Hair Loss Expert Interview

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Marc Glashofer was diagnosed with alopecia areata as a child, and was inspired as a hair loss patient to become a hair loss expert.

Thinning Hair, Aging Gracefully, and the Filler Debate with Dermatologist Dr. Marc Glashofer

Marc Glashofer was diag­nosed with alope­cia area­ta as a child, and was inspired as a hair loss patient to become a hair loss expert. Now he’s a der­ma­tol­o­gist that spe­cial­izes in skin surgery and cut­ting-edge thin­ning hair treat­ments.

In this extreme­ly infor­ma­tive episode, Dr. Glashofer breaks down the stig­ma of thin­ning hair in women and explains what can be done—and answers ques­tions about the most com­mon skin com­plaints, from dry­ness and hor­mon­al acne to rosacea and lines.

Bobbi also opens up about phi­los­o­phy on aging and her expe­ri­ence with Botox. You don’t want to miss their live­ly debate about the pros and cons of fillers.

Interview Transcript

I get asked a lot of ques­tions from so many women about what to do to stay look­ing young to stay look­ing healthy.

My advice is always the same. Start with what you’re putting in your body num­ber one and then you know what there’s so many things that you could do toe look bet­ter with­out alter­ing the way you look. So my phi­los­o­phy of aging and I don’t even like that word because we are all aging and that’s a good thing. It’s not neg­a­tive but my phi­los­o­phy is if there’s things that are real­ly both­er­ing you exam­ine how you could make them bet­ter with­out chang­ing your face. I am not a fan of fillers because most fillers I could see when peo­ple put it in their face.

It does­n’t always work per­fect­ly.

I’m sure there are plen­ty of fillers and peo­ple’s face that look great. I have seen a lot that haven’t do. I wish I had less lines in my face Yes but I don’t even both­er that ener­gy because there’s noth­ing I could do about it. And I find that when I’m arrest­ed and I am hydrat­ed from the inside out and I have the right mois­tur­iz­ers and creams on my skin I can han­dle my age.

I want­ed to have a der­ma­tol­o­gist on the pod­cast because there’s so many ques­tions I want to ask him about what can be done with­out alter­ing your face. I first start­ed see­ing Dr Glass Hoffer because I was con­cerned about thin­ning hair and just what hap­pens to her as you get old­er. He also has a con­di­tion called jalopy Sha which means he does­n’t have any hair but he hap­pens to be Ah hair loss expert.

I prob­a­bly because he was a hair loss patient. He has a lot to teach about our con­cerns. There is my con­ver­sa­tion with Dr Mark Glass offer Dr Mark Glass Hoffer.
Is that how I said That’s okay?

Pretty good.

A der­ma­tol­o­gist but more than a der­ma­tol­o­gist an expert in not only skin but also an expert in hair loss?

Yes that’s cor­rect.

So I’m expert hair loss as well

Azzam Fellowship trained in most micro graph­ic surgery and cos­met­ic der­ma­tol­ogy

And for the Zona most surgery spelled M O hs named after the sur­geon who invent­ed the tech­nique is a way of del­i­cate­ly remov­ing skin can­cers from usu­al­ly head and neck in oth­er sense of areas of the body

Okay well very inter­est­ing

The oth­er thing about Dr Glass Hoffer he’s my der­ma­tol­o­gist and I went to see him first because of hair loss

And when I walked in to say hel­lo because he was rec­om­mend­ed to me by anoth­er der­ma­tol­o­gist when I went in to say hel­lo

The first thing I notice is that he did­n’t have any hair

So your sto­ry is that you were diag­nosed as a kid with Alipay

Sha Yes

So it is iron­ic that I’ve got­ten into this ah field when peo­ple walk in their deal­ing with hair loss and the first thing they see is this shiny dome and uh gen­tle­men who has no hair and tat­tooed eye­brows and they’re like Well my in the right place and but a real­ly cute face

So how many guys look good with tat­tooed eye­brows in your body Yes my sto­ry

And what What sort of par­tial­ly let me on this path is I was diag­nosed at the age of eight with alope­cia area­ta

When peo­ple for the jalopy show that’s gen­er­al­ly mean­ing hair loss

Alopecia area­ta is a spe­cif­ic form of hair loss

It’s an auto immune con­di­tion

So basi­cal­ly my body and peo­ple have this con­di­tion

Our body’s immune sys­tem gets con­fused and instead of attack­ing bad things like virus­es and bac­te­ria and got from can­cers it attacks our own self­’s are our own auto him­self and so in my case it attacks the very effi­cient­ly and I have no hair so I have a form of alope­cia out­ta called alope­cia Universalists which is a more extreme form

Of course you had to get the bet­ter one Of course

Well if I’m gonna do what I’m gonna do right

But it was an evolv­ing process

And so when I was first diag­nosed what I remem­ber or con­struct­ed at this point in life is that when I was eight years old my father took me to the bar­ber and the Barbara point­ed out 14 sized bald patch and I’ve heard a lot of patients tell me that sto­ry

Kind of that An ini­tial orig­i­nal hatch and then I don’t real­ly remem­ber it allows around 12 or so

Coincidentally I was diag­nosed with some form of kro­nes 12

Ah yeah

Uh and so I was on steroids that point which is one of the treat­ments for elope Shadows

So prob­a­bly masked the pro­gres­sion toe lat­er on

And then I remem­ber through high school and junior high and high school just sort of kind of hav­ing var­i­ous patch­es of loss I would go to der­ma­tol­o­gists

That’s one of the rea­sons I’m in

Dermatology is one of my men­tors

One of the doc­tors

I was see­ing Dr Larry Miller who passed about a year ago

He evolved into a very close friend of mine and he got me into his con­di­tion and I used to go them every six weeks for shots and light ther­a­py

And as you could tell noth­ing real­ly helped

But he real­ly pro­vid­ed me with a lot of com­forts

Basically from about 12 to 16 17 or so I had patchy hair loss and then I remem­ber dis­tinct­ly

My senior year of high school is in the mid­dle of soc­cer game

My broth­er was there and I remem­ber com­ing off the side­lines and sweat­ing and I wiped my face and shocked look came over his face and some my team­mates that kind of wiped off like half my brow

