Hello, everyone.

And welcome back to an all new episode of The Financial Confessions. It's me, your host, founder and CEO of The Financial Diet, Chelsea Fagan.

Also a person who loves talking about money in all its forms. And before we get into today's episode, I wanted to take a moment to thank today's sponsor, Avast. Avast's new all in one solution, Avast One, helps you take control of your safety and your privacy online.

Learn more about Avast One at Avast.com. And today, I am very pleased to announce that we have received more questions than I think we've ever received for one guest. And this is not a guest that I think will be familiar to you guys.

But the subject matter is just so overwhelmingly interesting to you that we had to truncate and combine and summarize as many questions as we could. And we still won't have time to get to them all. But not only is today's subject matter something that I think has been on a lot of our minds over the past several years, especially young women, it's also something that I've talked to quite a lot about on the channel, both on the podcast and on my Tuesday show.

For those who don't know, struggling with acne and rosacea has been like a defining feature of my life, especially during my teens and early 20s. In fact, I have still to this day, I get a little triggered and a little flushed, when someone who has obviously beautiful skin complains about having a zit. I'm like you have no idea what you're talking about.

We don't want to hear it. This is canceled. But I also was someone on the financial end, who therefore, spent years throughout my 20s spending all kinds of money on various creams and serums and miracle solutions, and things that were recommended by influencers and TikTokers, and people in my own life.

And I was wondering over and over again why it wasn't working. I had a skincare routine that certain times was really long and elaborate. And then certain times, was really limited.

I changed my diet. I changed a lot of habits. And overall, my skin just kind of kept feeling the same.

So this past year, I finally took the plunge and invested in finding and having regular visits with a very highly reviewed, and in my opinion, high quality dermatologist here in New York City. One of the first conversations we had was when she sort of wiped the slate clean and was like stop all this stuff you're doing. Some of it is in direct conflict with your skin issues.

And you shouldn't be basing what you're putting onto your skin, which is an organ, on something that someone said on TikTok. I've also had several procedures with her that I've been very open about. Things like laser, which I have to say, years and years of all of the big skin quality improving products could not compare to one session with a good laser.

So let's start there. I've had Botox in my masseter muscle. And I've had other various lighter treatments that coincided with products that I was given to take home.

All of this is to say that although the individual items were much more expensive than the various serums and moisturizers that I was buying over the years, cleansers and all of that stuff too. Ultimately, they were tailored to my skin on a medical level. Because we tend to forget, but a lot of these skin issues we're talking about are medical issues.

Add to that, the fact, that many of us live under this new regime where having good skin has become like a status symbol, a sign of how disciplined we are, how healthy we are, how good we are. When those of us with real skin problems know that it's mostly just genetics. So all of that is to say, I wanted to spread the amazing knowledge that I have gotten from seeing a dermatologist by bringing one into our studio.

She is also a New York City based derm. She is a specialist in acne. And she has, might have guessed, fabulous skin herself, as well.

She's sitting next to me, Dr. Shari Marchbein. Thank you so much for having me.

Now wait, can I just say something to you? Yes, please. Because, I know that it looks like I fabulous skin.

But I too, suffer with adult female acne. And I'm on like five medicines a day for it. And it's so amazing, when people say to me.

And I think that that's sort of a driving force for my patients coming in. Because I've been very open and honest about the fact that I too have acne. Because it's so, so common.

And I don't know that you know this, but literally 50% of 20-year-old women have acne. 50%, which is a crazy number. And then it gets a little bit less. It's about 30% of 30-year-old women and about a quarter of 40 to 50-year-old women.

But I still see women in their 60s and 70s who struggle with acne. And it's really something that we don't talk a lot about. Your right, there's a thought of like, well, if I have acne, is it-- I'm dirty.

Or what am I doing wrong? Or I'm not doing enough. And it isn't about that at all.

So, just FYI, I am not the dermatologist that put you on this routine and did this. But I commend her. And I think this is really wonderful, because, working with a board certified dermatologist who tailors a routine for you is extremely, extremely important.

If not, you're just going to be spending a ton of money and frustrated that something that somebody said on TikTok or Instagram didn't work for you and why didn't it work for you. Maybe it made things worse, maybe it just didn't help at all. And it leads down sort of this road of frustration.

So I think partnering with a dermatologist is very important. But going back to the fact that I too have acne, I'm on a prescription routine for my own breakouts. Its empowering to say that I'm always very open and honest about it.

I don't know anybody who wakes up with perfect skin. We work for our skin. So those of us who have dealt with, I also have eczema, so those of us who have skin care, skin care disorders, diseases, issues, sometimes, it can feel like we're the only one.

But we're not. The skin is the largest organ of the body. It's incredibly common.

Acne is the most common skin condition literally in the world. Totally. Right?

And so I think that that's probably why you've gotten a lot of questions and interest in talking to a derm, because everyone battles with something. Everybody struggles with something skin related. Because it's such a common thing.

Totally. And I think-- I mean, I'm aware that more-- that many more people than we would think have acne as adults, for sure. I think the difference for me has always been there are people who have breakouts every now and again, they might get a little cluster on their chin when it's hormonal thing.

Yeah. But I think there are a lot of people out there. I definitely was one of these people.

A lot of the people writing in their questions are people for whom having bad skin really affects their life. Oh yes. Oh yes.

And I think that for-- especially, when you're on that sort of end of the spectrum, I would almost like, I've always-- I've almost become sort of angry when I see people really recommending things willy nilly, because especially for people who are on that end of the spectrum-- I mean, for me it's a mental health issue. Absolutely. But it's also something that like, you mentioned you're on several, I assume, oral and topical.

I'm on oral. Yep. I'm on-- Oral medications.

Yeah. We're talking about something, like there are very few other ultimately medical issues that we would outsource to just a pretty person. Correct.

Right. That you would listen to somebody on social media and say, oh, yeah, that's what I should do for my diabetes and high blood pressure. Sounds good.

Yeah. Absolutely. For some reason, all of a sudden skin and acne and other things get sort of outsourced to non-experts.

And I agree with you. It's been an issue that I have with social media as well. Because people will often just say things because they're getting paid to say it or whatever the case may be.

And again, what works for one person doesn't necessarily work for another. And I caution everyone, you don't listen to what an influencer says or what a TikTok video says to do for your skin. That is not where you should be getting your skincare advice and routines from.

You really do-- and I realize not everybody has a dermatologist around the corner like in New York. I was just saying you throw a dart, you're going to hit a dermatologist somewhere. So we're very fortunate here to have so many derms.

Not everybody has one. But a lot of dermatologists are still doing telemedicine and remote visits during the pandemic. And there's probably somebody that's close enough to you that you could get in to see them.

But yeah, those are-- I mean, those are all really, really good points. And it is definitely concerning to get health and skin care advice on social media. We will-- I think we agree with that wholeheartedly. 100%.

And I think also, I mean, so when you see clients. I mean, again, I'm sure it runs the gamut. But one thing that I think was sort of helpful for me to come to terms with as far as my skin goes and my expectations is that ultimately, there will be a lot of progress to be made.

And there has already been. Like my skin now is very different from how it was a few years ago. But ultimately, we're only going to ever have the genetics we have as it pertains to our skin.

So in terms of what people can realistically aspire to be able to change if they are doing the right things and they are seeing a dermatologist, where do you think the right line is between, I can improve this and I shouldn't have unreasonable expectations? That's a really great question. I want to go back, because I forgot to mention this.

You were talking about quality of life and self-esteem and things of that nature. There are many, many great studies in our derm literature that basically look at quality of life, depression, anxiety, and other things related to acne and other skin conditions. Acne.

Psoriasis. Rosacea. Eczema.

