@dr.mamina Exposes Which Anti Aging Treatments Actually Work

One of the most requested topics with midlife women is our skin. If you're midlife like me, you grew up generation X probably when we used to bake in the sun, we used to lay out with the baby oil, we used to lay on the silver mats, we did tanning beds. My gosh. I used to joke that I was tanorexic and I thought getting older would someplace so far down the road. It wasn't until I had actually a basal cell carcinoma wake up call in my mid-20s that woke me up to maybe this is not such a good idea to overdo the sun. But today this conversation, I have a triple board certified dermatologist on Dr. Mamina. She's got quite the following on social media and we're going to link all of that up on the session today because you'll want to follow her for her amazing tips. But I wanted to have a really real conversation with her today about what actually works, what's just marketing, what we can do to reverse signs of aging, what we're going to have to just accept and live with all the questions. And I also wanted to open up to all the cosmetic questions about Botox, tox and ZMN and fillers and lasers and just all of that that we see the noise on social media about. But what actually can we do to reverse the signs of aging? So thank you so much for being here today.

Thank you so much for having me.

So let's back up for a minute. You've got just looking at you on video and if people are watching on YouTube, they can see you've got that perfect porcelain skin. Skin. That's what it looks like to me. And you're a dermatologist. A board certified dermatologist. I'm wondering if you got into dermatology for like trying to fix your own situation with skin or you just were always good with your skin or where was that background that you even started specializing in dermatology?

Yeah, you know, I went into med school not even thinking about derm. I was very interested in like primary care. Actually my passion, and it still is my passion is looking at things more holistically. So not only looking at like how to diagnose and treat with prescriptions, but looking at diets, supplements, lifestyle, sleep, stress, all these other like external factors and internal factors that can play a role with health in general. And so my plan was to go into primary care and then to do like integrative or functional medicine. And it wasn't until my third year of med school when I was doing my rheumatology rotation, which was, you know, rheumatology is a subspecialty of internal medicine. It deals with a lot of autoimmune diseases, which is something that I'm also very drawn to and intrigued by. And I saw a lot of autoimmune skin diseases when I was in my rheumatology clinic looking at patients. And I just felt so much empathy and I felt so drawn to these patients and because it's really kind of significant how much the skin can play a role on our mental well being and our confidence. And I could relate to that. I felt, I felt like any small thing could really affect my own confidence. And I really wanted to help these patients who had some disfiguring skin issues. And I actually chose to do med derm. So it's a combination residency with internal medicine and dermatology. Because I was wondering about potentially even doing a rheumatology fellowship to and focus on autoimmune skin diseases. But anyway, so I ended up doing med derm. And I like dermatology. For anyone who's not familiar, it's such a great field. You probably see a lot of like the fun stuff on social media, whether it's like the pimple popping stuff or the Botox stuff. But it is such a comprehensive medical field. You could see both adult and the pediatric pediatric population. You can do fun cosmetic things. You can really do like nerdy, like complex medical derm, whether it's autoimmune or infectious diseases. Then you also can do a little bit of surgery, which I did like surgery, but I wasn't like ready to go into the OR and manipulate bowels. I was like, I was good with just like superficial surgery. And then there's also pathology. So you have to know, every dermatologist has to know what all skin diseases look like under the microscope. Like 30% of our board exam is actually sitting at the microscope.

Wow.

And that actually reignited my love for pathology because I also loved pathology in med school. And there's a subspecialty of dermatology called dermatopathology. And I ended up doing that as well, which is where the triple board certification came in. Because it's, you know, I'm also boarding in internal medicine and dermatopathology. But I just love that you can cover so much basis with derm. And unfortunately it's such a competitive field. And normally a lot of people know when they start med school that's what they want to do because you have to start, like publishing, you know, research and you know, getting to know like different derm departments, like both at your school and out other departments, like other schools, schools. And I just got like a late start, so I barely got into derm by the skin of my teeth. It was a very stressful process. But that's the one thing I do have to say is it is a very highly sought after field. So it is pretty competitive, but it's fun.

I love dermatology because, well, one, it interrupted my massive problem with tanning in my early 20s because I had this thing that was bleeding and it ended up being basal cell. And I'm so grateful for that because had.

Yeah.

By the way, when you have basal cells, to me it looks like a little pimple that just kind of doesn't go away and bleeds. But I'll never forget when that dermatologist removed it for me, like the amount of stuff that came out with it, it was like a huge ginormous lump that came out with it. And I thought, wow, we just see this little surface level, what that was, what was growing under. But I'm grateful for that because that stopped me from baking in the sun. So because a lot of controversy on social media, right. There's an agree that vitamin D is amazing. And I agree the sun and I agree that we get dopamine from the sun, but where is the line? And because I think there's some dangerous information that comes out with skin aging around the sun. Where do you fall on that spectrum and help us with this?

Yeah, I think this is a great question because I think that things have gotten so extreme. Like I think like derms have gotten really extreme about this. And then there's like this whole like other world of people who like are so scared of doctors and.

Yeah.