I did­n’t quite know that till the game was over

Uh obvi­ous­ly dev­as­tat­ing and you don’t real­ly know

You know where to go with that

So I start doing shots of cor­ti­sone in the eye­brows which it helped the cor­ti­sone shots that is get­ting from from Dr Miller

I would grow a patch of hair back and then devel­op anoth­er patch and sort of chas­ing your tail

As things pro­gressed

I start los­ing eye­lash­es right before start­ing col­lege

So kind of ah you know tough tough way to start fresh­man year

Yeah it kind of went in some extra remis­sion

I did a treat­ment when I was around 23 that grew on my hair back on my scalp

What kind of treat­ment So yes that’s one thing I want to touch on

It was basi­cal­ly called immunother­a­py and you apply a sub­stance a chem­i­cal to the scalp that caus­es a mild irri­ta­tion

And the con­cept is that you’re cre­at­ing an inflam­ma­to­ry response on the skin that draws the inflam­ma­to­ry cells from the hair fol­li­cle away and takes some­where else like a bet­ter par­ty for the inflam­ma­to­ry cells to go to

And it allows the hair to grow

And it works for May but then stopped work­ing

And unfor­tu­nate­ly that’s some­what the case with a lot of the treat­ments for this spe­cif­ic form of hair loss is it Sometimes things work for one per­son don’t work for anoth­er per­son or some­times things work

And then they stop work­ing

And then after that treat­ment all of a sud­den in med school over a one month peri­od time I lost about 70% of my hair stress

I was on a par­tic­u­lar­ly tough and chal­leng­ing rota­tion that at that time kind of can’t stop

You can’t just not show up for rounds and things of that nature

And the next thing I know I was down to about 10%

And it was time Teoh just shave off the last lit­tle wisps

And since then I’ve had the clean look that you see

Do you have any hair in your head Like Do you have to shave it all Or now it’s noth­ing

I occa­sion­al­ly will get a wisp of hair which is kind of fun­ny

You don’t try to call me over exact­ly

It’s sort of like this lit­tle like Snoopy hair that goes up and my my daugh­ter gets excit­ed mon­ey but she wants to pluck it out right when it comes

But the thing that was the best for me iron­i­cal­ly is after I lost it all and every­body was like Wow you look so good or this is it was sort like this kind of com­ing out type sit­u­a­tion where I was Oh gosh like how dif­fer­ent an awk­ward must have looked over all this time and nobody want­ed to say any­thing

And I was like a chance for every­body like this is good and embraced

This is kind­ly final­ly not hav­ing to fight or wor­ry about

Is this patch gonna come Is this gonna grow back or sort of like All right this This is it

This is who I am

This is down to the core obvi­ous­ly still work­ing on that

But I think there’s a cou­ple actors that final­ly just took their hair pieces off

I don’t know

Was it John Travolta I don’t remem­ber

And it’s like You know what So what It’s OK exact­ly

Okay for me I’d say you know back then was prob­a­bly Michael Jordan was one of the few peo­ple that you could real­ly rock that look you know it’s hard grow­ing up with this type of con­di­tion and nowa­days I look around and I’m like Wait a sec­ond

I had have so much grief grow­ing up with us

Now every­body’s has my look

And when did you get your eye­brows Tattoos So approx­i­mate­ly one point to my aun­t’s took me around some make­up artists

We were try­ing to get the right brow col­or and sten­cils and shapes and it was hor­ren­dous

And I was actu­al­ly try­ing to draw my brows on very artis­tic in that sense and came upon some­body who’s ah phe­nom­e­nal cos­met­ic make­up artist and she does the tat­too­ing

And so since then I’ve had it done and have had some touch ups along the way

Well this is a pod­cast and no one could see what you look like

But you don’t look weird at all like you look nor­mal

Like you just look like some guy that has like a shaved head

Ironically after some­body was hav­ing to explain myself of what I have iron­i­cal­ly now peo­ple come up to me like Remember this when I was inter­view­ing for der­ma­tol­ogy posi­tions and I was in Penn Station and par­tic­u­lar­ly creepy bath­room and this stom­ach came up and he was like insis­tent on find­ing out what my secret was for shav­ing my head

Here’s what what mag­ic solu­tion do I use What blade I use What direc­tion or angle do I go in And I kept insist­ing on telling him you know that this is not some­thing I shave and I don’t think he was com­plete­ly coher­ent

And he was get­ting angri­er and angri­er with my response

I was actu­al­ly giv­ing him my secret but I have that from time to time and a lot of patients come in and say What do you dio and I explain This is this is the con­di­tion and what’s nice about with the role that I play with hav­ing so much expo­sure to patients is that when I tell peo­ple that this is not some­thing that I actu­al­ly chose but I have this con­di­tion peo­ple say Oh that’s inter­est­ing

You know Bob in account­ing has this or my next door neigh­bor’s child has this sort of increas­es aware­ness

Yeah you

I mean cer­tain­ly The first per­son I heard was ah friend of a friend a girl who was mak­ing mush­room tea which now turns out to be Kombucha because she was told that that would help

So I don’t know if things like that help there’s

There’s no clin­i­cal­ly proven rig­or­ous stud­ies to show that a lot of things with the hair

Our coin­ci­dence some­times for what­ev­er the rea­son is espe­cial­ly with what I have the LP share out

If you get it lat­er in life some­times it devel­ops is ah patch that just spon­ta­neous­ly re grows and we don’t know why it hap­pened why things got off kil­ter and so there’s a lot time spon­ta­neous regrowth can occur

And so if you’re doing X Y and Z

We some­times like that attrib­uted to that often isn’t the case just hap­pens so we’re going to talk about what works and what does­n’t work in your opin­ion

But what are the caus­es of hair loss par­tic­u­lar­ly in women Absolutely

So you could break down the caus­es in terms of inflam­ma­to­ry and non inflam­ma­to­ry

It’s one way of look­ing at it in terms of inflam­ma­to­ry con­di­tions

There they’re rare

So we talked about what I have

The Alpi share IATA

There’s rare con­di­tions some­thing called like in Plan of Polaris or vari­a­tion of that called frontal fibro­sis jalopy Sha which is being diag­nosed a lit­tle bit more

