind of like I always say it's like, you know, charging your battery or using both uh jumper cables, you know, to kind of boost that charge.
• 7:49
  SPEAKER_01: It's so it's really great for evening out skin tone, uh, decreasing the appearance of pores, the uh, you know, treating kind of fine lines and wrinkles.
• 7:58
  SPEAKER_01: But the great thing is that you can use it right after a treatment, or you can use it as a standalone.
• 8:04
  SPEAKER_01: So I really like it.
• 8:05
  SPEAKER_01: And so again, there's peer-reviewed uh journal studies that show that it does improve the appearance of skin and reduces the appearance of photo damage, it improves collagen and blastin.
• 8:18
  SPEAKER_01: So that that's what I really like about it.
• 8:20
  SPEAKER_01: And there isn't another thing on the market like it.
• 8:22
  SPEAKER_01: It's called so me.
• 8:24
  SPEAKER_01: I know I used to thought it was called some, but no, it's so me.
• 8:28
  SPEAKER_01: Yeah.
• 8:28
  SPEAKER_01: Um, and so it's it's neat.
• 8:31
  SPEAKER_01: And so what's great about it is that, you know, most most of the in terms of offices that are already doing platelet rich plasma, whatever device they have that that generate, you know, that's used to do that, it doesn't have to be a special device that only goes with that serum.
• 8:46
  SPEAKER_01: So as long as people already are successfully using PRP, it's a very easy, easy add-on to a practice.
• 8:53
  SPEAKER_01: And again, it's it's a product that from you know, as a physician, um, it really I think provides like the ultimate like safety in skincare for the patient who's worried about putting on things that are, you know, animal derived or or from a human donor, let's say, or you know, if they have to do it.
• 9:10
  SPEAKER_00: How do you feel about that though, as a scientist?
• 9:13
  SPEAKER_00: Like, and be and I'm asking honestly, because I am so split on that.
• 9:17
  SPEAKER_00: Like, in terms of like, you know, like I know that we want things to be cruelty-free, and obviously we don't want human testing on a lot of things, but when it comes to skin health, and especially everything you just described, I'm thinking of this, you know, from a research standpoint, I'm thinking of a petri dish, right?
• 9:31
  SPEAKER_00: And you have the right medium that you put on top of it so that it can that the cells can grow optimally, you know, right?
• 9:36
  SPEAKER_00: So, like that's what I'm thinking when you're describing this.
• 9:39
  SPEAKER_00: But then at the same time, I'm wondering how will we ever know if this works for skin health if we're not using human testing, right?
• 9:46
  SPEAKER_00: If we're not doing that.
• 9:47
  SPEAKER_00: So, what are your thoughts around that?
• 9:49
  SPEAKER_01: So, if we're talking about this particular system, the PRP, yeah, uh, you know, of course there's variation, right?
• 9:56
  SPEAKER_01: Because my thoughts have always been okay, with platelet-rich plasma, you're you're using the person's own growth factors to target their own cells, right?
• 10:04
  SPEAKER_01: And if their own cells already got them to where they are, what's the guarantee that, you know, putting more of the same thing on the same cells, that the same is responding, how is that really gonna work?
• 10:14
  SPEAKER_01: But these are concentrated amounts.
• 10:16
  SPEAKER_01: These now become more than physiologic amounts, these become almost pharmacologic amounts.
• 10:20
  SPEAKER_01: So you're putting on more, just like it might just take more to get to the same, you know.
• 10:25
  SPEAKER_01: Maybe it takes, maybe it's like like say a car that gets older, it's mileage, it's not as efficient as when it was a younger car, right?
• 10:32
  SPEAKER_01: It's still gonna go distance, it's just gonna take a little more fuel to get there.
• 10:36
  SPEAKER_01: And so that's how I see that.
• 10:38
  SPEAKER_01: The reason that I know that SOME works is because there's the biopsy-controlled study.
• 10:43
  SPEAKER_01: There's a biopsies using the serum compared to the serum with the PRP to show that there really is improvement.
• 10:50
  SPEAKER_01: So there's actually histology studies to show that the benefit is not just visually, it's not just dependent on our eyes or a patient telling us, you know, this looks better, but actually proving through biopsies and special stains that there has been actually an improvement in skin wellness.