You know, scared of the whole system. And they think that like they need to just worship the sun and that's going to be important for their vitamin D and overall health. Yeah. And I've seen both sides and the pros and cons. So I do think that the sun plays a really important role in our health. And as you alluded to, you talked about vitamin D and just like our dopamine, just our overall mental health and well being really huge critical role with our circadian rhythm and that dictates so much of like what the genes in our body are going to do for the whole day and at night as well. And so I do think that having some sun exposure, which is kind of crazy for Durham to say, I do think having a little bit is important and especially like in the morning, I do think some. And you don't have to go crazy like even just 10 to 15 minutes. And I do still recommend wearing sunscreen, especially in the areas that do see sun all the time, like your face or the tops of your hands, the tops of your ears. You can still get vitamin D absorption through sunscreen, which is reassuring. Vitamin D absorption and metabolism is actually more complex than we realize. I have seen patients who are out in the sun all the time. They are tan, leathery. I check their vitamin D and it's deficient.

Wow.

It's more than just the sun. I think it has to do with your overall health and your lifestyle and like how you absorb other nutrients because. Because other things will help vitamin D work better and absorb better in your body through your skin. And some of that I don't even know. It's like just more complex than I think we realize. But I do still think that the sun is such an efficient way to get vitamin D. And so yes, so I, I think that you can do it safely. Protecting the areas at least that gets chronic sun exposure and still getting some time outside. I would say if you had to find time to be outside, like I said in the morning, you want to try to do it before 10am if it's in the afternoon after 2 or 3pm it's between 10 and 2 where the UV rays are the strongest. And you know if you have an iPhone like you just go in the weather app and it could tell you to the UV index like you want to. Ideally if it's like below three, that's safe and makes sense.

What about sun block? Because so it's my understanding that mineral sun blocks are better because it sort of like bounces the sun off of you where the chemical sunscreens, you're getting that in you. Do you have an opinion around that?

Yeah, so I know. So that's kind of the basic idea is that people think with mineral sunscreens the, the rays kind of repel or yeah, bounce off actually both. Your skin absorbs both. So. So you both absorb UV rays but there is a little bit more of, of like a reflection off of the physical sunscreens, the zinc and the titanium dioxide, the mineral sunscreens. But both technically do get absorbed and but the chemical sunscreens work with all absor. And it does get absorbed into that top layer of your skin. There has been some data coming out more recently that some can get also absorbed in our bloodstream. Whether or not that is harmful is still up for debate. That's a whole nother controversial topic because at insanely high doses given to non human species it has been shown to have some issues. Not like and this is just certain chemical sunscreen ingredients, not all of them have been. Some have been shown to be potentially endocrine disruptors at unrealistic doses to humans. So but it's the kind of thing where it's like, okay, should we still practice caution and avoid those? And that's still a gray area because nothing has been found in humans.

Do you personally use a mineral one or do you not do or do you just don't really think there's much of a difference or like what would you personally do on you personally?

I do both. Mineral or hybrid? Mineral and chemical.

Okay.

My main reason is because I do think that having mineral, I mean there's good. Of course there's coverage across the UVA and UVB spectrum with both mineral and chemical. But no, I feel that there's a little bit better coverage with UVA with mineral. I think that there's some amazing chemical sunscreens that we don't have in the US like in Europe and in Asia that have sunscreens that have really great UVA protection. So it's more just like I'm just a little bit more hesitant about that aspect of it. And then I would say like when I was pregnant because we just don't know, like we haven't seen any harm but we. But because we know that there is some absorption with the chemical sunscreen, I just unknown. Yeah, it's this unknown. So I just like, okay, fine, I'm just going to stick with mineral. When I was pregnant, totally.

So for me with the sun now and mine's more because I've had the skin damage, you know, I had the basal cell a few times on my face. But also the brown spots with aging, which I'm going to ask you a lot about brown spots in a few. But so for me when I'm outside now, I always do like the 15 minutes in the morning like you, like you said. And I try to walk like after sunset or you know, early in the morning. But if I am outside during the day, for me I wear just a big broad spectrum hat so I don't have to worry. I mineral base sunblock on my face and I do let my skin like my actual arms get. If it's a 20 minute walk, I don't worry about it. But if it's longer, I do also put Sunblock or a long sleeve shirt to protect. I'm in Arizona, which is like super hot. Summer sun is. I'm cautious of that. What about tanning beds? Let's talk about that for a minute. Because that was a big thing in the 80s and 90s. I was so guilty of that. And people get very defensive about tanning beds. Still say that, well, they live in an area that's rainy or cold, so they feel they need it. What are your thoughts on that?

Gosh, it's. The concentration is just exponentially higher. The risk of getting skin cancer is also exponentially higher with tanning beds. Like, it's just not worth playing with those, unfortunately. Like, I feel like that's where my.

Skin cancer came from.

Yeah. Oh, yeah. It's a huge cause of skin cancers, especially when we find skin cancers in younger people. Tanning beds are huge. It's. I mean, it's, it's insane because I always, like, you know, ask about family history or personal history, medical history, tanning bed use, and you could just tell like.

Sure.

The people, the young people who I diagnosed skin cancer and the majority of them have used tanning beds.