And we know very well that acne and having severe acne can be linked to depression and anxiety, a poor quality of life, low self-esteem. And I think that when we start thinking about skin care in that regard, this is really affecting the way that I think about myself, this has taken me 30 minutes to put makeup on in the morning to cover up my breakouts, and what that does to your quality of life. Right.

Even the idea because acne is a chronic condition of, I have to put on these medicines every day to control something. Right? Right?

That all contributes to how we feel. And we know that treating acne and being appropriately aggressive, treating it, so that we can get you as clear as we possibly can is really the ultimate goal. So that you can feel better about yourself.

It's like, when I see people come in and they're making eye contact with me or they come in and said, I'm not wearing a stitch of makeup. And I love how my skin looks. And I'm like, damn it.

We've done it. Like, OK. That's it.

Like that was my goal. My goal is, you can wear makeup if you want to. But if you don't to, I want to empower you to feel OK and comfortable in your own skin doing that.

And then as far as realistic. So you're right. First of all, there is no perfect.

OK. I can't stand when people are like, I don't want to have a pore. Someone said to me this morning, a patient said to me this morning, I don't like this sebaceous filaments on my nose.

Now, let me just say something. The fact that someone knows what a sebaceous filament is a problem. And I said that to her.

I said, the fact that what that means, means that you're watching too many TikTok videos. So that's the little stuff that you get out when you squeeze your nose. And we can all do that, right?

It's a pore. It's normal. It's supposed to be there.

And that's literally what I spoke to her about for five minutes. This is normal. You're supposed to have these.

I can't get rid of them. These are normal things about the skin. So I think we have to set realistic expectations as dermatologists with our patients.

I sit down and have what I call my acne spiel, where I kind of go over here's what it is. Here's why you're getting it. It's chronic.

I don't have a cure for this. But we have great ways of controlling it. And there's a lot of things about the body that we don't cure.

But we control diabetes, high blood pressure. And acne, I think about in a similar way. And the goal is not to never have zero breakouts.

It's not possible. I had a cyst here like the other week. And I injected it myself, because my medicine's weren't enough at that point.

So you're still going to get something even on the best routines. You're still going to get something every now and then. We're, also as dermatologists, here for you for that.

And so being totally clear with no pores and no break is not realistic. That's not going to happen. We are human.

We are living. So the only way to be poreless is to be dead. It's the same way to have no wrinkles.

So if you are alive and breathing, you're going to have pores. You're going to have wrinkles. You're going to get some breakouts.

And things like that. But I think, if someone is getting like an occasional breakout every couple of months, I'm kind of OK with that. We're at a good-- we're at a good pace at that point.

If someone's getting breakouts every day or once a week, it's just far too much. It's far too much. And I have migraines.

I suffer from migraines also. And I have found a wonderful neurologist this year, because I was sort of neglected for years. I neglected myself.

And then, I didn't see neurologists that really understood me. And my neurologist put me on some medication. And when she checked back in with me, she said, well, how many headaches did you get this month?

And I said eight. But it's OK, I can live with eight. And she said, that's not good enough.

We can do better than that. And that's, I guess, when she said that, I said, oh my God. Thank you for advocating for me.

Right. And so now I'm on different medicine for that. But that's what I think of in the same way.

Like you get one or two, it's OK. You're getting eight or more, that's too much. You're getting a breakout every day, you're going to break out every week, that's far too much.

Now, so for a lot of skin issues-- now, obviously, if you're someone who generally doesn't have a ton of skin issues, like you're probably-- is it fair to say safer to do it mostly yourself? Whereas if you're having skin issues, that's when you probably want to definitely seek out if you can financially, the consultation of a dermatologist? Yeah.

Well, for sure, if you have any skin condition. So if you're struggling with again, eczema, acne, rosacea, any of these, I would not really take it in your own hands to treat yourself. There are some over-the-counter products that you can use.

We're limited in what those are. For acne, we basically have salicylic acid, glycolic acid, and benzoyl peroxide. That's it.

That's not a lot, right? Right. So if you have very mild acne or you're like a teenager just starting to get acne, you might be OK with those.

You might be OK with like a salicylic acid wash or gel or benzoyl peroxide. And by the way, I love those products. And I really like them as a part of additional routine.

Right. They work well for very, very mild breakouts. Other than that, you need to see a dermatologist.

Because I combine multiple things together. It's not about one thing. When we look at studies on acne medications, they treat about 30% of acne lesions.

So a prescription takes care of about 30% of your lesions. So if you want to be clear, how many things do you think you need? At least three, right?

You need at least kind of three things in combination to clear your skin. And that's typically what as a dermatologist I end up doing. Sort of creating these routines for people based on their skin.

Well, I mean, but I would even go a step further and say like, so for example with myself, so I have acne. But I primarily have rosacea. Like-- I was just about to bring that up with you.

Well, trust me, under this it is red as-- I was just to bring up the fact that even acne or rosacea or whatever it is, are not always just straightforward in that way. Right. And we-- and they're often combined together in the same patient.

And so, yes, we have to tailor routines for that, so yeah. Well, I was going to say so I-- one of the things that has become huge in sort of like skin care, on the skin here internet. And I'm also looking at you r/skincareaddiction.

Some of you guys are way too intense and recommending things like-- in a very reckless way, in my opinion. But retinoids were huge and are huge. And obviously, they have-- I think they're one of the few products that really seems to have real impact in terms of anti-aging and things like that over time.

But my first session with my dermatologist, she was like, I brought my product. She was like you can't do that. She was like no wonder your rosacea is getting worse.

You've been using retinol and retinoids every day. That's right. And I think so, to that effect, if people are having these skin care issues, let's say they can't yet afford a dermatologist.

Would you say that it's better to wait and save for a dermatologist before trying to do at home treatments or routines? Well, first of all, remember, if you have health insurance, typically, you're paying a co-pay and maybe something else. I would like everyone to think about how much money you spend getting your nails done, buying a cup of coffee, and all these other things.

If you-- I'm being. serious. I'm not saying that everybody can afford to go to a doctor. But most of us have health insurance.

Most dermatologists take health insurance. So you have to sort of think about it as I'm going to see my doctor in the same way that you would see your general practitioner or your OB-GYN or whoever you're seeing for kind of routine stuff. And if you actually add up the needless things that we spend money on, your cabs to work, your Ubers, your coffee, your nails.

I do all of that by the way. I'm not shaming anyone. But don't then neglect your health as a result of that.

So potentially, look at, if you feel like you can't afford to see us, but it's just a co-pay. Potentially, look at other sources of where you could cut back. Because I think it's important to do.

Well also, many of those cosmetic products, just a few of those, would be one session with a dermatologist. Exactly. So we're spending a lot of money anyway.

You're going to Sephora. You're going to Ulta. You're buying expensive skincare, which I usually get rid of all of that.

People come with bags of skincare products. And you need none of this. And a great gentle over the counter cleanser that's $5 is going to be perfect for you.

So it's better to kind of scale back, pare back, stop spending money on expensive products that you don't actually need, and see a dermatologist. Often, we are misdiagnosing ourselves. So someone will come in and say, I have acne.

And I'm like, no, you actually have rosacea or an acne rosacea overlap. And then, we change things. And it makes the world of difference.

Right. Just because something works for somebody's skin, does not mean it's going to work for yours. And that's OK.

There's nothing wrong with that. We are all individuals. So just because somebody posts about something or says that oh, everybody should be doing this for anti-aging or for your acne, does not mean that you can do that.

And I think that that's a really great lesson. A, stop diagnosing yourself. B, go see your derm and if we stop spending on these other products, as you mentioned, you'll be able to do it.

I mean, we take insurance. So one thing that my derm told me. And I'm curious as to your opinion on this matter, was for the most part, the real meaningful differences in what you're talking about, what I'm talking about, which is acne rosacea scarring, complexion issues, that kind of thing, which I think is probably a lot of what people are thinking about, especially in my age bracket.