• 11:08
  SPEAKER_01: Now, if people don't change their habits and they're they're bent on getting sun and smoking and ingesting, you know, not having a good diet.
• 11:16
  SPEAKER_01: I mean, well, what is the best?
• 11:18
  SPEAKER_00: That's like countering the effects of the good, you know, that really is.
• 11:21
  SPEAKER_00: And especially, you know, going back to your point about free radical formation.
• 11:25
  SPEAKER_00: I mean, I think that's a very hot topic in skincare right now.
• 11:28
  SPEAKER_00: And I remember when I first um really got into it, I'm so glad, by the way, that you validated my um my understanding of using skincare for combating free radical damage because when I discovered this brand, uh Neode, they had this mist called um superoxide dismutase mist.
• 11:45
  SPEAKER_00: And as soon as I saw that, I was like, this is brilliant.
• 11:48
  SPEAKER_00: Like this is brilliant.
• 11:49
  SPEAKER_01: They really are.
• 11:50
  SPEAKER_01: And right now, you know, hot topic also being uh, you know, you blue light, high energy, um, you know, the high energy blue violet uh light, things that are emitted from devices, also, you know, being able to wreak havoc on the skin.
• 12:04
  SPEAKER_01: And, you know, people are so focused in it.
• 12:06
  SPEAKER_01: And it does take a long time to educate the public, the consumer, our patients about skincare and why we really should be very good about using it.
• 12:15
  SPEAKER_01: It doesn't have to be a 12-step regimen, but we know that you know, people are so used to UVA and UVB, and they think of UV radiation in total as just the the sunburner, the tanning, and they kind of forget that the whole spectrum also encompasses visible light and infrared light.
• 12:33
  SPEAKER_01: And as the wavelength gets longer, the penetration goes deeper.
• 12:38
  SPEAKER_01: The shorter the wavelength, the more it reacts with the parts that are more superficial, which shorter wavelengths include UVB and UVA, but UVB is still shorter and it targets that DNA in the upper skin cells, and it does, you know, lead to sunburn and mutations and skin cancers and all of that.
• 12:58
  SPEAKER_01: But the ones that penetrate more deeply, like UVA, blue light, and infrared, can age the skin in different ways because they cause breakdown of collagen.
• 13:08
  SPEAKER_01: They do cause thinning in deeper layers, leading to more wrinkles and sagging.
• 13:13
  SPEAKER_01: So all of it together, and actually, blue light can all visible light can also trigger discoloration.
• 13:18
  SPEAKER_01: And you know, we're kind of a global, we're a global society now, and and skin of color and diversity being a hot topic as well.
• 13:26
  SPEAKER_01: Yeah, it's but it's also realistic.
• 13:28
  SPEAKER_01: It's not that it's just a trending topic, it's just something we we have overlooked for so many years.
• 13:33
  SPEAKER_01: It's really important to educate our patients that do have um that do have darker skin types, that they might actually be more susceptible to some of the the damage from infrared and visible light through different pathways.
• 13:48
  SPEAKER_01: Maybe they won't sunburn as much because melanin is a natural sunscreen, right?
• 13:53
  SPEAKER_01: But at the same time, there's still going to be it, it's not gonna stop the penetration of infrared and uh blue and blue light, visible light.
• 14:02
  SPEAKER_01: So to me, these are just really interesting things.
• 14:04
  SPEAKER_01: And as you said, back to antioxidants, being able to neutralize some of those free radicals to then decrease the body's inflammatory response.
• 14:14
  SPEAKER_01: That's where it all plays together.
• 14:15
  SPEAKER_01: And that's what skincare can do so well for us.
• 14:19
  SPEAKER_01: I love that.
• 14:20
  SPEAKER_00: I love that you explained the role of skincare and skin health because this has been such a great topic or area for me, especially, because you know, on one side you have hardcore, you know, medical practitioners saying you don't like, you know, forget the big skincare industry, you know, come go straight to a dermatologist, but then you also have them selling skincare in the offices.
• 14:40
  SPEAKER_00: You know what I mean?
• 14:41
  SPEAKER_00: So, like you explaining this is very interesting and it makes so much more sense.
• 14:45
  SPEAKER_00: I love that.
• 14:46
  SPEAKER_00: Thank you for explaining that.
• 14:47
  SPEAKER_00: Now, one question I have um you mentioned that everyone is susceptible to different types of damage depending on the wavelengths of light.