Makes sense. Makes sense. Yeah. I'm completely against tanning beds, but I know if I ever make a comment, I get the hit of, well, I live in an area and I need the sun. So I don't. I want to know what the solution is. But I. But not the solution.

There's like lights because there's areas where, yeah, it's like dark for a long period of time. And I think there's just like those like high lumen lights that you could have like turn on in the morning and stuff. I, you know, but, yeah, but work around. Don't get UV rays.

Yeah, yeah, yeah. What about reversing damage here? Let's talk about. I want to talk about brown spots specifically, because that is my nemesis. I can't stand that I have so many brown spots. I think I've sort of won the battle on my face. I use great products and I've done IPL and all that. My body is another story. I don't know how to get rid of them. What can we actually do for brown spots? Is there really a treatment? And when we look at some of these ads for these companies with like hydrocunone. I don't even know if I'm pronouncing it right. I've heard those are highly toxic and dangerous. So help us understand this.

Yes. So, okay, you did mention earlier that you will let your arms get Exposed just for like 20 minutes. If it's longer, you cover them. I do think that honestly, any little bit of exposure, if it's during, especially those peak hours, it does accumulate over time. So like even like five minutes a day, it does accumulate. So if you're concerned about sun damage and skin cancers, if you have like a low risk for skin cancer and you don't mind, like, you know, getting sunspots or wrinkles, then I'd be like, okay, you don't have to go crazy with the sun protection. But. But yes, if that's something. If you're concerned about brown spots and of course preventing skin cancer, I would even. Yeah, okay. If it's during. If it's during that time, yeah, I would. I would try to make sure those protected. So that's the first step is like sun protection. Because if you're not protecting your skin, it's like one step forward, one step back, like with these other procedures and things. But yes, there's a few different things. And you brought up a topical ingredient, hydroquinone. So there's topical, then there's like procedures. So with topical ingredients, I would say the main workhorse prescription ingredient is hydroquinone. But it is something that we do not want people using long term now for a couple reasons. There's a couple of aspects. One, you mentioned that is it toxic? I know that it's something we don't recommend during pregnancy or even breastfeeding. There was like one small study, and I can't remember off the top of my head that it could even potentially increase the risk of skin cancer or some other cancer. And I wish I knew exactly what it is. So, you know, we don't like people using it on large surface areas. If you're trying to work on like a few spots, like on your face, it's fine. But we also want people taking breaks from it because people who use it long term, it can actually paradoxically darken the skin in a very. Yeah, it's very rare. So I don't want to, like, cause fear. And a lot of times it's riskier if you use a higher concentration than the standard prescription, because a lot of times we compound it to do something stronger than the 4% standard prescription that you can get. So the risk is higher with higher percentages, and the risk is higher if you do have a darker skin tone as well, if you do have more melanin that the hydroquinone can, like, interact with. So I would just say, like, yeah, even though it's a great skin Lightening and skin brightening cream. I would not rely on it. Another ingredient that I think should be like a workhorse staple in people's regimen for brown spots on their arms and of course for the face. By the way, your skin looks amazing. So thank you. You're doing a great job. But like using a retinoid that's going to help with multiple aspects of your skin. So there's over the counter retinol which is, it's the inactive form of prescription retinoid like tretinoin. So it doesn't work as fast. It can still of course help. But I'm a big fan of tretinoin and that over time it increases your skin cell turnover. So it helps kind of get even out your skin tone. It's getting kind of rid of kind of the older darker cells that are more sun damaged and evening out your skin. And then it's also working deeper on the collagen level to remodel collagen help kind of renew collagen and that will help with fine lines and wrinkles and creepiness. So it's doing a lot of different things. And so I think that's important.

Yeah. You know, and I don't want people to base on me, but I will share that I stopped using both those things. I'll tell you why. I because I do my blood work every 90 days and I understand I can't completely eliminate toxic low like we're exposed to toxins all the time. But I, my liver numbers went way up when I was using both of those and I thought, okay, this is interesting. So and I tried, tested that and noticed it a few times. So I personally stopped using both of those. Now whether that just meant my liver was doing what it's supposed to do and it's getting rid anything extra or it was coincidental, I don't know. But two things I started doing and I wanted to ask you about these is I started using an estrogen cream on my face.

I love that.

And a topical peptide. So I wanted to ask them mostly about the estrogen cream because women are going to ask about this.

Yes. Oh yeah, yeah. So yeah, we can get into the wrinkle space. There's a, there's a few more ingredients that can help with brown spots.

Oh, let's finish that first then. And then we'll talk about wrinkles. Yeah, keep going.

Okay. Yes, but no. Yeah. There's so many fun things. So for brown spots. So I think that's is interesting. I don't know which it could Be from. I could see it potentially being from tretinoin, though, because form can affect the liver. But there's, of course, other things that can help brighten dark spots. I think regular exfoliation is important. So there's like, over the counter, like, AHAs, like glycolic acid, lactic acid, malic acid, and there's stronger concentrations that you can get over the counter, 10 to 20%, like glycolic acid that you can do like once a week. That could make a big difference. And then, of course, you could do chemical peels in the office and we'll talk about office procedures. But there's other skin lightening ingredients that are. That are incorporated in skin lightening serums that you can use. Vitamin C can help. Tranexamic acid topically. Alpha arbutin, niacinamide, azelaic acid. There's options if you cannot tolerate some of these, like, stronger, like, prescriptions that I mentioned earlier.

