Beauty and the Beasts
Beauty and the Beasts is a plastic surgery and cosmetic surgery podcast hosted by Dr. Sam Jejurikar and Dr. Sal Pacella. Each episode explores trending cosmetic surgery topics, real patient questions, and the latest advances in aesthetic medicine. You will hear expert discussions on facelifts, breast augmentation, tummy tucks, injectables, and modern cosmetic surgery techniques, all explained clearly and honestly.
If you want trusted plastic surgery education, insights into cosmetic surgery trends, and real conversations from two board certified experts, this is your go-to podcast.
Beauty and the Beasts
The Truth About Skincare: What Two Plastic Surgeons Actually Use
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Dr. Sam Jejurikar and Dr. Sal Pacella cut through a two hundred billion dollar industry to answer a simple question: what actually works?
In this episode of Beauty and the Beasts, Dr. Sam Jejurikar explains why "medical grade" skincare is not a category the FDA recognizes, why a fifteen dollar sunscreen applied every day beats a two hundred dollar one applied occasionally, and how a genuinely effective regimen can be built for around a hundred dollars a month.
The two surgeons walk through the four pillars they recommend to patients: daily broad spectrum sunscreen at SPF 30 or higher, retinoids stepped down to retinols for maintenance, an antioxidant such as vitamin C, vitamin E, or niacinamide, and a moisturizer. Dr. Pacella makes the case for physical blockers containing zinc oxide and titanium dioxide, and argues that what you put in your body matters as much as what you put on it.
They also cover why the peeling and redness from tretinoin is a sign the product is working rather than an allergic reaction, why exosomes are heavily marketed and thinly supported by evidence, and how to think about laser resurfacing for sun damaged skin. Ablative versus non-ablative. Fractionated versus full field. CO2 versus erbium. Plus a blunt rule of thumb: the effectiveness of a laser treatment tends to track with its downtime.
The episode closes on the sun protection blind spots almost everyone misses. The eyelid margins. The light reflecting off pavement, right under the brim of that hat. The sunglasses that focus ambient sun back onto the skin. The ears. As Dr. Pacella puts it, it is the only skin you have.
Dr. Sam Jejurikar is a board certified plastic surgeon in Dallas, Texas. Dr. Sal Pacella is a board certified plastic surgeon in San Diego, California.
Beauty and the Beasts is available on Apple Podcasts, Spotify, YouTube, and everywhere you get your podcasts. New episodes every other Tuesday.
#SamJejurikar #DrJejurikar #BeautyAndTheBeasts #Skincare #PlasticSurgery
What is the largest organ in the human body? It's the skin. Absolutely. And that is an organ that can't be replaced. If you if you knock off a kidney, you can get another kidney, potentially. You can get a donor. Not that easy, but um, but your skin is something you cannot replace. And it's something I harp on my teenagers for constantly. And I think it's important to understand, you know, not only the type of product you use in sun protection, but the application and the frequency of application. Thank you once again for joining in for our Beauty and the Beast podcast. I'm, of course, Dr. Sal Pachella from San Diego, California. I'm here with my good friend, Dr. Sam Jajurkar, uh fantastic plastic surgeon, talented from Dallas, Texas. So, Sam, today we're gonna talk about our favorite topic, skin. Okay. Favorite topic as a plastic surgeon, skin is what we operate on, but we're gonna talk specifically about skin care. What do you need to do to keep that skin healthy? So, Sam, this is a billion plus industry. $200 billion annual revenue industry. Amazing, right? Every single cosmetics company has, and and other companies have options for skincare. There's so much out there. How do we make sense of everything?
SPEAKER_02Yeah, it's tough because you know, we are conflicted when we talk about skincare, because most of us sell skincare products in our office. And there's a whole area of um sort of medical-grade skincare that's been marketed, um, where people spend hundreds and thousands of dollars a month on their skincare products. Um, but it turns out that's not really even a thing. Like medical-grade skincare is not something that's recognized by the FDA. It's a marketing term that really describes who is selling the product and how it's packaged. Not to say that it's not good. Some of it is good, some of it isn't. But I think what our goal today should be to talk about the basics of skincare, what are the absolute minimum things you need to do? And then beyond that, what might be problems saying and what not, what might what might not be. So if I were to tell my patient that there is one thing that is the most important thing for their overall skincare regimen, I know what I would say, and I'm pretty sure you're gonna tell me the same thing. What is it? Hydration. Okay, I wasn't gonna say that, but that's a really good thing to say. But that's not but of a product you would put on your skin. Okay. What's the number one thing they should be putting on their skin? Moisturizer. Sunscreen. Are you just trying to mess with me?