Women come in with often a very itchy or painful scalp in a par­tic­u­lar type of hair loss which is clin­i­cal­ly rec­og­niz­able

You want to treat that soon­er rather than lat­er because actu­al­ly a scar­ring form of hair loss

It’s anoth­er way of cat­e­go­riz­ing hair loss between scar­ring and on scar­ring mean­ing the hair fol­li­cles them­selves are scarred down

And if they’re scarred from the infor­ma­tion you’re not gonna grow more hair through that fol­li­cle that open­ing

So you real­ly want to treat that ear­ly rare forms of alope­cia can be seen in nations have Lupus and so same thing you want to pre­vent that from scar­ring

So in terms of the inflam­ma­to­ry scar­ring alope­cia is way

Have that cat­e­go­ry then we have the more com­mon cat­e­gories

So major­i­ty women com­ing to see me have female pat­tern hair loss oth­er­wise known as andro genet­ic alope­cia

And just like we all know there’s male pat­tern hair loss

We’ve known that for a long time female pat­tern hair loss does exist and it’s just rep­re­sent­ed under rec­og­nized not talked about as much

But I also see a lot of women that they don’t nec­es­sar­i­ly have You know the bald pat­tern but they just have real­ly thin here where you could see their scalp

Yes like what is that from its a dif­fused form of hair loss And it’s basi­cal­ly men and women

They have dif­fer­ent ways of bald­ing of dif­fer­ent pat­tern

So that pat­tern you’re describ­ing with dif­fuse hair loss and sort of the part gets wider in the cen­tral scalp

In a lit­tle of the tem­po­ral reces­sion

That’s usu­al­ly how women have their bald­ing pat­tern and their hair loss pat­tern com­pared to men just going back to touch on it

anoth­er form of hair loss which is very com­mon in both gen­ders

But I Seymour and female Haitians is some­thing called intel­li­gent of flu Veum and that’s when you have rapid shed­ding of the hair

So a lot of times you see it or you hear about it after preg­nan­cy

A cou­ple months lat­er you might have a rapid shed­ding a few shed­ding of hair and it’s very alarm­ing in the show­er and clumps of hair com­ing out you’re see­ing in the sinker in the hair brush or on the bed

And it can hap­pen after any type of shocked to the body

So any type of stress preg­nan­cy is very stress­ful or a surgery or a big stress not you know dai­ly stress­es and nui­sances but some­thing like death in the fam­i­ly loss of a job divorce rapid weight loss any type of restric­tive diets that can lead intel­li­gent flu

Veum

You also need to make sure when you’re see­ing some­body with their loss that they don’t have under­ly­ing med­ical con­di­tions

It’s a thy­roid dis­ease a very com­mon con­di­tion espe­cial­ly in women

About 10% of women will devel­op some form of thy­roid abnor­mal­i­ty and that could lead to hair changes and then just going down the list of things

You want to rule out any new med­ica­tions to rule out any nutri­tion­al defi­cien­cies which are real­ly rare in this coun­try Thank good­ness but there are times when peo­ple are iron defi­cient or have defi­cien­cies and oth­er things but it’s not as com­mon but isn’t hor­mones like peo­ple always say Check your hor­mones Are your hor­mones okay Exactly

So that ties back into So what is andro Genetic alope­cia Andro refers to hor­mones basi­cal­ly main­ly testos­terone specif­i­cal­ly and Andrew Genetic genet­ic means just that

It’s the luck of the draw the roll the dice how we were born

So as women mature they have less estro­gen and the testos­terone lev­els don’t increase but they play more of a role

So testos­terone is what’s respon­si­ble in the byprod­ucts of testos­terone are what a respon­si­ble for caus­ing hair minia­tur­iza­tion and decreased hair growth and and the thin­ning that we see in both men and women

And so with men we do have decreased testos­terone

As we mature women you have decreased estro­gen and more of an effect of the testos­terone

That’s not nec­es­sar­i­ly mawr to sauce room which is more rel­a­tive effect of the testos­terone

And so you don’t real­ly have to have hyper testos­terone

So a lot of times have you checked the labs

All the labs look fine but the effects of testos­terone around the hair fol­li­cle are more sus­cep­ti­ble at a lat­er age

Additionally the genet­ic and we don’t know the exact com­bi­na­tion of things that lead the bald­ness

But we do know there’s recep­tors and as mol­e­cules and some peo­ple are more sen­si­tive to the effects of testos­terone

And I bring that up because some­times we see female pat­tern hair loss

Unfortunately I have patients that come in their twen­ties her thir­ties and you can have pre­ma­ture both male and female pat­tern hair loss

And so it’s not just some­thing that occurs lat­er in life but about 50% of women after the age of 50

Do you have some notice­able signs of female pat­tern hair loss Okay so what could these women dio like Who could expect to get a ben­e­fit and who real­ly should­n’t both­er And we always want to have an answer and usu­al­ly there’s not a good answer

That’s unfor­tu­nate because human beings like con­trol and like to be able to blame things so often you can’t pre­dict

And so some peo­ple come in and say You know my mom and my dad have full heads of hair and I have this Well it does­n’t always work like that but it’s not uncom­mon that we will come in and say I have a cou­ple of ants or my moth­er and very thin hair and they’re in their eight­ies and I just I don’t want to end up like that And that’s one of things that will bring them in to ini­ti­ate treat­ment

So one of things in terms of try­ing to cre­ate a treat­ment plan is edu­ca­tion affirm­ing that what they have is nor­mal

There’s a lot of women come in and they think they’re the only ones suf­fer­ing from this

And also it’s a stress­ful peri­od because it does sort of indi­cate that we’re get­ting a lit­tle bit more mature

Keep using that mature word exacts head over the old­er well because you know what No one talks about wom­en’s hair loss

It’s all men’s hair loss

On a per­son­al note when I first noticed things were chang­ing for my hair you know I I did­n’t under­stand it you know I did­n’t know any­one else that had this issue

