Episode 22 - 8 Hot Topics in Skin Right Now with Board Certified NYC Dermatologist Dr.Rachel Nazarian - Part 1 (Full Transcript)

This is a full transcript of the Nirvana Sisters podcast Episode 22.

Editor’s Note: Please know that this podcast transcript is automatically generated and may contain minor errors such as typos and word switches. For more information, be sure to listen to the podcast here.

Amy: 0:07

Welcome to Nirvana sisters, where we discuss all things health and well being to help you achieve your highest state your nirvana. Hi, I'm Amy Sherman, a marketing exec with a passion for wellness and beauty.

Katie: 0:19

Hi, I'm Katie Chandler, a former fit model that has a passion for health and fitness. We are

Amy: 0:25

sisters in law who share the same love for well being ready to sift through all the self care noise and bring you a splash of what we think is fun. So let's get started. Welcome to Nirvana sisters Nirvana sisters family. We are so excited to have Dr. Rachel Nazarian with us today. Welcome Dr. Nazarian. We have been wanting to have an amazing dermatologist on the show for a long time. So we're so happy that we got in touch with you to be able to spend time with us today and ask all of our crazy questions to you. So welcome to the show. A little background on Dr. Nazarian is she is a board certified dermatologist seeing patients in New York City she practices various aspects of dermatology including cosmetic treatments, lasers and injectables skin cancer screenings, general dermatology, dermatologic surgery and body contouring Dr. Nazarian has written many published articles in medical journals as well as widely respected dermatology textbooks such as treatment of skin disease and bukas emergencies in dermatology. Hopefully, I said that, right. You are a faculty member at Mount Sinai Medical Center's Department of Dermatology and you are written up in tons of different magazines and articles I've seen you quoted in media print TV, I saw you recently in an article and well and good and Vogue, and Harper's Bazaar, and new beauty and Pop Sugar, and so many more. So thank you for being on the show. Very excited to have one introduction and

Dr. Nazarian: 1:54

an intro. Yeah, I was like listening to God, that's why I'm tired. What would I what have I been doing? But you know what, it's it's all so much fun. And I love what I do. And I love talking about what I do. So I'm happy to go through the whole spiel, whatever you want to talk about, please ask me, it's what I do all day long with my patients. And honestly, it very, very, very rarely gets old. That's the great thing about this specialty. There's always new stuff coming out and new things to talk about. And it's just so exciting and fun.

Amy: 2:22

That's so awesome. Well, we can't wait to get into it. But before we do, we want to take a step back and do our nirvana of the week, which is really just when we talk about something positive, something great that brought us joy over the last week that just kind of made us take a step back because we're all so busy and crazy, especially after everything is sort of open now and everyone got back to running around. It's like good to take that step back and think about something little or big that give us joy. So I'll let Katie do her Nirvana, and then I'll know Thanks,

Katie: 2:49

Amy. Well, thank you Dr. Nazarian. For being here. We're really excited. So we appreciate it. But my weekly Nirvana I would say this week happened yesterday. We, for many reasons, my family and I, we haven't had much time to really enjoy the summer yet. So yesterday, we had like our first family fun summer day, we were at the pool all day and the kids were swimming for I think, honestly, eight hours. And don't worry we had on SVF and a lot of it, but it was it was great. It was just a lot of fun. Just to like you know, not think about anything besides fun. We really needed it. So that so that was that was mine. What about you, Amy?

Amy: 3:26

That's good. Oh, I thought you were gonna say putting contract on your house. But I guess that's another episode. We'll have to hear about that. I know. It's been a journey for you. So I have to so my kids actually left her sleepaway camp yesterday, so or not yesterday. What's today? Yeah, they love Saturday. And so that was a little bit bittersweet. I was so happy for them. But also it was kind of this weird feeling. But now we're kind of getting back into the swing and they're having a blast. So that's good. But I guess before they left, we did a night we went to the pool. And it was sort of during that golden hour where the weather's just perfect. And it wasn't planned. We just sort of went last minute and they were swimming and we just like ate there. But not even at a table just at our beach chairs. And it was just one of those casual nights. But one of those that you sort of are like, I'm so appreciative of like my sweet family. It was just a really great moment before they left and then another little one last night, all the fireflies are starting to come out in my neighborhood. So I went outside last night to do something and they just like literally got stopped because I looked up at the trees and they were so dark. But there were all these fireflies like lighting up and it was so beautiful. And all of our cicadas are now gone. So that was great. So that was just like a little spark of Nirvana that happened last night. What about you doctrine is their

Dr. Nazarian: 4:43

mind is really interesting. So the last couple of weeks, I've been thinking he's from Miami, my husband and I've been saying to him, God, you know what movie I want to watch. I want to watch the birdcage. You know, it takes place in South Beach, right? I only want to watch the bird cage. I just really feel like I haven't seen it in years. You know, I've forgotten most of what it's about. But remember the basic premise and And I was flipping through a television, I had a rough day flipping through the TV. And miraculously, it just happened to be on and just happened to have just started like I was like maybe 30 minutes, 30 seconds and a minute in and I called my husband we sat down we watch this movie that had been like begging the universe verse For for weeks now. I have never laughed this hard. I have seen this movie like, years ago, right. But for whatever reason, it was like so appropriate for today for like here and now in the world, politically, whatever. It it just made I think I had like stomach pains from laughing so hard at Robin Williams and like this whole brilliant cast. But I was so grateful for these two hours where I was just absorbed in this movie, and just loving life and laughing at it and just having a really good time. It was like the most therapeutic two hours I've had in a very, very long time. That sounds so good.