SPEAKER_01Well, of course. And and so well, let's back up a second. Okay. So I think, in my opinion, the care of your skin is not related to what you put on the skin, it's related to what you put in your body. Okay. That's that really is my philosophy. And I think you know, nutrition is a very important point for skincare. I think hydration is a completely um disassociated thing when we come to talking about skincare. And I can tell, even personally, in my life, okay, I'm spending a day in the operating room and I'm not drinking water or drinking electrolytes, and I look at my face afterwards and it's just right. And so I think hydration is really key. But I absolutely hear what you're saying.
SPEAKER_02Sun protection argue against hydration, right?
SPEAKER_01That's clearly, yeah, that that really but but skin care related to sun protection is absolutely critical. So, along those lines, tell me a little bit about you know, SPF and what's in the sun block or what's in the sunscreen. So, what do you tell patients? What is an important product to have? What's an important product to avoid?
SPEAKER_02Yeah, I mean, so I think when we're talking about sunscreens, there's a wide variety of products that are out there. Um, the most important thing that I'll impress upon people is it used to be you'd have to say, is it blocking UVA, UVP, you know, zinc oxide. Does it have the every sunscreen that I see that's out there right now basically is the same to at any store that I mean, I spent 10 minutes looking at CVS, looking at all the sunscreens. And the SPFs of facial sunscreens all tend to be 30 or more, which is sort of the minimum uh threshold that we're looking for. And to me, it doesn't matter if your sunscreen costs $15 versus whether it costs $200. To me, what matters is that you're applying it every single day. So what I like to tell patients is make sure you're applying sunscreen daily. A $15 sunscreen applied daily is a lot more effective than a $200 sunscreen that's applied every now and then.
SPEAKER_01Well, let's go back to something you just said a few minutes ago. So you said you went into CVS, you looked at them, and they're all about the same. Okay. Is that true though? The ingredients for for sun sunscreen. I think I'm not sure exactly what you're getting. Okay, so let specifically so let's kind of go back to that CVS. Okay. And I'm, you know, when I was a younger person and I didn't have a ton of money, and I just buy the lowest thing on the shelf, that's the cheapest, right? Spray on sunblock. That sunblock or sunscreen has avobenzone in it, right? Okay. Now when I put on sunblock, I you know, I surf quite a bit, I'm exposed quite a bit. I use a stick-on that has a reflective sunblock in it. Okay. So that is zinc or titanium. So what do you know about Avobenzone or Avo things that have the BNZ in them in sunscreen?
SPEAKER_02What do I know about them? Um, I you have a point to this that I don't know where you're going with it. So why don't you just tell them?
SPEAKER_01Okay, so that is a product that is almost on the verge of being banned by the FDA. Okay. So it that that phrase or that uh suff or prefix pre if it's a suffix or a preface, okay. Um, B-E-N-Z, that it that is a a hydrocarbon that is known to be carcinogenic. Okay. And but is that even are they selling those products anymore? That's they still absolutely are selling those products. I can tell you, you know, I'm I'm trying, always trying to put sunblock on my kids. We have products all the time that we see that come, you know, my wife might buy them, my kids might buy them, and they absolutely have those. And to this day, it has not been uh retracted off of the market from the FDA. So one thing I tell my patients is they constantly ask me about sunscreen, and I say, here is what I use. I use this surfer block. Um, it comes in a stick, it comes on white, okay. This is not a it's not a fashion contest, okay. It doesn't matter to me if it's white or not, okay. They they do make some expensive sunscreens that are zinc and titanium or reflective sunblocks that are clear, okay. Um, those I think are okay. All right. I I do my best to uh have patients avoid the ones with benzene in them because it can be toxic. Uh, we just simply don't know the extent of it. It destroys the environment, too. Not to sound like uh, you know, an environmentalist, but you know, that we have some stewarding to do um that gets into the water supply, it gets all over the place, and it is a carcinogen. And so, you know, I am a firm believer in the reflective sunbox.
