Can you tell if a woman is in pmenopause just by her skin when she comes into your office? It's amazing how so much of what I do is tell a woman that she's in pmenopause, just by her skin. So, she has no idea. And she'll tell me, "Well, I'm still getting my period." And I was, "Well, that's just one sign." I had no idea about that. Dr.
Dorsay is a leading dermatologist with over 30 years of experience, a global consultant for some of the biggest beauty brands out there. And every single day she's in her New York City office helping real women navigate the changes that nobody prepares us for. What I've learned and what I've observed in women as they've aged over the 30 or so years of my practice is that area around the mouth ages 10 to 20 years faster than your midface and your cheeks. Okay, wait. I'm stopping for a second.
Ladies, I want you to listen to this. Explain this again. It's just the way the skin ages. Today she's breaking down the truth about why our faces change and what really works for hair loss. What does hair loss actually happen in pmenopause and menopause?
Perry menopause is one long stress period. People aren't seeing what's growing. They only see what's falling out and it's like getting caught in a riptide. All you see is that you're losing ground, losing ground, losing ground. And it's horrifying to women.
What's an ideal routine look like for women? Especially a daytime routine. When you wake up in the morning, I think a gentle cleanser is helpful. Do you think women are going too far with cosmetic treatments just to kind of survive in a very ages society that we live in? It's such a good question.
I think about it a lot. Before we get started, if you could take a second to subscribe and leave a review from wherever you're listening right now, it would mean so much. Dr. Doris Day isn't just a guest, though today. She's my own dermatologist.
She's completely changed the way I take care of my skin and my hair. And because so many of you asked, she's also sharing solutions for hair loss that actually work. So, make sure you listen all the way through. And let's go ahead and get into it. Dr.
Doris Day, it's so good to see you. Great to see you. I'm happy you're here. I'm so excited for our conversation. I am, too.
You know, we did an outreach on social media to say like, you know, what are your big questions? Skin and hair always come in. So, I promise you, stay with us because we're going to get to all of your questions by the end of this and myths and all all sorts of things because there's so much on social media nowadays that can be very confusing. Yeah. And some of it is rightly confusing because there's not always agreement.
There's a a lot of discussion to be had. Yeah, absolutely. So, we're going to have a lot of it today. I first I want to ask what made you I don't think I've actually ever asked you this. What made you go into this field?
Well, I started out in internal medicine and what I noticed was that internists were very dismissive of the skin. When I went through residency, it's like oh it's just skin we'll call dermatology. But we never focused on it. But then as I went through and I had patients who came in and they were smokers. I would say you know you need to quit smoking emphyma lung cancer.
They'd be like me. But if I said oh smoker's lines and saloness of the skin will get better. They're like oh I'll quit smoking. So I realized when I went through this the skin to help change behavior people were way more attentive. And I learned that the skin is not just vanity.
People caring about their skin and their appearance are also having a say about themselves and conveying to the world how they feel and their general health. In the end, I'm a physician. I'm a healer. I'm your cheerleader as your physician. I'm here to celebrate your best features, your best qualities.
But I don't want you to just look better. I want you to be better. And the skin is how I reach people and start that conversation and help direct them in a way that will help them age as healthy and as beautiful as possible. And the largest organ in the body, right? Yes.
And and my favorite and your favorite. And you are you do consult on a lot of products too, right? And I know we're going to go over some during the show to just really understand because you get so overwhelmed with what's out there right now. Well, I used to work at a research lab before I did dermatology and through my training. I I did a lot of things before.
I was a journalist before and as a medical reporter, I covered a lot of skin issues because HIV was the issue of the day in the 80s and a lot of the findings were in the skin. So, I really learned about dermatology before even going to medical school. And then in between, I worked in a research lab at NYU working on skin function and how vitamins and certain elements affected keratinoide or skin cell turnover. So, I've always been interested in how what you apply to your skin affects your skin and your skin aging. And that naturally led to product development.
So, I've been working on product development with pretty much every company on the market, helping them with clinical trials and deciding what should be tested, things to bring to market, things not to bring to market. So, it's been so much fun for me to have a hand in so many of the products that you see that are available today. Not so much on the marketing side, but on the product development side. And that comes down to science. That comes down to research.