She told me early on that ultimately, the cosmetic quote-unquote parts of it things, like moisturizers, cleanser, serums, that kind of stuff. She's like that's really not going to make the difference. What's going to make the difference is going to be things like medications, in a lot of cases, topicals included.

And then sometimes, procedures, things like lasers, chemical peels, things that will actually make a difference. But that a lot of the stuff that people consider part of their skincare routine, you'd actually be OK with some of these simple over-the-counter stuff. 100% agree that you never, ever, ever, and I will say this again. You never, ever, ever have to splurge on cleansers or moisturizers.

First of all, hear me now. Hear me now. Cleansers, you wash off.

Why would you spend money on something that's on your face for 20 seconds that you wash off? So just don't. Am I allowed to say brands.

Oh my God. Name and shame. OK, so first of all, I've taken part in some studies that basically show that good gentle skin care using certain ingredients, so-- PS, it's going to be ingredients that everybody knows.

Because if you watch social media, you're going to know it. But things like hyaluronic acid and ceramides and glycerin and dimethicone. And-- there are some really just great gentle moisturizing hydrating ingredients.

So like CeraVe is a brand that I love. Because they're inexpensive, they have great products. In full transparency, I've worked with them as a consultant.

I'm not getting paid for this, but I've worked with them. So some of the things that you see on the shelves, I've helped them develop or I've been a part of advisory boards with them. Because I believe in their products.

And I use them, also my kids use them. And they're great products. You do not have to spend a lot of money.

So if you're somebody who has sensitive skin and more rosacea, you probably go more towards a creamy or hydrating cleanser. If you're somebody more acne prone or oily, you go more towards a foaming cleanser. So kind of knowing what your preference is with that is great, but going with a gentle cleanser that's not going to strip the skin, but that's going to be really great at removing makeup is perfect and fantastic.

So never spend more than a few dollars on a cleanser. It's not necessary. Don't get anything fancy.

You can if you want to, but you really don't have to. And I don't do that. So there's no need to do it.

And then for moisturizers, it's the same thing. CeraVe, Cetaphil just like rebranded and their stuff is really, really nice. They have great products.

They contain a lot of these wonderful ingredients. And there's very good studies that show that gentle cleansing, good moisturizing, help restore the skin barrier. And those are important things.

Because acne and rosacea are actually skin barrier deficiency sort of conditions. And so if we use gentle cleansers and we use good moisturizers in addition to the other things that we're doing, you're going to have a better outcome. If you don't moisturize, and you over exfoliate, and-- you're going to destroy your skin.

And that's what I think a lot of what we're seeing online is the overuse of products. And it's just it's too much. And it's really causing an issue.

There's like a weird phenomenon of people, I think it's kind of like a hoarding. It's like a status thing. It's like a weird obsession.

Here's my medicine cabinet. And here's my like 20,000 things. Or like the refrigerator.

The fridge. The fridge. And I'm-- and also, there's also been this weird-- there was a couple big influencers where I'm like, you just look really greasy.

It's become this weird thing to look, I guess, really dewy. But it's like-- they just look wet. And it's become-- Not your aesthetic.

It's not my aesthetic. Well, listen, it's also maybe touching a sore spot, because I have chronically dry skin. But, it's also, for me something that I think has gotten further and further away from what is ultimately the truth of the matter, which is that skin is an organ.

Skin conditions are medical issues. And basing them on an aspirational aesthetic or curating a ton of products around it. And I think many people have found, and there's been a lot of it on skincare addiction, the subreddit, where people had this insane 12 step routine.

And then they backed it off and were doing almost nothing, and their skin improved. Correct. That's right.

So usually, when people come in and I write down-- my patients come in, and I write down a whole routine for them, there is just a few steps. And I always say to everybody. You like three key steps.

Somebody, let's say who's not acne prone, someone is not us. You need three key steps every day, maybe four. You have to wash your face, you have to put a vitamin C serum on in the morning, and you need sunscreen every day.

That's the one thing. If you're going to do anything, you need sunscreen. And then at night, you wash your face.

If you can tolerate a retinoid, you do it. If not, you put on some alternative too. Bakuchiol as a gentle alternative.

Retinol would be a good option again, if you're not acne prone, meaning you don't need to treat your acne. And then you moisturize again. Those are my three steps.

It's so simple. For sure. You do not need 12 steps.

You not need to do anything crazy like that. And I think less is really more. And also, expensive does not mean better.

So like less is more. Affordable skincare is totally totally worthwhile for lots of things, including your cleansers and your moisturizers. And there are some other great products like vitamin C serums and other things over the counter.

You just have to be careful what you're using. Because not all of them are backed in science, and they don't all have good data. So there are certain things that are worth splurging on.

And other things that are worth saving on. For transparency, mine is seven, but two of them are medicines. So there you go.

Now, for-- Mine, by the way, is more than three as well. OK. But-- Mine, I'll just say.

Mine is more than three. Two of mine our medications as well. And I'm in my 40s.

So I use peptides. But I was really for basic, right? Like 20s onward, you want to start with that skincare, that simple skincare routine.

And then, we add more as we get more mature. Listen, or preventatively. Yeah.

There's nothing wrong with that. But, to move to the-- well, so actually, I know people love a hard and fast rule. Is it fair to say that if your step-- if your routine is more than just the basics, the very basic three step whatever, that it should only be that way with the consult of a professional?

No. I think that you could add things on your own if you are tolerating them. What I would say is that spending money on things that we don't know if they're going to work is a waste.

So again, I have patients coming in, and they've got like a seven step routine. And it's very expensive skin care. And it's brands that we are well aware of that really don't have extra benefit.

And then I'm putting this cream on, because I like how it feels. And then, I'm putting this cream on-- I'm like, that's like $500 worth of moisturizers that I don't feel like you need. But if you love it, you can use it.

But you don't need to do it. So I think that there's a personal choice that comes in. Some people just like that.

And they like the luxury of skincare. And that's OK too. I'm not shaming anybody.

But you don't-- I also want to empower people to know that you don't have to do that. And it's not like a status thing. And it's not like you're not worthy if you can't do that.

I don't do that. I don't have expensive-- I splurge on my vitamin C serums and my peptides and my acne medicines. Otherwise, I've got over the counter stuff in my medicine cabinet.

Love it. So to-- and we'll get to all of your questions, guys, don't worry. The burning, burning questions.

But so, to move quickly to the cosmetic aspect of it. So, as I mentioned in the intro, I have done a few things that would be considered purely cosmetic. Again, Botox and my masseter and a bunch of lasers.

Not a bunch, a couple. Huge fan of lasers. Cannot even tell people-- and I will say on the self-esteem front.

Aside from the benefits that it gives, I felt after I got my first laser and some key changes that years of expensive serums weren't doing, I was like, I feel so gaslit. I was like-- I was driving myself crazy. What am I doing wrong?

Yeah. So I do highly recommend lasers. And I think that lasers, as far as things go, are amongst the most low risk things you can do in terms of changing your appearance.

So the thing, I will say, as far as-- I know what you're saying about changing your appearance, right? Because we're not ever-- we don't want to change who you are or how you look. Like structurally is what you mean.

Yeah. Correct. Correct.

We want to enhance and help you feel the best way that you can feel. Lasers are actually extremely dangerous. And it's very, very-- to operate.

OK. I was like what? To operate.

It is-- if there is nothing else that comes from this, it is like you don't go into someone's basement and get-- and let them inject your face and take a laser to you. It is the wild, wild West out there, right now. You could take a weekend course, and basically, pick up a laser needle and start injecting and lasing people.

