Cosmetic Dermatologist, Debra Jaliman, M.D.

Hi, it's Doctor Robert Seikert with another new and interesting episode of Doctor Podcast today. My guest is Doctor Deborah Jalaman, who is a Board Certified Dermatologist and a Clinical Assistant Professor of Dermatology at the prestigious Mount Sinai Medical Center here in New York City. Dr. Jalaman is also in private practice in New York for many years on the Upper East Side of Manhattan on 5th Avenue. Dr. Jalaman is one of the most experienced and knowledgeable cosmetic dermatologists in New York and probably in the entire country.

She has many years of experience using a variety of different products, which we'll get into. Thanks very much for coming today. Nice to see you, I. Appreciate it. Thanks for giving us some of your time. Can you explain to the audience, Some of the audience may not be familiar with dermatology. Can you tell us what dermatologists, what dermatology is and what dermatologists do? Sure. So dermatologists take care of the skin, the hair and the nails. So it's a very exciting field because people have a lot of problems in those areas.

Right. And there are different types of dermatology. There's a medical dermatology and there's also cosmetic dermatology. You do both of those right. Exactly. So for example, medical dermatology would be, let's say you have acne or you have eczema, you have psoriasis or maybe you need a skin check. Everybody should have a skin check by a board certified dermatologist once a year. So we check your skin, look for skin cancer, look for changing moles. So that would be medical dermatology. And then of course, I do cosmetic dermatology to beautify your skin, make you look better.

All right. That that's good. You mentioned about skin cancer, I've been hearing a lot and reading a lot and also many of my patients come in with with skin cancers. It seems to be on the increase in recent years. Why? Why is that? Well, many factors probably, because there is a decrease in the ozone layer, that's one. And a lot of people are doing many leisure sports outside and there is UV light all around us. So for example, on a cloudy day, many people think not to wear sunscreen, but you have to wear your sunscreen every single day because there's ultraviolet light that reaches us even through clouds.

So I tell my patients, like you brush your teeth every morning, wear your sunscreen, wear a broad spectrum sunscreen with an SPF of 30 or above, and my favorites are zinc based sunscreen. So that's a physical sunscreen, not a chemical sunscreen. Right, but on the one hand they tell us that the sun and and UV light which we get from the sun helps increase our vitamin D levels. On the other hand, it causes skin cancer. So it's a it's a delicate balance. How do you balance that? Well it's interesting because actually you would have to have so much sunlight to get enough vitamin D So I would suggest just take a vitamin D supplement.

So take a vitamin D supplement but but cover your skin. Do you suggest the sunscreens even in the winter on on sunny days? Yes. So even on a rainy day, a sunny day, a cloudy day, every day, I tell my patients, wear your sunscreen. It's so important because sun damage is cumulative. And I can't tell you how many people say to me, I'm not outside, I never go outside. But you know what? Even if you sit by the window, you're getting UV light. UVA light goes through window glass, so you're getting UV light.

And even if you say you're not outside, you're still probably walking your dog for 10 or 20 minutes. You're going outside to get a cab or get a bus or go to the subway, so you're still getting ultraviolet light, and even 10 minutes a day is cumulative over the course of your lifetime. And let's face it, most of us end up at the beach or a park or somewhere, and you still get ultraviolet light. So you think the Zing paste products are are the best bet? I do think so, yes. Recently I've read that some of the products the sunscreens may contain carcinogens or chemicals that get absorbed into your body may cause cancer possibly.

Is that correct? Or well, there was a scare about that and that's why I say stay with zinc, because zinc is diaper rash cream. So if it's good enough for a baby, it's good enough for me, very safe, very effective. And zinc sits on the surface of your skin. It doesn't get absorbed into the body, so you know it's safe. All right, but does zinc leave a white cream on your skin? It used to in the old days, the old zinc was what you would see the white on a lifeguard space, right? But now they have zinc that's very much goes into the skin and you don't see the white anymore.

Wow. Well, that's that's great advice. Yes, I'm going to start doing that for sure. Is there an age where there's an increased risk of skin cancer and melanomas? So we see melanomas even in young people. We see them in 17 year olds, 30 year olds, and then of course in older populations. So if you were unfortunate enough to go into a sun bed, for example, that will really increase your risk of malignant Melanoma. So it's best to avoid ultraviolet light from the sun. Yeah, that's very interesting.