Makes sense.

Yes. So doing that. And then I mentioned chemical peels. I think that's a great. I love that actually, for the arms and the hands.

And that'll work on the arms. I never even knew that you could do that.

You can. It depends on, like, how extensive the brown spots are. Sometimes it's maybe like a lot of work that you may not because it's like doing a lot of chemical peels and then like, I think kind of hitting it from different angles. If it's very extensive chemical peels. And also doing lasers as well.

Yeah.

Like, whether, even with the laser, though.

It can come back.

Right.

I mean, I know I did that. Alessandra, is that the Alexandra laser and. Yeah, myself, like, like scab up everything and then they all came, right.

Yeah. Oh, yeah. So it's. It's hard, like, you have to, like, have a really good skin regimen and be super, super strict and. And I'm also a huge fan of, like, sun protective clothing because it is hard to, like, put sunscreen on your arms every day. Like, I have like, a very lightweight hoodie, UV protective hoodie UPF that I always put on before I get in my car to drive. And it, like, covers the hands a little bit too. It has, like the holes for the hands.

Oh, even in the car with the window. Yeah. Wow.

Yes. Yes. So UVA rays still penetrate window glass. And I think that's a huge cause of, like, the arm spots that I see, the easy bruising and the brown spots. So.

Wow.

I'm all about, like, either driving gloves, which. They make some cute ones now. And then. Or just like a lightweight UPF hoodie that you could just easily pop on. Because I don't recommend keeping sunscreen in your car just because, like, if your car is in a high temperature area, it'll like mess up the sunscreen.

Totally.

But yes. So that's for.

By the way, anyone listening that might be rolling their eyes at this? Like, well, that's excessive. Or I want this. Like, that's like my husband. I'm like, go for it. Yeah, but if you go for it, that doesn't have the brown spots and the wrinkles. We got to look at all this. I mean, I care. I do.

Like, yeah, yeah, yeah, exactly. Like, of course, if you're not into it, like, totally fine. Like, yeah, my husband. Spots.

Doesn't care. He's like, whatever. Brown spot, wrinkle, whatever character.

Yeah, that's it.

I'm like, I don't want that. So if I'm hearing you correctly, the kind of the big ones are the hydroquinone, tretinoin. Those are prescriptions. That's. That's questionable. Like if you tolerate or you don't tolerate. But that definitely works. If you can't do that, there's lots of other ingredients that you can ask your dermatologist about that gets. That will help. And then chemical peels are kind of like that next level. Or the lasers that you can do. I'm a fan of IPL lasers. Have you ever done that? I've done IPL on my laser on my face probably twice a year.

Yeah, I like ipl. We actually don't carry ipl, but I think that it is a helpful. It is a helpful laser. I'm a big fan of Fraxel, which is what we have in our office. Yes. Non ablative resurfacing. I think there is a little bit more of a downtime. So that's more annoying than ipl. But yeah, so it depends on like, you know, whether you're ready to have that downtime.

Yeah.

For it. Otherwise, like IPLs, I think are really great for people who haven't been exposed to lasers yet and they just want to like, start with something. I think that it's effective.

It doesn't feel good, by the way.

Warning.

It hurts. Yeah, it's like, it feels like someone's taking a lighter on your face.

But.

But it does. It does not work for melasma, but it'll work for sun spots, I think.

Sun spots. Yes.

I have a melasma spot that it won't get rid of. So.

Yes. You want To. Yeah. Make sure that you go to somebody who can also make sure they can differentiate between the two. I do not like lasers for melasma. I mean, maybe the pico laser, which is more specific for brown spots. But yeah, just the heat, too, can make melasma worse.

And that's what happened with. And I love my dermatologist, but he did not he. Because we just assumed it was like, all the ones. And I have this one that we kept going after and it just got worse. And it's.

Because it's.

It's probably hormones, changes in melasia.

Yeah.

Let's talk about the wrinkles and the fine lines.

Yes, yes.

And there's lots of options here. I want to start with kind of the topical stuff that we can do. Like, and then I want to talk about injectables and then all the different options here. So I just recently, in the last three months, I added a topical peptide and I added the estrogen cream.

Nice.

And I love it. It's estriol, I think, mixed with.

Yep.

Estriol mixed with hyaluronic acid, I believe, is what I. The compounding that I did. How do you feel about that?

I am a fan. I know, like, some people are, like, a little bit concerned about topical estrogen or like, even just estrogen in general as a. Like a hormone replacement thing. I think that the amount that's used is very little. And I think that the. The impact it can have is so great. So I'm definitely a fan. I think that I love it for areas where the skin is especially thin, like around the eyes. And I love it, like, if people starting to notice, like a little bit of. Notice wrinkles, like around their mouth. And then, like, I love it for the neck, too, where, like, people can start to really notice early the signs of creepiness.

Totally, totally. Okay. And you get that from your doctor. You would have to get it compound.

Yes, it would have to be compound.

Or you can use your vaginal one off label.