That is not what you should do. You really need to look at your-- whoever is touching you, their credentials. I don't like using the word provider, but that's what people have sort of [INAUDIBLE] my provider's credentials.

So there truly are just these weekend courses that you can take or somebody who's not a board certified physician, who has really no training, doing something. And they just kind of get thrust into it. And that's when we see issues.

I correct a lot of bad Botox, a lot of bad fillers, and we see laser disasters. It could be disastrous in the wrong hands. So I urge you to do your research, really look at the credentials of hopefully, the board certified physician who's treating you.

Make sure that they do a lot of these. and that they're expert in doing this. Before-- OK, so that's my little-- that's my soapbox. No, that's important.

But no, but you are correct in that I think when done properly, which is what we're always hoping for, any aesthetic procedure is really not going to change. It's going to just enhance in a really soft and subtle way and make you look refreshed as opposed to somebody be like, hey, who did your Botox? That is not the look.

That is not the look. That is not what we're going for. Well, what I meant, and I appreciate the clarification.

Because that is important. And we should not-- I see those signs in windows for like Botox starting at $10. And I'm like oh my God.

Run, run, run, run, run. Spend your money on anything else. And they're all, by the way, they're all over New York City too.

So even in places that we have very, very savvy patients and citizens, there-- I see a lot of patients who have gone there. And then they're like, it was like, it was not so great. And I'm like, I know.

Because that's what is-- sometimes, it is worth splurging for the expertise. That's the one time I'll say. You splurge on things like maybe, a vitamin C serum.

You splurge for the person injecting your face. That's not the time to cut the corners. You know what I mean?

Absolutely. So when, I mean, when I say that lasers are fairly low risk, I mean, in the sense that I think what most people fear when they're looking at cosmetic procedures is looking weird. Yeah.

Totally. Changing the way they appear. Totally, yes.

And also getting on I think a really, really dangerous hamster wheel of making small tweaks that necessitate other small tweaks that now call into question other parts of your face, so in terms of keeping the integrity of your face, lasers are fairly low risk in that regard. That being said, things like Botox and fillers, they're everywhere. They're more popular than ever.

I think many people are thinking about them. And we have done a couple of videos on TFD. We did one that was quite popular about celebrities gaslighting everyone about what they do and how their skin looks the way it looks.

And a lot of people will call out specifically, let's say, like a very elegant older female celebrity who looks great for her age and will highlight her as an example of someone who was never gotten cosmetic procedures. And anyone who's knowledgeable in the space will be like absolutely, she's gotten-- she just had a really good work. That's right.

And it hasn't gone overboard. Right. So in terms of people who are interested in exploring it, whether it's in a sort of corrective capacity or just to feel great the way you would for braces or cleaning up acne, how do you recommend people approach it so that they do what's right for them without going overboard?

So again, that comes down to partnering with a dermatologist whoever you're going to have injecting you to-- and you have to like their aesthetics. If you walk into the room. And I know that we're all wear masks now, so you kind of can only see somebody like here up.

But you have to like their aesthetic. So if you walk in the room. And you're like horrified by how somebody looks, don't let them do something to you, because you might end up that way.

There are many patients that come in that I either tell them, it's not an appropriate treatment for them. This is not the right time. You have to know when to say no.

This is not correct for you. So you really want someone who is trustworthy, ask your friends who they go to who they love, family members, other physicians. If you have a physician who you love and trust, ask them who do you recommend for this?

But you have to like their aesthetic. And I always do consultations with patients before I even touch them. So that we can get on the same page.

We hold up a mirror together. I write down a whole plan. And it's really saying, what is bothering you?

First of all, don't ever pay anyone for something that is not bothering you. If you look in the mirror, and you have brown spots and they don't bother you, do not pay someone to laser those off. That's not worth it.

It doesn't bother. If you look at yourself, and you say you know what, I really don't like my 11 lines. And I don't like that my brow is feeling a little heavy as I'm aging.

You know what? That's something that in a very subtle way we can correct with a little bit of Botox or Botox or the botulinum toxins, the modulator. So there's Botox and Dysport.

Because Botox is a brand. It's a brand, so I don't mean to say Botox. Botox, Dysport, Xeomin, Jeuveau, whatever you want to use.

So I think you have to prefer the aesthetic of the dermatologist or whoever is injecting you. And then, you guys have to come up with a very, very clear plan. My goal is that, because you never want your injectables or any cosmetic treatment walking into a room, we want you walking into the room.

Not people saying right, like oh wow, your lip filler looks so good. That's not-- again, not the look. And it's L-E-W-K look that we're talking about right now.

It's not the lewk. So that is not what we're going for. If that's what's happening, you need-- it needs to-- you need to find another person to do it.

That is not what we want. We want subtle is better. Less is more.

I also think what happened was-- if I have to be honest. And I'm sorry for anybody watching this who lives in California. But California came up with this like crazy aesthetic where all of a sudden, it was going to be this like crazy high cheekbones and giant lips and whatever the hell it was.

And then, everyone started like wanting to do it when that's not an aesthetic that we would normally say oh yes, this is how someone's lips should be. It was like an overdone caricature. And I don't know if it was a Kardashian thing or whatever the hell it was.

And so that really has pared back a lot, thank god. That was a few years ago. And people were going crazy.

And they were getting too much filler. They were coming in every three to six months, where really, you need filler once a year. It should be very subtle and very understated.

So Botox is like in every three month thing. Whereas filler, really, I don't see patients back more than once a year. If you do, you start looking overdone.

And again, that's where you need to have a conversation with your derm or whoever's doing your injectables, to say, OK, we're going to go at this pace. And so that's important. Getting on the same page and liking their aesthetic, maybe looking at some before and afters, word of mouth.

Again, you see somebody who you love how they look and maybe, it's a friend of yours. OK, so go see their dermatologist. Because you're probably in really good hands with that person.

So that's, I will say, you have to be, it's a buyer beware. Be very careful. Just because someone has a needle does not mean they should be the person injecting you.

Right. And just because it's less expensive than somebody else, again, this is your face and your body, take it very seriously. True that.

Also, stop using those goddamn filters to look at your face. Oh, stop. Stop the filter.

That is another very unhealthy trend. So I've never, in full transparency, I've never used a filter in my whole life. I think that they're-- it's really, really dangerous.

Why do you need one? Like first of all, you're like tricking yourself. And then you're tricking other people.

You're saying to yourself, I'm not worthy the way that I am. Which is not true. And then, you're giving other people looking at you a false expectation of what you look like.

And then, in turn, what they think then they should look like. Yeah. So like, let's just all be us.

I don't know. I just-- I don't get the filter thing at all. I think it's very, very dangerous.

There are some companies that have come out with a no filter campaign. And they don't use any filters on models, et cetera. We all have cellulite.

I don't care. I don't care how much you weigh. You have cellulite?

I've got stretch marks from like nursing my children. It's like, it's a body. It's a body.

We all have these things. And again, nobody is perfect. It is not possible.

It's not possible to have no pores and perfect skin and no acne. I was saying, before I walked in, I have a huge bump on my forehead from a bug bite or pimple or something here. And she goes oh, that's all right, you can't see it.

I'm like, I know it's there though. I know. But you know.

I know it's there. But nobody is perfect. We all have these things and to have to say to the world, I need to be perfect.

Maybe to be loved or I don't know what it is. Admired? I don't know.

Well, you're also creating a very, very-- because, I mean, we've all tried on those filters before on Instagram or TikTok or whatever Snapchat. You turn it off. And you look way uglier.

And that's not, that's not just your imagination. Your brain is actually now training itself to view you through this very specific prism where your flaws are not just erased away, but you're also being shaped into that very specific facial model, very similar to the one you described, the sort of California model. So then, when you maybe before, you felt that you looked great.

