Latest / Skin Anarchy / Dr. Michael SomenekDouble Board Certified Facial Plastic Surgeon

Transcript

Dr. Michael SomenekDouble Board Certified Facial Plastic Surgeon · Skin Anarchy

• 0:00
  SPEAKER_00: Hi guys, so our next guest is Dr.
• 0:03
  SPEAKER_00: Michael Salmonek.
• 0:04
  SPEAKER_00: Dr.
• 0:04
  SPEAKER_00: Salmanek is a double board certified facial plastic surgeon.
• 0:07
  SPEAKER_00: He is uh currently practices in Washington, D.C., and he's also the owner of his own practice, Somek plus Pittman MD.
• 0:15
  SPEAKER_00: He is also considered one of the leading experts in rhinoplasty and facial rejuvenation.
• 0:19
  SPEAKER_00: Additionally, Dr.
• 0:20
  SPEAKER_00: Salnenek has published numerous articles um in peer-reviewed medical journals, and he's often quoted for things involving cosmetic surgery issues.
• 0:29
  SPEAKER_00: So welcome to the show, Dr.
• 0:30
  SPEAKER_00: Somnik.
• 0:31
  SPEAKER_00: I'm so excited that you've joined us.
• 0:32
  SPEAKER_01: Thank you for having me, Ecta.
• 0:34
  SPEAKER_00: I would love for you to tell us um a little bit more about your background.
• 0:37
  SPEAKER_00: I know I kind of skimmed over it, but um tell all of our listeners everything that led you here.
• 0:43
  SPEAKER_01: Sure.
• 0:43
  SPEAKER_01: So I'm a facial plastic surgeon that trained in head and neck surgery.
• 0:47
  SPEAKER_01: And I've been in the Washington, D.C.
• 0:50
  SPEAKER_01: area for about 10 years now and started my own practice.
• 0:54
  SPEAKER_01: It's been almost five years, and um we really focus on regenerative medicine in addition to my surgical practice.
• 1:03
  SPEAKER_01: And I'm such a big fan of medical grade, cosmeceuticals, PRP, a lot of the regenerative regenerative things that are are coming out and developing on a daily basis.
• 1:13
  SPEAKER_01: So I kind of focus on the bigger picture with my patients, and not everyone is a surgical candidate, and I think that's a good thing.
• 1:21
  SPEAKER_00: I love that.
• 1:22
  SPEAKER_00: I love that you said that because I know there are a lot of people who are just they go straight to cutting.
• 1:26
  SPEAKER_00: So I'm glad that you said that.
• 1:28
  SPEAKER_00: Um, I I wanted to ask you, um, especially with your immense background in medical research, um, one of the things that I'm very curious about is um how can we incorporate true academic medical research into this um skincare, skin health industry, you know, like do you have any thoughts around that topic?
• 1:49
  SPEAKER_01: So I think the skincare industry obviously is a multi-billion dollar industry for a reason.
• 1:54
  SPEAKER_01: People have such an interest in taking care of their skin.
• 1:58
  SPEAKER_01: Yeah.
• 1:58
  SPEAKER_01: And I do think that's where the quality research is going to come into play.
• 2:03
  SPEAKER_01: And I was just talking to somebody last night about doing a split face study on one of these new skincare topicals that they're developing with PRP within the serum versus some other competitor thing.
• 2:16
  SPEAKER_01: And that's that's really how we start to develop innovation in the skincare realm and figure out what works and what doesn't.
• 2:24
  SPEAKER_01: Because how many of us have an entire cosmetic cabinet full of 200 products that we've and we leave them on the side and we're kind of like, okay, I did try that.
• 2:35
  SPEAKER_01: And then you're putting on 12 things on your face a day and don't know what any of it is doing.
• 2:39
  SPEAKER_00: Right.
• 2:40
  SPEAKER_00: Right.
• 2:41
  SPEAKER_01: And that's what brings me a lot of times I have such a passion for skin care with and with my patients.
• 2:46
  SPEAKER_01: I like to keep it as concise as possible.
• 2:48
  SPEAKER_01: I hate to throw 10 products on you and have you look at it, get so overwhelmed, and just be non-compliant, you know?
• 2:54
  SPEAKER_00: Right, right, absolutely.
• 2:56
  SPEAKER_00: I mean, I would love for you to really clarify the role of skincare in um overall skin health, especially when as it pertains to dermatology, because I think there's a huge gray area there, you know, um, in terms of is it uh is it like a replacement for going to the dermatologist or is it something that you can use to augment the care you're receiving?