• 14:54
  SPEAKER_00: Now, how do you feel about all of these LED masks that are coming out that are over the counter?
• 14:59
  SPEAKER_00: Like, do you think that they're doing more harm than good, or is this something that consumers should get behind when it comes to skincare?
• 15:06
  SPEAKER_01: I think it depends on the light and how it's used, and are people capable of following directions?
• 15:11
  SPEAKER_01: Because you know how how we are as human beings.
• 15:14
  SPEAKER_01: It's like if a little bit is good, more is better.
• 15:17
  SPEAKER_01: So it also depends on the wavelength.
• 15:18
  SPEAKER_01: And we know that certain wavelengths from LED, if we're talking kind of like the orange, red, more anti-inflammatory.
• 15:26
  SPEAKER_01: So if you can suppress that inflammation, that can be beneficial.
• 15:29
  SPEAKER_01: I mean, blue light, yes, it can be good for some things for you know, for fighting bacteria for acne, but we know some of the over-the-counter devices were were, you know, withdrawn from the market because of the possibility.
• 15:40
  SPEAKER_01: Theoretical didn't happen, but theoretical concern that if people use them for too long, could it damage the eyes?
• 15:47
  SPEAKER_01: Right.
• 15:48
  SPEAKER_01: Right.
• 15:48
  SPEAKER_01: So again, I think that used as they were designed to be used, we can use like orange light, red light as a call for a calming effect.
• 15:58
  SPEAKER_01: Many years ago, I remember there was a device in LED panels.
• 16:02
  SPEAKER_01: I think it was called, I can't remember if it was called like gentle waves or gentle something, but it wasn't the hair removal.
• 16:08
  SPEAKER_01: It was one that you was in office where you sat in front of these light bulbs, you know, the LED lights.
• 16:13
  SPEAKER_01: And they had they showed that used after three months, the effects you know on wrinkles on fine lines around the eyes was very similar to um having used a retinoic acid, a tretinoin cream, a prescription retinoid.
• 16:26
  SPEAKER_01: So I think that it can help and all of that, but again, if it's just being used as a solo, you know, as a monotherapy and not with everything else, yeah, uh it's just not going to um, you know, it's not gonna have the maximum effect.
• 16:41
  SPEAKER_01: So I circle back to skincare, I circle back to photo protection and um all of that because very much like you wouldn't send like one soldier out to fight a battle.
• 16:54
  SPEAKER_01: Yeah, you send a whole bunch of them.
• 16:56
  SPEAKER_01: You may have a star warrior in the group or a star basketball player, but it really takes a team to really get things under control.
• 17:04
  SPEAKER_01: And skincare is part of that, is one of the essentials of the team, just like you know, there are other essentials as well.
• 17:12
  SPEAKER_01: So sleeping, exercising, eating well, and there's just certain things that we know will benefit.
• 17:19
  SPEAKER_01: So that's that's how I see skincare.
• 17:21
  SPEAKER_01: I love that role.
• 17:23
  SPEAKER_00: I love that.
• 17:24
  SPEAKER_00: Thank you so much for for clarifying that.
• 17:26
  SPEAKER_00: Now, one um one more question I have is about SPF, because you know, obviously we want to protect our skin.
• 17:32
  SPEAKER_00: And um, you know, when it comes to SPF, how do you feel about, you know, I know you spoke of growth factors earlier and and certain other you know components that really help with um reducing some of the damage or really actually repairing.
• 17:45
  SPEAKER_00: So, how do you feel about the hybrid um of sunscreen with something that is more rich in, like, for example, growth factors or peptides or whatever it is that you think um could really benefit um our skin?
• 17:58
  SPEAKER_01: I'm all for a multitasking, you know, as long as it's multitasking uh photo protection or environmental protection, as I like to call it.
• 18:06
  SPEAKER_01: Yeah, because people should still wear it if they're sitting in front of their screens all day or sitting by windows, even if they're not outside on, you know, on vacation or something, right?
• 18:14
  SPEAKER_01: Or doing outdoor activities.
• 18:16
  SPEAKER_01: So the idea of using, and there's several commercially available products right now, you know, that have, for example, uh a sunscreen, you know, sun filter, a UV filter paired with DNA repair or paired with antioxidant.