Right, right, right. If you have that.

That's how I started. That's how I started with mine. But you can get it from a compounding pharmacy, which I think is great. You can use it with your other skincare stuff, which is amazing. Let's talk about injectables. Lots of controversy over that. And I want to share just sort of my journey real quick. Quick, too, because people are going to ask me because I. I share everything on social media. So for years ago, I would do Botox every now and then, and I stopped doing botox specifically because it really did some crazy things in my eyebrows, like for whatever. I have a very strong brow and it was like. And I also had a scar when I was a kid. I had a little tumor removed when I was a kid. So something opposite happens on my brow. So I just was like, I'm done with Botox. And then I would get.

Yeah.

Comments on social all the time because I had lines in my forehead and it would say like, you have bad Botox. I'm like, no, I don't have it. Just everyone's used to people having Boto. So I stood out as not having it. So, you know, I'm, I'm self conscious about all that and I understand the risk with Botox. So I tried something maybe several months ago called Zeomin, which is supposed to be a more natural option and I did way less, like just a, like a little bit, which just kind of took the edge off of things without giving me the space. So I wanted to ask you about, first of all, how much risk is there really with Botox? Like how dangerous is it really? Or is this something people have blown out of proportion? And then how much better is Xeomin? Is, or is that just a marketing thing?

Yeah, I think I know. No, this is a very, like, people are so interested in this topic. I think that overall, despite the name Botulinum toxin, which is what all these are, Botox, Dysport, Xeomin, they're all brands of botulinum toxin. It's inert and synthetic. It's, it's not, you're not going to get like botulinum poisoning from it or anything like that. The main risk is and it's fraction of a percentage. Like I don't even, I, once again, I shouldn't even give a number because I don't even know. But like it's a decimal. Like, okay, could be 0.01% of people like can get an allergic reaction to it. Like a systemic allergic reaction. I have not seen that. Knock on wood. But that can happen with anything. We see it way more with like vaccines. I mean vaccines are eliciting immune response and I think that vaccines are important. But, but I do think we see less, way less issues with something like Botox. When I say Botox.

So you're saying like just the same way someone could have a reaction to a vaccine, you're saying that could happen with Botox, could happen.

But it's like, yeah, but, but way less likely.

Okay?

Way, way, way, way, way less likely. And the main complications it's kind of like what you were alluding to is if it's misplaced. And everyone's anatomy is different too, so you can't do Botox the same way in everyone. Of course. And of course the amounts have to be different too, depending on the person and their muscle and their muscular anatomy. But the main issue with Botox is like, asymmetry. If, like, one side does not pick it up as well, or if the provider did not not put it in, you know, correctly, or if it migrated to one area more. So that would be potentially the main issue. And then bruising. But toxicity wise, like, I feel like I've heard a couple of stories, like, online of people.

I mean, I can definitely find stories on Tick Tock, and I don't want to dismiss those people. I'm sure that's real for them.

Yeah, yeah, yeah. And that's something I want to actually, I want to learn more about, because that's not something that we see as derms often.

Sure.

Nor is it something that we're taught too. But, like, I saw an Instagram, like, support group like, about it it, and I was like, I want to hear more because, I mean, I inject it like hundreds of times a week in people, and people are obsessed and they love it. In terms of Botox versus something like Xeomin, they're both Botulinum toxin. Xeomin is a smaller protein. Okay. So there's like less surface area, less protein substance for your body to react to, potentially, because your body can still create, like, an immune response.

So it's kind of like having a cookie, like, made with healthier ingredients or not healthy ingredients. It's still a cookie. Still not. Still a cookie might be a next, like, level up. Yeah, that's what I'm hearing.

Yeah. I think that if you are concerned about, like, the effects of neurotoxin, maybe Xeomin would be like, the one to start with. And I like that. Also you were getting a lower amount.

I got very low. Like, just. I. I was like, I don't want my forehead not to move. I was like, let me just see if we can just play with a little bit. So it just softens it.

Yeah, it just softens. Just takes the edge off a little bit. And that's my approach, actually, with most patients is I don't like freezing. I. Unless they like, specifically request for it. But, you know, I do, I do think that I have seen, like, over time, some people even develop like, a tolerance, like people who've been doing it for Decades.

Sure.

And so I just think that like, just you don't have to overdo it. Just do a little bit and just do it like two or three times a year.

Because I always joke, I'm like, we just look like 50 year old women with Botox. Then we don't look like 30. All of a sudden. It's like, I think, like, what's my goal with some things? You know, like, what is my, the goal? You know, people really were in uproar with me doing anything because I had an explant. So I had breast implants removed. And I talked a lot about reducing toxic load, which I meant, like, but I never, I never claimed to say I was going all like 100% granola. Like, I never said that. So it's when I share these little things that I have tried or done, it's like somebody will go, I thought you were going all. I never said that. So for the record, I never said I'm going all natural. I said that I'm reducing toxic load and looking for a better option sense.

And I mean, that's like the realistic way of doing it because sometimes it's impossible. We are inundated.

Yeah. Okay, talk to me about like Japanese face taping and like some of the these products. I tried those frowny things for me, they just smelled and didn't do anything for me. I've tried like the facial massage. I've tried Gua Sha. Like, how much do you think some of this really makes a difference? Or like it gets confusing?