But when you come off of something that's photoshopping you in real time to look like a model, your actual face is going to look a whole lot worse. Yeah. And there was a study, and I don't remember when it came out.

But it basically looked at like when we see an image on something like social media, our brain gets retrained. And it was like 10 seconds. Yes.

In a very, very short period of time, all of a sudden, we've now like retrained to be like that's the aesthetic. That's the look that we're supposed to go for. And that's all of a sudden, where like the cheekbone lip thing came in.

I also think it's a part of, if you do any cosmetic work, Botox or fillers or whatever. You start seeing that as your new norm. And so, a lot of times, all patients come in like, but I just want my lips a little bit bigger.

And I'm like, nope, they're perfect as they are. We're not touching them. If I do a little bit more, people are going to start knowing that we've done it.

We're leaving them. It's because, now, that is their new normal. Their new normal is more hydrated lip.

And so, then they think, oh, well, I could just go a little bit more. And you really, really have to trust, again, the dermatologist or whoever is doing your injectables to say no, this is actually perfect. You're not seeing yourself the way that you are right now, which is great.

And let's just leave it. Well, that was going to be my last question that is just on my mind before we get to all the audience questions. So I have developed from seeing-- I wouldn't consider myself in the entertainment industry, but I'm in the media industry.

And-- You're entertaining. I think you're entertaining. Thanks.

Yeah. I would definitely put you in that category. What am I?

A clown? No. But suffice to say, I know enough people who are in the spheres around me that I'm familiar with who have gotten cosmetic procedures, especially, so I'm on YouTube, obviously we're on YouTube for some of the listeners right now.

Systematically, every YouTuber that gets like a TV deal, they get all kinds of changes. They get veneers, which often look crazy. They get a lot of fillers. [INAUDIBLE] It ruins your face in a lot of cases.

But suffice to say, they go through a lot of these very key changes and then often, will sort of put themselves on it, influencers as well, on a hamster wheel of like, before you know it, you look like-- you look a little botched honestly. And everybody starts looking the same, also. Oh 100%.

Yeah. And so I've kind of from that experience, I think more than anything else, gained a huge fear of fillers, specifically. Mm-hmm.

And I know that there are-- the thing about fillers as far as I understand them is they don't go away the way Botox does. Is that fair to say? So filler-- I think where the filler fear comes from is what you're talking about.

And also, when you see somebody overdone. And we all know the celebrities that are overdone. And some of them have been very outspoken about like, oh, I'm having my fillers removed or whatever.

So when you see somebody who's like that and they've lost-- they've got no under-eye hollow, and they've lost any smile lines. It's like everything is just flat and kind of full. And, so I patients come in all the time.

That is probably the procedure that people are the most terrified of, the most. Because what they-- Getting fillers? Getting fillers is the scariest procedure I think for my patients.

Because they all say to me, if you're new to it, I don't want to look-- I don't want to look full. I don't want to look overdone and full. And what I explain again is, it's not the filler.

It's the person doing and injecting the filler. OK? So it's not-- like if you go to get your hair colored, I mean, I could throw some hair dye on you.

It's not going to come out the same way as a professional who really, really, really knows what they're doing and spends all that-- right? So it-- filler as well as Botox and so many other things is an art form. And you cannot just show up and let somebody start injecting your face.

It is where we put it. It's careful placement. It's a sprinkling of it, kind of all over, that makes the difference.

And having that aesthetic and very artistic and skilled eye in hand, and a good knowledge of anatomy, is very important. Fillers have a lot of potential complications. If we get it into a blood vessel, it could be very scary and lead to some severe complications, like blindness and-- yep, yep.

And necrosis of tissue, where you cut off a blood vessel and the tissue around it dies. So again, not something that you just go to someone's like basement or someone who got trained that weekend to do. You want to look for a board certified dermatologist or plastic surgeon or oculoplastic surgeon.

Somebody whose is certified to do this, who has special training to do it. Who knows anatomically if there's an issue, how to fix it. How to actually make this better.

A lot of the fillers are made of hyaluronic acid. That is a substance that is natural in our skin. OK.

So it's what gives our skin kind of-- you know when you use a holographic acid serum to hydrate your skin. That's why. It holds up to 1,000 times its weight in water.

So all of the good skin turgor and all the stuff that we have is hyaluronic acid plus collagen and some other things. And so hyaluronic acid is great, because I can dissolve it. So it's not a permanent filler.

Fillers, a lot of them will last, we always say at least a year. But they usually last two years. But at a year, we do like a little touch up, because we start to see it go away our body digest it, just like what our natural hyaluronic acid.

But the good thing about it is it isn't permanent. And I have an enzyme called hyaluronidase so that I can digest it with. So if someone's like, oh I-- I'll give you a great example.

I have a patient whose lips are overfilled from somebody else. And I am dissolving them for her, because it's overdone. It doesn't look good.

We need to dissolve it. And then, I will start fresh with new filler in a very beautiful subtle way. So we do these things all the time.

So the beauty of hyaluronic acid is, we can take it out if you don't like it. Also, keep in mind, you never have to continue these. So I stopped Botox for two years when I was pregnant and nursing.

And then, you can just go back to it again. There is no once I start, I must continue it. Any of these things can be stopped at any time.

Same thing with filler. Same thing with lasers. There's no I'm worried I'm going to get addicted.

I hear people say that all the time. I'm like, it isn't about that. If you love, how you feel when you're doing it, and you like how you look.

Of course, like any maintenance, our nails, our hair, our skin care routines, we're going to keep up with it. But we can reverse certain ones. Certain fillers are much harder to reverse than others.

And so I think that's where you get into a little bit of trouble, especially if you're dealing with somebody who doesn't know what they're doing. So again, it's buyer beware. Do your research.

I don't think that you would go and have a shoulder replacement with just anyone. Why would you do that with your face or body? Right?

Well said. There you go. So I want to take a quick pause here.

And once again, thank today's episode sponsor, Avast. As a digital first media company, and as you can tell from our discussion today, about all of the dangers out there of trusting the wrong people, digital safety too is also incredibly necessary in all forms and is something very important to us here at TFD. Today's sponsor, Avast, has been a global leader in cybersecurity for more than 30 years.

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Learn more about Avast One at Avast.com. And now, let's get back to our chat with Dr. Marchbein.

Oh, I love these questions. You guys-- you guys came the hell through on these questions. I want to know all the answers myself too.

Who needs you? Who are we going to ask about that? What is the best way to prevent wrinkles if you don't have them yet?

Sunscreen, sunscreen, and more sunscreen. So number one, do not spend a penny on anything else if you're not wearing sunscreen every day. The ultimate ager, the number one ager of our skin, is ultraviolet rays, OK?

So we have UVA and UVB rays that are coming down from the sun. They penetrate right through clouds. They go right through a window.

UVA? Right through this window, right through a car window, right through anything. OK?

And that causes wrinkles and sunspots, skin cancers. I mean, who wants any of that? And so sunscreen every day is really important.

You want to do at least a 30 SPF. Look for something that says broad spectrum, which means that it covers both UVA and UVB. And you need to reapply every two hours.

So one of my little tips is put sunscreen on in the morning, and you need a lot, you need like a teaspoon amount to cover your face and neck. So more than you think. So it's like two lengths of your fingers.

So put it like on two fingers then, that's enough. And then, reapply every two hours. But if you're wearing makeup, how do you reapply?

So I use a powder SPF to reapply over top. And there are a lot of great brands. So ISDIN, Supergoop, Colorscience, they all make great powder SPFs.

I probably have one in my bag somewhere. But literally, it's like a retractable brush and you just buff it back on top of your makeup. So that's a great tip.

Also, if you're by a computer, remember that we're getting blue light from our screens. And so I like a tinted sunscreen. Because it protects you from blue light, which are things like screen and pollution and things of that nature.