The the next thing I wanted to ask you about is, is cosmetic dermatology, which is your super specialty that that you have a lot of experience with. Can you tell us what cosmetic dermatology is? So cosmetic dermatology people come to me and they say I don't like the wrinkles in my forehead. I don't like my frown lines. I don't like my smile lines. That would be cosmetic dermatology. Or I have brown spots I don't like, or there's too much redness in my face. Or I was pregnant and I have the mask of pregnancy, or I'm getting sagging in my skin.

Those are all things that we address with cosmetic dermatology. All right, so it makes you look. Better, yes. Makes you look better, makes you look younger. Sometimes people say I'm losing my hair, so we address hair issues. So it's a lot of skin and hair to beautify the skin and make it look better and make you look younger. All right. That's good. Now, you were kind enough to bring some products with you today to to tell us about about this. I I see sitting right on top here is Botox. Yes. Can you tell us about Botox?

So Botox is a neurotoxin. And what that means is it relaxes your muscles. So let's say you're somebody who has a very dynamic forehead. You wrinkle your forehead a lot. You make a frown face. You crunch around your eyes, and what Botox does is it relaxes the muscles. Because some people have faces that are more passive, you don't see them move that much and they don't get as many wrinkles. So if you're somebody with a very expressive face, you're going to get more wrinkles. So what we do now is we put the Botox in your face.

And then about 10 days to two weeks later, the Botox takes effect and you'll see the wrinkles start to soften. Many times the wrinkles go totally away. Sometimes they're etched into the skin and so they're not totally gone. And then we can deal with the residual wrinkles. Or some people are just happy to soften the wrinkles. Right. So you mentioned that you put the Botox in the face. Could you tell us how you do? That how I do that. How do you put Botox? In my office we offer patients numbing cream so we can actually numb your skin for 15 to 20 minutes with cream.

And then we have a special machine that shoots cold air at the skin so it numbs the skin as we inject the Botox. So we use very fine needles and I inject the Botox into specific areas of the face. So it's very important that the person injecting your Botox know all the muscles of your face, so they inject the Botox in the exact perfect place so that you affect the exact change that you want. So if you want to inject for the frown, for example, you know exactly where to put it for the frown so that you don't get a droopy eye, you inject it around the eyes or you inject the forehead.

So you really have to know facial anatomy very well. So one of my pet peeves is somebody takes a two Week 2 day course on Botox and then they start injecting it. You really want somebody who knows right facial anatomy well and has done a lot of Botox. Right. And the needles are super thin. Super thin. Some of my patients tell me it feels like a mosquito bite almost. Exactly. So I would say for many people, they don't use numbing cream. We just use cold air. And for others who might be a little phobic of needles, we use numbing cream and we use the cold air, right.

It's critical. Comfortable It's critical to inject the right amount in the right place. I've had a few patients who had Botox injections elsewhere and they come in like this with their eyelid totally closed, and unfortunately there's no antidote for that. So once you've had Botox, it just takes time to wear off. There are certain eye drops I've been. Used to slightly. Raise the eyelid, yes, but I had one patient that was literally totally closed for about 6 weeks. It's pretty unpleasant. Yeah. So it's, it's really critical as you mentioned.

Now some of my patients ask me about Botox because it's injected around the eyes, around the muscles of the eyes and they always ask me, is it safe? Could you speak to the safety of Botox? So I would say in the right hands, Botox is very safe. It's very effective. But of course, you have to go to someone who knows how to do Botox and who does it often. It's like anything else you want to go to someone who's doing it repetitively, knows how to do it and is very well trained. I think it's very safe and very effective.

The most common side effects I would say are bruising. You know, that's what I usually say if somebody. So we tell our patients before, you're going to have Botox, don't have aspirin, don't have alcohol, don't have fish oil, don't have vitamin E These are things that could thin your blood. So for like a week before. And the bruising is like a black and blue marks. A black and blue. Mark, But that goes away in a few days anyway, excuse me. So sounds like Botox is very safe if if the right person is doing a lot of experience.