Amy: 5:50

Oh, I love Yeah, that's so great. I gotta watch that again. I haven't seen that in years. And that's so cool. I love that that manifested for you and that you enjoyed it. That's so great. Yeah, that's so great. Good. I love it. Okay, so we're gonna get into some quick fire questions before we before we get into it. So tell us a little bit about your background and how long you've been practicing dermatology and what your specialty is sure.

Dr. Nazarian: 6:14

So you kind of touched on it a little bit. I do medical and cosmetic and surgical dermatology. So basically, I do the basic stuff. You know, the skin checks, looking at moles trying to find skin cancers, acne, psoriasis, eczema, all the skin diseases we are trained to do as dermatologist but in medical school, we have MDs, we are physicians, so medicine first. And then of course, you know, you when you have healthy skin, you have beautiful skin. So the cosmetic aspect is so intertwined. And these, you know, these days, I do an awful lot of cosmetics too. And that includes lasers and lights and injectables like the different toxins and fillers, and then surgical. So if I find a skin cancer, we want to take those skin cancers out so we do surgeries to remove them. Sometimes people have things like cysts and little tumors like like pomos, we take those out as well. And it makes me feel like I am a tiny little bit like the rest of my family, which is made up of all surgeons, cardiac surgeons, bariatric surgeons, orthopedic surgeons. And so a little bit of my day is basically dedicated to being my version of a surgeon to dermatologic surgeon, so I enjoy all of it. And and like I said, I feel like every year there's something new that comes out and something else that I have to learn. And so that's a part of my job, too, is just keeping up to date with what's happening in medicine.

Katie: 7:38

Nice. And how long have you been practicing?

Dr. Nazarian: 7:41

Well, a little shy of a decade formally, but actually I was involved in dermatology since I was about 19. I was working in dermatology offices working in the lab grossing slides, Gaussian slides, for people that don't know is when you do a biopsy, and you take that little specimen of tissue, like a mole or whatever else you're looking to examine. It actually has to be processed soy processing, Matt, where I grew up in, outside of Dallas, Texas, and then spent summers also working with dermatologists did a little bit of research into amount of pathology and dermatology. So really, I feel like I've been doing this since I was 19. Because I started that when I was 19. And I still have so much more to learn, which tells you a lot about what's going on in dermatology.

Amy: 8:20

Yeah, it seems like there's always something new every time you turn around. But you don't always know. You know if it's real or not, because there's just so much out there, right?

Dr. Nazarian: 8:28

There is so much out there. Once in a while I'll see an ad or I'll read something in a magazine or see something online. And it's about this like miracle product or this like miracle ingredient, you know, that I've like never heard of. And you have to check yourself a little bit. Because you think how can I how can I not? You know, maybe I do maybe I don't know, maybe I'm not keeping up with it well enough or fast enough. And so if you look in and I will tell you, you know, 99% of the time, it's an awful lot of marketing gimmicks and new hype and clickbait that's out there, which makes me feel so bad for the consumer. Because the uneducated consumer, yeah, frankly, the consumer that's trying to educate themselves can be misled so easily for marketing. And you could walk into a big box beauty store. And even as a dermatologist I go in and I'm kind of wooed by these products, because they're just packaged so beautifully. They promise so much. And I have to remind myself, we just can't look at the label and trust the science. This is not you know, this is not what they're saying it is. But God the urges so strong because they do such a good job of presenting it to the consumer. Yeah, absolutely.

Amy: 9:37

Yeah, we have so many questions about those sorts of things as we get into this.

Katie: 9:41

So let's start off right away then let's get right into it. It's summer. We're right in the middle of it. S P F, tell us why is it important but not only in the summer? I assume you have your patients use it year round. And what's what's the reason for that?

Dr. Nazarian: 9:59

Well, can you say Question. You know, people when they think of sunscreen, they think of just sun. And when they think of sun, they think of summer. And so they assume they don't have to work the rest of the year. The reason that that is really a dangerous way to go through a year is that even though you're not getting as much sun, this is or is not as warm, I should say, this is not a temperature issue, this is a radiation issue. And radiation is present to some degree year round. And when it comes to sun damage, and skin damage, it's cumulative. So even if you're getting a minute a day, or 30 seconds a day, at the end of the year, you're getting hours and hours of exposure to radiation. That is why people look at when they're at, it's because they have 80 years of sun. And so if you can only protect yourself half the year, you're frankly still getting enough radiation that it's going to add up at some point, but you're still leaving yourself vulnerable to free radical damage, maybe not a sunburn, but free radical damage and skin cancer the rest of the year. Also, you know, these days, when people are indoors, they sometimes neglect to put on their sunscreen. And that's also a bad way to go through life. Because although UV B is kind of what people usually think about when they think about protecting themselves from the sun, because that's what prevents the sunburn. UVA actually travels through light and glass. So if you're working in an office space that has windows, you're still getting radiation through. And if the idea of getting a skin cancer doesn't scare you enough, let me remind you UVA is actually what ages you. So that's what's going to give you those wrinkles and those sunspots and those large pores. So for a multitude of reasons, you really need to put that sunscreen as a part of your daily regimen just like brushing your teeth would be just like washing and moisturizing would be so multitask. Right? So rather than have to think about like 10 different things to put on. Just make sure your sunscreen your moisturizer or one or for me, your sunscreen, your moisturizer, your anti aging cream, orange one. And that way, you're always going to feel naked without it I am uncomfortable when I leave the house without protection. So don't think about it too much. Just kind of sneak it into your regimen that will make it easier even if you have a simple regimen. It's got to have SPF in there.