So something with tint in it, is great. Especially, if you get Malasana. Or you're someone who hyper pigments easily.

You want to use tinted. I have a tinted SPF on right now. And then, you can just buff on the SPF powder over top.

So if you don't have wrinkles yet, that's number one. And then, I would say, we kind of talked about the top skincare thing. So a vitamin C serum in the morning is great.

That protects you from free radical damage from pollution and sun exposure. It also helps you build collagen. And it helps with brown spots.

So I would do that in the morning. And then at night time, a retinol or some vitamin A derivative. Because that builds collagen and can help with fine lines.

If you are too sensitive-- so retinol is an over-the-counter version, retinoids are like the class of vitamin A derivatives. And so we have prescription versions like retinol or tretinoin, which we know well for acne, but we also use it in prescription form for wrinkles and sunspots. So you can either get a prescription form from your derm, you can use an over-the-counter, if you've got very sensitive skin.

And then there's an ingredient called bakuchiol, which is a retinol alternative that I use for people who are super, super, super sensitive. So my super sensitive skin patients, who are like I want to do anti-aging, which we hate the word anti-aging, right? We want to do pro aging, how can I look as good as I can look routine.

How do I do that? But I can't tolerate a retinol. And bakuchiol is a great alternative.

And there's a brand called ISDIN that makes a great bakuchiol product, called Melatonik. But there's others available. What about Botox use preventatively?

OK. Such a great question. So I love baby botox.

I'm 44. I'm 44. And I started-- I started Botox-- Looking great.

Thanks, honey. Birthday's on Friday. And I started botoxing when I was 27.

Because guess what? That's when Botox was FDA approved. That's how old I am.

So guinea pigging it out. Guindea pigging out. So I was in my dermatology residency.

And we were like, what is this liquid gold? And let's figure out how to use it. I mean, we were we were babies.

And it was just on the market. And I will say that I love the idea of doing some baby Botox or preventative Botox. It is not for everyone.

If you do not have anything, no lines, no nothing, you do not need to be doing it. Great skincare is sufficient. But we all know that environmentally, sun exposure, pollution, smoking, and so many other things, dietary things-- I do see 20-year-olds who have wrinkles.

It's genetic as well. And so sometimes, starting just a tiny little bit, tiny little bit, little sprinkling all over just softens everything and also prevents them from getting deeper. So I really do love that.

Also, from age 25 onward, you start like slowing down how much collagen you're making. And your collagen starts breaking down. So that's actually when aging kind of starts 25 onward.

So if you feel that you are starting to see some fine lines or you have some lines at rest, or you're losing some of your structure, and many of us have a little bit of a heavier hooded lid, we can actually help that with a little bit of Botox. And so starting early is not a bad thing. You just don't want to overdo it, because then you look frozen.

And you need to be able to move. You look like Nicole Kidman. Like you have to-- I feel like that was fake for that show, no?

Nicole Kidman and a couple-- It's been a few years now that it's like-- I think the filler was overdone, but for the show. What was the show that they shot in New York? I don't remember, but-- I don't know, but-- Yeah.

There been some-- yeah, there have been some tricky moments. Some celebs. But it's-- you need to have wrinkles.

I always point out my crow's feet and my under-- my lines under my eyes. But I think that's-- the thing is that I think that if you didn't have those, you would look-- You would look crazy. --uncanny valley. And that's when you start looking crazy.

That's correct. Which is why I like to point them out, because it's the same thing that people like, I hate this, I hate my lines under here. I'm like, I have them, too.

And PS, I'll show you a picture of my eight-year-old children. They have them too. Right.

So like, it's normal. And you need to-- the neck lines, I hate these lines. I'm like, babies have those lines.

You have to have them. But just these things that we're seeing, there's a point where you have to say again, perfection is not realistic. It is not about not having lines and not moving.

It's-- you do-- that's called death. So you do need to have lines. You do need to have wrinkles.

And you do need to move your face. Correct. OK, there.

True that. OK. What do I do if not even Accutane is fixing my acne?

Is there a non-Accutane cure for my hormonal acne? Or am I just stuck with it for my whole life? OK.

I love this question so much. First of all, acne is chronic. And there is no cure.

So this is what I sit down and talk to people about all the time. You have to know that. And you have to really accept and understand that acne is a chronic condition.

Because at 44, I still struggle with it. So we're talking about adult female hormonal acne, right now, is what that question was about. So everybody has hormones.

All acne is hormonal. That's why teenagers start getting acne because of hormones. So all acne is technically hormonal, but this question was about adult female acne.

Accutane, for those who have tried it for adult female hormonal acne, is not a cure for that. So Accutane, which is one of my-- I love Accutane so much, is amazing for men, and it's amazing for teenagers, and it's amazing for that non hormonal acne or hormonal acne in conjunction with hormonal control. Accutane, and I repeat, is not a cure for hormonal acne.

Because there is no cure. And as soon as you stop taking it, your hormones take over again. And you get acne again.

And so I see a lot of women who have been on three or four courses of Accutane, and they're super frustrated. Because their acne keeps coming back. So you need to address the hormonal component.

And in the United States, what we have that is FDA approved are birth control pills. So birth control pills eat up hormone at the level of your blood. So they bind to testosterone.

And they also make more of something called sex hormone binding globulin. Which again, binds to testosterone. It also helps to regulate your period and gives you kind of a steady state of hormone.

So birth control pills are actually FDA approved to treat acne. And then there's a pill called spironolactone, which I am obsessed with. And I could not practice without.

And I'm on spiranolactone also. And spiranolactone is an anti hormonal medicine. It is not FDA approved to treat acne.

However, it's been used in the United States for like 50 years for other things. It's a diuretic. We use it to treat high blood pressure, not very well, but that's what we use it for.

And there's like millions of patient years of experience in Europe with this medicine. So we know it's very safe. It's very, very well tolerated.

And there are some good studies in the US about it as well. So I use spiranolactone like it's water. To me, it is like God's gift.

It's a wonderful medicine. It's overall well tolerated. And again, it's not a cure.

But we don't cure diabetes or high blood pressure either. So it's a pill that you have to take every day. Your dermatologist can help titrate that.

So we figure out whatever the lowest dose is to keep you under control. But I patients who run the gamut of doses. And that's really the key.

I also don't prescribe Accutane for adult women without them also being on spironolactone and birth control pill, because I know their acne is going to come back. And the worst thing is when you're frustrated that your acne comes back. So just to stress that, not having a cure is actually unfortunately correct.

There is no cure. So we're not going to cure your acne. We want to control your acne.

And if you're not finding it with what you're doing, continue to talk to your dermatologist. And if you're not finding it with your dermatologist, find another one who will listen and who will get you on the right routine. Accutane is not to be taken lightly, let me just say that.

Any medication has potential side effects. And of course, your dermatologist will go over this with you. So it's one of those-- you always, always have to sort of decide for you what's worth the potential side effects or the risks of these medications.

Absolutely. Every dermatologist will be like OK, you have rosacea. You know, sometimes cutting back on dairy helps.

And I'm like no, I'm just going to keep eating cheese and having some rosacea. [LAUGHTER] Not worth it. Right. So rosacea has a lot of environmental and food triggers.

Alcohol, all the good stuff by the way, it's like alcohol, spicy foods, caffeine-- Spicy foods? Spicy. Oh well, I'm done.

I'm a huge spice lover. No, I'm saying it's all the good stuff. It's like chocolate and alcohol.

So understanding that and knowing that, you know what, if I have a glass of wine, yeah. I might be more red when I wake up. Or I might have a couple of breakouts.

It's OK. It's OK. As long as you understand that is what's going on.

Right. But it's like an active choice. It's an active choice.