And it turns out two things were hap­pen­ing to me per­son­al­ly

One is my hair is 100% white

No one out there who knows what I look like

Can’t even imag­ine what I would look like with white hair

I’ve been col­or­ing my hair since I’m 25 appar­ent­ly the hair fol­li­cle is thin­ner When it’s gray cor­rect It can appear thin­ner

Yeah so I have you know less den­si­ty in my hair

But then I also was find­ing that that I was get­ting you know some spaces in my hair with­out the hair grows

So you know I freaked

I’m in the pub­lic eye you know I’m some­one that actu­al­ly my beau­ty is always like all about my hair you know my skin and my hair

And it was kind of scary

So I went to see you

And you know you auto­mat­i­cal­ly gave me this treat­ment Prp

So would you and I have to say it worked

It was a lit­tle painful

Little expen­sive but so worth it

But could you tell every­one what it is Certainly So Prp is one of the most recent and newest advances in med­i­cine and specif­i­cal­ly hair loss

So PFP sen­sor platelet rich plas­ma

So the platelets are these bags are tak­en out even cells

But these bags that are float­ing through our blood­stream

And when we get injured either inter­nal­ly or exter­nal­ly the platelets they rup­ture and they release all these growth fac­tors and regen­er­a­tive mol­e­cules

And these things help pro­mote tis­sue heal­ing

And so orig­i­nal­ly Prp was used in ath­letes

And before going to surgery some inter­est­ing ortho­pe­dist start­ed play­ing around the prp and inject­ing into these injured joints and they found that it was able to push off patients need for surgery

So in the lab and else­where peo­ple start say­ing Well what else Complaint Let’s Dio And we start­ed using it for a col­lege and reju­ve­na­tion on the face and then some ear­ly pio­neer start using it in prac­tice

And then about four years ago I said Hey you know this

This is inter­est­ing

I’m not quite sure why exact­ly would work but it’s it’s the sci­ence is look­ing good

And so I said I have to start try­ing it

So I start­ed try­ing it on some patients and lo and behold I saw results

Now what the results mean and this is part of under­stand­ing is always tell patients that no mat­ter what you do whether it’s prp or oth­er treat­ments when you are hav­ing hair loss you can only think about hair growth

How can I get more growth And what you for­get is that how do you stop the loss How do you min­i­mize the loss How do you min­i­mize the fit­ness and the shed­ding So that’s suc­cess

If you can do that it’s a hard­er thing to see

But about 50% of patients will get an increase in hair thick­ness and den­si­ty and some regrowth with Prp 50% 55 In what I’ve seen now that’s just in my use of it and what I’ve seen amongst my patients there’s unfor­tu­nate­ly cur­rent­ly there’s no defin­i­tive case con­trolled ran­dom­ized stud­ies

They are com­ing but it’s not there quite yet

But I start­ed doing it and I went from say­ing Okay this seems like it could work too

Yes this is this works and I can now offer this con­scious­ly that I know that this is some­thing I can pro­mote to patients and give them an option

Before Prp I used to say OK We’ve Rogaine and we could poten­tial­ly do some oral med­ica­tions and there’s hair trans­plant and there was noth­ing in between

People like I don’t wan­na get 15,000 hair trans­plant and it’s gen­er­al­ly safe

But there’s some inva­sive things involved peo­ple you know

It works

It’s great but its end of the road

And do you think Rogaine works Rogaine is of ben­e­fit for slow­ing the process down

I do not think it quote unquote works and regrowth and I don’t think it has been a big wow effect

But it’s some­thing that does ben­e­fit in terms of slow­ing the pro­gres­sion

The PRP results are more ben­e­fi­cial when you’re using the Rogaine Rogaine alone

I do try to get peo­ple to get Start that but by itself I’m not super impressed

Some peo­ple come in and say I don’t want to do Rogaine because it’s a pain to Dio and you know it’s after I see it’s messy but you know Prp it’s nat­ur­al on peo­ple like that

It’s your platelets

There are no side effects short of some of the dis­com­fort that you can attest to Uh you know I like to say in terms of the pain talk­ing about that

It’s like the gym

You know you’re not going to stay in good shape

You expend some efforts

If 10 is the worst paint your life and one is a noth­ing

I tell patients prob­a­bly about a 2 to 3 out of 10

I would I would give it a six

Me

No it hurts

It hurts

But it’s not that

I mean look I’ve done it because I did the first Siri’s which was what five times the way I do it

I do one treat­ment per month for four months

That’s what I call the load­ing phase

We try to jump start the hair fol­li­cles and then I rec­om­mend a main­te­nance phase usu­al­ly every four months

Sometimes peo­ple can push to six months and so it’s like 23 times per year for the main­te­nance

And what is it nor­mal­ly costs I know it varies where you live

It varies and so you’re in New Jersey not New York

So yeah it’s not as bad as New York exec­u­tive in New York you know things air

Everything’s more expen­sive here

I charge $700 basi­cal­ly I’m a true believ­er that it’s the platelets that are doing the heavy lift­ing and hav­ing the results

There’s a lot of things out there

People say Prp with stem cells Stem cells haven’t quite made it to re a life there in the lab and there’s great poten­tial of them

But there’s no such thing as real­ly true stem cells out there

I don’t per­son­al­ly believe that those things help any more than just sort of being able to charge more

That’s it is my opin­ion

I also dona out price any­body I know it is pricey but I feel like that’s a good price point for many peo­ple to be able to get it

And there’s so many peo­ple suf­fer­ing from it

I am def­i­nite­ly a believ­er but you don’t believe in biotin or any of that stuff

Dio

The stud­ies have nev­er played out the whole by it in sto­ry so to speak comes from back in the day

Whatever you want to describe that as 18 hun­dreds 19 hun­dreds when we did­n’t have as rich of a diet if you had a by its in defi­cien­cy and it was diag­nosed so you’d have a lot of hair loss and then you would have by its in rich foods and things and you’re going hair back

And so so while it’s amaz­ing it’s a mag­ic you’re So some­body was smart and said Well every­body has hair loss and they all want to take by its You know they want some­thing to dio So that’s where the bites and mar­ket came

I make I make a bite and gum­my and you know I eat it every day

I still have hair and peo­ple tell me that they’ve noticed their hair like com­ing in