• 3:14
  SPEAKER_00: So if you could tell us a little bit about that.
• 3:16
  SPEAKER_01: Yeah, when I first meet a patient, even if it's for a surgical facelift or something, I start off with asking them what their skincare is.
• 3:24
  SPEAKER_01: Because without a foundation of a quality skincare regimen, what I do to you is kind of gonna be useless.
• 3:31
  SPEAKER_01: And I could really optimize what I'm able to do if your skin is conditioned.
• 3:38
  SPEAKER_01: And, you know, I talk to people about treatments all the time, such as like laser treatments, etc.
• 3:43
  SPEAKER_01: And if your skin isn't conditioned, your healing is gonna be less and your results aren't are gonna be suboptimal.
• 3:48
  SPEAKER_01: So I put such a stress on what is your skincare and and how can we get it optimized for you?
• 3:57
  SPEAKER_01: And obviously, not everyone has the same skincare regimen, but it really is the foundation and it doesn't it doesn't supplement uh or I'm sorry, replace a dermatologist.
• 4:07
  SPEAKER_01: It's gonna complement everything you're going to do in your daily life, but it's going to make your skin better just because of being being compliant with it.
• 4:16
  SPEAKER_00: So, what do you think is something that's essential in um in most people's regimen for skincare before they see their dermatologist just so their skin is primed, like you mentioned, you know, and in the best state it can be.
• 4:29
  SPEAKER_01: I am such a big fan of having every single one of my patients on a retinol.
• 4:34
  SPEAKER_01: And I think that is such an underrated product that truly is one of the pinnacles of anti-aging for a topical cosmaceutical.
• 4:44
  SPEAKER_01: I mean, when you look at the mechanism of action of a retinol, it thins out the epidermis, which is the superficial skin layer, but it thickens that dermal layer right below, which is the collagen-producing layer.
• 4:56
  SPEAKER_01: So if you think about what that's doing translationally on your skin, it's it's reducing the fine lines and wrinkles, it's increasing the tone and potentially improving the texture.
• 5:07
  SPEAKER_01: I can always tell when someone is on a stable retinol regimen because their skin just looks smoother because it's naturally exfoliating.
• 5:14
  SPEAKER_00: That's so interesting that you mentioned the changes in the dermal layer.
• 5:18
  SPEAKER_00: Um, you know, because I know that, you know, so much in skincare and especially on social media, um, you know, there's so much talk about exfoliation and there's so much talk about sloughing off that top layer of dead skin cells.
• 5:31
  SPEAKER_00: But um I I'm curious what you think about exfoliation um versus retinol, you know, um, should people go for one or the other, or can we combine them into a good routine?
• 5:41
  SPEAKER_01: I think they go hand in hand.
• 5:43
  SPEAKER_01: However, I always do caution people when they are on a retinol that you have to cautiously exfoliate, or else you're gonna get a very raw face because that retinol is inherently creating a thinner superficial layer at baseline.
• 5:58
  SPEAKER_01: So when you go to exfoliate, you're just trying to gently clean it off.
• 6:02
  SPEAKER_01: And the way I liken it is if you're going to, in order for your cosmeceuticals that you're going to be applying to effectively penetrate into your skin, you do need to regularly exfoliate and be on a retinol because otherwise you're putting these products on a layer of dead skin cells and it's kind of just sitting there not doing what it's supposed to be doing.
• 6:23
  SPEAKER_00: Yeah, no, that makes total sense.
• 6:25
  SPEAKER_00: But I'm curious from your um, you know, professional opinion, what is the best uh way of exfoliating?
• 6:31
  SPEAKER_00: Is it chemical or physical or is there really a difference?
• 6:34
  SPEAKER_00: I mean, I I don't know if there's a difference.
• 6:36
  SPEAKER_01: So I think for like at-home purposes, which is what most people are going to want to do, there are some great kind of exfoliating polishes out there, which have very, very tiny like silicone beads and even um environment-friendly beads uh in there to kind of gently exfoliate while you're in the shower.
• 6:56
  SPEAKER_01: There's the Clarisonic brush, which many have used over the years, which Oh, I did.
• 7:02
  SPEAKER_00: I loved it.
• 7:03
  SPEAKER_01: Yeah, I kind of think it's like a sonicer for your face, you know, like it's it's nice, it's it's gentle, it's predictable.
• 7:11
  SPEAKER_01: It it you're able to control the pressure with it where you're not going to do something too aggressive.