I will be having both cheese and wine tonight. So-- Me too. RIP my face, but love that for us.

Look at us. OK. Oh, my face is always red.

I feel like I'll always need to wear foundation for the rest of my life. What's happening? Well, without seeing you, I wouldn't know.

But that could be rosacea. So I think we can both speak to this. So rosacea is characterized by kind of persistent redness of the face, usually the nose, cheeks, and chin.

There can also be some flushing associated with it. And some people have breakouts as well. So there's different types of rosacea.

I would definitely see a dermatologist for this. Lasers are wonderful for this kind of redness. So we don't have great topical or oral treatments for redness.

Some of the medicines that we use for rosacea, like one called azelaic acid, or Finacea, which I happen to love, can help in some ways with the redness. But lasers are the main safe treatment. And there's a laser called a pulse dye laser, which is sort of the classic quintessential laser for redness.

We do this once, twice, maybe three times if you need it. A month or two apart. And then usually once every year or two to maintain it.

And it's really a wonderful, wonderful treatment. But I would say, speak to your dermatologist. There are two topical medicines.

One is called Rhofade, the other-- I don't remember what the other one is. But they might help with it. But you have to put a cream on every day.

It lasts for about 12 hours. It's kind of annoying. Sometimes it's better to just do the laser, and then you don't have to worry about it as much.

But there are options. Are the natural makeup brands actually better for your skin? Oh, natural.

OK, so here's my natural schtick. Natural does not mean better. Poison Ivy is natural.

And I don't want to rub it all over my body. So there. Right?

Yes. So that's my-- again, I'm not going to natural shame anyone. Like you do you.

You make whatever decisions feel right for you and your skin. If you want to-- Oh sorry, not a regulated term. Just to clarify.

Correct. There is no standard for what clean or natural means. And in fact, a lot of brands, and I'm not throwing any of them under the bus, but a lot of brands who use these natural products are actually extremely irritating for the skin.

You look at a natural deodorant, has like rosemary and lemony, and all these things that, PS, are going to cause an irritant dermatitis-- like eczema in your armpit. Because it's really harsh and not necessarily something that you should be putting in this very delicate area. So we see a lot of eczema and other issues as a result of that.

If you love it. And that's where you feel like spending your money. By all means, do it.

Certain brands that I really like that are more like mineral based, so I'll put it that way, are things like bare minerals, IT Cosmetics, Colorscience. I'm trying to think if there are any others that are really like. So if you want to go in that direction.

I think that-- I love those companies. Dermablend is another great one, really good for sensitive skin and all skin types, really nice coverage, and they're more mineral based. But yes, natural and clean have zero standards in the beauty industry.

So we don't even know what people are talking about by doing that. I also don't like fear mongering. So I really don't like the idea you have me telling you something is really, really, really bad for you.

So don't do it. But I have no studies or science or data to back that up. It's just literally based on fear.

And therefore, your fear perpetuates the sales of these products for these companies. But there really is no data behind it. I mean, there are companies that will tell you that retinol is bad for you and all this other stuff.

And it's just not true. So you do whatever makes you feel good and right for your body. But you don't need to be doing that.

OK, is there any way to remove capillaries or brown spots on my face without lasers? Not really? No.

Well, capillaries, which are blood vessels, which we all get them around the nose. And then, so many of us get them on the cheeks and the chin and other areas. That really is a laser thing.

There are some products like niacinamide that can help with redness. Licorice root, kojic acid helps with brown. There's lots of ingredients that can help around vitamin C serums, different alpha and beta hydroxy acids, glycolic lactic.

I mean there's retinol, sunscreen. There's tons of things that you can use. But probably, the best result depending on what you're going to do is laser.

But I always say lasers are supplemented with skincare. So I would never do a laser on someone and then be like, OK, I'll see you in a year. There's always a skincare routine that goes with that.

And it does come down to the same things that we talked about before, the vitamin C serum, sunscreen, some retinol or vitamin E derivative, and then depending on what your underlying concern is, if it's brown spots or hyperpigmentation, yes. We have other things that we could do. I love a little chemical exfoliant.

Those are great because we see a lot of hyperpigmentation from acne as well. So a chemical exfoliant with some glycolic or lactic acid. Don't overdo it.

If you overdo it, you're going to really strip the skin and make it angry at you, and potentially, cause more brown spots. So do not overdo it. And then other ingredients, tranexamic acid, kojic acid, licorice root, et cetera, can be helpful.

But if you need to dial into which products to use, talk to your derm, or I mean, I'm happy to talk about some things that I love. But no, I think lasers ultimately are going to be your best shot followed by good skin care to support it. I've personally reached the conclusion that anything that's a textural issue with skin, you're probably just going to have to see a derm.

And it's peels, lasers, things like that. Yeah. Textural for sure.

You could throw over-the-counter shit at it for years and not make a difference, in my experience. Yeah, texture for sure. OK.

Why do I always break out on just one side of my face? I'm not sleeping on this side. Yeah, this is-- I have to be honest, I don't know the answer to this also.

But I'm going to give you my hypothesis. Do you want to hear my hypothesis? Wow, we're breaking new frontiers of science.

I know. Here's my hypothesis. Because we all do that.

I get-- my cyst is always here on my chin, on the right side of my chin. It's always where I get cystic breakouts. So I think that the reason is that oil glands in certain parts of our skin and everybody is different, that spot might be your forehead.

I don't know. But those oil glands are basically more sensitive to the hormones. And so that is your trigger spot.

It's the same spot that you get your patch of eczema or your cystic breakout. So I think that that's what it actually is. I think that certain oil glands are more dialed in to kind of the effects of local hormones.

And that's why you end up getting cysts in those areas, because that is extremely common that someone will get a cyst in the same location every month or every two weeks during ovulation and when they get their period. And I think that that's what it is. But I don't have good science to support that.

But I'll say as a dermatologist for 14 years, I do think that that's the answer. I love it. I just did our own study right here Wow, look at this.

So this is one that actually-- so I've experienced this. So a lot of people lose weight and have loose skin. And for example, if you're someone like me, you lose weight, you have a little looseness in skin.

Is there anything you can do for that that is not surgical? So if we're talking about, let's say, facial skin-- Right. OK.

So what's interesting about losing weight is that a lot of times people will say oh, let me wait two fillers until like I'm at my goal weight. And then, you actually need more fillers if you are losing weight. And it's something like one syringe per however many pounds it is.

But you need more because you're losing collagen and elastin. And a sign of youth is sort of the full face that we had as kids. So when we lose weight and things start sagging a bit and we don't have that same fullness to our face, it can actually age you.

And so you might even need a little bit more filler. So I will say, number one, filler is actually really helpful in these cases where we're not adding filler. This is where an aesthetic keen eye comes in.

We're not adding filler. You would never put filler in the middle part of my cheek here, because I'm really full here. This is my-- I have a full cheek.

It's a nice cheek. I love my cheeks. They are little apple cheeks.

I know. And I love it. But you-- I would never dare to put filler there, because I have a full cheek.

But we can support up kind of-- and do what we call a little liquid face lift where we put a little bit towards the back of the cheek, a little bit in front of the ear, a little bit to shape the jawline. And it can help of just pull this back. And I'll say, support and restructure as opposed to add volume.

Because that's what I think a lot of people are afraid of. I don't want to add volume but. We can add support and structure and just kind of lift things back up with some filler as opposed to adding volume.

Well, and for the-- because a lot of people when they lose weight, they have a lot of loose skin, especially if they lose large amounts of weight in other parts of their body. There are a lot of creams out, there are a lot of things that you put on out there to tighten. Are those all bullshit?

I don't think that those work very well. I don't think this work well. They're radio frequency with microneedling may help a little bit.