Katie: 12:12

What do you say to people that say, Well, it's a cloudy day, it's raining? I don't see the sun? Do I still need it?

Dr. Nazarian: 12:17

Everybody knows the story of somebody who was outdoors all day, and it wasn't Sunny, and they just didn't put on sunscreen. I mean, how many times have you heard that I heard all day long, right? And they got burned, they didn't realize they got burned. Radiation goes through clouds. So don't be fooled by the temperature or what it looks like just protect yourself. And also sun damage comes in different forms. People are looking for that burn. But some people actually have very low, like many people actually have low levels of sun allergy. So maybe they're not burning, but they just feel a little dry and itchy from the radiation emits radiation, right? So people get when they have breast cancer, it's radiation is the same thing. So you know, look for those subtle signs that you're not doing your skin any favors, that you're not doing a good enough job protecting your skin, it'll it'll remind you. So I think the more you now the more cautious you'll be our job is to educate people. But eventually, maybe we will use your first little wrinkle. That's usually when it starts when you start to notice your ports get a little big, maybe that's when it starts. But there's something that will motivate you, it tends to be more cosmetic than medical and that's fine. I'll use whatever motivation I can. But you will be motivated to put on your sunscreen daily, cloudy or not.

Amy: 13:28

Yeah, and I can relate to that big time because I got my first basil. So when I was like, young, like 30, or something I remember was like, a couple years after I got married, and I was freaking out and I've gotten like 10 Since I mean I've had them everywhere. So ever since my first basal cell, Game Changer sunscreen every day I sit in the shade. Katie knows I'm like a grandma, I will not be in the shade. And I will not be in the sun in the sun always a hat. I'm like, so paranoid about it. Because I've had so many. I don't know, from being fair being in the sun genetics. I mean, my dad is actually dark complected. But he's gotten a bunch of basal cells too. But yeah, so I'm super aware of it. But I feel like even though it's talked about so much still, most people are not thinking about it as much. And it's interesting that you say it's radiation, I never really think of it that way. Just think of it as like bright light and heat, but not the radiation part, which makes you feel like wow, I really need to put it on. So do you recommend putting on SPF before everything else or after because I never know.

Dr. Nazarian: 14:28

That's because it's different depending on what you're using. I think this is a part of the problem too is that there's different ways to protect yourself from the sun. And there's different ingredients and there's different vehicles that they come in meaning. So a vehicle would be like a cream versus a lotion versus a serum versus a spray versus an oil, right. There's just so many different forms of them, and that determines its place in your regimen. Most sunscreens would go on last like let's say you're gonna wash your face, you're gonna pat you know Pat dry, you're gonna moisture eyes, you would put on your sunscreen. And the only thing that would go on after that is maybe a little bit of makeup. That's how most of them work. But you know, there's powder form that you would also just do last even after you do makeup, you would want that to sit on top, the big classifications for sunscreen come in mineral or physical versus chemical write chemical needs to be absorbed into the skin. And it works by changing that radiation into a different form typically heat versus a physical or mineral which acts by shield, you know, it's basically a physical blockers where it gets its name from and reflects the radiation away from your face. They work in different ways. They are both wonderful. But also depending on which one of those you're using, it may change how you apply it. I say when in doubt, just, you know, put it on after your moisturizer and you should be just fine.

Katie: 15:51

Do you have a favorite sunscreen? Okay, that you Yeah, what's your what do you what's your go to?

Dr. Nazarian: 15:56

So for me, I change every few years, you know, I've evolved. So I had to do a starter sunscreen, as I call it, which is just like super lightweight and feels like absolutely nothing and disappears and don't even know you're wearing it. And that's how I started because as somebody who doesn't really wear makeup, I didn't like the feel of anything on my face. I hated it. And so that was Elta MD UV Clear which is like a cult favorite in the dermatology world. Okay, super easy, simpler. As I got older, it actually wasn't motivating enough. Even for me as a dermatologist to just have sunscreen. I just didn't feel like I wanted to put it on during the day. And so I switched to something that is made by a brand called revision. It's revision true physical. I love this. I love this for a number of reasons. One is because actually the base is an anti aging cream that always motivates me to put it on. It has a high SPF and it's a little bit tinted. So it goes on kind of like this beautiful sheer tent, it covers everything, I don't have to do anything else. I put on a vitamin Sam, I put on my sunscreen, I'm out the door, and it is everything in one, I'm like a mama of three, I don't have time to do anything. So it goes on about the door. I'm super, super happy. What I recommend for my patients, it really depends on what they want. I don't think patients realize that this the sunscreen game has evolved so much that there's really cosmetically elegant options out there for everything, whatever you want, you can tell me whatever you want, I will find you essentially that is curated for those issues, redness, dryness, anti aging, wrinkles, you know, discoloration, you want something lightweight, do you want something that has little dewy look, you want something matte, whatever you want, you tell me I know what's out there, I will, you know, point you into the right direction. And I will help you find something you are obsessed with it because that's my goal, I want you to be really motivated to do it. And if anti aging motivates you, which it generally does, this way, you know, for men, if super lightweight, and pretend it's not even they're motivated to let you go. So that's where I am now your physical. That's amazing.

