Rethinking Aging in Aesthetic Medicine: Integrating Longevity Science into Aesthetic Practice - with Dr. Suzan Obagi, MD

Wrinkles, sagging, and pigment are easy targets because we can see them, measure them, and sell treatments for them. But I keep coming back to a more uncomfortable question: are we actually treating aging, or are we only managing the appearance of aging? In this conversation, I sit down with Dr. Suzan Obagi, a leader in cosmetic dermatology and cosmetic surgery and Associate Professor in Dermatology and Plastic Surgery from the University of Pittsburgh Medical Center and former President of the American Academy of Cosmetic Surgery, to follow the smoke back to the fire and talk about what really drives skin aging and recovery.

We break down intrinsic aging versus extrinsic aging and why epigenetics, inflammation, and oxidative stress matter as much as lasers and injectables. Dr. Obagi explains what collagen, elastin, and glycosaminoglycans do, why their production peaks early, and why menopause can accelerate collagen decline. We also get honest about hormone replacement therapy: how estrogen affects skin, mood, joints, vessels, brain health, and wound healing, where risks truly live, and why many women are still mismanaged with symptom-only fixes. If you care about healthspan, longevity, menopause skin changes, and better surgical outcomes, this part will shift your perspective.

Then we turn practical. You’ll hear the simplest high-yield skincare routine we both rely on: cleansing, well-formulated antioxidants morning and night, moisturizers that support barrier function, mineral sunscreen, and retinoids with realistic timelines for results. We also unpack why some medspa “annual” treatment advice keeps people on a treadmill, and we look ahead at where anti-aging medicine may go next, from rapamycin analogs to NMN to the promise and complexity of Yamanaka factors.

If this made you rethink your approach to anti-aging skin care, hormone health, or aesthetic medicine, subscribe, share the episode with a friend, and leave a review so more people can find it.

Dr. Suzan Obagi links:

Instagram: @suzanobagimd

Website:http://dermatology.pitt.edu/people/suzan-obagi-md

Tweet me @realdrhamrah
IG @drhamrah

Transcript

Welcome And The Big Question

SPEAKER_02 0:02

Alright, everybody, welcome to another great episode of the Darry Hammer Podcast. Let me start with something that might sound a little uncomfortable. Especially if you're in aesthetic medicine. What if everything we've been doing to treat aging is mostly focused on the wrong target? So not completely wrong, but incomplete. Let me explain. For years, um actually decades, we've been trained to treat what we see: wrinkles, volume loss, skin laxity, pigmentations, you know it. And we've gotten really good at it. There's many devices, many products that help us in doing so. Lasers have evolved, injectables have evolved, skincare has become a multi-billion dollar industry promising transformation, and in many cases it has. But there's the question I've been asking more and more, especially over the last few years. Are we actually treating aging, or are we just managing the appearance of aging? I always use this analogy. We're treating the smoke, but we're not always addressing the fire underneath. Because the real drivers of aging, what's happening at the cellular level, things like inflammation, hormone changes, metabolic health, mitochondrial functions, those are often not even part of our conversation. And yet, they determine everything. How your skin heals, how your collagen behaves, how long your results last. So today's conversation is one I've been really looking forward to because it brings together both sides of this equation. I'm joined today by someone who has been at the forefront of cosmetic dermatology and cosmetic surgery for decades. Someone who understands skin at the highest level, but also appreciates the deeper biology behind it. Dr. Susan Abaji, board certified by the American Board of Dermatology and American Board of Cosmetic Surgery, who is also associate professor of dermatology and plastic surgery at the University of Pittsburgh Medical Center, and is the director of University of Pittsburgh Medical Center Cosmetic Surgery and Skin Health Center, and former president of the American Academy of Cosmetic Surgery. Susan and I were recently on a panel together at the American Academy of Cosmetic Surgery annual scientific meeting, where she spoke about the role of hormones in specific when it comes to skin health and aging. For me, that was the bridge, that was the missing link. That's where the conversation needs to go. So today, we're going to talk about skin, but not just from the outside in. We're going to talk about what's really driving aging, why some treatments work and others don't. And whether we as a field need to rethink the entire way we approach anti-aging. So this is going to be a good one. Thanks for coming back on my podcast. So good to have you. And I want to start with the first question, diving into the deep end. And ask you maybe an uncomfortable question in aesthetic medicine. Are we treating aging or are we just managing the appearance of aging truthfully?

SPEAKER_00 3:39

Yeah. I think that's a very important question. And I you and I have had so many side conversations over the past few years about this topic because we're coming into it ourselves. And we're realizing that we are all going to live hopefully a longer life. The question is, do we want to live just a longer life or do we want to live a longer, healthier life? And with that being said, I think our population definitely is getting older. And we're going to see by I think 2030 more people over the age of 65. By 2050, a vast amount of the population will be over the age of 65 and fewer younger patients. So we do need to evolve how we approach our aging patients. Because up until this point, I think you're correct. We look at them, we can completely describe the hallmarks of aging in their appearance, whether it's the changes in the bone structure of the face, the loss of the fat pads, the change in skin texture. And up until this point, we fix what we see. And I think those of us who are at our our age, and of course, granted, I'm much older than you are, are coming into the point where we're starting to reflect on our lives and say, you know, I, for my own self, want to live a longer health span. And so we start educating ourselves about the field of longevity. And we are realizing more and more that that's also applicable to many of our patients. So those of us who are really taking that interest in educating ourselves are then translating that to our patients and bringing them along for that journey. And that's what's going to be the true change. Because as you and I talked in our lecture and our session at the American Academy of Cosmetic Surgery, even when we're doing surgery, there is a role for really managing the patient's systemic health prior to starting to do the surgery so that they actually heal better, so that the results last longer. And so it's it's very exciting. I think there will be a shift, and hopefully you and I can nudge that along.

SPEAKER_02 5:59

You know, you obviously when someone listens to you and listens hopefully to the end of the podcast, they might think, well, this is obvious. This is we all know that a healthier lifestyle or you know, maybe uh optimizing your health before any procedure will help that. But why do you think as a profession that is not something forget about being practiced but even taught currently? Because people think if there is something at the forefront, it starts with the educational institutions, curriculums. And so how long do you think it's gonna take for things to change, to evolve? Because you and I just discussed uh before the podcast when we were talking that I think this uh shift in thinking has to start with uh the young surgeons with education because there's gonna they're gonna be the future. But we have to set the examples as the educators. So there is a responsibility that comes with it. But prior to this responsibility, there has to be a self-awareness and a self-education. So where do you see how how long do you think this shift is gonna take, which we're gonna talk about?