It comes down to understanding what really works for for the right reasons. Absolutely. I would be a lab rat if I could, but there's only so much time in a day and I love seeing patients, but it is kind of cool to see how new products are formulated and developed. And this is a really hard process coming up with products that are formulated not just so that they're active when you apply them to the skin, but that they're not irritating and that they don't inactivate each other and that they get absorbed the way that you want and they have a shelf life that you want. This is a complicated process.
It takes a lot of research development, really smart scientists to create formulas that are very well tested, that have stability, that have both in the lab efficacy, but also offtheshelf efficacy. Oh, I love that. All right. I'm excited to to talk about what you have with you. When women come into your office, I I guess I'm picturing myself, but when women step into your office in midlife, what are they most coming to you for?
Mostly they come in and they are starting to feel like they look old. And what's so interesting is that they'll start complaining about jowlling and things that they feel, but not so much that they see it, but they're feeling it. And I think people feel the aging process before they see it. Nobody else sees the things that they see in themselves, but they're starting to notice those signs of aging. And my job is to help them rebalance.
Help them understand that yes, you are changing, but you're not diminishing in your beauty. And here's why it's happening. Here's how we affect it. Here's the things that we need to now do differently because of this new phase of your life that you're in. And that's generally in the 40s.
And what's happening in your 40s is you're starting to go through these hormonal shifts. And it's a bit of a roller coaster. And people go through it at a various time span. Sometimes it's late 30s, sometimes it's early 50s. It's it's different for everybody.
But it's the universal one day my face just fell apart or my scars. I would have a mark and it used to clear, now it takes longer to clear. I have more redness. I'm breaking out in a way I never did before. My hair is shedding.
I have vaginal dryness. It's something dermatologists deal with. So, it's really I had no idea about that. Yeah. Dermatologist, we deal a lot with STD starting on, but we deal a lot with the genital area both in women and in men.
And and that's something that I think many of us take on because nobody else seems to want to and they think of it as just a cosmetic issue that women just need to get over and say, "Who cares?" But in reality, we care as dermatologists and it is more functional. It's not just a vanity thing. It's also about urinary tract infections, pain on during sex, urinary incontinence, all of that we we deal with to some extent as dermatologists. How much your role as a dermatologist is dealing with the emotional side of how women are feeling about themselves. It's a huge part of what we do and I think that's where my journalism background really comes in handy because as a investigative medical reporter, I kind of want the scoop.
So, I want my patients story and I want to be their mirror, but I want to be their beautiful mirror where they tell me their story and I'm able to reflect it back but in a positive way. So, when somebody comes in and they look in the mirror and they don't like what they see, I help them see their great qualities, their beautiful eyes, the way their bone structure is or the way their hair frames their face and all the things that they have that they can celebrate and that we can also enhance the emotional side. I mean, we have tissues in our office. We have tears all the time because people confess things or they they come to terms with things. I always say people come to me because many times because they've come through something and they're ready to face the world or they've come to something and they need my help.
So a lot of what I do is emotional support. And the benefits are incredible. Like I can watch my patients go from when I walk in, no eye contact, looking down a little bit in to when they leave being up and looking and smiling and feeling different. And I haven't even done anything yet. All I did was give them hope.
And that's one of the most important thing I think your physician does is we reframe in a hopeful way. And there was just a study about this that showed that when your physician has confidence and gives you hope, you can take the same data. So they took two groups of people and one they gave the medicine and the doctor said I know what you have this is the medicine it will help. Then they took another group and they said well I'm not sure what it is. I'm not sure if this medicine will work.
None of them got actual drug but the patients who had the doctor who framed it in a way where they focused on what they knew and what they could do got better. And the ones who had the doctor who said yeah you know you're just getting old. It's a part of life. Wrinkles are going to happen. Just deal with it.
Like those patients are going to leave feeling old and they're going to age faster internally, not just in the skin. So what I do is about confidence, too. Can you tell if a woman is in penmenopause just by her skin when she comes into your office? It's amazing how so much of what I do is tell a woman that she's in pmenopause just by her skin. So she has no idea.
And she'll tell me, "Well, I'm still getting my period." And I was like, "Well, that's just one sign. That's not all the signs. It's everything else you're telling me. It's that you're complaining that your hair is thinning and that your skin is changing and that you're you're getting more jowls or that you have more redness in your skin or you're dry and itchy or you have some vaginal dryness or all those things we've been talking about even itchy ears, itchy scalp. All of these things can be a sign of hormonal changes when they come on all of a sudden and then I start asking and are you kind of feeling like you're more or you thinking people are more stupid like which which one is happening here?