You know I could only hope that it’s true

I will nev­er tell some­body you know to not take it in the sense it’s not harm­ful

It’s more just that I can’t rec­om­mend it because it has­n’t been proven to be the case in a sci­en­tif­ic way

Like most sup­ple­ments like most sup­ple­ment exact most sup­ple­ments Get Pete out

There is actu­al­ly a recent study show­ing that too much bites and can actu­al­ly affect cer­tain lab tests

So if you’re tak­ing high dos­es of vit­a­min and you go get cer­tain rou­tine blood work from your pri­ma­ry care doc­tor those tests might be altered if you’re tak­ing too much bias in so well we tell peo­ple only to gum­mies

And I know there’s peo­ple that exact­ly native also so I won’t tell you

Do not take your gum­mies if you want

You can you know

And maybe it does work for some and maybe does­n’t for oth­ers

But a lot of times peo­ple we want some­thing to dio

For instance an anal­o­gy is when I’m doing skin can­cer surgery peo­ple come back and say Hey I want I want some­thing to put on my scar And there’s cer­tain things you can rec­om­mend usu­al­ly sil­i­cone sheet­ing and things that nature

But a lot of times your body is pret­ty amaz­ing in its heal­ing and peo­ple come back and say I use this prod­uct and got and you know my scar went away

It’s more your scar­let away because it was well suit shirt and your body just did what it was sup­posed to dio

I don’t know

I I might dis­agree with the sen­a­tor

I’m only an hon­orary doc­tor but you know whether you put vit­a­min E on some­thing or some kind of oint­ment that you are cor­rect you are cor­rect

It’s not vit­a­min E and that’s anoth­er myth that I’m gonna spell now

Vitamin E actu­al­ly can cause a con­tact der­mati­tis

Vitamin E keeps the wound moist and so we found that it’s not the vit­a­min e per se

You can use vas­selin which can keep the area moist so moist wounds moist scars and things that nature hydrat­ed skin feels bet­ter

And that’s sort of the con­cept of sil­i­cone sheet­ing when she and cre­ates sort of a micro envi­ron­ment where it’s more moist and things of that nature going on way learned a lot about hair

Now let’s go to skin okay because you treat peo­ple skin

What’s the biggest com­plaint when peo­ple come in So this time of year you see a lot of dry skin

Once guys we mature our skin

I’m start­ing to see it to our legs and our skin else­where gets very dry and very Scalea

And we don’t like that

And some­times not just try­ing Scalea

Someone’s becomes itchy and get these lit­tle patch­es of the excel­lent form

That’s sea­son­al things

You see that pret­ty fre­quent­ly

Of course acne is one of the top diag­no­sis we always see and we see a lot of that year rounds and what is adult acne caused by so adult acne espe­cial­ly female of the lack needs which is usu­al­ly who gets the adult acne is hor­mon­al­ly dri­ven

I saw a woman today who had clear com­plex­ion all through­out her teenage years and ear­ly twen­ties and now she’s break­ing out

And the adult female acne usu­al­ly has This char­ac­ter­is­tic pic­ture does­n’t always but usu­al­ly kind of the cys­tic lit­tle bumps under­neath the skin

There they’re often hard to get rid of you in the jaw line around the mouth

And what show­ing is that That same med­ica­tion I men­tioned before spirono­lac­tone which is used at times for hair loss

It has a great great sig­nif­i­cant effect on adult female acne so I usu­al­ly will rec­om­mend that over an antibi­ot­ic com­bines with a retinoid so so retinoids of the first line agents in act­ing in any form of acne

What it does is it helps break up all the dead skin cells that are in the fol­li­cle and that’s the process of cause acne

We have thes dead skin cells behind that get a back­up of oil with­in the oil and get bac­te­ria growth and then an inflam­ma­to­ry process

Acne is there is a bac­te­ria com­po­nent but acne is actu­al­ly an inflam­ma­to­ry process and the retinoids

They hit every lev­el of acne

They open up the pores they decrease oil size and oil pro­duc­tions

You notice greasy so you can have as much bac­te­r­i­al growth and they also do have some effects on the bac­te­ria

So retinoids of the first line agent for any for of acne retinoids also slow down the break­down of col­la­gen

So there’s an enzyme that nat­u­ral­ly breaks down the col­lege and we have

And on the mol­e­c­u­lar lev­el retinoids help min­i­mize the effect of that enzyme

So it keeps our col­lege in more plumped and more around

And retinoids can help with fine lines and dark spots and just over­all com­plex­ion

And Rosie glows

How do we keep the col­la­gen or can you sew Patients come in And they say You know I was at X y and Z store and I saw all these things on the shelves

What should I do for my skin So the two things I always rec­om­mend two things I would love to have every patient on and and my wife on in my mom on it and myself

So sun­screen

Anytime you’re gonna be out­side for a sig­nif­i­cant peri­od time you remem­ber not just dur­ing sum­mer time

If you know it’s April and you’re going out­side for 45 min­utes here and there All that sun adds up

When we’re in our six­ties and sev­en­ties and eight­ies we see those effects some­times ear­li­er

Of course if you’re going ski­ing you know you have to con­sid­er the rims of the years that knows those areas get burned pret­ty pret­ty eas­i­ly

Top of your head up your head

So sun­screen for any CF get­ting sun expo­sure can have

And then at night time I rec­om­mend some form of a retinoid because the retinoids are real­ly just great for reju­ve­na­tion cell turnover

And we talked about the decrease in col­lege and break­down in the fine lines and dark spots

And is that a pre­scrip­tion or non pre­scrip­tion I think the pre­scrip­tion strength prod­ucts work bet­ter are retinol prod­ucts that are on the mar­ket and they work fine enough

But if you’re gonna do some­thing I would go for the actu­al prod­uct that tech­ni­cal­ly works bet­ter

But some peo­ple don’t have time to go see the doc­tor and get a pre­scrip­tion so if you do some­thing a retinol based prod­uct is a ben­e­fit and you have to make sure that you’re not over using it

It’s one of those things where less is more

Use it just so you get the ben­e­fits you put onto your eyes or not so you can be put it very very spar­ing­ly