SPEAKER_00 7:28

It's going to take some time because I know for a fact my daughter is currently in medical school. They do not teach about longevity, they teach about addressing disease. What we need is What is the difference for the for the listener?

SPEAKER_02 7:43

What is the difference? Uh because longevity is just such it seems like a buzzword, but there's a lot into in in this word. So for the audience, quickly describe what's the difference between treating disease and longevity.

SPEAKER_00 7:59

Longevity truly is the fact that we are all, if we take relatively good care of ourselves, are going to live longer and longer as we have compared to generations past. And I want to throw another word in there. Aside from a longer lifespan, we really need to change that focus now to a longer health span, which means that we want to spend the vast majority of our years healthy as opposed to just living to 90 and having a lot of systemic diseases. And what needs to change is that we need to recognize that aging itself is an inflammatory disease process. When you label aging as a disease, in a way, and this is not to take away from just the knowledge and maturity we gained through the years, we're solely talking about how the body ages right now. We need to look at it as most of what we see as aging is uh is impacted by our environment. So we have intrinsic aging, which is just our biologic clock. And that biologic clock is going to slow down over the course of years. But none of us live in a bubble. We are breathing the air that's polluted, we are drinking water that may be contaminated, we are ingesting foods that have a gazillion chemicals in them. So we are now accelerating the aging process by these extrinsic factors, which now is called extrinsic aging. And that's the disease process. So, yes, we're all going to age, but how can we modify those extrinsic factors so that we age well? Once we change that thought process and treat that truly as a disease, then we'll see the medical schools come on board and educate about that. Unfortunately, there's no pharmacologic reason for companies to invest in this right now, although there are some interesting medications out there for increasing longevity. But right now, since most pharmacologic companies want to treat diseases, that's where the focus and the money and all of that's going to be. So they're going to treat diabetes, they're going to treat hypertension, they're going to treat obesity, they're going to treat cancer, but no one's looking at the preventative side of it because there's no money to be made there. And that's sad because a lot of what we teach in medical school now is driven by things that we can treat pharmacologically. And we really need to improve what we can do just behaviorally with modifications and so forth.

SPEAKER_02 10:42

It's one thing you said we are experts in defining skin aging, the hallmarks of aging, describing everything. Every textbook you open up as a student, resident, fellow, and even for us, every article that's still published so focuses on the symptoms of aging, right? And then the next step is okay, how could we fix it? And at no point there is even forget about a paragraph, there is not a mention or a sentence, a word about why that occurs. And you you you talked about a little bit about what what I call the or what is called the epigenetic factors, meaning the influencers of the aging process, the influencers of lifestyle. You know, today you talked about all these extrinsic factors, you know, back in the days, which today still in most countries in the world, factors like simply smoking and drinking, which at this point everybody knows how bad it is, not only for your health, but for the aging process. I mean, there is so many twin studies out of uh Finland, even here out in the United States, that really show the effect of the extrinsic factors, of the epigenetic factors like smoking, drinking, uh lifestyle, lack of sleep, stress, all of those things on your aging process. And but that's never mentioned. Is it because it's not interesting? People accept it, they're like, well, you know, it is what it is. You know, people live their lives the way they want. Our job is not to educate them on that. Our job is just to fix it. We are fixers. We are skin fixers, we are tissue fixers, like mechanics in the mechanic shop. No one asks, how did the car crash? Why did the car crash? Maybe we should build in some safety features into the car so we don't crash it. But if you're a body shop, you're not interested in that, are you? So do you think there is an ethical obligation or an ethical dilemma within what we do and a responsibility that we carry to educate patients on that? I know I'm taking us a little farther now, way into the future, but I'm asking these questions to maybe evoke some curiosity and rethinking, perhaps, from our profession.

SPEAKER_00 13:17

Well, I think right now depends on the kind of surgeon that you're going to. If you're going to somebody who's only going to be doing body lifts and body work or facelifts and rhinoplasties, and then send that patient home and wait till they need another procedure and not see them again. That's a different type of practice. That's not somebody who's going to be easily convinced that they need to take into consideration the patient's longevity and how to set them up for aging well and how to set them up to delay the need for surgeries in the future. Because their job or their practice is set up to just do procedures. I think my practice is a little bit different. I get a sense that your practice is a little different. I build long-term relationships. My patients are my patients for life. I've had I've been very fortunate in that I even have many patients that are still with me from residency and fellowship years. Wow. And I take care of their children now.

SPEAKER_01 14:15

Wow.

SPEAKER_00 14:16

So I think that's an honor. And I love that. So I do want to make sure I take time that to educate my patients about behavioral modifications, lifestyle changes, hormone changes that they can make to help them age better. And then when they need procedures, I'll do the procedures. But my focus is not solely on the procedures.

SPEAKER_02 14:39

And and so let's talk about skin aging for a second, because you know, we talk a lot about the hallmarks, and we assuming the audience knows these things, knows what happens to the skin. You know, all they see is maybe wrinkles, wrinkles in the skin and color changes. But I think when we try to address aging of the skin and help in prevention thereof, and also treating the already occurred aging, it's important to understand first what happens for the audience. And as most listeners are necessarily not have not necessarily studied biology or anatomy. So let's talk about uh skin aging very briefly for the layman. What happens during the skin aging and is there a stage or a decade where that part of the aging accelerates and what are the causes of it? And then we can talk about obviously the extrinsic factors, which are obvious hopefully to most people, but mainly focus also on the intrinsic factors.

How Skin Ages By Decade

SPEAKER_00 15:48

Sure. So if we look at just skin aging in general, what's going to happen as you intrinsically are going to have your biologic clock slow down? The skin is comprised of the epidermis, which is the top layer of the skin. That's the part that you feel when you touch your skin. Then you have the dermis, which is the part that you pinch. And that dermis has collagen, elastin, glycosaminoglycans in there. And those each have a role. The collagen gives you skin firmness, the elastin gives you bounce back. When you pull the skin away, it snaps back. And the glycosaminoglycans give you hydration. Now, patients are shocked. I always pose the question to them when they come in. At what age have we peaked in our collagen, glycosaminoglycan production, elastin production? And it's 18. Somewhere around 18 to 25, that's our peak, bone density as well. But we don't talk about bone density until we start to see osteopenia and osteoporosis. We could talk about skin health. Our peak skin health is around that time, 18 to 25, and then it starts to decline. From 18 onwards, you start to have a 1% decrease each year in that production of those three proteins. So from 20 to 30 to 40 to 50, that's a 30% drop in what your body is normally making. By the time women hit menopause, that decline doubles. It goes from 1% decline a year to over 2% decline a year. So it shows you that you're taking away something, whether it's estrogen, progesterone, testosterone, that is a driving force for skin turnover and skin collagen production. And by entering menopause, that you're having that 2% decline in those production of those proteins. So that that's what's happening as we are intrinsically aging.

