Cosmetic Treatments for 40s: Injectable Secrets from a Dermatologist! Part 1 | Dr. Shereene Idriss

Welcome back, little nerds, to Pillow Talk Derm, where we do this thing every Saturday morning at 10am I'm Dr. Sherene Idris, a board certified dermatologist, and I am here today to focus on cosmetic treatments in your 40s. It is important that you know that I want to be your aging coach. I want to be your coach who stands by your side as we go through this thing called life to ensure that you look and feel your best throughout every decade. For those of you who do not know this, I have been in practice for nearly, let's just say over a decade and a half now. And the reality is I see patients every day, five days a week in my office in New York City. Yes, I show up online and we talk about skincare and we talk about the beauty industry, but I breathe and eat and sleep cosmetics and skincare. And I wanted to bring in my expertise from my practice into YouTube because you guys have been asking me a lot about cosmetic procedures. But I wanted to take a step back because it's not about a single cosmetic procedure that's going to be the holy grail. It's about understanding the overall thing that is happening in order to know where to plug and play. So today is the day that we start. We are talking about cosmetic treatments for your 40s. So get your pens and papers out and let us get nerdy. It is a known fact, I think, because I've said it so much, that I turned 40 last year. So in two weeks, I am turning 41. And I want to preface it by saying age is not a skin type. Yes, certain things shift as we get wiser in life. Most of us become a little bit drier. We start to lose collagen. We're going to talk about this in a hot second. But age itself is not a skin type. There are people who look 40 and have very glowy skin, and there are people who look 40 and have very dull skin. And so you cannot generalize your age for your skin type, but we can generalize certain shifts that happen in the aging process throughout each decade. And we're going to talk about this now in terms of aging. There are maybe five buckets you can think of when you think of signs of aging. One that most people think of are lines and wrinkles. Are we developing lines around our eyes? Do we look like we're constantly frowning? Do we have smile lines? People are hyper focused on wrinkles. And wrinkles can either be dynamic because you're smiling or you're upset or you're Surprised. But then they become stiff, static, meaning they become imprints on our skin over time. They get deeper. Yes, because, number two, we lose elasticity and we lose collagen. That's the second sign that people often think of, because now it's become a known fact that basically every year and starting in our late 20s, we lose around 1% of collagen a year, and our skin elasticity starts to get weaker. The breakdown of collagen starts to happen both due to age, but also due to environmental factors like sun damage, oxidative stress, internal stress, etc. And so our skin starts to become a little bit saggier. And if you have textural issues, they become more pronounced because we don't have that tightness of our skin to make it appear stretched as we get older. Three is volume. People are either going to sink or sag. And obviously, this is a generalization. There are people who do both. But you can think of volume shifting in your face as you age in terms of are we sinking and are we just skipping skin on bones, or are we full of volume? But the volume isn't here. It's. Here is an important, different differentiating factor. Four, which is, I think the most important sign of aging is your skin tone. And I didn't want to lead with your skin tone. I wanted to lead with what people fully, really think of as they think of aging. But for me, your skin tone is the number one sign of aging. That is the thing that appears first, really, starting in your late twenties and a few years ago, I'd be much more bullish about saying, oh, you think your freckles are cute at 17? They're going to get really messy at 28, 29. And I a lot of hate online. And so I was like, okay, people are sensitive about freckles, but the reality is freckles compounded with sun damage starts to look messy. And that happens in your late 20s, early 30s, and it starts to get messier as you get older. But brown discoloration is only one aspect of color. There's also redness. We start to become more blotchy. We develop blood vessels across our face, and the combination of the brown and the blotchy together starts to look messy. And that is literally the biggest part of how you can help yourself. We're going to get into that in a hot second. And the last sign, the fifth bucket, is your bone structure. As we get wiser in life, the foundation on which our face sits is changing. We do not have a permanent structure. You may not Notice the asymmetries when you're 10, 12, 15, 16, 17, 21, 24, 25. But starting around 28, 29, 30, 30, there's a shift and you may start noticing, why is one eye higher than the other? Why is one cheek lower than the other? And I think in today's day and age, with social media and selfies, people are noticing it faster. But that's because your bone structure is not symmetric. And as you get older, your bone density gets smaller, it thins out, it lessens, and we get hollower, and this thins out and our jawline starts to recede and we become. That is the inevitable fact of life, that we are going to melt over our bone structure. So it's very important that you understand that the bone structure, no pun intended, is the foundation of how your face will age. So the question that I often get then is, I don't