You you've done many Botox. Pages. Well, actually I started doing Botox in 1991911991. It's a long time ago. It didn't. It had FDA approval. Botox for it was originally used by ophthalmologist and but it didn't have FDA approval for cosmetic use, so it was an off label use. In 2002 Botox got approval for cosmetic use. So I was using it way before. There were a handful of people that were using it very early on. So I have a lot of experience using Botox, and I've taught a lot of people how to use Botox.

Now By now, 11 million people worldwide have had Botox. 11 million people. So it's got a long track record, well over 20 years. Yes, exactly. It's very safe and effective. Yes. I've I've seen recently in the last couple of years there are some products that are similar to Botox that have come out. What do you think of those? Are they the same thing or or any? Different. So I use another one that we use a lot called Zeoman and it's very similar to Botox. It doesn't have as much protein in it. So some people like it.

They feel it's a little more natural, but it's the same neurotoxin basically. So it's it's very, very similar. So patients like that a lot. Some people want Botox, some people want Xeomin. There are other ones. There's one called Dysport. So they're very similar, these neurotoxins and it's just your preference. It's like some people want a Gucci bag, some people want a Prada bag. So it's the name. I think the problem with Botox is that they call it a toxin and that scares people, so technically it is.

A. A toxin. But at the concentration and dosages that you use, it's it's not really toxic. Yes, it's very low. It's a very like I always say to patients is a spit in the ocean because it's a very small amount of the toxin in the area that we use all. Right. Well, that is very informative about Botox. There are other products that you brought here today. One of them here is Juvoderm. Yes. Now that's that's not like Botox, that's a filler. Can you explain what what fillers are? Sure. So as we age and we get wrinkles, we lose the structure of our face.

So our skin is made of collagen, elastic tissue and hyaluronic acid. So what this is, is this is pure hyaluronic acid and we're putting back the hyaluronic acid that we lost. And for example, let's say you smile a lot, then you can lose hyaluronic acid in your smile lines. So we can replace that hyaluronic acid by injecting hyaluronic acid into your smile lines. We can inject it into your marionette lines like here. We can inject it into your frown lines, into your forehead lines, into your crow's feet.

So we inject different fillers depending upon the location in the face. I see and so that fills in spots where you have the. Wrinkles, right? Yes. So you have loss of hyaluronic acid, right? Right now you refer to it as hyaluronic acid, but it's really that's just the medical. That's the medical. It's not really an acid because people think of an acid as something that burns. It's a sugar. It's actually a sugar. It's a repeating sugar, but that's what our skin is made of. So in the old days we used to inject collagen back into the skin, but then they realized that many people were allergic to the collagen, so they started injecting hyaluronic acid instead.

So people don't have allergies or reactions. To you know, it's possible, but very, very rare. So we don't even have to skin test you People come in, we inject it. The good thing about hyaluronic acid is if for some reason somebody doesn't like it, it can be dissolved out of your skin. So it's not permanent. By injecting something else, something else. This comes in the form of a thick gel. You're actually injecting a gel that contains this. Hyaluronic gas, Exactly. And I understand that it also contains an anesthetic in it.

Exactly right. Inject it doesn't hurt that much. It doesn't hurt that much, but in my office, once again, we offer people numbing. We use cold air because we want to make it a very comfortable experience. But some people don't opt for it. Some people say no, I'll just take the injection and I'll use the cold air, let's say. And some people have nothing, they just have the injection. Right. How long does Juvederm last? For example, if you're doing lines in somebody who has these folds from their nose to their corners of their mouth, how long will that last?

It varies, but I would say for most people it lasts about eight months, so it lasts a good amount of time. It's much more than Botox, which we didn't mention, which only lasts three to four months. 3:00 to 4:00. So usually what we end up doing is we do 2 Botox. Botox is for one filler, so you come twice for Botox and once for a filler. Right. Some of my patients who've had Botox a lot tell me that after many sessions of Botox, they actually have fewer wrinkles. Yes. Is that true? I think so, because what I have found is you're training your muscles not to be so active.

So I tell people it's the opposite of exercise. If you want really good muscles, you exercise a lot. If you want really weak muscles in your face and you don't want as many wrinkles, then you come for Botox every three to four months and just stay on top of your Botox. Right. And the Botox doesn't make your wrinkles worse if you stop getting. It no, now it just goes back to what it was. Sounds like a great product. Yeah, patients really like their Botox. Maybe you could do some on me live on Twitter.

