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- 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.
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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.
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"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.
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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.
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