want to do all these cosmetic stuff. How can I help myself? And that is why I have been focused on skincare, on social, and I've been wanting you guys to feel empowered about how you help yourself through skin care. Because skills skincare can really change the most superficial layer of how you're aging, which is your skin and your skin tone. If you have that evenness in your skin tone, you're going to look more radiant, you're going to look more fresh, you're going to look like you want to show up. And that makes the biggest difference. And that is something you can control. That is something that you can make a change with, especially when you're using the right products for the right reason. So before I fully get into this video about cosmetic procedures, go watch my skincare video on skincare in your 40s. Really important that you guys lay that foundation so you save yourself thousands of dollars down the road on cosmetic treatments, because you will. If you start taking care of your skin, it's like you don't go get liposuction and then not go to the gym. We don't go in for a laser treatment and then not do the right skin care to make sure that it's maintains. So I actually like to start my patients on the skin care to make sure that they're militant before we do the laser so that I know that the laser is going to be a better return on their investment than if they didn't have the skin care to begin with at all. So that's really important. So now let's jump into in office treatments. Now that you have an understanding of the basic breakdown of aging, you can think of treatments in a more organized fashion and you're not going to be taken for a ride. And the number one rule we start with all of this is there is not one single miracle treatment. When I get asked what should I just get? There is nothing that you should just get. It's not one thing. Because addressing lines is never going to address your wrinkles. Addressing your elasticity is never going to help your volume. Addressing your color is not going to fix necessarily your skin texture. And so you need to have that understanding. So nobody will ever tell you this is the latest and greatest device that just came to the market and you're going to turn back time in 20 minutes with no downtime. That doesn't exist. And I hate that marketing. I cringe when I see that marketing. And when people come in and Morpheus was the crazy year and a half ago. Ah, Morpheus. Is it nothing? Is it? It takes a little bit of everything to look seamless and to look good for your age. And when you think that there's a miracle treatment, that's when you start looking done and that's when you start looking puffy and that's when you start looking scary. And that's when people start fear mongering online, telling you all non invasive stuff is bad. Go get surgery at 28, because that's normal. It's not normal. It's not normal to get a facelift at 32. That's not normal. So let's start first with lines and wrinkles, because this is one that you probably already have in your 40s. There are a lot of people, though, who have no lines and wrinkles in their 40s. And I tell them you don't really need any treatment for that. But there's also a lot of people who've lived a certain kind of life or who show their emotions a certain kind of way, who have now more lines and wrinkles on their face. And this is where Botox comes in. And we use Botox as the umbrella term. But Botox is a type of neurotoxin and toxin is a scary word. And so that's why people just use Botox, because you don't want to say, oh, I'm putting a toxin in my face. But you are, you are. It's not going to kill you, it's not going to paralyze you. Obviously there are weird, extreme ends of the spectrums of things that can happen to some people if it's done incorrectly. But Botox has been around for several decades now. And this neurotoxin basically slows down how your muscle contracts so that you are giving your face moments of pause. The reason I say slows down how your muscle contracts and not paralyzes you, because paralysis is not the goal. Paralysis where you are fully flat, not able to move your forehead, landing like this is not the goal. You're going to look older, you're going to look weird. You want to get these neurotoxins in a way where you still have movement, but you're minimizing that movement, allowing your face to move lighter. So you're giving your face moments of pause. And that is a very key part. You don't want to be Botox the whole time throughout your 40s, because your muscles will thin out completely. And by the time you hit your 50s, you're going to be flat, flaccid, and your eyelids are going to be heavier. You want your muscle memory to come back, you want your Botox to wear off, and you want to have normal movements in the interim so that your muscle memory can hold on to your face and hold on to your structure. There are different types of toxins on the market. There is Botox, like I said. This one was FDA approved in 2002. It's been over two decades that has been FDA approved. And it's been being used longer than that. It really does start to kick in within three to seven days. But it takes two weeks to fully kick in. And the first time you get it, you're going to last five or six months. You're going to say, wow. The second time, third time, maybe the same thing, but eventually it lasts on average. And no one really tells you this. 12 weeks, three months, and that's fine. And that's actually what I want, because I want your movement to come back. And I think it's important that you guys understand this, because that's something that nobody really tells you. It doesn't last that long over time. And