SPEAKER_01 17:51

Now add to it, I was going to say add to it.

SPEAKER_00 17:54

Any external factors. If you tanned your skin a lot, spent time in a tanning bed, if you smoked, you're literally adding fuel to the fire now. If you eat a high sugar diet, if you don't have an antioxidant-rich diet, all of this plays a role in how fast the skin is going to age, and you're going to accelerate that. So I'm telling you what the baseline is, and then everything else that's extrinsic is going to accelerate that.

SPEAKER_02 18:20

So you talked about glycosamine, glycan proteins, and elastin and collagen. Just briefly describe what those are and what their function is just for the layman, so they understand the relationship between those and skin aging.

SPEAKER_00 18:37

Yes. So collagen is what gives you your dermal thickness. So, you know, we as we age, we know skin gets thinner and it's more fragile. So that's because of the loss of collagen. As we get older, skin gets drier. That's because of the loss of the glycosaminoglycans, which act like sponges and suck up water and keep that dermis hydrated. And then also as we get older, skin gets lax and wrinkled. And that's the loss of the elasticity or the elastin fibers that give you that bounce back and keep that skin firm rather than lax.

Slowing Aging With Daily Habits

SPEAKER_02 19:14

So when you knowing this now, understanding that it sounds like this from what your description, this aging process, one to two percent aging over time, is inevitable. How much of it can we slow down? And what are some strategies that you recommend to slow slowing this process down?

SPEAKER_00 19:37

Well, definitely taking care of the external factors as much as possible. Patients really think that all they have to do is throw on some sunscreen and that's enough. And there is no sunscreen that's 100% protective. Otherwise, you'd be walking around covered in zinc oxide, white paste, the really thick stuff to try to prevent some of that damage. So I always say you've got to use sunscreen and the hat as much as you can to try to minimize the impact. And I said minimize, you can't completely avoid the impact of those environmental rays on the skin. That's one thing. Don't smoke, eat a healthy diet, because some of those damaging rays are going to get through and they're going to cause free oxygen radicals in the skin that then go into the skin cells and damage the nucleus of the skin, so they're damaging the DNA. That's what causes that epigenetic shift. So that means that I was going to say that means that our and for your listeners who don't know what epigenetic shift is, we are born with a set of DNA and genes. But if you check our genes today, yours and mine, we are different than what we were born with. And that's because of this epigenetic shift. The environment has caused changes in our DNA from the damage that's accumulated over time. So our genes have changed now. And so we need to try to minimize that. We need to try to minimize antioxidants with antioxidants to the free oxygen radical damage that's happening. So that comes from applying antioxidants to the skin. It also means eating an antioxidant-rich diet. We need to make sure we're taking in enough protein because as we age, our ability to build muscle mass diminishes. So we have to exercise, try to keep our muscle tone strong and feed those muscles with the right protein so they can build muscle mass. But the most important thing to understand, whether it's menopause or andropause, which is the male equivalent of menopause, as we live longer, we're going to spend many more years in andropause and menopause. So female patients right now, given how long we live, can expect to spend four. Of their life lifetime in menopause. We need to address that because we had a faulty study, the Women's Health Initiative, that incorrectly said that the bioidentical hormone replacements caused breast cancer. And so for 20 years, women got shortchanged and were not given the proper hormone replacement therapy. A lot of doctors now are aware of this and are having these conversations with their patients to try to make sure that they capture those patients during the perimenopause phase, but at least try to get them even early into menopause to start them back on estrogen, progesterone, maybe even low dose testosterone, if they don't have any risk factors for that, so that they spend a healthier amount of time during that 40% of their life.

Menopause Hormones And Skin Health

SPEAKER_02 22:57

And the way you said it, which is the reality which dates almost half of a woman's life is spent in peri and postmenopause. And those happen to be the patients that we see that we treat. Almost like a frenzy of desperate attempts and methods to correct or what we erroneously call reverse the aging process, which we're not. I believe actually we're contributing to it in some ways, especially when it comes to injectables. But that's maybe we'll get into that topic. I know that's a very controversial topic. So I want to know from you, maybe you can guide us in the audience on how you are trying to address this issue and address it at the cellular level, meaning adjusting hormone levels in an attempt to improve or even avoid skin or slow down the aging process that you described. We we already know who is affected by this. I mean, perimenopause starts ten years prior to menopause, which I think the average age of menopause is 49 to 50. Which means perimenopause starts at 39 to 40. And then you have menopause 10 years later, and then another 10 years you have menopause. So there is about 20 years perimenopause, and then there's postmenopause. So it's a huge patient population. And I know in my practice it's 80% of my patient population last time I checked. Describe first the effects of hormone decline and skin aging, specifically the thickness and the quality, as well as what how improvements of hormone levels can mitigate that to a degree, and how you if or if you're trying to integrate that treatment in your skincare regimens and treatments like lasers, IPLs, skincare products, etc.

SPEAKER_00 25:50

Yes, I think you said it before. We are fixing the car after it broke down. And what we really need to do is make sure people are taking care of that engine before it breaks down. And so I'm constantly now trying to bring this up as a discussion point. Even when patients are coming in for something as simple as Botox or neuromodulators or fillers, which I you and I might disagree a little bit on some fillers. I do use uh fillers in my practice judiciously. But I that gives me a chance to have a conversation because I'm seeing my patients every three to four months, which is really fantastic from that standpoint. And I can bring them up to date on the latest knowledge I've gained during the interim since I saw them last. And I think what I try to educate them on is if they're starting to see dryness in the skin, fine lines and wrinkles, skin changes in the neck, all of that, those are signs of hormone decline. And I do have, I'm lucky to have midlife GYN in our neighborhood that I can refer to to make sure that she's checking their estrogen and testosterone levels and trying to get them on the bioidentical hormones so that it doesn't uh let them go into full-blown menopause where they're starting to really suffer from the estrogen withdrawal. Estrogen is basically the antioxidant effect in the body. It actually helps to increase the production of certain antioxidants in this in the body, not just the skin. It has anti-inflammatory effects on joints, on the vessels, on the brain. It has really good effects on wound healing, which is why younger patients heal better than older patients. And it has tremendous effect on wound and scar remodeling as well. So basically, every cell in your body has estrogen receptors, your keratinocytes, the fibroblasts that are in the dermis making all those good proteins, your vascular cells, your immune cells, they all have estrogen receptors, which is why the minute you take away that estrogen, all of a sudden women have more autoimmune diseases, women have more joint issues, women start to have cognitive decline, women start to have increased risk for cardiac disease, stroke, all of that. Now, I don't want to downplay the risk of estrogen and progesterone in terms of breast cancer and uterine cancer, but that risk is always there. And you have to tailor the approach to the patient's family history and to how often are they going for their mammograms and doing their pelvic exams and all of that. So I'm not out here saying everyone should just be on it and it's a panacea.