Absolutely. All right. We'll do that later. Yes. Here's another product that you brought. It's called Restilane. Can you tell? Us about that. So this is this one is called Restilin Lift and it's a very robust restaurant. So it's very thick. It's large particle size and it's good for something where you have a deep depression. So let's say you have very deep smile lines, it's good for that or let's say you have very deep lines near the corners of your mouth. We use a lot of rest and lift and patients like it a lot because it does last a long time because it could last also eight months.

So patients like that and it's very safe, very effective. Main side effect is bruising. Bruising. Same thing, yeah. Is that also how uronic acid? Or a different formic acid. Yeah, different form. I see and I see you have another restylane box here, a different color. Yeah. So this is called Restylane Silk and this is the opposite of lift. It's very fine particle size. So it's for very fine line. So let's say somebody has fine lines on their upper lip and they don't want to enhance their upper lip.

They just want to get rid of the fine lines. I can take very small syringes and very small needles and fill each individual line with restle and silk. So that's something that's very popular. Or let's say somebody wants to enhance their upper lip, but ever so slightly they don't want somebody to know. I can use restle and silk for that. Or also there are people who have very fine lines in their nasal labial folds, you know, in their smile lines. And somebody young, let's say somebody in their 20s or 30s, they don't have deep lines.

I can use restle and silk for that. And also another good use of it is I can use it for crow's feet. So sometimes people don't want Botox and they just want me to do their crow's feet. So I do it with Restle and silk. Right. Some people use Botox in the lip as well. How does that work compared to the rest of the? Silk what Botox does is it prevents you from getting more lines. But if you have deep set lines already, you need something to fill those lines. So let's say you're older and you've already had the lines and they've set in, then I have to fill the lines.

And the other thing I want to mention is, let's say you have very deep frown lines. Now we've done your Botox, but you still have lines at rest. So the Botox, you're not frowning anymore. But we look at you and you still sometimes people say, look, I need more Botox, but it isn't that they need more Botox because they're not moving. So they don't need more Botox, but they have lines at rest. Then I take Restylane Silk and I fill in the lines at rest with the rest of them Silk. I see. So if Botox doesn't get rid of the deep wrinkles completely, you can fill them in with with other fillers.

The appropriate fillers, right? Wow. And now they're looking like a teenager. They're very, very happy. So we have pictures actually which we can share. We can actually post it with with yours. That shows somebody with the deep wrinkle, then with Botox, and then the addition of filler. So the three a set of three pictures. So it really shows the. Difference these are these pictures on your website do. You yes they are on my website so we and it's. My doctor jalaman.com. Yeah. So it actually shows the progression.

So somebody can see the difference of how sometimes Botox doesn't solve the whole problem and then we need to add something else. That's that's interesting. Do you have information about these products on your website also so people can read about? Yes, that's very interesting information about the different fillers. So you you, the experience really is critical in deciding which filler to use, what part of the face to use it in, how to combine it with other products. That's where the experience.

Comes in because let's say for example, today somebody came to me and she said, look at my lips, they're very lumpy. Why do I have lumpy lips? I didn't do her lips. And so the person used the wrong filler for her lips. So we had to dissolve it. And then she'll come back next week and then we'll reinject it with the right filler. So that happens a lot. If you put the wrong filler, you can make a lump. So you have to know which filler to use in which location, and also where to put the filler. So you're perfectly balancing the person's face.

So it does take a bit of artistry, you know, It's not just one-size-fits-all. Right. So it's art and. And science. Mixture of both and you actually have to be a sculptor to to do this correctly. Yeah. Right. What about this product? So, yes, so this product is called Bella Taro and it's it's very thin and it's very good for under the eyes because you know when you're filling under the eyes you have to be really careful. It's probably one of the most important areas of the face. It's an area that people ask me about a lot, and the most important thing about under the eyes is to know when to fill and when not to fill.

Because many people have bags under their eyes and they want filler and it's not the right solution. They really need a blepharoplasty, They need to have the bags removed. They need surgery. They need surgery, right? So I have to know when to tell people you need a surgeon. I'm not the right person for you and when I can fix it when they have a hollow and I can fix it, but I need to put the right filler in because you do not want to put too heavy a filler in under the eye because you can really cause problems.