as you start using it over time, you'll notice that the three months do fade, but your movement in the interim is not as crazy and your lines do not get as deep. And so it's a long haul game when done right. If you think you're going to get Botox every three months to always look flat so the line never develops, you're going to look older, faster, faster, and you're going to look weird. The other thing that also exists are dysport. Dysport works slightly faster than Botox, but it spreads more. So if you have heavy Eyelids, I would avoid that one. Zeomin is the purest form, but it spreads the least so you can really pinpoint it much more effectively, especially if you have heavy eyelids. I think of Asian populations, I like Xeomin much more than Dysport or Botox because I could be more precise on where I'm going and I don't want them to feel heavy if they have a hooded upper eyelid. The other one is Jeuveau, it is the newest one on the market and this one came out a few years ago. It's very similar to Botox in its appearance and its duration, etc. And the newest one is Daxify, which was a flop when it first came out because it over promised it was supposed to be your botox that lasts 10 months. And I remember being very vocal online, being like, this is jack shit, it's not going to last 10 months. And you know who's going to eat shit at the end? The providers. Because patients are going to come in being upset that it didn't last, thinking it's our fault. But it's actual medicine, it doesn't last that long. It lasts like Botox. It really was not a good move on their part to oversell and under deliver when they launched. But it's a good product, It's a good product, it just doesn't last that long. So these are the, that's the world of toxins that you can think of in terms of your face. I'll tell you this. I like to inject people in two steps. It's a waste of my time and yes, I lose money, it's not to make more money, but the reason I inject in two steps is I inject the lower forehead, I let it settle and then in two weeks if I'm using Botox or one week and from using this port, I like to inject the upper forehead so I can make sure that they stay with some slight movement. They don't get over treated, they don't get heavy, they don't get frozen. I'll also tell you I am picky about Botox for the crow's feet. I think a little bit of lines is better than no lines at all. Because when you have no lines you look like this. So you, you smile and your eyes become round and people look insane and they don't see themselves because they're not emoting in front of the mirror. So they don't realize that they look insane until one day maybe they wake up and they're like, what happened? I Hate it. I banned it. I don't want it. And then they quit it for three years and then they come back three years later saying, can we do this now? And that's okay too. But I think I'd rather you not go through the fact of you hating your face and you keep it subtle throughout time. The second thing that you must address in your 40s is probably going to be your volume. And I know filler has a bad rep these days on social. It has become the devil. We have seen people who are overfilled. I've seen people who look amorphous. The reality is, I did a video on this and people are like, you can't blame the drug companies. I blame the drug companies and unethical providers. Yes. Because the drug companies have sold fillers to anybody who's willing and able and capable to inject. And people are like, oh, I'm just going to shove more in your face to try to milk you for as much money as I can right now without necessarily caring about how you're going to age in the long run. So you have to find yourself, your aging coach, who's going to want to grow with you. If I recorded myself, which unfortunately I cannot, inpatient care, how many times a day I say no is mind boggling. And I tell people I'm losing money. For them to know that I'm saying no in their best interest because I want their face to age correctly. And you must follow a face with pictures. You must follow a face in a very detailed fashion, not just through pictures, but also through emotions and to see how someone is emoting in order to know if they need the filler. If you are somebody who is sagging, fillers are never going to lift your face, but they can create an optical illusion, an optical illusion of height and depth, that when you look at someone, you look more even, you look more put together. You have a slightly little line. The difference between a Mercedes and Alexis. Both are very nice cars, but one has extra definition on their side panel that gives a detail that looks richer versus the other. That is just one panel without any thought for that detail. That's how you should think of fillers. It is a game of detail in optical illusion. It is not about filling a face. It is not about puffing a cheek. It is not about picking up an under eye. It's not about making your lips look like Picasso or anus on your face. It is about defining yourself in a way that is. But you have to find the right provider. You have to find the right provider. And not all board certified dermatologists are good at it, and not all nurses are good at it, and not all PAs are good at it. And that doesn't mean that there are PAs who are not good at it. There are some who are amazing and there are some germs who are incredible. I think you have to find find the right person who is certified, and I think you have to find the right provider who can take care of you if something goes wrong. If hits the fan, you want that person to have the knowledge of medicine, anatomy, the product to take care of you if she hits