SPEAKER_01 28:53

Of course.

SPEAKER_00 28:53

It is a true medication. There are the risks that go along with it. But I think if you can make an educated decision as a patient, many will choose to go for their annual screenings and take that chance of a small increase in the risk of any breast cancer or endometrial cancer for the tremendous benefit in all the other aspects of health. More women die of excuse me, more women die from dementia, osteoporosis-related disease, cardiac disease, all of that than they do of breast cancer. So it's not to say it's not important, but you have to educate your patients so that they can make that decision for themselves.

SPEAKER_02 29:38

100%. I mean, you we already see the shift that's happening in the awakening and the education that has occurred in the past two years. Now, the estrogen patches, there's a shortage of estrogen patches of many patients that are freaking out. They're they're like, I'm on my last patch and I don't know what to do. And what that says is two things is first the need that there is and how far backed up the industry, the pharmaceutical industry is with supplying the demand. I don't know why they've been waiting for this. I mean, the cast was out of the bag a couple of years ago. I don't know how maybe they miscalculated it. But that tells another story on how desperate the this peri- and post-menopausal population was that as soon as they learned about it and educated themselves, they went all in because a lot of these women, you know, they are my patients, they are suffering when they talk about their pain, they say it with tears in their eyes. And and I didn't understand for a long time. I didn't know, I always, and that was my fault and my ignorance. I never understood why they're so emotional, why and and because I was never taught in training. I was just taught that there's some people that are very emotional, some people they're not emotional, others are crazy, and then there's a normal people, stay away from the crazy people. You don't want to deal with the emotional ones. Well, after 20 years of practice, I'm like, then I can't treat anyone if if that was the case. But how how can we help these people? Now understanding the root cause of a lot of these issues was the hormonal imbalance is was very eye-opening for me. So several years ago, I really tried to invite a lot of experts in this field, like Mary Claire Haver, etc. And I learned so much about it, and it was so humbling for me. So I approached my patients with a complete different empathy and understanding, and always addressed that before I even make suggestions about what treatments we're gonna do, or even before we schedule their surgery, because you yourself alluded on the effects of hormones and wound healing. You know, talk talk to us a little bit, both for men and women, right? You know, in a negative and positive way. I mean, we are treating scars with steroid and Kenlock injections and or wound necrosis. We're so worried about wound necrosis, flap necrosis. Well, a lot of this can be mitigated and prevented through addressing at a cellular level and optimizing these patients before we take them to the operating room. So talk to us a little bit about hormones and wound healing as well as scar formations or mitigation.

SPEAKER_00 32:55

Absolutely. But let me backjack one second to something you said, which is you're talking about hormone absence now in menopause and the fact that women come in with anxiety and depression, and it's not anxiety and depression about their appearance. That estrogen deprivation increases anxiety and depression.

SPEAKER_01 33:18

In general.

SPEAKER_00 33:19

In general. And so what's happening is women are being prescribed anxiolytics or antidepressants when they should be given estrogen.

SPEAKER_01 33:27

Yes.

SPEAKER_00 33:27

For any patient that doesn't understand this, think back to when you were a teenager and you were having premenstrual symptoms. You know, the those women who have premenstrual symptoms, right, leading up to their menses, with whether it's depression, hot flashes when they're sleeping, change in appetite, that's your hormone withdrawal. That's almost like a mini version of menopause, right there that you're experiencing as a teenager and young adult every time you're pre-menstrual. And we used to always say, Oh, that person's pre-menstrual, they're they're tearful. We would just chalk it up to something in their head. And it's truly the hormone deprivation that's happening at that time of a cycle. Take that forward. As you said, we start to enter perimenopause 10 years before we actually are in menopause. When do we see the highest number of women being given antidepressants and anxiolytics that age group? And it's because they're having that hormone deprivation at a low level. Address it. We need to address the root cause, not the symptom. We're not, we should be able to do that.

SPEAKER_02 34:38

You know, Susan, this this really makes me this makes me upset. This makes me so upset at a different level. Because this makes me upset because I feel like we're making it way worse by prescribing antidepressants. I can't tell you how many of my patients are on antidepressants. And I wonder, I I just wonder how many of those could have been simply treated differently.

SPEAKER_00 35:06

Well, you know what? It's not too late. Here's my advice to my patients, even those that are already through menopause. And I think what I try to educate them, they tell me, Oh, I'm already done, I don't have any more hot flashes, I don't need to go on hormone replacement. And I tell them, it's not for the hot flashes. You need to be on this so that you reduce your bone loss risk, so you don't want to develop osteopenia overseas and osteoporosis. You need to be on this to reduce your risk of dementia, to improve your cardiac health and your skin health. So there are more reasons to go on it than just getting through hot flashes. That's not the only reason to be on it. But there's this thinking that if you're over the age of 65, for example, and you've been in menopause for 10 years, if you're if you've been in menopause 10 years or longer, that there's no reason to put you on hormones. And I beg to differ. No one has studied that. No one has looked at this older generation and tried to give them hormone replacement to see if they benefit. So we do know maybe it doesn't benefit their heart, for example, as much at that point because maybe they already have calcifications. But no one's looked at does it benefit their dementia risk? Does it benefit their overall bone health? And so I tell my patients, okay, you've been in menopause over 10 years. You need to have a frank discussion with the midlife GYN and say, I understand I'm in that group that they don't know if it's going to help me, but we know it's it no one's looked at whether it's going to hurt. So if someone's going to be.

SPEAKER_02 36:54

You know, you humbled me at the meeting because that was a question from the audience afterwards. And the question was whether it helped we should take it beyond 10 years post-menopause. And and I was wrong because I thought from what I had learned that there is no added benefit. But then you really humbled me, but and and and I completely changed my thought process on this by what you just said, because that was exactly your response. And you said, well, the studies are about cardiovascular risk. They are not, they didn't look for other benefits like bone health, dementia Alzheimer's, for skin health, for a lot of other uh factors, and because we just don't have any studies.

SPEAKER_00 37:44

Yes.

SPEAKER_02 37:45

So I that's a huge potential.

SPEAKER_00 37:48

Yep. I tell my patients, you may have to be your own guinea pig. You may just have to read up on the risks. And if you're willing to take it, find a doctor that will listen, that will start you on the estrogen and progesterone.

SPEAKER_02 38:02

Good luck with that.