• 7:16
  SPEAKER_01: And really the cheap way of doing it, say you don't have an exfoliating polish or a clairsonic, is a good old washcloth, but you have to be really gentle with the washcloth, or else you can create really raw areas.
• 7:27
  SPEAKER_01: I've been a victim of that myself.
• 7:29
  SPEAKER_00: Yeah, yeah.
• 7:30
  SPEAKER_00: No, I mean that's a great point.
• 7:31
  SPEAKER_00: But I and I'm wondering because I know there's so much hype around this idea of micro-tears due to physical exfoliance, you know, for a while.
• 7:39
  SPEAKER_00: And I I was, you know, thinking about it and I'm like, you know, I wonder what a doctor thinks about this.
• 7:43
  SPEAKER_00: I mean, how relevant are micro-tears?
• 7:45
  SPEAKER_00: Is it something that can make or break your skin?
• 7:48
  SPEAKER_00: Or, you know, what are your thoughts on that?
• 7:51
  SPEAKER_01: Well, I mean, it can cause like a kind of almost like a superficial abrasion to your skin.
• 7:56
  SPEAKER_01: Yeah.
• 7:56
  SPEAKER_01: And I've absolutely done that to my skin because I am such a regular, regular retinol user.
• 8:02
  SPEAKER_01: And there's times when I've been a little too aggressive with the washcloth or the polish.
• 8:07
  SPEAKER_01: And you do see kind of like little areas of redness on your face that kind of need to heal, almost like a very, very superficial scab.
• 8:15
  SPEAKER_01: So I really do stress to people to just be gentle because you really don't want to cause microterrors into your skin, because that's a little more damage than the skin is asking for.
• 8:24
  SPEAKER_00: That's interesting.
• 8:24
  SPEAKER_00: Yeah, I'm glad you clarified that because you know, on social media it was everywhere.
• 8:28
  SPEAKER_00: It was like people were posting slides, you know, like one step away from histology slides.
• 8:34
  SPEAKER_00: I was like, what is going on?
• 8:36
  SPEAKER_00: It was pretty extreme.
• 8:38
  SPEAKER_00: But um, I actually want to ask you, um, you know, in terms of combining therapies, I'm very confused about this because I know that there's so many therapeutic options out there.
• 8:47
  SPEAKER_00: There's lasers and, you know, um, obviously surgical, you know, techniques.
• 8:51
  SPEAKER_00: But what are some things that, you know, the average consumer should be looking at in terms of therapy?
• 8:57
  SPEAKER_00: You know, going when you go to a dermatologist or a surgeon, you know, what are some things that everybody can really kind of think about and it would benefit their skin?
• 9:04
  SPEAKER_01: Yeah, I think when you're looking at truly achieving anti-aging levels and really making positive improvements to your skin, combination therapies is where it's at.
• 9:15
  SPEAKER_01: And there is because there is not just one single treatment that is a cure-all, right?
• 9:22
  SPEAKER_01: And so, you know, if you're going in and you want to improve like texture and tone, there's microneedling with radio frequency.
• 9:29
  SPEAKER_01: But what I also use for my like semi-older population that is getting like deeper wrinkles and sun damage, is I combine a little very superficial CO2 treatment with them to target some of those things.
• 9:41
  SPEAKER_01: And that is a beautiful combination treatment that works quite nicely, but even more than that, it matters on what they're putting on their skin after.
• 9:50
  SPEAKER_01: That's part of the combination.
• 9:52
  SPEAKER_01: And if you're just giving them like cetophil moisturizer, no offense against cetophil, I'm not paid for them or anything, but you know, that is a very, very weak kind of topical that has nothing in it.
• 10:05
  SPEAKER_01: And versus if you're gonna give them something that has like growth factors and peptides that's gonna penetrate into their skin and really help their skin heal, you're gonna see such a difference in that combination treatment.
• 10:18
  SPEAKER_00: So, you know, I have a question, a follow-up question to what you just said, because for me, you know, um, I also have a science background.
• 10:24
  SPEAKER_00: And I when I think of growth, like, you know, growth peptides, and when I think of these like molecular level, like, you know, you're altering the um, you know, molecular cascade of events that's happening, how does that really work with skincare?
• 10:36
  SPEAKER_00: I mean, is it is it is there some merit in that?
• 10:39
  SPEAKER_00: Or I mean, I I've I just have a hard time understanding it.
• 10:43
  SPEAKER_01: Yeah, well, I did for a long time as well, and I potentially still do, but you know, there it it really matters with the product.