Which way are you going? Which way you going with that? Or has your sleep changed? Or even your weight? They'll complain about weight and they think they need ompic.
So all of these things when we put it together instead of just focusing narrowly on my one organ system, but when I expand it out to like how else are you feeling? Are you feeling more anxious, more depressed? When I bring those things in, then I say, you know what, these are all signs of pmenopause. And here's a list of doctors that I've collected who I know know how to manage that. So, it's something that I'm learning to manage, but until I can do it better than those doctors, I'm referring to those doctors and I know that they'll do the right tests and they'll guide them in the right way.
So many of them come in and tell me and it drives me crazy. Their doctors will tell them, "Don't do it. It's not healthy. It's not safe. Some distant relative had breast cancer.
It's not safe for you." Hormone therapy. You're talking about hormone therapy or they'll say, "Yeah, my my doctor said I could just go on the pill, but they don't measure anything. They don't collect data. They don't ask them questions. They don't focus on it." I think that until we train more doctors to understand this process, how easy it is to measure and to help women through this very important time of their life.
I think once you hit pmenopause, you're entering your best years and potentially your most beautiful years because you understand now that it's about you. And if you don't focus on you, then things are not going to go well. But if you do, you can have the most fun and be useful into your 90s and beyond. So, we just have to reframe how we see this decade and not think of ourselves as imploding on ourselves and becoming invisible, but actually a time for us to blossom. We have experience, but we're still youthful and we have so much to offer, even more than when we were in our 30s.
Thank you for saying that because I think it's so important. And I do think that women are at a loss with where to go because if they're not especially if they don't even know they're in permenopause or menopause. So they not might not be thinking to go to the OB/GYN first, you know, but they're seeing some of these other physical signs that you're talking about. And I'll work with even psychiatrists. I'll work with it's a multidisciplinary approach.
It's an OB, sometimes it's a therapist, sometimes we need a combination of things, but it's not just one thing. It's the things I do in the office. It's adjusting your skin care, adding hormone therapy when appropriate, sometimes adding SSRIs or other things for at least a little while, if not indefinitely. It's okay. And then working out differently, going more towards resistance training, focusing on your sleep, adding different supplements, just taking stock of those things.
We talk about creatine and some of the things, protein in your diet, how we have to focus on not just hoping we get enough, but actually making that a priority. And you'll see the difference in your skin. There's studies that show that resistance training improves the collagen in your skin. So if you work out here, even the collagen in your skin of your face gets better. It's a systemic effect.
I feel like that's going to have people into the gym faster faster than anything else is going to happen there. That feeling of my face is falling. What exactly is happening at that time? That's because now it's accumulation of a couple of different things. One is 20 to 30 years of cumulative sun exposure.
So whether you were at the beach with the reflectors or you were just active outdoors reflectors at the beach. That was never me. My dad never allowed it. He always said never go in the sun. So I was in the library doing book reports all summer.
Of course you were. Yeah. I was in the sun. So and then so it's cumulative sun exposure, pollution, stressors, all those things. And diminishing estrogen.
So estrogen receptors are in the skin. There's a certain type of estrogen receptor in the skin called the estrogen beta receptor. When you hit pmenopause, your estrogen decreases and that you need for collagen production and the receptors also decrease. And as that decreases, you're not as able to build back collagen. So now when you have insults and you've had repetitive motion on top of it, you see thinning of the skin, weakening of the collagen at the base of a wrinkle even more.
So when you have a crease, it's always going to be weakest at the at the bottom of the crease, right? That's why it folds into that crease. Then when you have even more loss of collagen, those creases get deeper and deeper. So and you're not able to repair the fibroblasts that build collagen. That's the molecular cell that builds collagen.
That also can get exhausted. And there's this pathway called mTor, which is a master regulator that also becomes dysfunctional and that goes around estrogen as well. So once you have depleted estrogen and then a dysfunctional master regulator of this molecule called mTor, you end up having advanced accelerated aging of the skin, which all sounds horrible except that we are now studying this at a molecular level and coming up with mechanisms to help both prevent and reverse it. So it's a great time to be getting older because we're going to live longer, live healthier, and look better in the process. Okay.