SPEAKER_00 38:03

And eventually testosterone. I find that they're starting to, though. I have found, I have found, at least in my community, I have someone I can work with that is doing it. But even that person, that doctor, is giving them the lowest level estrogen and not including testosterone at some point. We have to catch up. Testosterone is not just for libido. That most doctors are prescribing it just to improve libido. They have to understand testosterone is working in conjunction with the estrogen to help us build muscle when we can't build muscle as much anymore. And when you build muscle, you make your bones stronger. So it's about strengthening our patients. If they get benefits in their libido, fabulous. But that's not the main reason to just do it or not to do it.

SPEAKER_02 38:53

You know, we just need more education, like you said.

Hormones Wound Healing And Scars

SPEAKER_00 38:58

Yes. But coming back now, this was a long winded answer to get back to surgery. Yeah, we do know that within 12 hours of surgery, your body has produced massive amounts of matrix metalloproteinases, which are these enzymes that are breaking down collagen and elastin and remodeling that dermis in response to the injury or the surgery. And unchecked, that response can be deleterious and cause delayed wound healing. Estrogen protects against that by inhibiting too much matrix metal protonases from being made. So it's a vital component of proper wound healing. And you need that so that you don't get the wound dehiscence or the wound breakdown. And at the same time, when you have estrogen-rich skin, that skin is thicker, more resilient. It has the ability to heal much better. And estrogen has, like I said, beneficial effects on the blood vessels that you need to come in and heal that wound as well. Even male patients, when they were given topical estrogen to apply to wounds that were not healing, their wounds healed better. So it's really important for male patients and female patients for wound healing. And it's going to be extremely important for patients that are transgender, that are transitioning from one sex to another, because you you may have to manipulate those hormones even a little bit more and optimize them a little bit more during the healing process so that they heal from these major surgeries that they're going to have.

A Simple Skincare Routine That Works

SPEAKER_02 40:39

And this is something that I've anecdotally observed within my patients. I have now two groups of patients. I have the ones that, when they come to me, they are on a longevity journey, they have had their hormones regulated, optimized. I mean, they look amazing, they are happy, they feel amazing. I mean, if I could ask for a patient, I would ask for that type of patient. And then post-operatively, everything is so smooth. I mean, there is no forget about wound distance and breakdowns. I mean, their wounds heal amazingly. I mean, the wound edges, there's lack of inflammation, there is the whole process is so accelerated. And I know it's not a blinded study. I mean, I obviously know that they're optimized, but this has been just my observation and I compare it to the past. It could be also my techniques have improved. I don't know. But the thing is, the science backs it up, like you said, and it's not difficult to do to optimize these patients, because if we don't, the downside is all the other potential complications and wound issues that we have to then deal with, not to mention with the unhappy patient. You know, they have high expectations. So today, because of those expectations, because not only from a healing standpoint, like how they heal, but how quickly they heal, the expectations are going up. You know, more and more of our patients are out of town, so they don't want to want to fly back after their surgery, they want to look presentable when they go to the airport, etc. And they most of them want to go back to work. They have those expectations that after like a week, they're like, why am I still bruised? What's the swelling? It's like, well, it's been only a week. So they have these expectations, which some are unrealistic. And but when we look at optimizing these patients, not just from a lifestyle standpoint, which is what I do also, but also from a hormonal standpoint, we can meet a lot of their expectations at all levels. And and so that's something that has been a different approach in my practice, I know in your practice. And the other aspect I want to talk to you about when it comes to simple things, like let's not even talk about lasers, let's talk about simple skincare, which you're an expert on. From all these skincare creams, now obviously you're carrying a huge legacy with the Obaji skincare, and I think just for the audience, many might know that you're the daughter of the the father of modern skincare, Dr. Zayn Obaji. And we I think the Obaji skincare started the sophisticated and modern version of skincare, which was beyond. I remember back then, all my mother had in her bathroom was the Nivea box, the blue Nivea box that uh of cream. It was terrible. Now thinking of it, it was terrible, right? But that's all people put on. And so with all these modern skincare now, we expect, of course, the patients expect miracles. They even ask uh at a tea party or they're on a vacation, they meet someone, hey, what's your skincare? Meaning they expect miracles from just a skincare. How do you couple the education on uh the epigenetic extrinsic factors and intrinsic factors with the hormones and lifestyle? How do you tie that into your skincare regimen and recommendations?

SPEAKER_00 44:37

So I think I'll build on what we've already said so that I don't repeat that. Yeah. But you have to optimize everything from diet to hormones. That's a given. I do tell them there are some basic rules that you have to follow for good skincare. I follow them myself. I preach, yeah, I practice what I preach for the most part.

SPEAKER_02 45:00

Obviously.

SPEAKER_00 45:01

Thank you. I'm actually a hundred years old and you just wouldn't know it. I know.

SPEAKER_02 45:07

I was gonna ask you half an hour ago when you talked about the extrinsic and intrinsic factor. I mean, by the way, nothing applies to you. So people are sitting there, if the if for the ones that are watching, they're gonna want to know okay, just cut to the chase. What's your secret, Susan?

SPEAKER_00 45:24

Oh, thank you. So I say the most important thing morning and evening is cleanse your skin well. Because you need to remove makeup, oil, environmental pollution, all of that. And it has to be a relatively good cleanser that's going to remove all of that buildup. So that you have now a clean canvas on which to apply your skincare. Everybody needs an antioxidant. It could be al ascorbic acid, it could be an antioxidant serum, but it has to be well formulated. I know you also have your skincare line. It's difficult to formulate well-made products, especially antioxidants, because the first thing they want to do is oxidize.

SPEAKER_02 46:10

Especially vitamin C, the LScorbic acid.

SPEAKER_00 46:13

Absolutely. So there are special techniques that you have to undergo so that when you give a patient a product, you know it's delivering the results. I stand behind that. I will never recommend something that's not going to give a patient a results. Every step I give them, I tell them has a function in the skin. So they after they wash, they put on an antioxidant. Morning and night. Most people are telling their patients, just put it on in the morning because you're going outside. But you deplete it during the day. That antioxidant gets depleted as it's combating all those high-energy visible light, blue light, UVA, UVB, all those rays hitting the skin use up those antioxidants. So you have to reapply it again at night. Antioxidants are key. Those are to help your skin combat the rays that get through your sunscreens and so on. The second step is to have a good functioning moisturizer. For some patients, that moisturizer has to have a glycolic acid, phytic acid, or polyhydroxy acids in it. So that it helps to gently keep the skin from building up that thick dead layer and allows your other products to penetrate better, but it gives hydration. Some patients, though, as they get more mature, might not tolerate even the polyhydroxy acids as well. So it starts in the younger ages as glycolic or phytic acid, midlife more polyhydroxy acids. Later in life, it may just be a very well-compounded moisturizer that keeps moisture onto the skin. It gives the skin hydrate. And then you seal it all in with your sunscreen. And for me, hands down, until we get a new ingredient approved by the FDA, it has to be a mineral sunscreen.