• 18:30
  SPEAKER_01: Like anything else, I'm not a formulator, but I will talk to formulators and talk to skin, you know, cosmetic chemists and say, okay, it's great you have this combo, but are the ingredients individually available, right?
• 18:42
  SPEAKER_01: What's the bioavailable?
• 18:44
  SPEAKER_01: Because they're mixed in together, does that mean that it's really getting to the skin?
• 18:48
  SPEAKER_01: Or are they in amounts that are effective that can actually do something, right?
• 18:53
  SPEAKER_01: So one of our favorite sunscreens has been one that also has 5% niacinamide in it.
• 19:00
  SPEAKER_01: And niacinamide being such a great antioxidant, great for the immune system in the skin, pigment regulator, anti-acne.
• 19:08
  SPEAKER_01: I mean, it does a whole multitude of things.
• 19:11
  SPEAKER_01: And so having that in a sunscreen, for example, if like if I have a young acne patient and they're they're put on a medication, and I'm telling them, don't even think of this as a sunscreen, think of this as additional treatment for your breakouts to help with the marks that are left behind, to help you have a better skin barrier so that you're not as prone to sensitivity from the medication.
• 19:31
  SPEAKER_01: So I think the combination ones are great as long as they've been shown to be to be effective.
• 19:39
  SPEAKER_00: That's I mean, I that makes total sense to me.
• 19:41
  SPEAKER_00: And I actually have a question because you brought up acne about acne scarring, because I know for me as a woman of color, I one of my biggest problems with skin has been um, you know, I had acne as a teenager and I had gone to a dermatologist who was on antibiotics, whole nine yards.
• 19:57
  SPEAKER_00: But um one thing I suffered with was these indentation like scars for my acne.
• 20:02
  SPEAKER_00: Now, if you have that kind of scarring versus just hyperpigmentation, like how can we deal with that kind of um damage to our skin post, you know, acne flare-ups and whatnot?
• 20:13
  SPEAKER_01: Sure.
• 20:13
  SPEAKER_01: So if you have, there's there's several things that you can do, right?
• 20:17
  SPEAKER_01: Any type of scar, and there's different kinds of scars in acne, right?
• 20:20
  SPEAKER_01: Because there is just post-inflammatory hyperpigmentation.
• 20:23
  SPEAKER_01: There are also what are called ice pick scars that look just like what it sounds like, right?
• 20:28
  SPEAKER_01: There's also what are called rolling scars, which are the ones more like what you're describing, where you have an indentation.
• 20:34
  SPEAKER_01: Yeah, and if you actually pull on the skin tight, it makes it look like the scar goes away.
• 20:39
  SPEAKER_00: Yeah.
• 20:40
  SPEAKER_01: Rolling scars are some of my favorite because those you can really treat nicely with devices.
• 20:47
  SPEAKER_01: Oh, really?
• 20:47
  SPEAKER_01: You know, you can do it with devices, or but you can also do it with skincare because anything that's done to stimulate collagen production, to help build more collagen, because a scar is basically a loss, a focal loss of collagen in a specific area.
• 21:02
  SPEAKER_01: So if you can help build that collagen by stimulating production, you know, production of that protein, but also minimizing free radical damage, then a good skincare regimen is going to help.
• 21:13
  SPEAKER_01: At least it's not gonna allow it to progress.
• 21:16
  SPEAKER_01: But things that also work are, for example, I like what are called biostimulatory fillers, something like polyelactic acid.
• 21:24
  SPEAKER_01: Um, for example, also known as sculptor aesthetic, or um that can be used to help thicken the skin underneath and improve the appearance of the scars.
• 21:33
  SPEAKER_01: Right.
• 21:33
  SPEAKER_01: Um really well.
• 21:34
  SPEAKER_01: But another favorite treatment is microneedling with radio frequency, because with microneedling, you're creating very controlled wounds, which of course now the body has to clot, right?
• 21:45
  SPEAKER_01: So it has those little platelets that are rich in growth factors.
• 21:47
  SPEAKER_01: So that's one way, it's like doing like little micro PRP, you know, with microneedling, but then radio frequency, which helps tissue with tissue tightening and making that skin more taut, that also helps.