Yeah, I've seen some of my patients who've had fillers injected there. And it doesn't. Look like it doesn't. No, I've seen it too, and many times. I'm dissolving that filler as well, you know. Use an enzyme hyaluronadase. Is that what you use exactly? Yeah. We use the one called Vitrace 'cause there are two, and it's very effective and it dissolves instantly so you actually see it dissolve before your eyes. And then you wait a while and and you can treat with other appropriate fillers at that time.

Now you've treated a lot of, I understand, prominent people and supermodels and tell us a a bit about how that works. So when we have to treat somebody very famous, we always have to make sure they don't have a photo shoot the next day, especially somebody on film, because there's continuity when you're talking about film. So the the pictures have to match and we don't want them to get a bruise. So it's very important to ask people very carefully. And even for our regular patients, we want to make sure somebody doesn't have an important event.

So that's very, very important because we have a special instrument where we can visualize the veins under the skin, so we can mark their veins. But you can't be 100% sure that you're not going to bruise somebody because even being so careful using very small needles, you never know. There's always an unknown component and you can bruise somebody. Right. That's gonna be a tiny little capillary. And if you hit it just right. It you'll you'll. Bruise. It might bruise. Yeah. So we're always very cautious and it's also very important to have a dialogue with the patient to make sure that we understand what they want and they understand what they want.

So I can give them exactly what they want so they're happy. Because especially people who make their money on their face, if they're modeling, if we're doing lips, we have to do it very gradually so that their pictures don't change drastically from one photograph to another. All right. So critical for actors and people in show. Business or entertainment in the street. To have this done properly and let's see, we have Kybella. Can you tell us about Kybella? Kybella is an enzyme that dissolves fat so some people would like to inject it all over their body, but it is FDA approved for under the chin for a double chin.

And the way it works is it dissolves the fat and you get multiple injections and then a month later you can repeat it. So it usually is 2 sessions. The problem with it is it does cause a lot of swelling and a lot of bruising. So many people, if they want to have it done, they have to wear a scarf and they really have to cover their neck, so it does have. For about how long? For a couple of weeks. Couple of weeks, yeah. So you. Want to do this a few days before. Your wedding or a party or something else?

No. But there is another way to get rid of fat under the chin, which we do a lot in our office, which is called cool sculpting. We put a hand piece and it freezes the fat and it's also very effective. Also takes 2 treatments, so it's the same 2 treatments and we just freeze the fat and then you actually the fat gets metabolized by the body and it's gone. And the good thing about both of these treatments is the fat never comes back because you only have a certain amount of fat under your chin. And once it's gone, it's gone.

It doesn't come back. How long is the cool sculpting session for under the chin? It's 1/2 hour. Half hour? Yeah, that's cool. So two sessions an hour. And then? You can and you use cold sculpting on other parts of the body. As well, yeah, we're big fans of full sculpting. We've been doing it since 2010. 2010, So lots of experience, lots of thousands of patients. Yes, yes, we do. Knees we do. Arms, we do the flanks, we do the back, we do the stomach. So very popular and patients like it a lot because it's, you know, it's not so much for weight loss, it's for sculpting fat.

So you know people, we tell people you want to be close to your optimal weight and then we just sculpt any fat that you can't lose. So you're not concerned about Ozempic wugovi Munjaro ruining your? Business. No cool so cool. Sculpting is is focused fat removal. And it's very focused and. Specific parts of the body where where you have excess fat and everybody's a little different. Yeah, 'cause somebody could have, like could look good in clothes and then they could just have little love handles.

Or they could have a knee that has a little extra fat and, you know, on the edge. And then we just do that. So we're just doing little areas of that. So surprisingly, you could be a bikini model and still have a little fat you don't like because these are people that are very critical of their body. So you'd be surprised who's had cool sculpting. So they're people who have beautiful bodies. And it used to be when people would come in and they'd be clothed and they'd say to me, I want to have cool sculpting, I'd look at them like, really?

But then I understood why. Because it was subtle, But they were people who had perfect bodies, who worked out all the time. And there was a little bit of fat, like a pinch of fat that they didn't like, and we could get rid of it. And it made them happy. Or why not? Right. And you can't go on a diet. No, to lose a pinch of fat when you're the perfect body weight or you're even thin. Right, so cool sculpting is is really amazing that you can focus on specific parts Is is it safe? Is cool sculpting.