the fan. That's always what you want to look for. In addition to their aesthetic, their ethics, their ethos, other than fillers, there are bio stimulatories, things that stimulate your own collagen. There are things like Sculptra that was created for people with hiv. Those are for sinkers. You have no volume. You want to create an underpading. Sculptra, as of recent, has gone in a bad rep as well, online saying, oh, it's terrible if you want to fill it. A facelift. I've been practicing over a decade and a bit and no plastic surgeon has ever told me it's been terrible for their facelifts. And the outcomes of my patients facelifts have been amazing. If it's done right, you need to think of Sculptra as something that can enhance your own collagen production. And a lot of saggers might say, I think I need it. But the reality is, if your face is holding onto the filler correctly, do you really need the sculpture? No, it's an investment time wise, financially, emotionally, it takes time. Each time you inject Sculptra, your baseline is here, you promote more collagen, and then your body eats it up. And it takes time. So the second time you come in, you're only here, and then you need a second treatment and the third time it's here. So it takes time to get that collagen to get produced. But the reason I like it is to create a scaffold for those sinkers on which eventually we can shy away from sculpture and do light filler to maintain the face. Because they're probably petite, they're probably bony skin on bones. And you want to make sure that you're defining them exactly. Like I just said, optical illusion wise. Other biosimilaries are like radiesse. Radiesse is a firmer filler. It's not a liquid like sculpture is. It's like calcium. It's hard. I will not put it here because you don't want something that is hard to sit on a shifting base that is actively aging because then you will look off. So you have to be very picky about radiesse and where you inject it in a face in order to make sure that you have the right structure, definition, height, proportion. Then we have other things that are really fun and also very dangerous. Fat grafting. We take fat from elsewhere in your body and fat is a great resource for stem cells. Stem cells can regenerate our own skin, it can regenerate our collagen, it can regenerate our tissue. It is amazing and it can do beautiful things. But what no one tells you about fat grafting and not everybody's a candidate for this in their 40s, I think who saved this for 50s and we'll talk about it more then, is only 30 sticks. So when someone takes fat and injects it under your eyes, only 30 is going to stick. And I would bet my life savings that that person is not clairvoyant and cannot tell you which 30% is going to stick. So I've seen people with lumpy bumpies because the provider tries to do it just once and it looks messy as they get older and not good and puffy. So you have to make sure that the person has the right temperament and the right longevity that they want to grow with you in order to do this. Because it's not something that you could just do once and call it a day. And maybe you have done it and you've gotten away with it. Good for you. And it looks fine, but that doesn't mean it is the norm. I have seen more bad fat grafting than good in terms of lumpiness and bumpiness. So you have to be careful how you do that. And then the last one that we're going to talk about for injections is prpp. PRPPF is your own blood that we take and we spin it. PRP is platelet rich plasma. PRF is platelet rich fibrin. The difference really is that prp, you get more volume. PRF, you get less volume. With prp, it's a faster release of growth factors. With prf, it's a slower release of growth factors. PRP has more inflammation, swelling, bruising. PRF has less. I actually prefer PRF for the under eyes and PRP for the scalp. And everyone has their own preference. I have my own way of spinning it and doing my little thing that I do to it in office to make sure that it kind of amplifies how it works. I like to introduce trauma to the area before I inject it so that people so that the skin can regenerate better, because that's the goal of it. But is it ever going to fully volumize your face? No, it's going to strengthen your tissue and act like a fertilizer to strengthen your tissue. But as you age, you're going to need some sort of maintenance. It's like you don't buy a Bentley and not maintain it. It doesn't mean a Bentley is going to last forever. Neither are you. Even though you are a Bentley, you're not going to last forever. So you need to maintain. And that's sort of how that works. Now the other buckets that we did not fully address yet are skin color, which I have done a full video on and I will link it below. Skin laxity as well as non FDA approved injectables and your bone structure fully. So I don't want to go overboard. It's 21 minutes already into this video, so I will break down this video into a second part if you guys are interested. I hope this helped break down an understanding of what's available in terms of cosmetic treatments for for you in your 40s. I tried to break it up with the two biggest ones that people ask for in their 40s. But notice I didn't talk about skin tone. But I want you first to go back to the skincare video for your skin tone to really understand how you can empower yourself before you talk about what treatments are available in office to make sure that you have an even skin tone next to godliness. So with that being said, I hope you guys have a beautiful Saturday. Can't wait to read the comments on this video and I will see you guys next week. Have a great weekend.