Well, there that's some good news. After after understanding what a wrinkle where a wrinkle starts, what are some of the ways that you can get a lift without a lift for your face without maybe getting a full face lift? Is that possible? Well, yes and no. So, only a facelift is a facelift.
And if somebody is looking for a facelift, it's always the first question I ask my patients. Would you have a facelift? Is that something you'd be interested in? And if they say yes, I refer to plastic surgeons because nothing that's non-surgical is surgical. I mean there's two different pathways, two different buckets.
And understanding that this is a big battle between dermatologists and plastic surgeons is that dermatologist and companies will say this will lift. And in reality, they're right and wrong. Fillers don't lift. Fillers fill, but the effect can be lifting. So it's two different things.
When I do devices like I love softwave, this device doesn't actually lift the way a facelift lifts, but it improves the collagen and the texture of your skin, which is a lifting effect. When I use a filler, a hyaluronic acid gel or calcium hydroxy appatite, one of the products that I use, it's not actually lifting, but by improving the quality, I mean, sometimes it is lifting. If I sneak it in behind the hairline, it can be lifting, but for the most part, the effect is an optical lift. An improvement of the skin quality, which is a lifting effect. Okay?
And in many ways, it complements a facelift because if you just pull estrogen depleted, thinner, older skin, it's going to look smooth, but it won't look younger or more youthful. But if you improve the skin quality, you'll still have some lines, but you'll look more youthful and you'll look even better in many ways. So, you mentioned a couple of things that's going on. You know, dry, itchy skin. We have thinning skin.
I've noticed like crepey skin, I guess it's called, but my neck and I saw it on my legs the other day. So, I want to I want to kind of drill down on each one of those and then we'll go into what you can do for them. But dry, itchy skin was not anything I even prepared for. Like I I knew that estrogen deplete, you know, you have a depletion of estrogen and that causes moisture loss throughout the body, but dry, itchy skin is something really real and real disturbing for a lot of women. So, what happens is with that estrogen loss, a few things happen.
Your skin microbiome. You have microorganisms that live on the skin. They become offbalance. So, they're not the same as in younger skin. Those microbes also are what the sebaceous glands, they eat what's in the oil glands.
So, the oil glands when you have less estrogen become less active and can diminish. You have the most oil glands in the T-zone and then it diminishes as you go down the body. And your T-zone is your is the forehead and the nose. And their nose. Okay.
So this zone is always oily. Like when I remember when I was a teenager around my period, I'd have like an oil slick on my forehead. I know that diminished. And you're kind of happy at the time not to have an oil slick, but then you get dry. And then as you go further down on the body, you already have fewer oil producing glands called sebaceous glands.
And so you get drier and itchy. That disbiosis that that lack of microbiome plus the less production of oil by the oil glands leaves your skin dry which means the barrier is no longer protected because one of the things the follicles produce is something called natural moisturizing factor. So you have less of that and now your barrier is less protected. A little bit of itchy skin you scratch now the barrier is not intact. You're more prone to infection.
If you add in on top of that things like insulin resistance, which happens in in pre-diabetes, then you're now at greater risk of both discoloration, inflammaging, which is inflammation that can increase your risk of infection in the skin as well, yeast infection and bacterial infection. So, it's not just a cosmetic issue, it's a serious medical issue. So, I treat almost everybody in pmenopause as if they were insulin resistant. And I So what do you give them? We talk about hydration from the outside, decreasing long hot showers, especially in the winter, patting the skin dry, moisturizing within 2 minutes of getting out of the shower, moisturizing at least twice a day, and really focusing on barrier protection, using shea butter, camides, things that are natural to the skin.
And there's so many great brands and products that don't feel sticky or greasy that you can use, but understanding that you have to hydrate and take really good care of your skin and hydrate from the inside as well. Drinking more water, eating fruits and vegetables, and being careful about the time in which you eat. So intermittent fasting may work for someone in their 30s into their 40s, but once your mTor becomes disregulated, intermittent fasting doesn't work as well. We look for things that are going to minimize your insulin resistance. So, changing the order in which you eat food.
Start with a few walnuts before you eat your meal. So, more fats. More fats and and proteins before you hit your carbs and that lowers those glucose spikes which will minimize your insulin resistance. Less snacking, eating just more discreet meals and less snacking. It's just fascinating how everything really and and how a lot so many things come back to lifestyle, too.