SPEAKER_01 48:04

100%.

SPEAKER_00 48:04

Zinc oxide or titanium dioxide blend. Tinted is even better because that iron oxide gives you even an added protection beyond just the zinc and titanium.

SPEAKER_02 48:15

Yeah, it's an extraordinary.

SPEAKER_00 48:16

That's your morning routine. Yeah, that's your morning routine. In the evening, you wash, reapply your antioxidant serum, and then you need to apply your retinoids. And that retinoid can be retinol if you're very, very young. Retinaldehyde for 30-year-olds on up. And then as you start to need more, you add in a prescription tretinoin a couple nights a week. Eventually the goal would be to use that even more. And then as we get more mature again, if we're not on hormone replacement, we might find that our skin doesn't tolerate that prescription retinoid as much. So we revert back to two nights a week, the prescription retinoid, five nights a week, the retinaldehyde, that combination. Now, if patients have pigmentary issues in there, we add in a skin brightening agent. But again, it's about consistency and it's about making sure that you're not just using your skincare and then thinking you can go outside and expose your skin to sun. It's about always having a hat on, always having your sunscreen on every day, because even sitting in front of this light that I'm in front of here, that's emitting high-energy visible light and blue light. So we have to make sure that we have our sunscreen on all the time.

SPEAKER_02 49:35

Yeah, I think the blue light is something that most people uh underestimate, especially the ones that uh work in front of computers all day. And even regular people that I mean, if you look at from a social media usage standpoint, the average American spends over four hours a day on their devices. I mean, that's a long time.

SPEAKER_00 50:02

That's a whole other conversation.

SPEAKER_02 50:04

That's that's that's a long time. I mean, it blew my mind, and I'm guilty too, but I do a lot of work for an education on that. So, but the antioxidant advice, which is, you know, I use the alascorbic acid, which is vitamin C. Many years ago when we did the podcast, I took your advice and I used it both in the morning and evening. And I give that advice to that's something that I learned from you that I said makes total sense. Like, why how come I didn't think of it? It's like, what was I thinking, not putting it on twice a day? It's like, what's what's the harm? And if I look today and and I think uh the the judicious application and the discipline and the consistency with all of what you said is really key, otherwise it won't work. And how do you educate a patient that is not consistent with it with with this? Because they have these expectations, they think they put it on and within a week they expect miracles. How do you how do you get those patients to become disciplined, uh, especially those with high expectations and the ones that I guess the best example are the men.

SPEAKER_00 51:12

They are tough. Although sometimes they will start to use their wives' products, and then they'll come in and say, okay, my wife said I have to come in and get a consult because I can't keep using hers.

SPEAKER_01 51:24

Yes.

SPEAKER_00 51:25

But you know, skin is constantly turning over. And when you have healthy skin, you literally go one full cycle of turnover from the base of the epidermis to the seratum corneum and then off in six weeks.

SPEAKER_02 51:41

And that changes with age too. Can you slow down?

SPEAKER_00 51:45

That does it slow down as we get older. But as we incorporate retinoids onto the skin, you're turning those genes on again that will start to normalize that cycle. That's why retinoids are so important. And they do the same in the dermis with collagen, elastin, glycosaminoglycan production. They stimulate those fibroblasts to make that. But that's six weeks. So truly, if you want to see improvement, you have to give it a full skin cell cycle. I tell patients you'll see if you follow things consistently, you should see improvement within six weeks. If you wait full three cycles, which is 18 weeks at this point, that's when you really see very nice improvement of the results of a good consistent skin care regimen. The second thing I tell patients, there is no quick fix. You want lasers, you want peels, for example, you want a procedure. The minute you have it done, the results are going to start to reverse again. The only way to get the biggest bang for your buck is to prepare your skin well in advance so that when you have a procedure done, your results are even better. And then to go back on your skincare regimen so that the results are maintained. There is no other way. There's no shortcut. Otherwise, you have to come back every month and have a procedure done in the office. I tell them your best investment is your skincare, and then you have to do less in the office. And that's antithetical, I think, to a lot of ways that physicians and medispas are thinking because they think if they put a patient on a good skincare regimen, they're not gonna come in and do procedures, so they're not gonna make as much money off procedures. I'm looking at it, I'm trying to build trust, I'm trying to build a long-term relationship. I'm not there to capitalize on procedures nonstop. I want my patients to really look good. So I'm gonna give them that, and then when we do a procedure, they're going to be happier, which builds even more trust in what I'm telling them, which makes them want to stay as my patient for a longer period of time. I think so. I approach it a little bit differently. I would encourage every cosmetic provider to think about it that way. Don't think short-term gain, because the more you improve your patient's health, the more they're going to trust you and want to stay with you.

Consistency Over Medspa Quick Fixes

SPEAKER_02 54:08

Yeah, you mentioned something about the business model that is, I guess, for lack of a better term miseducating our patients that a lot of these pop-up med spas have, you know, without calling anyone out, it's just any business has to be profitable. And the profitable business is the recurring business. And a lot of these are set up that way, like you alluded to. And if you count the numbers of those pop-up spas compared to institution like ours, I mean, we're outmanned by the thousands. And I feel a lot of and I've felt this trend in the past ten years, the majority of the population, their first entry in anti-aging and rejuvenation is going to a Met Spa and trying to get a treatment, and that's where their journey starts. And there are the ones, there are great Met spas, and I know them, I'm friends with them. They're phenomenal. They're they're ethical, they educate themselves, they're just they're just a student of the field. They really want to do good, they want to do great work, they want to help their patients. But a lot of these corporate run spas and they're part of these MSOs and they're part of these basically profit business machine that are educating the patients erroneously the way I know it, because uh the patients tell me. They come and I had just last week a patient came and said, I'm here for uh CO2 laser. I said, It's always weird when someone walks into your office and requests a certain procedure, isn't it? Without having discussed their problem, their goals, and everything. So And so I said, I'm curious to know what makes you think you need CO2 laser and how much do you know about this? Why do you believe that's good for you? She said, Oh, I get it every year. And I heard, uh, you're the best, so I'm here now. And I said, Why who told you that you need CO2 laser every year? She said, Well, that's everybody knows that, you know, where where I had my laser and I said I have to come back every year because that's how long the effect would last. Only a year. So this education is going on and educating our public whereas I have patients and I learned it actually through my patients many years ago when someone came with immaculate skin in her 70s. Like skin like yours, immaculate, like flawless. And I asked her how old are you? And she's like, I'm proudly, I'm 72. And the first question I asked in awe, what's the secret? How is your skin so great? She's like, Oh, I had laser 20 years ago, just one time. After that, literally, she said everything you just said about the skincare regimen, verbatim with the retinols and everything, judiciously said I haven't skipped a day. And that's a power of skincare and maintaining it, like you just said. You don't need CO2 laser every once a year. You can just that just to set the clock back, and then you maintain that and with proper skincare and judicious application and consistency. So I learned that because I saw it with my own eyes. Otherwise, I would maybe I wouldn't believe it. But when I saw the pattern, and this was not just one patient, this is like consistently over the years. I saw these patients and I asked them what's your secret, they all said the same, it's almost like they're read from the same script. And so, to your point.

