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Skin Care Treatments, Tips & Advice Blog

(percussive music) – Hi, I’m Dr. Dendy Engelman. I’m a board-certified
dermatologist in Manhattan and I work for Manhattan
Dermatology and Cosmetic Surgery. I’m here to take a deep dive into the Go to Bed With Me comments section in order to get to the bottom of some of your burning questions. In this episode, we’re gonna
talk specifically about process, tools, and injectibles. First step, we’re gonna
talk about process. (percussive music) The first comment is from Mona Sabbar. “Dear Doctor, I’m really
concerned about dairy products “and their relation to acne. “Can you explain it
briefly, thank you,” heart. Okay Mona, you are exactly right. Dairy does play into acne
and there are two things in diet that can play
into increased breakouts and we used to think that it was chocolate or greasy food and that’s
all kinda been debunked and the two things that
really have been shown and proven in the dermatologic literature for making increased breakouts are dairy and high glycemic index
foods, so those are foods that spike our blood sugar really quickly. So what I tell patients
every day is pay attention to your diet and how it affects your skin. If you feel like you had an
indulgent weekend of pizza and ice cream and you’re
breaking out on Monday, then maybe we have some
interplay with dairy being a culprit in our breakouts. So let’s try to eliminate
that as much as possible. The good news about skin
is that if it’s good for your body, it’s probably
good for your skin as well, so we have to think about healthy living, clean eating, drinking a lot of water. Probiotics to take are not
only good for gut health but they also are great for skin health and so that can be an
easy way to implement some tiny changes that not
only make you look better, but make you feel better as well. So Vee V said “celebrity
skin is 70% procedures “and 30% skincare.” I would put a pretty
significant percentage also on great genetics. I mean we all are kind
of dealing with the hand we’re dealt and certainly
celebrities are born with some pretty good
hands in their appearance and stature and figures. That said, not all
celebrities have great skin. I treat a lot of
celebrities and I help them with a lot of skin
issues, whether it’s acne, rosacea, sensitivities,
and procedures are also a big part of looking great. I always have patients who come to me and they just think that
celebrities flawlessly and effortlessly look amazing
and that is not the case. There’s a huge commitment to both skincare and procedures, almost weekly, in order to maintain their looks. One thing that I think
patients can do at home that is very much like
celebrities is really just stick to a good routine. I mean there’s not a
ton of magic in the fact that all these great
products that we have at home will not work if they just
sit in the medicine cabinet, and the people who I
treat who are celebrities are certainly dedicated
to having good skin, and they know that if they kinda slack off on their products that
really work for them, then their skin doesn’t look as great. Maddie said “I watched a
video where a dermatologist “said that if you mix skincare products “from different brands, you’re
mixing different chemistries, “his words, and can cause irritation. “Is there any truth to this?” Maddie, I would say that there’s probably a little bit of truth in the testing. I mean obviously if you’re
a formulator for skincare, you want everybody to buy
every product in your offering. The reality is if you use
an over the counter cleanser and somebody else’s vitamin
C, and someone else’s retinol, it’s probably gonna live
compatibly together, but we don’t know because they haven’t been formulated together,
and so there probably is some truth to mixing
chemistries, but I don’t think that it’s gonna counteract the efficacy of each individual product
if you wanna mix and match. That being said, you
certainly want to make sure that you’re using the right
products at the right time, and there are certain
chemicals just categorically that you may not want to mix. For example, you might not
want to do a very strong glycolic acid and then
follow that with a retinol, that’s gonna be too
irritating for the skin. So it’s not necessarily
a formulator per se, but just the active ingredient. Lady S says “can we stop with
the microtear BS and lies? “There’s literally no such thing.” Well Lady S, there is
literally such thing, and I see it all the
time and the good news is that we’ve gotten away from
a lot of the harsh exfoliants that are in a lot of formulas. I mean when I think back to
when I was an adolescent, the St. Ives Apricot
Scrub was one that had like harsh particles in
it, and that can cause microirritation and tears over time. Certainly under the eye, where
that skin’s very delicate, around the nose if you ever look at people and they have like these dilated vessels that are there, those
are areas where the skin is very sensitive and prone to injury. So we want to love our skin at home and we don’t want to do anything too harsh in order to irritate
it, but the reality is, you can cause some injury in your skin based on certain skincare
products or even devices. Munira Jamali says “you do
know that clinical trials “have proven there is no benefit “to consuming collagen in your diet? “Collagen is produced
endogenously by your body.” Munira, you’re half right. Collagen is produced
by the body but you can increase your body’s stores
by oral ingestion of collagen. And this is where it gets really tricky ’cause not all ingestible