So I think that there's definitely a role for these and I will tell you which ones I use. I don't think anything replaces the effects of Botox or Xeomin, but I do think that they could be helpful, especially if you do not want to use the Botox or Xeomin route, the frownies and the face tape. So. Okay. Interestingly, I've never tried the Japanese face tape. I'm very intrigued as to how that is different from some of the other adhesive face patches that we already have. But the concept basically is we also still make expressions at night.

Okay.

And I think that by using these adhesive patches, it can help minimize that. Like I said, it does not compare to Botox. But where I do find it to be helpful that something that Botox cannot fix are for people who are side sleepers. And chronic side sleepers can get these diagonal lines in their forehead that go like this. And then they could also get lines in their chest. And those are just literally because of the way your face is smashed on the pillow or the way that you're, you know, know your chest is, like, kind of curved. And so that's where I do think those patches can be helpful. More so than, like, Botox or Dysport. But yeah. So the same thing goes with the Japanese face tape. I'm. I'm intrigued by the Japanese face tape because it sounds like it's more effective. So I'm going to honestly try to get my hands on some of it because I'm personally very curious. But I think it is something that people can think about if they're not into Botox or Dysport. I've tried, like, the frownies. I think the brand was co sio and like, I. It just. To me, it's not comfortable. Like, they smell. Smell when I sleep. I mean, I'm willing to try it.

Again, but it felt like I was like I had paste on my. I was like, this isn't working for me. I didn't.

Oh. Oh, yeah. It just felt, like, too uncomfortable. Like, I didn't want all that stuff on my face while I was sleeping. But that is an option. I am a fan of, like, facial massage and gua sha. Just like I'm a fan of, like, massage for the body. Things can accumulate and build up. And, you know, we do, like, exercise our bodies. We may not exercise our face, and there's some areas may not move unless they're, like, physically manipulated.

Right, right.

And so fluid can build up. And this is not talked about by derms at all. This is, like, just my own personal belief.

That's what I wanted to hear.

Yeah. And I do think facial massage. I think gua sha is helpful. You don't have to get a gua sha tool, but I think it makes things easier than.

So help me understand that. Okay. So this is where my brain goes and I get a little confused. So I'm sure someone listening is confused, too. So if you think about, like, if you do Botox, okay, talk about your forehead for a minute. It. It freezes the muscles.

Muscle.

So you stop getting the lines because you've frozen the muscle. But the thought process on doing, like, some facial massage and deep work is to activate that muscle so you don't have the droop and the aging and the changes. But aren't those kind of going. They're like opposite approaches. So one's freezing and one's moving. What? So it's confusing to me.

Yeah, well, when you're moving the muscle, it's more just. You're not moving it the way that you're moving it with the facial expressions. You're just. Just sort of almost just like stimulating the muscle so that, like, blood is flowing through it and it's able to just help with circulation in your skin. So I think that's the main difference. It's like you're not massaging it, so that's creating the same wrinkles that you were with the expression. And then I think just massaging and doing gua sha is helpful because. Because you also need muscle movement to help with, like, the circulation in your face, like I just mentioned. And you actually is, theoretically, you're not really getting that. There's like, a little bit less of that if you are getting Botox. So I think all the more reason to like, to like, just help boost circulation by, like, doing facial massage. Like I said, it's not the same type of muscle movement as, like, making expressions. Sure. So it's. You're not making those kinds of wrinkles and. Yeah. And just like, helping just to move fluid face.

So you can do it even if you have Botox in your face. If I'm hearing you correctly, you can do gua sha. Even with that.

You can. I would, to be on the safe side, I definitely wouldn't do it for the first 24 to 48 hours after using it. And if anything, I would probably even wait like a week just to make sure that the Botox or the Dysporter ZMN is completely like. You want to move.

Yeah.

Correct. Yes. Yes. And the movement's the greatest in the first six hours after you get the injection. But we just tell people. I mean, I tell people the first 24 hours for sure. Don't get like a massage or. Yeah, don't exercise.

What about upper lip lines? The vertical?

Yes. Oh, my gosh. Okay. Yes. Those are one of the hardest lines to treat. So I would say to tackle that early, like, if you're prone to them. Genetics plays a really big role for those. But I tell patients, I tell patients it takes a village in terms of how to treat those. It's. It's hitting it from different angles. I think it in terms of, like, first of all, just like, preventative measures to minimize drinking with a straw. As. As I know, like, making a straw makes drinking so much easier. But. But anyways, minimizing straw, of course, don't smoke. And then procedures that are done. You can get Botox. We only do a little bit. I do max 4 units above, and if they want to do below, I'll do max 4 units below. Because if you go beyond that, like you won't be able to pronounce certain words. You won't be able to like eat properly. So very conservative with that and that definitely helps. But if you have really deep wrinkles, that's only going to take you so far. I do think that fillers can play a role. We use very fine fillers. So you know, the ones that are more lightweight like Restylane Refine, Juvederm Ultra can work. And then. Or like Volbella Juvederm bulbella and then RHA is another brand a the RHA 5 that's just a fine and you.