Yep. And having more omega-3s. Even when I have patients who have who I put on Accutane, the teens, I always have them go on an omega-3, start taking that as a supplement, they get less dryness through the Accutane and they tolerate it better. So, there's a lot we can do. Crepey neck and chest skin, like I don't know how to describe crepey skin.
It's crepey skin. Is it from thinning? What What is the crepey skin caused by I guess? And what can we do about it? Well, the skin on your neck is very thin skin and it does age faster than your face.
What I've learned and what I've observed in women as they've aged over the 30 or so years of my practice is that if you take the skin from the corners of your nose down to your chin, that area around the mouth and extending out a little bit to the jawline to your neck is all the same. It all ages the same. So the area around the mouth ages 10 to 20 years faster than your midface and your cheeks really than your eyes and everything. Yep. It's amazing.
Why is that? It's just the way the skin ages. There's no good reason. Okay. Wait, I'm stopping for a second.
Ladies, I want you to listen to this. Explain this again to where I I have never heard this before. So, the area around the mouth going from the nose all the way down to the neck all ages faster than the midface. If you put some someone if you put a mask on a woman and then you guess her age and then you take the mask off, she's going to be 10 to 20 years older. If she's had sun exposure and hasn't protected her skin.
So protecting the area around the mouth. Now it could be and the area around the eyes also ages a little bit faster like right the lower eyelids that also but the midface ages the best. And the thing is is with under the the nose is so humid. If you breathe through your nose, you're going to breathe off the sunscreen in 10 minutes. Nothing lasts there.
So you I like a sunscreen stick for the upper lip. And then any eye cream you put on, put on the upper lip as well. But the Why do you put the eye cream on the upper lip? Because they're both round muscles that squish in. They close like a purse string.
So it's the way that they move and they're both kind of thin skin. So I I treat them the same. It's kind of an easy way to treat. So when you pat it on the up on the lower eyelids, just pat it on the upper lip as well. And the other thing that happens that I think accelerates the aging of the lower face is that the mandible, which is your jawbone, as women age, it shrinks and it recedes, which pushes it back and that makes the skin sag a little bit, but also it makes the lower lip collapse in.
When the lower lip collapses in, then every time you close your mouth to to swallow or to just close your mouth, you have to pucker a little bit, which makes upper lip lines. So the mistake people make is that they fill the upper lip and the upper lip lines and what happens there? You add bulk and weight. So now people have a projected upper lip, a flattened collapsed in lower lip and a small chin and they look done and even older. But if you correct the jawline and the chin and add a little bit into the lower lip, you'll need almost nothing in the upper, just a little bit to blend.
And the person will now naturally correct the upper lip lines and they'll age much better. So, it's understanding aging at a structural level and how hormone depletion causes bone to deplete even in the face and how that structurally changes your face. Mhm. So, the other big mistake that people make, this is the last thing I'll I'll help you understand. That's one of the most important things I talk about, is that as we age, naturally, our brows drop and the orbit, which is the bone that surrounds the eyes, shrinks, which means the hole that they're surrounding, gets bigger.
So, the eyes tend to sink in a little bit and the brows and the lids can drop, right? Which makes your eyes smaller from above. And people feel hollowed underneath. So then they get under eye filler in many cases which pushes your lower lid up which makes your eye smaller from below. Now they have smaller eyes but they feel like their cheeks deflated.
So they go in and they go I want a cheek lift. Put more volume in my cheek. So as if it does that which it doesn't. So they get more volume in their cheek. It's coming from a dermatologist.
So just understand I'm so grateful because I have and by the way there is good news coming up of things that you can do. We have solutions. We just want to we just want to go through all of the what you're dealing with. Well, this is what we're dealing with that where people get what we call filler fatigue because they try to chase what they see instead of understanding the source. Yeah.
So, the more filler you put in the cheek, the further your eye is from the surface and the smaller your eye looks yet. So now you have these small cheeks. But if you understand that we have bone changes that are structural, superficial and deep fat pads that age at different rates, ligaments that are going to support how those structural changes happen. And if you discreetly add filler in, you can look gorgeous at every age, authentic and natural and not overdone and not done at all. And that's the beauty.
But it's a matter of having a proper assessment. Someone needs to look at you and talk to you and watch you naturally animate and watch even look at pictures from your 20s, 30s, 40s to see how your trajectory has been and then help you understand that just like when you're 20, you can't look like you're six. You have a different foundation, different structure, when you're 50, you're not going to look 20 or even 30 because you have a different structure. But you can look beautiful and even more beautiful. It's just a different beautiful.