Katie: 18:03

Yeah,

Amy: 18:03

I love that I'm gonna have to follow up with you to get some of those recommendations. And we'll put it in our social media feed for our listeners, because that's such a I never thought about it that way because there's certain ones that I like and certain ones Katie likes, but I never thought about it based on like, if you're dry or for this, you just kind of grabbed the one that feels the best. But it's actually interesting to think about I'm gonna have to check out.

Katie: 18:23

I didn't even know that was off good to know, had sunscreens for XYZ, you know, I just thought it was like one thing kind of across the board. So yeah, that is great to know. Tell us a little bit about Helio care and how does it fit into your daily skincare regimen.

Dr. Nazarian: 18:41

So Helio care is something that I caught on to many years ago. It is a supplement, it can turn it contains Fern extract. This is like a fern that comes out of Costa Rica. And it is really exclusively grown and processed by this company. It's actually patented with this firm block technology, right, and I'll tell you why that's important too. But the purpose of this is to make you really a little bit less sensitive to sunlight. So I used to give it to patients that would get like sun allergies in which a lot or had some sensitive conditions like lupus or melasma, which is discoloration you get in the sun. And it was just part of my treatment regimen. It's actually been around for a very long time published immensely in the medical journals. Most dermatologists know about it, but it also helps neutralize free radical damage because it's just filled with antioxidants, right? And so when you're thinking about your skin aging, that you always think about ultraviolet radiation, but this is completely flawed thinking because we know that your skin will age worse in a city environment than it would in a country environment right. Just due to other free radical damaging agents, whether it's pollution and smoking and all this other stuff like visible light all those things ages. It just colors our skin then it breaks down on collagen, it breaks down the elastin. And it just makes us look saggy and baggy and old with time. And so you actually need more than just sunscreen to protect your skin from aging. Right sunscreen protects us from sun. But like I said, there's so many other things that will cause oxidative stress and free radical damage. So I started taking Helio care for that purpose. I mean, I consider it something that kind of really helps my sunscreen in some way, but also protects me against all the other aspects of what I consider to be aging factors in the environment. And I mean, I just can't speak highly enough about it. You know, I just started working with this company this past year. And, you know, I still don't know why it's not like insanely popular. I don't know, I don't know what it is. You know, I've spoken to a lot of dermatologist about it. We're like, is it the packaging? I guess it's kind of boring. You know, I don't know what it is. But boy, my whole family is on it. My husband's on it. I have like, literally, this is my desk or sitting at the office. It's sitting right here, just in case I actually forget it before I leave the house. I have it here.

Amy: 21:07

Do you just take one a day,

Dr. Nazarian: 21:09

I mean, you actually can take to what I normally do is I'll take one and then if I plan on being out again during the day, like if I'm walking around on the weekends, I'll take another one about an hour later on vacation, I definitely will take two if I'm like, pulled someplace on and I get like forced to go to the beach, I'll always have it there. And then I just take one a day normally when we know before I come to the office, like when I'm dropping the kids off at school, there's like a little bit of a walk there as well. And so now it's just part of my daily routine.

Amy: 21:38

So the recommendation would be to use Helio care, and obviously your SPF. So it's like the internal and the external in a way. And with something like that help with basal cells, like would it be beneficial to take that if you're prone to getting basal cells like I am? Yeah,

Dr. Nazarian: 21:55

so that's a great question. I mean, the closest I can say is free radical damage can cause skin cancers. Here, the oak hair helps neutralize free radical damage. Does that make sense? So in my mind, yeah. Right. So in other words, right. I mean, not only can I not hurt, I do feel like it helps a lot. There's another version of Helio care actually, that contains a form of vitamin B called niacin amide. That actually, we have many studies in the medical literature that shows that does help prevent against skin cancers. And so if I have a patient that is prone and has many skin cancers in the past, or I think has a higher risk of building skin cancers, I'll actually recommend that for them. They have another version called Heliocare Ultra that has extra antioxidants in it, that's really, in some ways, I think of it more as like a anti aging booster supplement. If you think about supplements, though, it's really important to remember that it's not FDA regulated, right? This is not considered like a medication, it's considered an extract a supplement. And so any company can just like, say they're doing the same thing and get that plant and kind of grind it up. But you can't do that when it comes to your own health. So I don't like doing random knock offs, or whatever it is because I don't even know what part of the plant they're using. Right? Like the whole plant doesn't have the same level of actives. The leaves have the important part, that's really what protects it from the sun. And Costa Rica is what allows this plant to stay so viable in really difficult, arid, dry conditions sometimes, right, that's what makes it stay so healthy and strong. If you're gonna grind up the root and put it in a pill, not gonna do the same thing. So I'm really adamant with my patients that, you know, we don't experiment when it comes to extracts and supplements. I only want the stuff that's been studied, I only want the thing that's in the medical journal. So you know, that's that's Helio care. And you know, just one other thing you can do you eat healthy too, you want the right antioxidants in your diet, you want the right anti inflammatory things in your diet, you're going to know if you're treating your body poorly, and your skin is going to show if you're treating it really well and that means from the outside and also means from the inside.