Inject right in the line.

You can literally go right into the lines. Those are better for people with like deeper lines.

Okay.

So there's filler and then I also recommend micro needling. I love micro needling, by the way. It's just like a. Is like a great. Just helping tighten skin, helping with fine lines and wrinkles throughout the face especially also if you don't want to do Botox or Xeomin. I'm a big fan of micro needling, especially with PR like PRP or prs.

Okay.

Yeah. Or pr. We don't do PRF in our office. I want to. But anyways, we're sticking with PRP right now.

But which by the way, that's platelet rich plasma where you draw your own blood, they spin it down on a centrifuge and then so it's your own body fluid basically getting injected back in or put back in with the micro.

Yeah. Also another controversial thing that people. I mean it's controversial because some derms are so anti it. I'm more open to it though. We haven't done it in our office. But with microneedling you could also do exosomes instead of. Instead of PRP because these all contain growth factors that help stimulate collagen production. But anyways, getting back to lip lines, microneedling with or without PRP or exosomes. And then another and then like the fourth thing I recommend is lasers, like the Fraxel laser.

Okay.

A non ablative laser. And yeah, hitting like I said, it takes a village hitting it.

I just had CO2 laser under my eyes and I so wish I had done it above my lip at the same time. I didn't, but I wish I had because I don't want to go through it again. But it was like that was such a pain to do do at the same time. No, I've not done any Filler actually believe it. Like, I. That's one thing I've stayed away from, and it scares me, and I'll tell you why. And I'm curious how much of truth goes to this. I think as we age and our face kind of changes shape. What I notice, at least in my. On my friends that are in their 50s and have filler is it just starts looking like this stuff on top of sagging. So it starts. It might look good on somebody in their 30s, and then somehow, like, late 40s, 50s, it starts looking funny. And then I've heard that it can migrate, that it can move, and two, that it never fully goes away. Is that true?

Yeah, all those things can be true. It's not the case for everyone. And, yeah, I definitely think that we see more of those issues and people who get a lot of filler.

Okay.

So I would definitely. Because it's one of those things, like, when you get it the first time, and if you just get a little bit, you're like, oh. Oh, wow. Okay.

Yeah.

And when they see that, they think, okay, more is better.

Like eyelashes and boobs. That was what we.

Exactly.

I've seen that trend with that, too.

Oh, my gosh. Yeah.

Like a little lash. And next thing you know, we've got tarantulas.

Oh, my gosh. We got. Exactly. And so there's a little bit of, like, facial dysmorphia, like, body dysmorphia coming into play, too. And it's not just the person getting it. I think the injector is also responsible for this whole process, too. But, yes, typically, if that does happen, which I feel like more and more people are talking about it, and so I think it's becoming more common. I think it's because people are getting a lot of filler, and I think there's this movement now for people, like, optimism, opting out of filler or getting less filler. And we're seeing in studies more and more that, like, filler is lasting longer than the nine months to a year and a half that we thought in the initial studies and in our patients. And so especially in areas where it's injected, where you're not moving so much. So, like, if filler is injected under the eyes, like, we're not, like, moving those muscles. Like, so we're seeing those hang around longer as opposed to, like, around the mouth, where people are, like, talking more, that. That gets metabolized faster. So. But yeah, it's. I think it's still a little bit of a controversial subject, but I definitely think migration is possible with lips.

I see that all the time on people where maybe it starts looking like a duck lip.

Yeah, definitely. I'm like, oh, with the lips I always do such a small amount because that can. Yeah, yeah, that can definitely make or break.

And this is kind of warning to anyone listening if you ever want to do surgery, you have to dissolve all that anyway. Like you can't get optimal like facelift or even anything if you've got filler right there. They can't really see what's going on.

On. It's. Yeah, it definitely makes things harder for the surgeon for sure. Especially if you do Sculptra like that class of fillers Radiesse, where that's actually more of a permanent filler.

Okay.

And basically I was hearing a plastic surgeon talk about it like it's almost like putting glue between the pages if you're doing like Sculptra. So it's like so hard to go between the layers of the skin. So it makes surgery down the the line so much more difficult.

I personally take, I mean I was very public with this recently. I had an up. Well, I did at the same time as CO2 laser. I did upper eye BLF lower and a fat transfer. So I'm a fan of surgical more than I am some injectables for that just because to me it's, it's more. I mean nothing's permanent. We're going to still age. But it sounds more invasive but it's actually less over time because you're just fixing and reversing versus injecting, injecting, injecting. So that was my preference on that for.

Yeah.

What about. These are just some random weird questions I wanted to ask you. And these are all from social media cuz they like I, I get these weird things from Tik Tok or Instagram and I have to ask like I now hear that you're not supposed to wash your face twice a day. You're only supposed. What do you. Is that baloney? Is there a reason?

Yeah, it's person dependent.

Okay.