It’s not rec­om­mend­ed to do that much of inter­views of her high strength

I would

When I use retinoids I mois­tur­ize first and then I take a piece size amount and spread to my entire face under­neath my eyes

I might do it like once or twice a week of very small amounts

Sometimes when I see my mom she’s scal­ing in

What’s called the nasal labi­al falls from the nose Teoh to the lips and she’s like I’m using that cream But why am I get­ting this And I’m like Oh you just putting it like right in that area because that’s where you have a lot of vol­ume loss and try­ing to stim­u­late com­mon infor­ma­tion she said

Yep that’s not how you want to do it

And what about Rose Atia Have a lot of peo­ple that say What do I do about orga­ni­za­tion shares Rose Asia is a frus­trat­ing con­di­tion autho­riza­tion sort of a cousin of acne

Some peo­ple for the real­iza­tions

Acne Rose Aeysha

It’s a com­bi­na­tion of inflam­ma­tion where you get the red bumps and a vas­cu­lar con­di­tion where peo­ple’s blood ves­sels is just more sen­si­tive

We know spicy foods and red wines and Citrus fruits

Things like that

You know things that way enjoy can cause blood ves­sels to open

And so we get a com­bi­na­tion of flush­ing and readi­ness as well as bumps

Some peo­ple have both those com­po­nents

Some peo­ple just have the red

Some peo­ple just have the bumps

So there’s a lot of things you could do

Topical med­ica­tions some of the same ones you’d use for acne

And then we also use anti inflam­ma­to­ries there

Some med­ica­tions at work like steroids but are safer than steroids

They’re a ben­e­fit

And then some peo­ple come in for just the readi­ness

And there’s some mol­e­cules or specif­i­cal­ly meant to clamp down the blood ves­sels

Topically help get rid of the readi­ness tem­porar­i­ly and at times we use lasers

Lasers actu­al­ly work the best from the readi­ness of rose

A ship like what Lasers

There’s a vast your lasers and lasers work based on wave­length and what they tar­get there’s lasers have a 5 85 and 5 95 wave­length

There’s one lady in par­tic­u­lar

I like the V beam lasers

Another one called XlV which real­ly helped tar­get those blood ves­sels and basi­cal­ly makes a lot of us go away makes you less red

I think lasers are amaz­ing places are amaz­ing and peo­ple come in

They say I want laser

There’s so many dif­fer­ent uses of them

It’s not just one lasers

How much of your prac­tices Lasers I’d say about 25 to 30%

My prac­tice is cos­met­ic

And with­in that I do Fairmont A

Lasers some some peo­ple

That’s their entire busi­ness

Exactly

Some peo­ple

And we owe a debt of grat­i­tude to those because a lot of often are doing the tri­als to prove the effi­ca­cy of his lasers

Huh Well let’s talk about wrin­kles or I like to call them lines

So there is like char­ac­ter lines right So what could you do about lines in the face So So lines in the face depends where in the face and so we’re talk­ing about most com­mon­ly the we call them the Levins those lines between the brows

That region is called the globe

L A

And there’s three mus­cles there that when we use that over years and years and decades they start to make this mus­cles

They cre­ate creas­es in the skin

So lines in the glob­al a region between the brows and the four head­lines what we call the crow’s feet around the eyes Botox is the best med­ica­tion for that and I love Botox

I hate Botox

We’re gonna hap­pen

What about it We’re gonna have a debate Number one

It’s bot­u­lism poi­son­ing

So you’re putting it in your face okay It’s got to go some­where

It’s got­ta end up in the brain

It’s got­ta do it does­n’t just like go into thin air

The inter­est­ing per­spec­tive and that’s what peo­ple do

It is cre­at­ed from bot­u­lin tox­in and basi­cal­ly it’s so dilut­ed out

Eso dilut­ed out

It has no adverse effects

Like eat­ing a bag of micro doz­ing hero­in

Yeah well what we do that for pain on And you know God for­bid when some­body has can­cer were using poi­so­nous sub­stances to try to erad­i­cate that not com­par­ing obvi­ous­ly can­cer and cos­met­ics

But it’s basi­cal­ly we are using such a micro dose

You’re look­ing at that

It is safe

So it’s not like you’re eat­ing a old can of beings that you found and you’re eat­ing get­ting a whole dose of bot­tom that will kill you

All right

So I I’ve done it a cou­ple times and when it first came out I must have been in my for­ties and we did­n’t know You know if it was good if it was bad it just came out

I had two of the worst side effects ever round job

I had a brow drop ones and my hus­band thought I was hav­ing a stroke

And I nev­er admit­ted to him

It was Botox

And the oth­er time I had a you know an eye­brow that like shot on the spot bro

And I went to like the best New York terms

Even go to it just and I’m like our God is telling me some­thing and I just stopped

That’s one thing

Okay I’ve had bad

I’ve also seen so many women

I’ve seen real­ly good Botox Okay But I’ve seen so many women who have this like intense shiny fore­head

Yes and the rest of their face and body is wrin­kled and it does­n’t

It does­n’t match

It does look so when you get to a cer­tain age like it just does­n’t work

So I I agree with you

Let’s address the side effects so any­thing can have poten­tial side effects

Basically how bot­u­linum tox­in works or Botox is it

Basically it caus­es the mus­cles and make facial expres­sion

It min­i­mizes their move­ments

You know some peo­ple appar­ent­ly par­a­lyzes

It stops it

It does­n’t make a com­plete paral­y­sis unless you use a large until it leaves your body

Then you start mov­ing and it’s a pro­tein

It’s basi­cal­ly a pro­tein that’s tak­en up by recep­tor and that pro­tein breaks down over time over the next cou­ple months so it does­n’t stay in your body

It does­n’t eat away at your brain

It does­n’t do any­thing that’s def­i­nite­ly been proven

That should allay your con­cerns

There does­n’t work like that

You’ve got Botox every 4 to 6 months

Something

Do it even more fre­quent­ly for decades and you’re not have any long term side effects

But even in the best of hands you can get a brow drop

Basically there’s a mus­cle around the I called you know the big Larrys occu­py and if you put it to close the brow you will get that brow drop