Katie: 24:08

It's so true because I have definitely been not doing my best lately with my diet stress eating a little bit and I can see it I see it like all over my face. I see it in like the little dehydration wrinkles that sometimes I haven't sometimes I don't have and like you know, when your face is like inflamed or so I really can't see it in your face, and then you break out more. And all of that can be linked right back to everything you're consuming. Right?

Dr. Nazarian: 24:35

Absolutely. The skin shows everything. I mean, it really is just a reflection of what's happening on the inside, how you're feeling and how you're treating yourself. Whether you're sleeping, whether you have a good diet, whether you're getting enough water, whether you're giving it the right tools to defend itself, which is a huge part of it. I mean, if you're just going to go eat whenever you wanted and then go to sleep and you never brushed your teeth. Think about what happened. to your teeth, they would literally degrade with cavities, right? You would lose them. Your skin requires the same amount of self care and maintenance otherwise, if you're not giving it what it needs to protect itself, it falls apart. And you know that because when you look at beautiful skin, it looks so healthy, it like glows, doesn't it? And when you're looking at somebody who doesn't take care of themselves, you can see it in their face. There's nobody that doesn't take care of themselves that has this like gorgeous, you know, glowy skin. There's just some things you can't fake. Right? I love that.

Amy: 25:30

Yeah, I totally agree. And I'm so it's like, the older I get, the more I'm noticing people's skin and like obsessed with getting my skin to be clear and even. And that kind of moves on to the next thing we wanted to talk to you about is how to even out skin tone because there's all this talk about Retton on retinoids, and Trent Nolan and all this stuff. And can you break down for us like, what it is the difference is what we should and shouldn't do. I started experimenting with a retinoid but like I don't really know much about it. I just feel like there's so much information, it's hard to know what it is and what it's for and all of that if you could just give us the one on one on that we'd love it. This is the

Dr. Nazarian: 26:10

one of the simplest part of the anti aging regimen is the retinoid. Okay? So retinoids are vitamin A derivatives, that's all they are vitamin A derivatives. And we know that this class of vitamin A derivatives can stimulate collagen, and stimulate cell turnover and help give you fresh, healthy, new skin. So if you think about it, old skin is kind of like damaged skin, new skin is healthy and youthful looking. And so if you can get that cell to turnover faster, create new skin cells stimulate more collagen, replace the old tissue, it's going to look beautiful, and youthful and young, right? Full of bounce less wrinkles, smaller pores, smooth, even off the tone, because you're getting rid of the old skin cells. That's your retinoid. That's just a that is a just umbrella term for everything else that we're going to talk about right now. Got it, Retinol is an active form that you can get over the counter. So you'll find a lot of products at your local drugstore will contain retinol, which is also also a vitamin A derivative, we're still talking about the same class, but has to be converted to retinoic acid in the skin after it's been absorbed. So it's weaker, it takes longer to get to the active form. It's more gentle, right, it's not going to dry you as much. But you're also not going to see the improvement as quickly you will see improvement. It's not that is not going to work, it will work. But because it's inactive, and it's a couple steps away and that that sort of pathway. It's just you know, it's not as dramatic sometimes, that's all Trent know in which you also mentioned, Trent Nolan is actually a prescription retinoid that is closer to the active form. So when you put that on your scan, you actually start to see the improvement sooner, it's a little bit more dramatic, it is closer to the form that actually does something it's a little bit farther down the pathway. The downside to that, of course is that retinoids have an adjustment period where your skin has to get used to them because they're getting the cells to turnover faster and they're doing what they need to do they shut down the oil glands a little bit. And so if you are too aggressive with your retinoid use, your skin's gonna feel a little bit dry, it might even freak out a little bit get red, you could flare an underlying condition like Rosae show if you use it, you know too much too fast. But if used properly, tiny little bit to the whole face couple times a week, maybe mix it with moisturizer, you know ease in like dip your toe in a little bit with the retinol even if it's treading on your skin actually will often adapt beautifully and with time will get used to it and then with time will show its benefit. So, you know, there's really no downside to being on a retinoid you know, we don't really recommend them or prescribe them if you are pregnant or breastfeeding. Although I will tell you the caveat to that if you're really up to date on your literature. Actually, there is a third generation retinoid that is safe in pregnancy and breastfeeding. So I do recommend that and I certainly did that for myself for all three of my babies. So you know, we grow and we evolve and there's something for everyone. But I do think on some level, a retinoid should be somewhere in your regimen there is just literally no reason for it not to be and just like you were saying about sunscreens how to pick the right sunscreen. I can do the same thing with a retinoid you can tell me what your skin issues are in the sense of like, do I have rotation? Do I have eczema? Do I have dry skin I try to write and I freaked out once, whatever. And I will give you the right retinoid to use that will be tolerable. I really have yet to find someone that hasn't been able to tolerate at least one of the retinoids that I recommend.