• 10:51
  SPEAKER_01: Does the product carry with it a delivery mechanism, a carrier to bring that growth factor into the level of the skin that is needed?
• 11:00
  SPEAKER_01: And not all skincare products, as you know, are created equal.
• 11:03
  SPEAKER_01: So there are some really quality skincare products out there that have true science behind them.
• 11:09
  SPEAKER_01: And they have shown that yes, we have a carrier molecule that is able to deliver your retinal, your growth factor, or whatnot.
• 11:17
  SPEAKER_01: And they've derived certain molecular sizes for this.
• 11:20
  SPEAKER_01: So it's not as easy as just throwing growth factors in a moit shea butter and putting it in a jar and giving it to someone that's just gonna sit on their surface, you know?
• 11:30
  SPEAKER_00: Right, right.
• 11:31
  SPEAKER_00: No, that makes sense.
• 11:32
  SPEAKER_00: And the delivery component really makes sense because you always need that for almost any medical um therapeutic, you know, like when you're delivering it.
• 11:39
  SPEAKER_00: So you you you need to work on that.
• 11:41
  SPEAKER_00: It makes sense to me.
• 11:42
  SPEAKER_00: So thank you for that.
• 11:43
  SPEAKER_00: I I actually want to ask you, um, when it comes to like, you know, just patients, seeing patients every day, what are some of the hardest, like the challenges you have with patient care and like, you know, in terms of people having a misunderstanding about something when it comes to skin health or something that you find yourself explaining to a lot of people?
• 12:02
  SPEAKER_01: Yeah, I think the era of social media has caused an exponential amount of confusion and similarly um misplaced expectations.
• 12:14
  SPEAKER_01: And I think most of my day is establishing expectations and educating patients to get them on the same page and help them understand what they may want is potentially not realistic and or may require many treatments to get there.
• 12:31
  SPEAKER_01: So um it really comes down to, I mean, I consider myself as an educator in the office on a daily basis, trying to educate people on the foundation of their skincare, what potential surgeries are appropriate for them, what non-surgical interventions can meet their expectations.
• 12:47
  SPEAKER_01: I have a constant, you know, back and forth with people who come in saying, like, oh my God, you offer, I saw on your website you offer this non-surgical facelift.
• 12:55
  SPEAKER_01: And I look at them when their skin is hanging down to their collarbones.
• 12:58
  SPEAKER_01: And, you know, what that might and you know, you look at them and say, I'm sorry, it's not a magic wand, it's a non-surgical treatment.
• 13:08
  SPEAKER_01: So I'm always very transparent with them that this non-surgical intervention isn't for you, and I don't want you to spend money or put forth money on something that you're gonna look in the mirror three or four months later and say, I don't see a damn bit of difference because you probably don't.
• 13:23
  SPEAKER_00: Right, because it's not meant for you, right?
• 13:24
  SPEAKER_00: That makes total sense.
• 13:25
  SPEAKER_00: I mean, you know, for me, I've never gotten anything um done surgically.
• 13:29
  SPEAKER_00: And when I for me, it was always scary, you know.
• 13:32
  SPEAKER_00: So, do you have people come in that are like really afraid?
• 13:34
  SPEAKER_00: Maybe it's their first time, and they're like what what's your advice to all of us out there that have never gotten um anything done uh surgical for our face or anything for our you know, aesthetically?
• 13:44
  SPEAKER_01: Yeah.
• 13:45
  SPEAKER_01: So I mean, I'm a facial plastic surgeon, so I only deal with the face, which is like I think exponentially more scary to deal with than say like body surgery that you can conceal very early on with clothing, right?
• 13:56
  SPEAKER_01: While you're healing.
• 13:57
  SPEAKER_01: Yeah, yeah.
• 13:58
  SPEAKER_01: Every single one of my patients, I would say probably 90% or greater, have some reservations about having a surgical treatment.
• 14:07
  SPEAKER_01: And it really is about walking them through the process, explaining the explaining the procedure to them.
• 14:14
  SPEAKER_01: And what I found in the past couple of years has worked as uh has worked equally as well is um really showing them my patients before and afters and going over them to show them, you know what, you're still gonna look like yourself.
• 14:29
  SPEAKER_01: That's a huge, huge concern with most people, and it's a reasonable concern.
• 14:33
  SPEAKER_01: And they they're worried that they're gonna lose their identity.
• 14:37
  SPEAKER_00: Yes, exactly.
• 14:38
  SPEAKER_00: Exactly.