But some­times there’s even dif­fu­sion even in the best of hands

People know their anato­my you can inject it and you can get the boat text

Going in a place gives you a spot or give you a drop

But I always tell patients you know it does­n’t hap­pen fre­quent­ly but it is a risk

And now they’re putting

Botox under the chin for necks

So there’s There’s some­thing called Splittism a bands that you sort of see when peo­ple when they clinched down on there

If you could see those bands espe­cial­ly if some­body is very thin and that can release those mus­cle bands there’s a mus­cle down in the low­er face

Put a lit­tle boat tex­ting even lit­tle upward turn of the smile

I’m a big fan of Botox but if you could do aging grace­ful­ly is per­fect and I’m advo­cate for that and I wish I could be more like that

When you do these things you have to do them con­ser­v­a­tive­ly

I call it the Newscaster look and it’s it’s a look

You see these peo­ple on TV and there frozen like they’re just com­plete­ly frozen

And I per­son­al­ly do not like that

Look I hate that look and it looks like they’re done

They don’t look nat­ur­al

There’s no expres­sion

And how many actress­es do you see in your like who I can’t even tell if that’s who it is

And that hap­pens

And that some­times hap­pens

Lost age of life

I feel for peo­ple that’s that’s their career and their there so wrapped up in what they look like

Aiken empathize with that Because you know just with my hair loss grant I can imag­ine as Anak ter some­body who’s in the pub­lic eye and you have it in your sort of look at one point and then all of a sud­den you’re you’re chang­ing and you don’t

You try to cap­ture that and some­times you over jump it

And when you ever jump it whether it’s you know uh over­done I job too much filler and chic implants

It all could have done well and many col­leagues to do do it amaz­ing­ly well

But some peo­ple think that you know go go big or go home

And I think there’s like this over laser look­ing over Botox over­filled over laser look and just like you’re say­ing it’s like peo­ple they might look quote unquote good but it almost does­n’t look nat­ur­al

But I I think of it like when I’m weed­ing my gar­den

Okay you’re mak­ing it look bet­ter

But like where do you stop Where does he obses­sion When am I done It’s true and it’s the same thing on your face

It’s like you know Okay I’ll do this

I’ll do a lit­tle bit of this all of a sud­den

It’s like all right that’s not work­ing

Let me do this too

And then all of a sud­den what do you do Your In your 60 sev­en­ties there was a high degree of body dys­mor­phic syn­drome inva­sions more syn­drome and peo­ple try­ing to chase after every sin­gle

Do you see this crease to see is is this wrin­kle and it’s a seri­ous thing and I will tell peo­ple you real­ly don’t need this

I actu­al­ly think that you should not be push­ing things that peo­ple don’t need and put the brakes on it when when they need it

Yeah but I also think there’s a cer­tain time in your life where you just have to say OK okay

I’m not that any­more

This is who I am now in hos­pice man

Yeah

No no no

And you know I mean look I plan to be you know a grand­moth­er one day

You know I don’t want to look like one but it’s OK

You look great per­son­al­ly

And 2025 years ago these prod­ucts weren’t around col­lege and was the first filler out there

Even actu­al­ly sil­i­cone was the first pil­lar out of there

Yeah Believe it or not it was actu­al­ly decent filler

But except now all these women have to take their sil­i­cones out because it’s affect­ing their body

That’s ah dif­fer­ent

Yeah I know but I’m a holis­tic health coach because I real­ly do believe that you have to be a lit­tle care­ful of what you’re con­stant­ly putting in your library

Completely

I agree

And tying in tow

The hor­mones and girls are hav­ing a peri­ods ear­li­er

Yeah well you have to be care­ful of what we’re putting in

What we’re con­sum­ing

What’s in our envi­ron­ment Note No doubt

So these things weren’t around before and so peo­ple did age grace­ful­ly end

There’s a lot to be said for that when used cor­rect­ly and in mod­er­a­tion like every­thing you can make that case every­thing

These prod­ucts whether it’s fillers lasers Botox or oth­er approach­es can pro­vide a cer­tain per­son ben­e­fit time

I will

I will accept that

And I do believe that it’s okay to con­tour

If you’re some­one that wants to con­trol your face

I don’t like con­tour­ing

That’s okay

We’re allowed toe have dif­fer­ent things

And I am

I am

I’m also very excit­ed cause I think there’s gonna be more things on the hori­zon that will help

And I know one day there’s gonna be a laser that gets rid of you

Know that 11 between your between your brow

So I was walk­ing on it

I will

I will sign up for that

Thank you

And what do you think about the you know the body treat­ments like do you think you know what­ev­er those things are called that gets rid of the fat cells What whole skulls going They work they work once again

Your work is always got­ta You’re real­ly encap­su­late

What work means you can’t come in and be obese and say cool sculpt me and you’re gonna walk out the six pack co sculp­tures real­ly specif­i­cal­ly meant for some­body who isn’t rel­a­tive­ly decent shape for their age

But you know the hor­mones is slow­ing down and they’ve got sort of pock­ets of fat

They you know the love han­dles and spare tire and thighs and things of that nature and they’re like This is annoy­ing

I go to the gym expe­ri­ence five times Ah Week and I can’t get rid of it

So cool scope is help­ful for that

Once again when you get cool Sculpt song you just grab this pock­et of fat and it just all goes away

You’ll have about a 30% wrin­kle reduc­tion with each treat­ment you dio

And so there are ben­e­fits

30 per­cents

Pretty good

It is good

It is painful though right It can be

Let’s get him

I believe you know pain is ah pain is pain

Minor mat­ters

Cool sculpt

There’s two dif­fer­ent ones

The cool­ing tech­nique basi­cal­ly is based on If you cool the fat cells such agree you kill a fat cells and one fat cells are sore­ly

They’re finite amounts so once they’re gone they’re gone

You know what hap­pens when you put on the weight again You’ll you’ll add the fat to a dif­fer­ent area well into the cells that per­sists

It’s not going to get rid every sin­gle but so there’s the cool­ing

And then there’s the heat­ing

They both work by by work­ing

You have to sort of meet with some­body and real­ly assess your goals and real­ly have a real­is­tic goals

Have a nutri­tion plan work­out plan and then basi­cal­ly you can do these oth­er things