You definitely don't want to overdo washing your face. It's. It depends on your skin type as well and like what you have on your face. But yeah, and, and a lot of it also depends on the cleanser too. Some cleansers are like super gentle and moisturizing and like would be fine to use twice a day. You definitely want to wash your face at night. You want to wash off like all the exposure that you had, all the Elements of the day, whether it is pollutants, makeup, sunscreen, all that stuff. So that's really important in the morning in terms of whether or not you should wash your face. I mean, I think it's still important to at least rinse your face with water. But I would say you can wash your face if you have, like really oily or acne prone skin and you want to wash off, like, any of the heavy products, products you used. If you use like a heavier moisturizer or something, you just want to like, clear your face and like, have a fresh template for the next skincare products. Because if you're using acne treatment also in the morning, because some acne treatments are twice a day, like you want to clear off what's there.

Makes sense. I wash in the morning because I use a red light every day and I want like nothing on my skin when I go sit in front of the red light. So it's like the first thing I'll do is wash it and then go sit in front of the red light for me.

Yeah. There's so much nuance, like when I see all these, like, statements.

Yeah.

Like, it's like, sure, yeah, okay. It's good to just wash your face once a day, but there's more to it.

Right. That brings me to makeup wipes. Same thing people really hate on makeup wipes, but they really help remove your mascara. So how bad are those?

Yeah, yeah. I think there's multiple aspects to makeup wipes. I think that they're okay if you don't have access to like a topical makeup remover, micellar water, or like a cleansing oil that does also can do a really good job at eye makeup. Makeup. Makeup wipes are good. Like, they're convenient because they're just like kind of like less messy to deal with. I think the issues that we see with makeup wipes as derms, certain preservatives have to be used to, like, keep the makeup wipes fresh. And sometimes people can get like a contact allergy to those.

Okay.

Contact dermatitis. So they can potentially be more irritating than other cleansing agents for makeup. And the other thing can be like just more of an environmental issue, like, oh, is it wasteful that you're using like these cloths every day? But I would say like, like, it's always good to have like a little makeup makeup wipes at your nightstand for those days where you're just like, I can't do anything. But like, if you could at least just remove your makeup.

Swipe that off.

Yeah. Please. Like, I keep them in two places.

I keep them. Well, I use them for. If I have a lot of eye makeup on, I'll use it first before I wash my face. That's because if I use the oil, it just. I don't know. It doesn't to me. I've done that. I've done both. But that's when I. And I also use them. I keep them in my gym bag because if I'm gonna go like hike or do something sweaty, like, I might want to just quickly wipe, wipe off. So that's for sure. Times that I really like them.

Yeah. And if it doesn't irritate your skin and that works for you, then that's great.

I just. It's funny because I had a video before my eye surgery on social media that went kind of viral, but I was started with me using makeup wipes and the amount.

Oh my gosh, you're destroying your skin.

I was like, okay, gosh, I know.

There'S so much nuance to that, but yes, yes.

Yeah. So. And then my final question, which is really nothing with cosmetics, but it's how often do you recommend people do a full body skin check in our age group?

Yes. Yes. So that is also person dependent. I do think that if you have not seen a dermatologist and gotten a full body skin check, you can do that no matter your age, no matter your history or your skin type, your demographic. And then once you're in the derm office, they can determine how often you need to get one. Okay. For people who usually need to get one yearly, they usually. Of course, if you've had a personal or family history of skin cancer, namely melanoma. Melanoma is more so a genetic. Genetic. More so genetic. That's the dangerous one. That's the dangerous one. Thankfully, it's not as common as the others, but yeah, that one has a little bit more of a genetic component. So there's that. If you've had any really bad sunburns as a kid or in your early kind of childhood where it resulted in blisters, like water blisters on your skin, you are at much higher risk for skin cancer. If you used a tanning bed more than 10 times, which I feel like many people have had that a risk. If you have more than some derms, say more than 50 moles, some say more than a hundred moles, you are at slightly higher risk for melanoma if you have a lot of moles. So that's another reason.

Yeah.

If you're on any medications that could be suppressing your immune system in any way. Like people even with psoriasis are on like these injectable biologics, Crohn's disease, like you know, these can all suppress the immune system and that can increase your risk of skin cancer.

Wow.

So those are like probably the general rule of thumb if you have like, if you can burn really easily. Like if you are that fair skinned person with freckles, red hair, blue eyes, like that sort of phenotype that look are at higher risk as well. And then some people I will see every three to six months if they have like more risk factors, if they do have like multiple atypical moles, if they've had multiple skin cancers or a lot of pre cancers. But yeah, basically the list that I mentioned though is for those who should be checked regularly.

Great. Well gosh, this was so informative today.

I love this.

If you're on TikTok, she's got a great TikTok account. Where are you? You're on. You're on all the profiles.

All. Yes.

On all of them or where do they find.

Yes, yes. Dr. Mamina. Dr. M I N A on Tik Tok, Instagram and YouTube.

Amazing. Amazing. Is that the best place for people to find you? Is there a website that you want them to go to if they're in your area?

Yes, my website's Dr. Mamina.com I do practice locally. I have a pretty full patient load so I'm currently not taking new patients. That might change. We'll see. But I have two great partners as well. So you're welcome to, to like look up my practice and still come to my office and follow her to see.

Me and follow her for.

Yes.

Thank you so much for today. This was super informative. Thank you.

Thank you so much. I love this. Thank you.