Amy: 29:54

Yeah, we're definitely gonna follow up with you on that too because so it sounds like you should do Some sort of retinoid, it's a pm treatment, right? You do it at night correct. And then someone would do either a retinol or retinol and they wouldn't do both because essentially, it's the same thing. One's just stronger than the other. Exactly.

Dr. Nazarian: 30:14

So there's no need to do both. You can start retinol if you really want to use it and get used to that and then move on to a prescription strength retinoid like Trent No. And if you want or, you know, actually now they have a prescription strength, retinoid over the counter even right because adapalene is in like proactive MD It's like used to be prescription now it's over the counter. So it's there. But you could ease into it slowly see how your skin does make sure that you don't have an issue don't get too dry. But yes, so what you would do really, if you want to have like this perfect skincare regimen is you start your morning by washing your face, very gently, having dry, and then what you would do is you would put on a vitamin serum of sorts, which would be your antioxidant, right? That's neutralize free radicals damage topically, put on your sunscreen, I take my Heliocare and then in the evening, you wash your face, you pat dry, you put on your retinoid of choice, and maybe a couple other things that hopefully all come in one. One products, you're not putting on 15 different products like the Koreans do, we're American, we want like the multitasker, right, like one or two. And thankfully, we have those products that do everything we want in one. So I put on another product that has you know, antioxidants and peptides and both factors and all these other things that we also no helps with anti aging. I mean, anti aging, to me is kind of the dumbest term ever. Because what does that even mean? Doesn't mean anything when the anti aging was aging mean, right? When you're talking about skin, it's actually broken down on many different levels, right, it's your skin is drying out more, you have discoloration, you have some redness, maybe some browns, you're losing collagen, you know, you've lost elasticity there, like actual pathways that have been taking place in your skin that when you put it all together makes you look old. So when you're anti aging, this is not just like one thing that you're trying to fix, you're trying to fix all those different parts of the skin. This is an organ that have all now shifted as you've gotten older and are reacting to the stressors from the environment. So you want things that help you maintain moisture and hold on to moisture and help stimulate collagen and elastin and help remove the pigment and help smooth the skin and, and there really is no magic bullet for that as close as retinoids come. They don't do everything right. So you really want to make sure you're addressing different aspects of the anti aging picture as we put it.

Amy: 32:39

Yeah, I wish I knew about retinoids earlier I really I like learned about it, I guess over the last six months or so. And I started using this brand called the ordinary you know that brand. And I can't remember how much it is the Sochi point. 5% Yeah, it's super cheap. And it's I heard it was good. But I didn't know there's all these different percentages. And I was just like, I'll just get this one because it seems like a lower percentage. Is it? Is there a cap that like an over the counter versus prescription? How do you know what concentration? Or what percent reality

Dr. Nazarian: 33:15

is, is even forgot even the over the counter, even in the prescription world? Honest to goodness, it doesn't really matter. I mean, the dirty secret with a lot of the stuff is that most of the time the patent is running out on a brand. And they need something else to patent. Right. And so then they go from like, you know, whatever it is point oh, five 2.06. Okay. Does it really, really, really matter? No, of course, it doesn't matter. It doesn't make a huge difference. No, it's literally the same thing. But they have to kind of create these new, proprietary patented percentages in order to stay branded, you know, in order to justify whatever price for something that is exclusive. Right. And so that's where you see all these different numbers popping out in medicine, and even frankly, over the counter. It doesn't really make a difference to me. It's over the counter. And then it's prescription. And I have patients that come in and they said oh, I've been doing like the you know, the point oh, five now for a year. Can I go to the point one, you know, and I'm thinking of, you know, it's like not even worth the argument anymore. Like but to me, it's more like the Joe was a little bit stronger than the cream, like that kind of stuff. Alright, fine, a little bit more no better absorption, or certain classes of retinoids first generation second third,

Amy: 34:36

you know, sometimes work a little bit differently. Yeah, mine's like a serum. Right? That

Dr. Nazarian: 34:39

tends to be So yours is over the counter. Right? This is the ordinary over the comfortable. Yeah, it's like a drop and like serum, they tend to be a little bit more potent. Don't even worry about the percentage. I think it's gonna be really gentle. I love the ordinary. Mostly because you said oh, it's low or something. That's it. Oh, yeah, it's cheap, right. That was like I wasn't even thinking of the percentage I was thinking of the price. Because that's actually the thing I love the most about this company. They make good products. But also they're just, they're just so reasonably priced and like rationally price like there are some things that are worth shelling out for. I shell out for them. There's some things that are expensive, and they're just expired, but they're worth every penny. But then there's some things that are, like expensive, and they're supposed to be cheap. And like, why aren't they cheap, they should be so cheap for people. And these companies just like inflate the price. So I like the ordinary, I've been impressed with their stuff, I'm happy and I'm super happy with their price point because that means everyone should be able, hopefully, to do something like that, or add it to their regimen.