SPEAKER_02Yeah. Yeah, I think that's that's very uh important for our viewers, you know, to know. And and then again, it illustrates, I think, that a lot of the products that you can buy that will be useful though are ones that you can buy over the counter. In our med spa, in our practice, we obviously sell more expensive products that are you know not white and that are that are you know titanium and zinc oxide, but ultimately I think you can get by with a relatively inexpensive product. Right. The next thing that I think is really important as sort of a mainstay of skincare is some form of retinoids or retinols. And so um, you know, as you know, tretinoin is used to be called retin A, but tretinoin is sort of the medical strongest form of retinoic acid that's out there, and it comes in different prescription strengths. 0.1% is the strongest. What's the point of retinoids? Retinoids actually will cause epidermal or the top layer of the skin to turn over. It causes fibroblasts, which produce collagen to grow, and then it causes more collagen synthesis. So if you look at the product that we apply to our skin that I think does the most in terms of reversing the signs of aging, it's it's retinoic acid. The problem is, is many patients, when they apply retinoic acid, um, think they're having an allergic reaction to it. They'll say it's making my skin peel, it makes my skin turn red, and they will discontinue. And that's really a sign that it's actually working. So, in the world of cosmaceuticals, they've now developed a lot of retinol products. Retinols tend to be a lot more expensive, but less potent than retinoic acid, but it can be better tolerated from a side effect standpoint. My personal philosophy, and please tell me if you agree with this, is I do think retinoids are very important for patients. I'll tell them we want you to use this product for six months to a year to kind of create maximal improvement in your skin quality. And then once you sort of reach this point of stabilization, you can transition to a retinol product. And then at that point, it's going to be maintaining what you've done with that. Do you find, I mean, I'm sure many of your patients are on that. Do you have any sort of philosophy where those products are concerned?
SPEAKER_01Yeah, I mean, I think the traditional product of retin-A, I think is something I'm pretty familiar with. Um, particularly, you know, I do a lot of skin cancer reconstruction, a lot of skin cancer work. Um, our our dermatologists recommend that all the time because it reduces, you know, as you said, it it flakes off the epidermis. If you have uh skin cancer, you can kind of see it come through the skin a little bit more. So I agree. And I think um it really is about patient tolerance. You know, I that episode you said, well, I'm allergic to this, you know, I do hear that not infrequently from patients. So it's really about tolerance of what they can deal with.
SPEAKER_02Yeah. And and I think the next pillar of a skincare regimen should be some form of antioxidant treatment. And that can be a vitamin C or a vitamin E niacinamide product. Um, basically, what you're doing with an antioxidant is you're getting rid of free radicals that can damage the skin. And again, um, I think that um that, and along with um bleaching creams and patients with pigmentation like myself and even like you, who are a little bit, you know, have some melanin to them, can be really helpful to make the skin look uniform and to give the skin a healthy glow. I think those personally are my pillars, that along with moisturizer. And I think, you know, depending on people's budget, can probably be done for $100 or less a month in a way that can make their skin look very good. Now, the question is, what do you think about other products? Like products, your exosomes all the time. Like we sell tons of exosome in our med spa. Um exosomes are products that have a lot of promise. And you know, they're supposed to be uh releasing signals, you know, the DNA signals that are gonna essentially allow your skin to have these beautiful properties, but there's just no data to back this up. So when people ask me what I think about ectosomes, I tell them not to spend their money on it.
SPEAKER_01I don't know what you think about that. Yeah, I agree. It's uh, you know, I think in medicine we have to understand that we make decisions on evidence, right? And so we don't make it on popularity or marketing necessarily, right? And so I agree with you. There's you know, there's all sorts of stuff out there that are that's talking about how beneficial it is for skin, and a hell of a lot of it is not proven.
SPEAKER_02Yeah. Now, let's say you have a patient, Southern California patient, who's spent their years out in the sun and they just haven't done a great job of taking care of their skin. And they come to you, they have a lot of pigment changes, they have fine wrinkles. You know, how are you gonna tell that patient, look, this is the thing that I think you should do first for your skin? Like, is it gonna be skin care? Is it gonna be some type of resurfacing? Like, how are you gonna steer that patient?