collagens are created equally. There are studies that
have been documented in our dermatologic literature that show that they’ve not only
traced it from ingestion but it’s been incorporated into the dermis in meaningful amounts enough to decrease the depth of crows’ feet
by 20% in just eight weeks. Now it’s not the only thing that we can do to create collagen, you
can also use retinoids and you can use vitamin C, these are all different ways topically to also do that, because the problem
with ingestible collagen is there’s no vegan form,
and so it needs come from an animal source and a lot of people want to shy away from
that and I understand that’s certainly a personal choice. If that’s something that
you follow in the lifestyle, then you can go at it
in a topical application in order to increase
more collagen production. The one that I recommend to patients is called Verisol Collagen, V-E-R-I-S-O-L, and that’s the one
that’s really been proven in the literature to support the skin, increase total body stores of collagen, it’s not just helpful for your skin but also for your joints because collagen is one of the main building
blocks and substances of connective tissue. Now let’s get into the fun stuff, tools. (percussive music) “Are cleansing brushes,
washcloths really necessary, “and can you wash your
face in the shower?” Yeah, you can totally wash
your face in the shower and you don’t have to have
a cleansing brush or tool. A lot of people, especially dermatologists and those who are
treating a lot of rosacea or people with sensitive skin actually are a little bit hesitant
to recommend cleansing tools because it can irritate the
underlying skin condition. So if you’re happy about
washing your face in the shower and that’s working for you
and you don’t have acne or breakouts or any skin problems, then by all means, continue to do that. So if I were gonna rank
things from most gentle to strongest I would
certainly say that hands are probably the most
gentle, we can obviously regulate and feel how our
pressure that we’re using. Then I would do like
muslin cloth or something very soft that is helping to remove but not with any texture. Then I would go to textured washcloth. Then I would go to cleansing brushes. The problem that I find
with cleansing brushes is that people sometimes get into trouble by giving a lot of pressure. You just want the brush to do the work, so just hold it where it’s
barely contacting the skin and it’s gonna exfoliate
for you, but people who have acne kind of want to beat it up and they’re really angry with it and they press into the
skin, and then over time that can exacerbate the
acne that’s underlying. So we want to be really
gentle in our cleansing, we want it to be effective
but you don’t have to spend a lot of money in
order to get a clean face. So So Zen asks “question,
what is your opinion “on at-home dermarollers? “Who should use them, how and how often “should they be used? “Also, jade rollers. “Do they have a scientific basis “or are they just a gimmick?” I like home dermarollers
for certain indications like those who have acne scarring, but not on active acne. I think that that can
worsen existing acne, so if it’s old acne scarring where people have textural irregularities, I do find that you can get some improvement with persistent at-home rolling. We do in office procedures where we do much more aggressive microneedling, but some people can’t
afford that or they don’t have access to those who offer it, so it’s certainly better than nothing and it can help with textural changes. That said, we wanna be really
careful with the products that we’re using when we’re undergoing these at-home dermarollers,
because some things can make it more irritating
’cause you’ve opened up channels into the
skin and so it’s kind of being absorbed deeper into the skin and can be really irritating. For jade rollers, I really like them. I don’t know if they’re a gimmick or not but I think that there’s a lot to be said about facial massage. It’s not as hot in the
U.S. as it is in Asia, but those who do this frequently really, I find benefit for them. Their skin looks better,
it’s less congested, especially under the eyes
and areas that tend to be a little bit more puffy. It helps to improve the lymphatic drainage and so I’m a big fan of facial massage. I think that it’s great
and if this is a way that helps you to remember to do it, even for five minutes a day, it’s not gonna hurt and it may help. One of my favorite tools
is one called Conture, which is C-O-N-T-U-R-E,
and it’s basically like a gym for your face, it
uses pneumatic compression to pull the skin up into the device and then puts it right back down and that increases blood
supply, oxygenation, and over time helps stimulate collagen. So it’s kind of a fix-all for
whatever issue you’re having, whether it’s pore size,
fine lines, wrinkles, you can use it on the
face, the neck, the chest, and so it’s one that’s
kinda from here to here, one size fits all and
you just need one device, and so I really like that
one because it’s also gentle, it’s not having any break in the skin, it’s not gonna cause
irritation, but over time it really works. So Eva C says “what do
you think of shaving “the fluffy hair on one’s face? “It’s supposed to make your skin healthier “but I’m not convinced,
especially as a woman “with thicker facial hair.” So I was just in my office before this and I was talking with
Mila, my esthetician about dermaplaning, which
is the in-office procedure that we offer to remove the lanugo hairs, those tiny little white