Very safe. It's very effective. It's FDA approved and you know it used to. Their motto used to be if you have an inch to pinch you could do cool sculpting, but now it's like you could have 1/4 of an inch to pinch. You could have the tiniest pinch and we can get rid of it. It used to be the hand pieces were bigger and now they've made smaller and smaller hand pieces so you could freeze less and less fat. So you have these sessions. The fat kind of dissolves away and disappears. So the fat it. Doesn't come back in that area.

No, because you have a limited number of fat cells in that area. And you know, it's interesting because they found that people like Jacques Cousteau and people who were in cold water all the time, they couldn't keep up their body weight. So they realized that it was the cold that metabolized the fat. So that's how they started thinking about cool sculpting. And they it also happened that there was a child that had a popsicle in their mouth that was always eating popsicles. It was a crazy thing. And they realized that the child was losing the fat in their cheeks because they always had a popsicle in their mouth.

So that's how they realized that cold was affecting fat and that's how they developed It was developed at Harvard. They developed cool sculpting based on these, you know, ideas that cold was really destroying fat. Well, I'm gonna keep popsicles in all my pockets. OK, fair enough. And turn the air conditioning up to high all. The time. Well, you know, when the air conditioning is higher, your metabolism has to work more. So it's better than being in a hot room. I didn't know that about. That's why it's called Cool Sculpt.

Cool Sculpt, Interesting. We have another product here. Can you tell us about that? So this is exosomes. And exosomes are grown in a lab and they're growth factors. So in my practice, we use a lot of growth factors. We can take growth factors from your body. And the way we do that is we do it with something called, I'm sure you've heard of PRP. So PRP is used in medicine a lot. It was originally used in joints and now it's used to grow hair. It's used for skin, for wrinkles. And we actually draw your blood, we spin the blood and then we take out the growth factors and we concentrate them and then we inject them back either into your scalp to grow hair or into your skin to minimize wrinkles and to grow your own collagen.

So then people decided they could grow exosomes and take the growth factors and we could take these exosomes and we could add them to our PRP or we could put them on skin, but the skin couldn't be intact skin, it had to be a braided skin. So we could take a laser that opened up the skin and put the exosomes on and we could help regenerate your skin. What does PRP stand for for? Platelet rich plasma. So it's the plasma. We take the red blood cells, we toss them away, and then we take the plasma with the growth factors and we inject it back into your skin.

And that'll grow hair back. Yeah, we can grow hair back. We can put it under your eyes and get rid of fine lines and wrinkles, regenerate the skin. We can use it in the neck for lines, we use it in the face, we can use it on the upper lip. So it has a lot of uses and a lot of people, many people say they don't want filler, they want their own, you know? So this is taking your own, it's totally natural and causing your own body to regenerate your own collagen. How is this applied? Is it a topical?

Or this one's. Topical. It's a topical, so it supplements the PRP. It supplements the PRP, so that's another thing that we do a lot of. How long does that last, the PRP and and this product? Well, the interesting thing is, let's say we do PRP and we regrow your hair. Then if we just maintain it once every six months, PRP, we can maintain your hair. And a lot of people, we put them on pills, so we can also maintain it with pills. So we can just stimulate your hair, get your hair growing and we can maintain it.

So it's quite good, makes a big difference. Well, I didn't know that you also mentioned laser. Do you do a lot of laser procedures? For the skin, so we do lasers and we also do radio frequency. So lasers we do for a lot of things. Let's say you have wrinkles. So some people, you know this isn't for everyone, right? Some people would rather do a laser. So let's say you have fine lines and you don't want to do injectables, you don't want to do Botox. We could take a laser and get rid of your lines with a laser.

And there are different kinds of lasers. There are lasers that break the skin and then you have some downtime. And then there are what we call non ablative lasers. They don't break the skin, they stimulate the skin from underneath. There's no downtime and we can stimulate your body's collagen and get rid of the lines without even breaking your skin. So it's done underneath. So you can use lasers for lines. You can use lasers for acne scars. We can use lasers for brown discoloration to get rid of the discoloration.

We use lasers for red discoloration. We use lasers for brightening. So there are many different lasers for tattoo removal. For hair removal, so many, yeah. That's going to be a big industry, I think, yes, if not already. I've seen some silly tattoos lately. Yes, it's it's easy to put the tattoo on. It takes a lot of time to take the tattoo off, so you better think twice before you get it. We do a lot of those and then in my office we do a lot of radio frequency skin tightening. So in our skin there are cells called fibroblast and they make our collagen.