Is anoth­er tech­nique out there called M Scope which actu­al­ly caus­es micro con­trac­tions and tone mus­cles That’s for a very unique group of peo­ple

Why is that the basic You have to be in good shape once again if you have too much ad opposed too much fat cov­er­ing your mus­cles

So it’s meant for some­body who is in real­ly good shape who just needs to who wants get toned up

I mean per­son­al­ly I think it’s some­body who’s prob­a­bly a mod­el or an actor

Okay so now I’ve got a speed round of ques­tions But all right what’s the last thing you ate Ah cheese sand­wich

What’s your drink of choice I hate to admit this

Ah Diet Pepsi

Oh no

Pepsi

I was talk­ing about tequi­la and vod­ka or why I was gonna get that Diet Pepsi

All right Now your health coach is start­ing

Okay I’m tak­ing over this episode

No Diet Pepsi

I’m try­ing to come

Really Trying to cut back

My wife refus­es to buy it for mad

She knows how many I know

It’s unhealthy

Drink cof­fee I do

You dio I’m a big fan of cof­fee

I’m a big believ­er in caf­feine

See Okay Caffeine’s fine but there’s green tea

There’s Expresso

I mean you know I know you’re a guy that likes chem­i­cals but it’s that

And you like sci­ence

Go Rino

I know

Read about the Sinai

Its denial

But my drink vod­ka

Okay

How do you drink it Martini up with blue cheese olives

My name with nice

What’s your per­son­al skin care rou­tine Less is more

I use a mois­tur­iz­er

Sunscreen in the morn­ing

And which one Whatever’s in my draw­er

Usually some form of a sam­ple that some­body wants me to try

And then in the evening I if I remem­ber I am a guy

At the end of the day I try to do some form of retinoid a cou­ple times a week

Maybe

What do you think his skin care item that most women don’t have but need some for­mer retinoid

I’ll tell you skin care item that I hate

The women have two things

I’m not a big fan of exfo­li­ate

Er’s okay is full

Leading is actu­al­ly quite bad or rou­tine

Exfoliating I think dries out the skin and can pos­si­bly cause more

Ah acne and mawr

Ah dry­ness and decreased glow so to speak

And sec­ond thing is the mag­ni­fy­ing mir­ror

Oh gosh Now you for what you do

You you prob­a­bly advo­cate

I don’t well for putting on make­up

I don’t I don’t I don’t believe in mag­ni­fy­ing mir­rors

I believe in skin­ny mir­rors

I believe in good light mir­rors about here that I nev­er look in a mir­ror in a air­plane bath­room mag­ni­fy­ing their 11 of my pro­fes­sors back in train­ing at Tulane used to say Do you have a mag­ni­fy­ing mir­ror Come

And if you answered yes you’d say Throw it out

That’s the first thing you have to do because nobody sees you like that

You take that mag­ni­fy­ing mir­ror you’re like Oh my God what’s going on You don’t look like that either

Expect you don’t like this

I wish women would get rid of that OK And then to So when you talk about exfo­li­at­ing do you mean just a wash­cloth A loofa Are you talk­ing about scrubs they’re talk­ing about You know what­ev­er those treat­ments are that gets your cells off

So I’m not I’m not against all exfo­li­a­tion

If you have like one of those Clarisonic rush­es or a com­pet­i­tive that if you do that from time to time once a week once every two weeks it’s not hor­ri­ble

But some peo­ple come in and I say You know what Treatments or med­ica­tion or using they say likes for Lady about this exfo­lia­tor of CVS and I bought this and and they’re actu­al­ly they’re phys­i­cal­ly they think the acne is caused by dirt and so they’re phys­i­cal­ly scrub­bing and rub­bing and they’re using loofahs

And they’re they’re just strip­ping away the nat­ur­al mois­tur­iz­ing ele­ments of the skin and the cre­at­ing irri­ta­tion and makes the skin more prone to acne

So that’s what I mean by exfo­li­at­ing

You know there’s a role for chem­i­cal peels is a role for exfo­li­at­ing but not exfo­li­at­ing in a way that’s too harsh and too fre­quent

So you’re prob­a­bly not a fan of the Obama gee method which is pure­ly exfo­li­at­ing

Ah it’s a lit­tle rough

It’s a lit­tle rough

Yeah mod­er­a­tion

Moderation

Okay So tell me if these things are worth in your opin­ion facials my opin­ion peo­ple ask me how do you know what you think by facials I think facials are like mas­sages

So you know if you have back pain or you have a seri­ous ortho­pe­dic issue if you get a mas­sage it’s not gonna address the under­ly­ing issue

But it’ll make you feel good

I think the same thing with facials

How about sheet masks Not a huge fan of masks

I think they do more harm than good but peo­ple think they’re doing some­thing

How about facial rollers Those new jade rollers Whatever those are you see Oh yeah Graham I’m not not a big fan

There’s some of that der­ma rolling to those inter­viewed on in the past

People like to be phys­i­cal­ly and evolved in their reg­i­mens and so they feel like they’re doing some­thing

Or like back in the day they used to have like this clinch­ers you could like do the mus­cle exer­cis­es

And so I don’t believe in a lot of those things

You have facial exer­cis­es Do they work in the­o­ry I mean if you’re stim­u­lat­ing the mus­cles of facial expres­sion but it would have to be such a amount of facial move­ments in real­i­ty

No it does not work

Okay well this is real­ly inter­est­ing

And I want to make sure that I get a pre­scrip­tion for retinoids four before the day’s done

But where could peo­ple find you So I prac­ticed in north­ern New Jersey pri­mar­i­ly in Livingston

But I run between a num­ber of dif­fer­ent offices because I dio skin can­cer surgery in a few dif­fer­ent offices

But to the days per week I’m in Livingston doing cos­met­ic der­ma­tol­ogy hair loss and some of the General and no Instagram

I should have I should have been scram

I’m sort of in that fun­ny gen­er­a­tion where I know Facebook like an email and do things of that nature

Your daugh­ter hope­ful­ly will be com­ing up and she could do it might devel­op the newest Exactly

But this is real­ly infor­ma­tive

And I real­ly appre­ci­ate that you came in

Thank you so much

Thank you Bobbi

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