• 22:00
  SPEAKER_00: lot so doing the crisis and we also know that for example microneedling there are you can for example apply apply a serum afterwards whether it be like one's own PRP you know where you have extra absorption of those growth factors or whether you want more antioxidants like vitamin C, vitamin E that can so you can then start doing those combinations where you have what's called basically a device assisted uh skincare delivery that's that's very interesting now and if when it comes to like creating um channels in our skin I know there are a lot of at-home rolling devices that have like small needles you know and and I know that a lot of people use them unfortunately a lot of people also hurt themselves using them but um does that really work in terms of doing that and then putting on your serums afterwards because I know a lot of companies you know they claim like well if you use this device first then you do your skincare the efficacy of your skincare is gonna go up and I'm just like I don't understand that I don't know if that makes sense I mean I'm very confused about it I know such companies and I've consulted for companies that have this but here's the thing if you've got a skincare if you have a home microneedling device it's usually a roller yeah not getting into all the physics when you roll a device on the skin think of like a rolling pin like you use for like you know rolling out dough if you're you know if you're baking or something yeah yeah the angle at which the needle inserts it definitely has more potential for damage because it's not going in at a perfect perpendicular it's not going in perfectly perpendicular 90 degree angle and it can cause more trauma by kind of tearing at the skin also needle sharpness is not necessarily guaranteed so all of that are things that we you know we have to think about um when we're doing these treatments at home the other thing is the depth of penetration if if it's all you know like if we're talking about for scarring for example the needle isn't getting deep enough to even impact the collagen so really it just becomes about making the epidermis just the outer layer the stratum corneum slightly more permeable so I'm not sure that I'm completely convinced.
• 24:07
  SPEAKER_01: Right right you and me both yeah but so I really would like to see some biopsy you know some studies with some controls skincare versus the device plus skincare.
• 24:17
  SPEAKER_01: And uh and of course these studies can get expensive they need to go on for at least three months they need to be blinded you know blinded evaluator uh the person having the treatment done can't be blinded because you can't blind a microneedling device unless you have like just a very smooth thing just because it's going to be different.
• 24:34
  SPEAKER_01: So I think science still has to really drive our decisions in skincare.
• 24:40
  SPEAKER_01: But we also know that it's not you know not not everything can be a you know a rigorous trial that way.
• 24:47
  SPEAKER_01: So and then we go back to the whole fact that cosmetics all of what we're talking about skincare with the exception of sunscreens which are regulated as over the counter drugs by the Food and Drug Administration skincare does not have the oversight of the FDA.
• 25:02
  SPEAKER_01: So other certain substances that have you know been banned from skincare you know worldwide it's just really wildly unregulated so yeah there's there's a lot there's more you know the more you you delve into it as you know I'm the same thing happens to you as I'm sure as happens to me is like the more the more you read and the more you you delve into it the more questions you have.
• 25:21
  SPEAKER_00: Yes exactly and the more you realize that there are huge white spaces in the understanding in dermatology you know in dermatology.
• 25:28
  SPEAKER_00: I mean that's something I think I've been trying to put that message out there is that you know you've got for from the consumer standpoint you can't simply say well this doesn't work for me and it's a bad product no because we can't formulate something that we have no data about you know data and it isn't one size fits all and we do have unique you know you know people somebody who lives at uh in Denver is not going to have the same needs as somebody who lives in Miami right and we talk about if we even talk about altitude right for every kilometer we go up uh in altitude we go up and it's 1.6 kilometers is a mile but we go we get 10 to 25% more UV radiation so the role of photo protection or sunscreens becomes that much more vital at higher altitudes.
• 26:13
  SPEAKER_01: Wow I had no idea about that that's very interesting yeah one time whenever you want we'll do it just to talk on just sunscreens and photos yes please oh my gosh please come back if you have the time I would love to have you back.
• 26:25
  SPEAKER_01: Sure well I really appreciate the opportunity to have this discussion with you I think it's a lot of fun and I love when they're whenever there's a chance to try to clear up some of those you know skincare myths that are out there.
• 26:36
  SPEAKER_00: Absolutely and it's been such an honor hosting you Dr.
• 26:39
  SPEAKER_00: Bucai thank you so much for your time and everyone out there if you have any questions for Dr.
• 26:43
  SPEAKER_00: Bucai please leave them in the concept art for this um this segment of the episode thank you so much doc.
• 26:49
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• 28:00
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