So if we can trick the fibroblast to make you more collagen, we can tighten your skin. So what's great about radio frequency is it has no downtime. So there are different ways to use radio frequency. There are some machines where you do it once and you're done, but it tends to hurt. So we have to give you medication. So some people don't want to take medication. Then we have other machines that we do multiple times. So let's say we stimulate your skin once a month for four months. No downtime, no pain and no medication.

So it depends which route you want to go. So there's a lot of different pharmaceuticals and drugs and also lasers and other equipment that you have to become an expert at and and also know how to use. Pick and choose. We have to help the patients Pick and choose because let's say you have very dark skin. There are some lasers you can use, some lasers you can't use. So you have to really be an expert on which laser to recommend to a patient. Because let's say you're very dark skin and you use the wrong laser, You can end up looking like marble cake.

You know where your pigment is really uneven, right? So you really have to go to somebody who has all the lasers so they don't just tell you, oh, we can use this one laser for everything. It doesn't. So you have all these lasers. Yeah, we do, Yeah. So we have a lot of lasers we have. Require a lot of training. And a lot of training. And then even for radio frequency, we have 3 radio frequency machines and then we even have a radio frequency machine just for the body because some people just want to tighten their body.

So we have 3 for the face, then we have one for the body. So it requires a lot of equipment I would say. But they come out looking great. Yeah, people really like it. It's it's very nice because a lot of these have very little downtime. Some have downtime, but we always discuss that in detail because we want you to know that for some things you're not going to be going to a party for a couple weeks. And you have to gauge people's expectations so that they know what the result is going to look like.

Exactly. And so in our office, we only show our before and after pictures. We don't show them from the company because I want people to know what we've actually accomplished because to show a picture in a brochure, I don't think it's realistic. I think it's good to see what your doctor has actually done. You know, we show our Botox, our filler, our laser results. So patients should be asking their dermatologists, show me some of your before and afters as opposed to just the companies advertising material?

Yes, because then you know your doctor really did these procedures. Right. So it it sounds like dermatology has become very technology oriented as well as well as pharmaceutical oriented. So much so, I think so. Yeah. Can you tell us why you decided to become a dermatologist and and how many years of education and training did it take for you to master all these complex procedures and techniques? So I wanted to become a dermatologist because I'm very visual person. I like visual things. Now you have to understand it's so many years ago, there wasn't really cosmetic dermatology in those days, but I was just very interested in visual things and I knew I was very good with my hands.

I was always very artistic and I when I was a kid I used to make jewelry, so I did very artistic things. So when it it came time to cosmetic dermatology, which started to become popular during my residency, then it was very good for me because I was good with my hands, I was artistic and I have a great visual memory. So I pretty much in those days had a pretty photographic memory. So for dermatology, it's great because if you see something really rare and you remember it, then somebody comes in with the rarest thing and then you know what it is because you've seen it once and then 20 years later somebody walks in with that rare thing you still remember.

Still remember it. I have similar memory about eyes. I I can memorize what people's eyes look like. Even if I haven't seen a patient for several years, somehow when they come in, I see the name I I kind of visualize your eye in in my brain. So I guess we were somehow. Meant to be. See, I wouldn't have been a good cardiologist because they used to say to me, listen to the stethoscope, listen to the heart. Do you hear the the thump? The thump I'd be like, not really. So I have to pick a field where you have this skill that goes with the.

I better go into dermatology. That's interesting. How many years for people in the audience, younger people who are interested in becoming doctors, physicians, dermatologists, tell us about the training that's required after college. So you go to college, then you go to medical school for four years, and then dermatology is another four years. And then there are people who do fellowships. At the time I finished, it really wasn't popular. I would have, but it really there weren't fellowships in those days.

Now you could do fellowships. So that's even super specializing things like MO surgery for cancer and other things. Like that fellowship, right? Do you recommend people become dermatologists? I think it's a great field. I mean, yeah, I still love what I do for sure all these years later. I really do. So you enjoy what you're doing. It's not work, It's like. A hobby? No, I really like what I do very much. That's interesting. What new things do you think are going to happen with dermatology in the next 5 to 10 years if if you had to predict?