vellus hairs that people have. And she really feels like it improves the absorption of chemical peels and makes the efficacy much better. Really when you’re removing the surface of the skin cells and the
hair, it does exfoliate the skin, and your skin
will look glowy and pretty and better, but you want to make sure that you leave it to the
professionals, I think, ’cause some of these at-home devices, unless you just want to use a razor, I’ve seen some patients who’ve come in and they’re irritated and they’ve actually like lacerated their face,
so we wanna keep you safe and let’s leave the blades
to the professionals, unless you’re using like a standard, run of the mill razor, which certainly, a lot of my patients do
and it works for them and that’s fine too. So Audrey says “don’t know if dermarolling “and vitamin C is such a good mix.” Audrey’s not wrong. It sometimes can be a bad mix
depending on your skin type. Vitamin C is an acid, and
some people can’t tolerate it. It can be irritating to the skin, it can cause redness
and irritation even in non-compromised skin, so
if you’re dermarolling, and having little channels
of microinjury into the skin, it could potentially irritate you. Kenny follows up with “it
is when you’re using 0.25 “which it looks like she was. “Any deeper and could cause stinging “if it’s L-ascorbic acid. “I use 0.5 and have never had a problem “using vitamin C after.” So this is just talking about
the depth of the needles, 0.25 over 0.5 and that’s
the depth of penetration that you can get based on
different dermarollers. So certainly the deeper it
goes, the more the potential for irritation but I
would say that’s really more specific to the skin type than the depth of penetration,
so if vitamin C irritates you when you’re not derma
rolling, then certainly don’t use it when you are. Let’s move onto a juicy
topic, injectables. (percussive music) So Laura Cole says “does anyone know “what is the difference
between Botox and fillers?” I do Laura, and you wanna
go to someone who does, too. I always see this and I kinda laugh when I’m in the checkout
line and one of the tabloids will say botched Botox and it’s like clearly not a Botox issue,
but it is confusing. Like you know that they’ve
had some kind of injectable and the layperson often
can’t read is that too much neurotoxin or is that too
much soft tissue augmentation, which is filler. So the differences are quite real and one is relaxing muscles, that’s Botox, and one is filling in volume
or helping to lift the skin, and that’s filler, and
so the easy rule of thumb is anything from the cheekbones up is kind of a Botox issue,
and from the cheekbones down is a filler issue. For licensed and trained professionals who do this all the time,
we do break those rules but it’s just an easy starting point. So if we think about wrinkles between the, you know, the 11s, between the eyebrows, into the forehead, the crows’
feet, that’s all Botox. The tear trough, the mid-face, the jaw, the lips, all of that is
more of a filler issue. The smile lines, those are all areas where we put filler in order to improve the appearance of the skin. Definitely the take
home here is you always want to go to someone who
definitely knows the difference and where to use what and how much. Neurotoxins in the face
are not for the neophyte, I mean we have to have
a great understanding of facial anatomy and the
activity of the product you’re using and the dose,
so we wanna make sure that you go to someone who knows exactly what they’re doing and
what your needs are. And honestly, I always
tell patients this too, if you don’t feel comfortable during the initial consultation
with who’s gonna inject you, then run away, don’t
be talked into anything that you don’t feel comfortable doing. For neurotoxins, all of the
ones that we have available today are a baseline of Botulinum toxin and that is a relaxant, it works to block the communication between the nerve ending and the muscle, so basically
they can’t speak to each other so when the nerve tells
the muscle to contract, it doesn’t hear it, and
so the muscle’s relaxed. Now we used to think about
Botox being something that was so obvious that
people, you could tell they definitely do it
and now we can use it in very subtle ways to
where it just looks softened but you still have full
expression and are able to move and give nonverbal
communication when you need to. For filler, most of them
are hyaluronic acid, and that is just a sugar. It’s naturally occurring in our body and if we think about the
dermis as like a dried sponge, the sponge material is the collagen, and when you add water
and plump up that sponge, that’s the effect of what
hyaluronic acid would do. It holds about 1,000 times
its molecular weight in water so it really plumps up
the tissue from within. The good news about
hyaluronic acid fillers which we know hyaluronic acid is in a lot of beauty products
that we apply topically ’cause it’s so good at
pulling in moisture. Hyaluronic acid fillers are reversible, meaning that we can inject an enzyme and they can be melted and dissolved and that is a nice safety net to have. A lot of the other fillers are made from calcium hydroxylapatite
or something called PLLA and those once they’re in, they’re in, and so they are not
reversible, so you need to know what filler’s being used
and where it’s being used and why it’s being used. So feel free to ask
questions to your injector, they should easily be able to answer them to make sure that you’re comfortable with what’s going in your face. Kelly Smith says “how young
is too young for Botox?” Hmm, “I didn’t think 28
year olds got Botox.” Well Kelly, I have much younger than that who come in for Botox