Amy: 35:34

So you could start doing retinoids as young as you want, like theirs is What's the age people should start age

Dr. Nazarian: 35:40

does a lot of people aren't retinoid, really, really young for acne, right? Because we use it to treat acne too. You can even put them on babies. I mean, you know, you could do it for whatever age you want. Now, from an anti aging standpoint, I find if you're old enough to ask about it, you're old enough to use it. Right? You know, I think I'm not I'm not so negotiable with the sunscreen, I think that everyone should be wearing sunscreen, you know, six months older, if you're going to be outdoors, throw a little something on. But I think we've retinoids I don't think 20 is too young. I think you got to preserve what you have, you know, it's a lot harder to repair your skin a lot harder to repair your skin, it is a heck of a lot easier to preserve what you have. Plus it always looks better when you've preserved what you've gotten naturally than trying to recreate the way you were which can't be done. It's just expensive and exhausting, you know, but

Amy: 36:30

Right. It's like, I wish I wish I knew about all the skin stuff that I know now when I was in my 20s like the only thing I was doing them like eye cream. But other than that, that's probably sunscreen here and there. And I think

Katie: 36:41

about a yawn, every single wrinkle on your face. Yeah, it's good to know that you can get these retinas for good price, I definitely overpaid on my serum that I've been using. I'm gonna go find the ordinary,

Dr. Nazarian: 36:55

sometimes honest to god, I have patients that come in and they're using like, la mayor or whatever other like major expensive, you know, skincare company product. And I don't even pull it, pull it away from it. I don't take their toys away, because I do in all tell them. It's really expensive. They don't have to use that we there are other things. And they'll say something Oh, but I like it. And I think you know what? Okay, I like that you're taking care of yourself. And I liked that they have this ritual, and they they're investing in their skin, maybe they're paying too much, but it makes them feel so good. And I think that's ultimately what you're paying for to it's not that they don't work these products, they've, some of them have good ingredients in them for sure. And I think once they've been educated to at least know that they don't have to if they don't want to, but they just like that product. They like seeing that product. They like seeing that label. You know that psychological effect. I'm okay, actually, frankly, I'm okay with that, too. I have people that pay an awful lot for super crazy expensive sunscreen. You know what, if you're gonna put it on every day, you know, we say the best sunscreen is the one you actually wear. So if you love the way it smells, and feels and looks, and you pay 200 bucks for it, and there are sunscreens that cost 200 bucks. Okay, all right with it. As long as they know.

Katie: 38:04

I've definitely had a little bit of a journey with the retinoids and everything that my doctor put me on, how do you say to know in a year ago, because I was having all of this crazy adult acne all the sudden I hadn't had acne since I was a teenager, and then it came on. And then that was too strong. For me it was I think it was like a rosacea situation like a lot of really dry patchiness. So then I've downgraded to the serum. And that's still it. I mean, you have to kind of play play with what works for your skin, don't you think? I mean, I was doing it every night. And I realized that's too much then I did a couple nights a week now I'm doing I do it one night a week. And it seems to not like overdrive me out. But do you think it's fair to say that people if you don't have a dermatologist that's directly telling you how to use it to just kind of like ease yourself in, play around with how many nights how often you should be using it?

Dr. Nazarian: 38:52

I do I think that's totally fine. I think what happened to you is really classic. People will have this underlying rosacea they're not aware of and they're treating their acne and they'll get started on the retinoid and it will flare their rosacea very, very badly, which is super distressing, especially when you came in you already upset about a couple pimples, and then to have a rosacea flare, it can be kind of devastating. Whether you're younger or older. I don't think it matters at that point. So yes, I think you know, if you don't have a dermatologist telling you how to do it, you always start just slow and low. It's not a race, it may feel like you're trying to make up for lost time, but it's not a race. And even if you can only use it once or twice a week. Great and fine with it. You know there are little tricks that you can use to try and make your skin a little more. You know, tolerable tolerable, I guess or you make the retinol a little more tolerable for your skin and that makes your skin as dry when you apply it applying it to wet skin increases absorption. Put on a moisturizer before you put on your retinoid whether it's a retinol or tretinoin mix it diluted down you know and then like I said afford once or twice a week at most. And those things will help you they will. But again, if you're not sure where to look, and you've tried everything, I promise you, there's some retinoids that have been compounded with hyaluronic acid that make it anti inflammatory and hydrating. There are some that are compounded with a whole slew of anti inflammatory antioxidants, which offset the irritation profile. So this is not a new field or new problem. And you better believe that companies have already been on this and looking for a solution for years now. So there's plenty of options out there even for sensitive skin. If you want to get started on a retinoid. That's great.

Katie: 40:37

That's great information

Amy: 40:38

you were mentioning, I want to go back when you were talking about the regimen like in the morning, and you were saying you put on a vitamin serum, what kind of vitamin like a C or what what do you suggest. So

Dr. Nazarian: 40:48

C is the most popular one, the one that I use actually has like a bunch of different types in there, including C and E. So I use this brand called skin better science, there's like a lot of studies on it, you know, we have to we trust the science and medicine always. So as much as you want to like go with a product that says like 70% of people thought they look brighter. You can't this is not the way it works in medicine, it has to be studies and clinical trials, and we need to be able to see what it's actually doing black and white. So most of the most actually, all of the products that I use fall into that category, you know, like science backed. So I use a pump of that in the morning, and it's just chock full of antioxidants, including C and E, the primary ones if we're going to try to keep it simple, and that will basically just try to neutralize free radical garbage they come in contact with during the day live in Manhattan, you know how it is. And also I'm in front of a screen with a laptop or a TV or a phone. You know, we know now that like visible light will actually impact the way your skin looks to by creating more pigment triggering melasma causing aging. Suicide not to scare anyone but so you know, I kind of put that on to think of it as like an invisible shield underneath my sunscreen.