SPEAKER_00 58:10

Yeah, I agree. Daria, I have those patients. I've taken I have patients now who are in their 70s. I treated them in their early 50s. And they were probably to this day, actually, they still are my most diligent patients when it comes to skincare. They travel with their skincare, they will use nothing else on their skin without calling me first. They follow my plan. And okay, we have done the major resurfacing when they were 50 and 51. They were each that age. Now at 75 and 76, they have had a couple medium-depth loop heels in between all of that, but they still get stopped all the time. People are asking them all the time about their skin. And they see look, their skin is younger now than at 50 and 51, but they have kept using their skincare regimen. They don't skip a day. They take it with them, God forbid, if I've had patients go into the hospital, they take it and line it up on their counter in the hospital and they use the protection. So I think that's the most important part. You can't, you know what? I don't look at the medispas down the road, for example, and say, oh gosh, you know, they're just trying to turn over treatments and get patients in as many as they can and just do procedure after procedure, because eventually those patients will come to their senses and they'll come and look for a good provider that has their best interests at heart. So I just think, you know, eventually those patients will make their way over. And then we can educate them. But hopefully, this podcast will reach a lot more people and make them really think hard about how they're spending their time, their effort, their money, and really refocus that attention because everyone wants a quick fix. I want the quick fix. I have all the lasers in my office, but I'm not on that exam table getting these treatments done all the time. Same. I do about one treatment a year in the practice, and that's about as much as I have time for.

SPEAKER_02 1:00:18

Yeah. No.

SPEAKER_00 1:00:19

So I have to use my skincare.

Longevity Research Drugs And Funding

SPEAKER_02 1:00:21

I know. Well what are you, Susan? Well, I'm curious, what are you excited about for the future when it comes to skin and anti-aging? I mean, you you you described in the very beginning of the podcast, and I wholeheartedly agree with you, it's actually the intro question in many of my keynote speeches when I asked the audience or challenged the audience to look at aging as a chronic disease, which is a theory or concept that is has been popularized by Dr. David Sinclair out of Harvard. And he describes it beautifully in his book. Where do you see the future of our profession and of anti-aging and rejuvenation in general? Is there anything that you have inside and are looking forward to see what will happen and whether or not we get to live to apply it or at least to witness it?

SPEAKER_00 1:01:23

Yeah. I well, I'm going to say, you know, for our audience, educate yourself as much as you can. And you mentioned David Sinclair's book, Health Span or Lifespan. Lifespan was the name of the book. It's a phenomenal book. I also like Outlive. I also like Unbreakable by Dr. Vonda Wright. She's a midlife menopausal bone specialist. She's an orthopedic surgeon. I love Marty McCary's book, Blind Spots. And he's now our FDA commissioner. So that's where my hope is. And I'm hoping he's listening to this podcast. Because first I want to say thank you for removing the black box warning on estrogen.

SPEAKER_02 1:02:05

Yes.

SPEAKER_00 1:02:06

And thank you in for in your book, Debunking the Myth of the Women's Health Initiative study. So everybody should read that book because it talks about cholesterol and how we follow dogmas in medicine without really thinking, like, how did we make this decision? And he goes through and method methodically breaks down those dogmas and says, you know, we were wrong to follow this. And here's what the science really shows. So I'm hoping when you have progressive medical leaders, maybe they can start to influence. Like I said, he's a commissioner at the FDA. Maybe he can start to allow people now to research longevity medications and really classify aging as a disease so that we can develop medications for it. We I know lots of companies right now are looking at RAPILOGs, which are analogues of rapamycin, which is one of the medications that is used to treat patients going through transplants so they don't reject a transplant organ, but when there's pulsed intermittently, it may have, I'm saying may have some improvement in longevity. We do know David Sinclair is a big proponent of nicotinamide mononucleotide, NMN, and how that may impact the cellular energy at the mitochondrial level, because the mitochondria are the energy power cells of the bigger cell itself. And you need they're almost like the battery pack, and you need that energy to be replenished, and that declines as we age. So there are things that we should look at because I'd love to have more than just one doctor or one scientist out there saying, This is what you should take because I'm taking it. I'd rather see a long, a long-term study, a prospective study, placebo controlled if possible, looking at people who take it, people who don't take it. And do we see an impact in the aging markers? Do we see an impact in energy production? All of that so we can speak scientifically about it the same way we speak about every other disease process. So I am excited that this will happen, but we need money to go towards that. Whether that's money from the NIH, which right now they won't they don't see aging as a disease. So the NIH will not usually fund studies related to anti-aging. We need to change that. And maybe some people out there are listening to this that might actually start to think about this as a disease process and say, you know what, for the sake of our population, we need to invest some of our resources into how to get people to live a longer, healthier lifespan.

Yamanaka Factors And Reversing Cells

SPEAKER_02 1:04:50

Yeah, I think that was very beautifully and eloquently said. And I think there is on the other side of that, is there are private companies that are currently researching these very things that are funded by billionaires. You know, a lot of these billionaires, they're loving life, they're sitting and living life and thinking, man, I don't want to go to the next life. I want to stay in this life as long as possible. And I want to milk this, I want to live as long as possible, healthy. And they have endless money, they're billionaires, so they're funding a lot of these research. So actually, you took we talked about David Sinclair. I think he is working with a company that is working on turning back the genetic, the ep genetic clock through epigenetics. Have you heard of the Yamanaka factors? Have you heard of the so so the Yamanaka factors in I think He mentioned them briefly in his book.

SPEAKER_00 1:05:54

Yeah, so so I I don't know a whole lot about them.