and my general approach is never age, because I have 22 year olds who need Botox and I have
42 year olds who don’t, so it’s really what your face is showing, and so when I look at and
assess someone’s face, if they have expression
lines that are there when they’re not making the expression, that’s kind of our
benchmark for when it’s time to start talking about
Botox because we know that over time they’re
not gonna get better, they’re only gonna get worse. So if you start gently,
just relaxing those muscles so that they’re not making the lines, you’ll never have the
wrinkle and so that’s the whole idea, it’s very
controversial to talk about preventative Botox, it’s
not that you’re preventing you know, I have a two year old, I’m not injecting her preventatively with Botox, but at some point, you know,
you start to see the signs of aging and you head
that off at the pass, and so that’s how I approach prevention, is looking where the problem’s gonna be, stopping that, and softening
it so that you don’t ever have the lines, and so
that’s the approach I have. It’s not really an age, it’s more of what your face is showing. Botox in a medical indication is used for all kinds of things, TMJ, migraines, torticollis where you can’t
even straighten your neck, and these were originally
the medical indications for which it was used and then we realized that it can be also used for
unwanted facial expressions that are causing
wrinkles, and so there are plenty of applications
that are not cosmetic that the medical usage
of Botox is there for and I’m so happy that we have that to help in both the medical use
and the cosmetic use. McCallMeLauren says “I want
Botox so badly,” sad emoji. “Isn’t it expensive AF though?” Kind of, but it’s worth it. I would say that it just depends on what area we’re treating. Certainly, one of the first signs that we show signs of aging
is around the crows’ feet area and that doesn’t use a lot of neurotoxin, and therefore it’s not
gonna be as expensive. If you’re a man and you have tons and tons of wrinkles in your, between your eyebrows and on the frontalis, then
that’s gonna take a lot, so the price goes up
because the more we use, it’s a very expensive
product even for me to buy, the more the cost is for the patient. So if you start early, I often find that patients can go
even longer than what’s been reported in the package insert, which the longevity of the filler is every three months, but
I have those who push it to four and six months if they start early and those muscles are never
really regaining full strength. I do tell my patients,
this is like a luxury item. I mean I really want a certain bag, and it is an investment,
but if it makes you happy and it makes you look
better, often over time it’s a great, worthwhile investment, and I always joke that when
I first came out of training, the girls would splurge for
those great pair of shoes or the bag, and I was like honey, if the guy’s picking you up at the bar ’cause he loves your bag, you’re going after the wrong guy. So if we put the investment in our face, that’s the accessory you
carry around all the time. So in that, to me, that’s worth every bit of extra investment. So I would say that yes,
it is a luxury item, but it’s certainly a good
investment in yourself when done correctly and naturally. So K6Kirei says “is it
possible to be vegan “and use Botox and fillers? “I read that Botox and
fillers aren’t vegan “and they are tested on animals. “So are there vegan friendly fillers?” I don’t know of any
medical device or medicine that isn’t tested on
animals, and that is just a sad fact, but the FDA
is never going to allow for something to be approved
for human consumption or usage without documenting
safety in non-humans. So sadly, there are not
any vegan friendly fillers, but you know what, there’s not even vegan friendly Advil. Everything that we
consume or use on humans has been tested on animals
and that’s just the sad truth, but we have to keep everybody safe. So Oseb says “I have
the feeling that there’s “something wrong with his lips.” And then Dream Catcher says “lip fillers.” And then Laura Cole says
“does he have lip filler? “I feel like everyone does now. “Are they that bad?” I just saw a patient today who I thought had had terrible lip
filler and she hadn’t, she was young and she was getting married and she brought it up, she said, “my lips are so asymmetric.” So not all people who have
asymmetry to their lips or what you would consider distortion have actually even had medical
or cosmetic procedures. Also, we certainly can
go overboard with filler. I mean we’ve certainly seen
all kinds of bad work out there and I honestly never fault
the patient who had it. I fault the injector who did it to them, because we should be a team and come up with an aesthetic that
works for both the patient and the injector, because I have patients who wanna go bigger, bigger, bigger, and that is not my aesthetic
and I won’t do it to them. Now they may trot right out of my office and into someone else’s, but that, you know, they’re kind
of a billboard of my work and I don’t want them
running around New York City saying “Dendy Engelman did my lips.” So that was our last one,
thanks for joining us. I’m Dr. Dendy Engelman and this has been another episode of Derm Reacts. So please subscribe to the Bazaar channel and give this video a big thumbs up if you liked it and want more of these. Drop your questions, comments,
or even your debates here and maybe we’ll choose
yours for the next episode. (calm music)

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