Amy: 42:01

Do you do moisturizer than after the sunscreen? Or you do more?

Dr. Nazarian: 42:04

I actually don't? I don't moisturize because my sunscreen is. Like I said multitasking. You know, so it's it's a moisturizing anti aging tend to sunscreen. And

Amy: 42:16

yeah, the one you told at the end, okay.

Dr. Nazarian: 42:18

So there's a lot there's a lot to this, right. So it's like tinted. So if you're gonna block block visible light, right, which I just told you about how it damaged, right. So if you want to block visible light, you can only block it with something tinted, you cannot block visible light with something invisible. So as of now we have not come up with you know, we've not invented a way to block visible light with just regular invisible sunscreens that like melt into your skin. So really has to be something tinted that does that. So this covers all my bases. Plus it's a physical block or a mineral one, which, you know, it's kind of like less likely to irritate which I, which I like if your skin is a little bit sensitive. But yeah, so it's really like the way I'm deciding what to use is actually very, very well thought out for many, many reasons, even though we kind of make it sound really simple to our patients sometimes. And believe it or not, this isn't even the only sunscreen on the market that does this stuff. Like there's a lot of other options that kind of do the same thing that are tinted, that are higher SPF, their anti aging during westernizing. But one may feel a little different, one may smell a little different. So you get to kind of try and see what you like. But

Amy: 43:27

I feel like there's also conflicting information on a moisturizer with an SPF versus just a separate SPF, because you hear people say, no, just use a moisturizer and then use a separate SPF. And then some people say to combine it. So it's like you never know but I'm going to listen to what you're talking about. But it's like it's there's just so much information out there that for people I'm glad we're talking to you. Because I always was like, Oh, I don't want to get one of those mixes because I don't know if it's as works as well as if you just put regular

Dr. Nazarian: 43:59

does, you just have to make sure you're applying the right amount, right? Like it's the same thing with like your sunscreen and your makeup. That is I don't mind it. But if you're not applying enough to get the SPF on the label, which is like you know, two milligrams per centimeter squared of skin or as we like to say it now just like the two finger length rule, you kind of have to put two strips on your fingers and then use that to rub into your face and neck. And if you're not using that much of whatever you're putting on, you're not going to get the SPF that's label on the bottle and you're going to be selling yourself a little bit short. So for situations like that, if you know you're putting on enough which you should be for the stuff that feels like moisturizer, it's gonna go on like moisturizer, you're gonna be fine. There's no need for anything else. Amy is that yeah,

Katie: 44:44

that's a really good

Dr. Nazarian: 44:45

tip to finger length with two finger links about I should say. So you kind of put the strip on your two fingers here. This is for face and neck right this is for both your face and neck if you're going to be going out with Want to remember that kind of not to neglect this area under the chin, and you rub it, you'd be actually surprised at how well it goes in Rub, rub, rub, rub rub on the neck. That's it.

Katie: 45:10

Nice. That's great. I've definitely

Amy: 45:16

felt like I have either, like using a piece is good to know.

Dr. Nazarian: 45:20

I mean, it's another reason not to use low SPF right you lose, you use a low SPF and you don't play enough, you're getting even less than the SPF, you thought you were right, you're using an SPF 15 And you're applying it just weekly and lightly. What are you getting like an SPF five. But if you use a higher SPF, you know, so keep those things in mind for you.

Amy: 45:40

So what's the minimum SPF you should use like 40 or

Dr. Nazarian: 45:44

I think what you were saying before is like you don't know who to listen to there's like, the other thing that always occurs to me when people say things like this is that there's just an awful lot of people talking right now. And I think a lot of people truly feel like they have the podium and the right to speak and they know about skin but they actually don't know anything about skin. You know, these like skin experts never even studied skin. They just it's all you know, anecdotal evidence that they've tried and use and want to share their experience, but then present themselves as actual experts and it really confuses the consumer because there's so much noise because everyone wants a seat at the table. But at the end of the day honest to god just trust the physicians please just trust the physician. You know, you know, we spent like, absolutely studying this stuff. I mean, it's it's easy to think you know what's going on because you can see the skin and so everyone feels like they have this personal experience with their skin that they want to share. But there is so much going on underneath the surface. You know, it's an organ like anything else. It has its own unique immune system. It has its like what to me one of the most fascinating things in the body skin

Amy: 46:59

we hope you enjoyed part one of Dr. Nazarian this episode we found it to be very insightful. Stay tuned for part two next week where she goes through all things, dark circles under your eyes, fillers, eye surgery, body sculpting and a game changing injectable for cellulite. So stay tuned for part two next week. Bye for now. Thanks for listening to Nirvana sisters. For more information on this episode, check out the show notes please subscribe and leave us a review. also find us on Instagram at Nirvana sisters. If you loved what you just listened to or know someone that would please share it and tag us. Tune in next week for a fresh new episode of Nirvana sisters will continue to watch out for all things wellness so you don't have to. Bye.