Certain injectables actually, something like Sculptra, that can help build collagen over time. Maybe helpful in these cases. So that is more of-- it's not a true permanent filler.

But remember, we were talking about ways that we could dissolve. That one's really hard to dissolve. So use with caution.

Use with caution. And make sure that who is doing the injections. But that can actually build and stimulate collagen around it.

So I think that could be something that would be helpful. So Sculptra, certain lasers like Fraxel or other lasers where we're stimulating collagen, can be helpful. And again, depending on where this looseness is, it could be-- I have a little bit of loose skin on the neck.

Well, we can laser that. Or we can put a little Botox in to tighten it. Or we pull back a little bit with filler.

There are lots of ways of doing it that's sort of non-surgical depending on what your needs are. I love that. Yeah.

I also, by the way, love topicals here, so like topical peptides, retinol, oils, things like that. Anything that helps to stimulate collagen is going to be great. We're all learning so much.

OK. See how entertaining you are? Oh, get out.

Look at you, I'm feeling so affirmed. What is one popular or viral product or application that is total BS? One viral product that-- I'll say something that-- can I say something that I like first?

Sure. OK. So I like slugging.

And that's a very viral thing right now. I like slugging, but not if you're acne prone. I was going to say, I feel like you've covered up your pores with Vaseline?

Oh my God. No, no, no. You cannot do it if you're acne prone.

So caveat here is if you're breaking out, you can't do it. Awesome. If you have dry skin or eczema, which by the way, we're talking about acne, but a ton of people have dry skin and eczema, great for you.

Dermatologists have been slugging, which didn't use that term, forever. It's actually like a known skin care thing that we do for all over the body. We do for babies.

We like coat babies and stuff to keep them hydrated. So it's great if you have sensitive, dry, sensitive eczema prone skin. Really, really, really not good if you're oily or acne prone.

So don't do it if you are us. Or if you're both acne prone and have dry skin, well, you're just screwed. Yeah.

Like me. Well, then you just moisturize really well. I do love slugging though on eyelids and lips.

So basically wearing Vaseline or some CeraVe healing ointment or Aquaphor or whatever you want, eyelids and lips, I always sleep with that at nighttime. Because that does not-- that doesn't care by the way, if you've acne. These are the thinnest skin areas of the body.

They're the most prone to getting dry. And you know if your eyelids get dry, they look wrinkly and all the things, especially in the wintertime. So sleeping with like a thin coating of some Vaseline jelly on eyelids and lips is the key to life.

I've been doing it for years. And I absolutely love it. So I will say that is a trend that I actually really like.

Oh my God, there's just so much on TikTok. Oh God. There was this terrible thing recently.

There are so many bad things. Basically, if it's on TikTok. Just don't do it.

If you remember a few years ago, they were like gluing the lip up to make it look fuller, like literally, a full on glue moment. And then you were getting like contact dermatitis on the upper lip. I have no idea why someone would do that.

And most recently, and this is actually quite dangerous, they were doing the inhaled tanning spray. What? Yes.

Don't do this, folks. I mean, like should we even talk about it? But there are people who are getting tan, inhaling a spray.

It is extraordinarily dangerous. What is it? It's literally a-- I'm going to I'm going to botch the name.

But it's like melaton-- I'm going to-- I'm going to figure out the exact name of it. But it's basically like a melatonin type of derivative that causes pigmentation of the skin. Melatonin?

Like the thing that helps you sleep? Melanin. Melon-- yes.

But it's-- I'm like just blanking on the name right now, but it's an inhaled version. And it is very, very dangerous and is totally like not controlled. And this is not safe.

And it was all over TikTok recently. And it's not something that should be done. What about-- OK, this is not a question.

But I have to ask. What about face yoga? Oh yeah.

I don't believe in any of that stuff. Yeah. I wish it were true.

I know. I know. Even-- and I know some derms might disagree with me, even using like the gua-- the stone that pulls up.

Do you know what I'm talking about? I just feel like it's so reckless to just be pulling on your skin all the time. I just don't-- listen, if you love doing that as part of your grooming and your routine, OK.

But otherwise, it's just not necessary. I just think it's one more thing to kind focus on that we don't need to be focusing on. Melanotan.

See, I was-- yeah. Melanotan. Melatonin.

Melatonin 2. It's like-- there's a number or something with it. That is so scary. [INAUDIBLE] getting is melatonin.

Yeah, melatonin. Alpha melatonin. It's made in different forms, such as a tanning nasal spray that is most commonly sold as an injection.

Exactly. Extremely dangerous. Do not do this.

Do not do this. Thank you for that-- thank you. I had a senior moment.

How do I get rid of giant pores? I've tried-- I've had them for years and nothing is helping. Right, because it's normal.

Because the thing is that's you, genetically. So some people are oilier, some people are drier, some people have big pores, some people have small pores. This is genetically determined.

You can thank your mom and dad for it. There is-- Dad you cursed me. He really did.

But, right, we get it from someone. Pores are genetically determined. We cannot change them.

Things that can help reduce the appearance of pores, but keep in mind, pores are meant to-- There's a reason. Right. Keep in mind, pores are meant to be there.

They're going to come back. You can't get rid of them. And poreless is not the goal.

So retinoids can definitely do it, because they build collagen. And so pores are basically the walls of the oil gland or hair follicle. So if you build collagen, you thicken the walls.

And it could theoretically make your pores appear smaller. That's number one. Number two, primers and things of that nature can obviously temporarily do it by almost fooling the eye and giving an appearance of the skin that looks more poreless.

Alpha and beta hydroxy acids can do it. So beta hydroxy acids like salicylic acid are actually lipophilic, so they get down into the pores and kind of clean them out. So cleaning those out can kind of help.

So sal acid and glycolic and lactic and other alpha hydroxy acids to a gentle kind of exfoliation of the skin. And so again, can improve the appearance of pores. So alpha and beta hydroxy acids.

That does not mean, by the way, go scrub your skin or start like dousing it every day with a chemical exfoliant. You will destroy your skin. So alpha and beta hydroxy acids, retinoids.

I also like those Biore pore strips. Someone's really upset about their nose. I'm like do one of those a week.

It'll make you feel better. It's going to fill up the next day. But if it makes you feel better that for a day your nose looks amazing, OK.

And then, retinoids. And then like primers. And things of that nature.

But manage expectations. Manage expectations. Also, sometimes certain lasers like Fraxel or Baby Fraxel like Clear + Brilliant.

Because again, we're building collagen. Can actually over time help with pores. I was going to say we're on a pore plan with my derm.

And it involves a little laser. But to be fair, the laser does a lot of things. And pores is one of them.

So-- Correct. So we do have certain lasers that can help with that. Again, it's all in the vein of where you're going to build collagen and that can help with the appearance of pores.

Well, Dr. Shari Marchbein, this has been such a great conversation. Yes, it has been.

Thank you so much for joining and thank you guys all for your amazing questions. We did address a lot of them in the first part of our conversation. But we were hopefully able to get to some of the juiciest ones.

So where can people go if they're interested in maybe having a consultation with you here in New York? So you can visit my Insta. But don't believe that-- no, I'm kidding.

You can believe what I say on Insta, because I'm a dermatologist. But it's-- @DRShariMarchbein. And I'm in Midtown.

I'm 41st in Lexington. So you can Google me or go to Insta or however you want to. And I'd love to see you in the office.

Amazing. Do you take insurance out of curiosity? I do take some insurances.

OK. Great. Absolutely.

We love to hear that. Yeah. Well, thank you so much.

We'll be linking all of that in the description slash the-- what is it called? The show notes. Slash the show notes.

And as always, thank you, Shari, of course, for being here. And thank you guys for tuning in. We will see you next Monday on an all new episode of The Financial Confessions.

Bye, everyone. Bye. [MUSIC PLAYING]