SPEAKER_02 1:05:57

Yeah, I hope I don't uh screw it up. I think Was in 2006 Shiny Yamanaka, Japanese scientist who then later, I think in 2012, got the Nobel Prize and medicine for that. He discovered there's these four factors, proteins called Yamanaka factors now. So the idea is that you know every cell in our body has exact genetic copy, right? We all have the same exact genetic copy in each cell, whether it's in our brain cell, heart cell, skin cell, every cell, hair cell. What makes a hair cell look like hair and a heart cell look like a heart and function like a heart is which part of those genes are turned on and turned off. And that's determined by through methylation process, through on and off switches, through proteins that peptides that sit on those genetic sequences and turn them off or turn them on. So based on what gene is turned on, a certain protein gets transcribed, and the function of each cell is determined by the proteins. The proteins are basically carriers, and so for the layman, they are the parts of the cell that are responsible for the function of the cell. And so the Yamanaka factors, they are factors that when they get into the cell, you inject them into the cell, they turn the genetic clock back through into a turn that cell into a stem cell, back into its original function before it had uh been induced to become another organ cell, a heart cell or a brain cell. So it's a mis is it's a stem cell. And so that has been proven for that he got the Nobel Prize in medicine. Now the thing is we don't want all our cells to turn into stem cells, so that wouldn't be necessarily good because you know you have then also risk of cancer and so forth and promoting cancer. But then what they now, what companies are trying to do is injecting tiny amounts of these Yamanaka factors, very tiny amounts, enough to go into the cell, and instead of turning it into a stem cell, just turning into a younger version of that cell, like retinal cell that is not functioning anymore, and let's say you're blind because as a result of that, you cure then the blindness. The retinal cell anti-ages, the genetic clock of that retinal cell turns back, and now it's functioning again, and you have you obtained your vision again. And they've done that on animals, on mice. There are some mice that they equivalent to human life, they are living up to 250 years, cured blindness in blindness in mice, turned gray hair back into dark hair. I mean, literally that has been done on animals, and so what I'm excited about, I mean, we have the mechanistical proof and evidence, we have you know animal studies, phase one studies. The challenge now is the delivery method, how do you inject it effectively and how much? And there are now companies. I think one the company that David Sinclair is director of has like something like a hundred billion dollars funding from all these billionaires. So I'm not gonna rely on the NIH, I'm not gonna rely on the government because for those changes, administrative changes to happen, even with people like Marty McCary, who if there was a time, it's now because he's the guy, as you said, and that's what I'm super excited about. And I feel his book should be read by every medical student, by every resident, by every fellow, and every physician practicing.

SPEAKER_00 1:10:06

And all my patients, your patients. Everyone should read it.

SPEAKER_02 1:10:09

Oh, I recommend it to everyone. I'm like, you know, read this and then we'll talk. And uh, so I'm as hopeful as I am and excited as I am, I'm even more hopeful and excited because there's so many private industries that are funded with billions of dollars by all these billionaires that are interested in this field. And I think the field of longevity has been really grown as a result of funding from billionaires. And and so I hope I don't know if we get to practice it, but I hope we get to live long enough to live take advantage of it, which then begs the question what are we gonna do with all this extra time that we're alive? You know, what's gonna happen? Maybe choose another profession and do pick another way of life. I don't know. Like for you, if I told you I can add 50 years to your life, like you get to live 150 years, how would you spend those years? What would you do?

SPEAKER_00 1:11:08

Oh gosh, I am a perpetual student. I would just learn everything. I love history, I'd probably go get a history major. I love other aspects of medicine, maybe do another residency. I love photography.

SPEAKER_02 1:11:24

Oh, me too. I love that too.

SPEAKER_00 1:11:26

I love photography. Really specialize in home life skills. I love playing piano. I'm not good. Maybe I should become better.

SPEAKER_02 1:11:36

Same.

SPEAKER_00 1:11:37

So yeah, I could easily feel oh, and I love to garden and cook.

SPEAKER_02 1:11:41

So there's enough time.

SPEAKER_00 1:11:44

So it's not enough time in a day, but if you give me another 50 years, yeah, you got you essentially got another life. Yeah.

Practical Takeaways And Closing

SPEAKER_02 1:11:51

And so that's what I'm excited about.

SPEAKER_00 1:11:53

Now, what we need to tell our patients though, yes, that's exciting for the future, Daria. But what we need to tell our patients about is let's say you're in your 40s or 50s right now, and you love to do any of these things we mentioned, including maybe skiing, playing tennis, all of that. The only way you're going to ensure that you can continue to do that in your 60s, 70s, 80s, 90s, is to take care of yourself today.

SPEAKER_02 1:12:22

Yes.

SPEAKER_00 1:12:22

Using everything we talked about in this discussion.

SPEAKER_02 1:12:25

Thank you, Susan. That is, I think, the best advice. And you can't live for tomorrow, you have lived for today, and there's a lot that you can do today, like you just said, not just for your skin, but your general health. And I always tell my patients if something is good for your skin, it's also good for your brain, it's also good for your heart, it's good for your lungs, it's good for your muscles, it's good for your bones, it's good for your entire body. And it all starts with for me, the three the four things, which is sleep, diet, nutrition, exercise, uh, and mindfulness. Those four things can prevent Alzheimer's dementia. My good friend Dr. Majit Futuhi just he was my podcast guest, I think, two episodes ago. He just published his new book. He had many books on this topic. One of the foremost authorities in neurology and neuroscience. And Vanda Wright, when it comes to bone and muscle health. So those are the things that you can do today, and it will also benefit your skin and your appearance when it comes to aging. And even Dr. Sinclair said, and that's according to studies, if you look young, if your external appearance is younger than your actual chronologic age, meaning the younger you look, the younger you actually are biologically, and there is a correlation with that. And and that all starts and ends with your lifestyle and how you treat your body. And so I want to thank you, uh, Susan. You actually are my first podcast guest that I invited back on this pod after having it done for six years now. And I was very excited about our conversation. So thanks for taking time out of your busy life and coming on. And I could talk to you for days, and I'm I I really hope that at least me and you can do something within the academy like we did this year to continue this and not make it like a one-time thing and encourage and inspire others to educate themselves and join us on the panel, and hopefully, even invite some of these experts to come in and educate our community.

SPEAKER_00 1:14:55

That would be wonderful. It's my pleasure to be here. Thank you for having me.

SPEAKER_02 1:14:59

Thank you so much, Susan. And I know we'll talk a lot, and I hope you have a great day.

SPEAKER_00 1:15:05

Thank you. Have a great weekend.

SPEAKER_02 1:15:07

You too. Episodes over. I hope you enjoyed my conversation with the one and only Dr. Susan Bobaji. Please don't forget to leave me a review on Apple Podcast if you enjoyed this podcast, or leave any questions or comments on Spotify, and I will get to them as soon as possible. Until next time. Bye bye.