SPEAKER_01Yeah, I think um, you know, for those patients with tremendous sun damage from skin or from the um just not paying attention for years, I think there's the best and most important strategy is laser treatment, laser resurfacing. But that is in a sequence, as you describe. Okay, so I think before you do laser, you have to prep the skin in order to do that, right? So, and that's where the retin retinols and and retinase come into importance, right? So you want to sort of flake off all that dead skin first. You want to recompact the stratum corneum and the epidermis, you want to get it ready for that laser treatment. And there's all sorts of lasers out there. In fact, you know, there are Swiss Army knives of lasers that you can use, um, fractionated lasers, full CO2 resurfacing lasers, uh, PDL lasers for pigmentation things. Um, and again, I think you know, you you have to choose the right weapon in your armamentarium for each particular patient.
SPEAKER_02Yeah, and and for patients that are out there, it can get really confusing. Um, I think there's basic terms that they should know. Ablative versus non-ablative lasers, basically, how much heat is it generating versus it not generating heat. Um, fractionated versus non-fractionated, non-fractionated or full field, there's no little skip areas, tends to be a slower recovery. Fractionated, you create little skip areas. CO2 versus erbium. Basically, it's telling you what the chromophore or what basically what the what it's what the the laser is attracted to. CO2 and erbium people tend to patients tend to come in requesting CO2 lasers a lot to me. And that's fine. We have CO2 lasers in our practice, but a lot of times erbium is gonna be better for them based on their skin pigmentation. And so I think patients should realize that the efficacy of a laser treatment is very much related to the downtime. The longer it takes for you to recover from it, the better the treatment's gonna be for them.
unknownRight, right.
SPEAKER_02So um, you know, I think it's not a top, you know, in the beginning you said this is a topic we're very excited by. There was an element of sarcasm in that things like talking about surgery, not about lotions to rub on your skin. But it can be confusing. There's lots of products that are out there. And the the mentality for patients sometimes when they haven't taken care of themselves is that they need to throw a lot of money at something to fix it. Remember, if you are a patient, if you are trying to figure out how to take care of your skin, make sure you do hydration, like Dr. Pachella said. You use a titanium oxide or zinc oxide containing sunscreen, like Dr. Pachella was saying. Use retinoids in the beginning, and then you can transition to retinols, use some sort of antioxidant, use moisturizer, and that's your skincare regimen right there.
SPEAKER_01Let me make a point here too. Um, you know, and I think um, for those of the listeners and um viewers out there that have children, okay, and you know, I am a father of teenagers in Southern California. It's a constant struggle on skin sun protection. Okay. What is the largest organ in the human body? It's the skin. Absolutely. And that is an organ that can't be replaced. If you knock off a kidney, you can get another kidney, potentially, you can get a donor. Not that easy, but um, but your skin is something you cannot replace. And it's something I harp on my teenagers for constantly. And I think it's important to understand, you know, not only the type of product you use in sun protection, but the application and the frequency of application. For example, for somebody who does a lot of eyelid surgery, particularly cancer eyelid surgery, okay, I can't tell you how many times I have patients come in with cancers along the margin of the eyelid. And they say, you know, I've used sunblock for 20 years. Okay. Well, we don't really tend to put a lot of sunblock on our eyelids. And that is a really an area that is problematic. Or, you know, Doc, I don't know what the issue is. I use a big brim hat all the time. And why did I get this skin cancer on my upper face below my eyelid? Well, sun does bounce off the pavement and it gets reflected back upwards. So it's really not enough to just simply wear a hat. You're not getting direct exposure, you're getting secondary exposure. Glasses, okay? Sunglasses, one of the things we wear to protect our eyes from the sun, sometimes cause problems because if you look at my glasses here, there's a convex surface on the inside. If I'm wearing my glasses like this and ambient sun is hitting from behind me, well, guess what that's doing? It's it's focusing right back at me on my eyelids. And so certain areas are really susceptible to sun damage, and that's in and around the eyes and around the nose, the ears we constantly forget about. So hammer your kids, get them really believing in sunblock. It's the only skin they have. That's great advice.
SPEAKER_02And on that note, I think we can wrap up this episode. Thanks for tuning in, and we'll see you on the next one.