I think it seems like they keep coming out with newer and newer fillers. They're trying to make a filler now. I hear it's coming out where there's a new filler that just came out that you could recreate the bone in the jaw. So it's very firm. So a lot of people start to lose their jaw bones as they age, and they have a weak jaw. We could actually put filler in their jaw, which we do now, but it actually will feel like jaw bone. So that's really interesting that you inject. Yeah. So. That's a gel that hardens after you inject.

Yeah. So that's new. That's just coming out. And then there's another new filler that's just coming out that you can actually put it globally all over the face that really plumps up the entire face. So something microdroplets. So that's new technology. So I think the fillers are gonna keep evolving. I think the tightening machines are going to keep involving, they keep getting better and better. So I think laser technology, I think freezing technology, the hand pieces. So I think a lot of it will be the tool kit that we have is going to get better, better, better, you know?

That's that's promising for the future, yes. Now every doctor I'm interviewing and you're the the 7th or 8th specialty I'm entering, I ask everybody about AI or artificial intelligence. What role do you see AI taking in dermatology now and in the near and distant future? I think now they're starting to use AI to teach dermatologists, so that's something really new for training. I think they will also use it for diagnosing skin cancer. So it'll be who can beat the machine. You know, for me, years ago, somebody brought a computer into my office that was supposed to be good at finding a skin cancer.

And they said to me, we're going to show you lesions and you'll tell us what you think are skin cancer, and we'll tell you what the machine says. And I could beat the machine, but that was years ago. Now with AI, probably the machine's going to beat me. You know, the AI is going to get so good. So it'll be able to scan people and give very accurate diagnosis for skin cancer. And just the other day a patient said to me she put her skin lesions, which I had already diagnosed, but she didn't know yet because we only did one biopsy on her.

She said I put it into, you know, AI and it said I have this, I'm really worried. And it was very accurate. What It wasn't exactly right, but it was very accurate. What she told me she put into an AI machine. So I think it will be great for diagnosis. I think it will be great for teaching and I think it, you know, definitely will be very helpful in dermatology. It won't do the injections though for. A while now, it won't do the and it won't do the surgery, right? Right for until the robots connect to A. Yeah, yeah.

Then the yeah, the robots. Potentially you could load every skin condition lesion cancer into a computer and the computer has instant access to billions of. Images, images. Well, you know, it's so interesting because I remember when I was studying for my boards, I got every Atlas I could think of and I got every slide set. And I would just look through them and look through them and look through them. And then when I started practice, the rarest tumor would come, but I remembered it because it was imprinted in my brain.

So it's like trying to be as good as a computer, really. And people would come and I was so young and they'd say, how do you know, like, and I would tell them what they had something really rare. And they'd say, I've been to the May before we got the diagnosis because we take a biopsy and they'd say, I've been to the Mayo Clinic, I've been here, I've been there. Nobody knows what I have. How could you? You're 30, you're not going to know what it is. I go, well, let's just wait and see. And then I would and I only say that because I think I am printed so many images on my brain and I had such a good photographic memory.

But that's what you exactly what you're saying. That's what you're doing with a computer, and that's computer is going to be better than anybody's brain, right? So, so far, real intelligence up here is still better than AI, but I think AI is getting ahead of us. Right. I'm sure it will ultimately surpass us. I think now we still have to put the pieces together with the whole history and sometimes it's complicated and get the whole story right. But yeah, ultimately country is going to be better for sure.

Any risks to AI in the future? For sure. I don't know them because I'm not an expert. But you know, I think sometimes we have the risk of the patient. Now I see thinking they know more because they go online, you know, so I tell a patient you need to have a recut on your biopsy and they go, but I see nothing. And the computer said this and this, said this, and but the pathologist said you need a recut and they have microscopic cells in your skin. So we have to take it out or you're going to have a Melanoma.

So sometimes you have to listen to the doctor. Right. That's another use for a is to actually look at the specimens of the biopsy and recognize certain cancer cells or other types of diseases that might be rare. Yes, exactly right. Well, that's been very educational, informative and entertaining. Thank you very much for coming today to spend some time on doctor podcasts. I think the audience is going to love this new session that we had. Thank you for having me. Thanks very much. Great, great to see you.

Thank you.

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