• 14:41
  SPEAKER_01: And they're they have a huge hump, and that's been part of their family ethnicity for generations, but they they don't want it, but they they still want to look like their family.
• 14:50
  SPEAKER_01: I explain to them that these are it's small subtleties that we're changing on your face, and we're really just refining and improving your overall appearance.
• 14:59
  SPEAKER_01: That's it, but you still absolutely look like yourself.
• 15:02
  SPEAKER_01: And I use an imaging program in the office, a 3D imaging program.
• 15:06
  SPEAKER_01: Okay over it with them where I'm able to simulate what I can give you as a surgical result.
• 15:13
  SPEAKER_01: And I think that puts their fears at ease because it allows them to visually see what my what my image is or what my surgical uh thought is of what they can get.
• 15:25
  SPEAKER_01: And I think that it puts us on the same page as well, you know?
• 15:28
  SPEAKER_00: Absolutely.
• 15:29
  SPEAKER_00: I mean, I would feel a lot more comfortable if you were able to show me, you know what I mean?
• 15:33
  SPEAKER_00: Like, oh, well, this is where I'm going, this is my vision.
• 15:35
  SPEAKER_00: Like that would make a huge difference as a consumer.
• 15:39
  SPEAKER_00: So um, you know, I wanna I wanna ask because, you know, it's interesting to me that you know, people are still so reluctant.
• 15:46
  SPEAKER_00: And I and I made a comment on one of my earlier episodes about how whenever you hear about a bad nose job, it's always in America.
• 15:54
  SPEAKER_00: It's rarely in Europe.
• 15:55
  SPEAKER_00: Now, I know you've been trained by some of the best.
• 15:57
  SPEAKER_00: So I, you know, obviously your work is very different than what I'm referring to.
• 16:01
  SPEAKER_00: But what are what are some of the common mistakes that you notice in rhinoplasty by other, you know, maybe other people that you've seen do it, or you know, some common mistakes that are made.
• 16:13
  SPEAKER_01: Yeah, I think, well, about 40% of my rhinoplasty practice right now is a re is revisionary.
• 16:19
  SPEAKER_01: So um it's it's quite a lot.
• 16:22
  SPEAKER_01: And these are people who have had two and three rhinoplasties coming in to see me.
• 16:26
  SPEAKER_01: I think one of the biggest things that you see that is sort of a dead ringer for a nose job and just doesn't fit someone's face is an overreduced nose.
• 16:38
  SPEAKER_01: It's that super sloped, um, I call it a sliver tip.
• 16:42
  SPEAKER_01: It's like that tiny pointy nasal tip that exists in nature.
• 16:49
  SPEAKER_00: Yeah, it does not look right.
• 16:51
  SPEAKER_00: It's like a berry on the top.
• 16:53
  SPEAKER_01: Exactly.
• 16:53
  SPEAKER_01: It looks like someone dropped a berry on your nose and it's just like this tiny little thing.
• 16:58
  SPEAKER_01: And it's it's about maintaining facial proportions.
• 17:02
  SPEAKER_01: And it's rare that there's only a few faces out there that that nose can fit on, and so it's not a one size fits all.
• 17:08
  SPEAKER_01: So I deal with people that uh that have overreduced noses and subsequently have developed nasal obstruction because the cartilages that used to be in their nose, providing that lord that sort of larger nasal tip, have been removed or decreased so much that they no longer have the support.
• 17:25
  SPEAKER_01: So when they're breathing, even just like sleeping, they feel nasal obstruction.
• 17:30
  SPEAKER_01: And so it's about restoring the support and structure to the nose.
• 17:34
  SPEAKER_00: Wow.
• 17:34
  SPEAKER_00: Yeah, I mean, I can imagine like because you know, I've always wondered about like if you if you restructure bone, right?
• 17:40
  SPEAKER_00: It's it's gonna cause problems in some way if it's not done right.
• 17:44
  SPEAKER_00: So that's why I was asking.
• 17:45
  SPEAKER_00: Um, but that's interesting, that's very interesting.
• 17:48
  SPEAKER_00: But I want to thank you so much for your time, Dr.
• 17:50
  SPEAKER_00: Somnek.
• 17:51
  SPEAKER_00: This has been amazing, and I've learned so much, and I would love it if you would come back and tell us more science stuff.
• 17:58
  SPEAKER_01: Oh, I would love to chat with you again.
• 18:00
  SPEAKER_01: It's so great talking to you.
• 18:01
  SPEAKER_01: Thanks for having me.
• 18:03
  SPEAKER_00: Thank you.
• 18:08
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