So, that's my only warning is if you're chasing lines, and this is where women go wrong. They're so afraid of aging. They think if they blow out every line and wrinkle by filling or lasering or pulling, they're going to look younger. It's not the case. But if you understand your structural changes and you match what your body needs, you'll look so beautiful, so elegant, and you'll you'll look in the mirror and go, "Oh, yeah, that's me.
I look like me." It it is a less is more in a lot of ways in terms of it's the right amount is the right amount in the right place in the right way. Sometimes it's less. Sometimes it takes a lot to get there. Yeah. Skin tags and acne, both of those things, do those start popping up during this time?
I mean, I had a friend over last night. She said, "I have these new tag these new like marks all over my face." And I said, "Are they skin tags?" She said, "I have no idea. It just started. She's around 60 years old. Is that normal?" Well, I don't think of it as an age issue.
It's a genetic issue. And if you live long enough, they're going to show up. So, yeah. So, things happen as as time goes by and people will get bumps. Skin tags are usually on the neck or under the arms.
There's some things like serereia kerattosis they're called, which are just little overgrowths of skin on the face that we can just gently burn off and melt off. But some people get them in their 20s or 30s, some people get them in their 60s or 70s, some people make many, some people make none. Okay? So, that's not a hormonal thing. It's not a really It could be a little bit of hormonal.
It's more genetic than hormonal. It's not usually sunrelated, okay? But it can be hormonal. Do you see hormone therapy impacting the skin? Oh my goodness.
So much. So much. And that's why I can tell when someone is in pmenopause because they're missing it. But when they add it back, I get so happy when they when they go see the doctors I recommend or when they come in and they've already been doing it because I know that whatever I do is going to look better and last longer because now I have an element that is going to support the work I do. It's a regulator of aging.
You have estrogen receptors in the skin and we need to keep those active, keep them effective, keep them working so that you can keep building collagen. Otherwise, you deplete it and then nothing works as well. How do you feel about topical estrogen? I know estrogen cream is something that's I don't know if it's relatively new, but it seems relatively new to me. And so, if when we talk about estrogen cream, we're not talking about the cream.
We're not talking about the patch, right? And we're not talking about vaginal estrogen. We're talking about something you apply topically to your face. So, but usually people are applying vaginal estrogen to their face. There's no FDA approved estrogen cream for the face.
So either it's vaginal estro estrogen cream that we're adapting or it's compounded. Okay. And that can work, but I think that it might be effective. It's probably safe, but I would love to see better quality longer term studies on it. But in theory, it it makes sense.
I don't think it's really ready for recommendation for everybody yet, but I'm certainly interested in studying it. So hopefully we'll have good answers, but we can't rush the answers. But I think that there's there's a reason to hypothetically think it could make sense and be useful. All right, let's talk about ideal routine because it feels like every day we're inundated with new products on the market. I'm adding more steps to my routine.
Sometimes I leave one out, sometimes I add one. What's an ideal routine look like for women, especially a daytime routine? The way to think about it is there's musthaves and nice to haves. Okay. So, for the musthaves, when you wake up in the morning, I think a gentle cleanser is helpful because a gentle cleanser will remove whatever you have left from the night.
Then, I'd like a vitamin C serum in the morning or a vitamin C cream because this will give you added antioxidant benefit against pollution and UV damage. Then, we'll depending on what you have. So, the next one can be an option of things. If you have redness, you might add an anti- redness serum or cream. This might have an ingredient like azelic extract or cintinella aiatica or niacinomide.
Those are elements that can help with redness if you're prone to that. If you're oily but you still want some hydration, you'll add a hyaluronic acid serum. And then if you're very dry, you'll add a moisturizer. And sometimes you'll layer these. So this could be one or three steps depending on where you're at.
And then an eye cream in the morning is always helpful. This is kind of a nice to have, not necessarily a must have, but I do like an eye cream. And you'll always use your third finger to pat it on because you never want to rub that area. It's the thinnest skin in your body, so you really want to be gentle. And then rub it under the brow.
And then my pro tip is on the upper lip as well. So eye cream goes under the eye with your middle finger, a little on under the brow, and then on the upper lip. Okay. So, three places for eye cream. Yep.
And then the last is going to be your sunscreen. Now the way to apply sunscreen is before you get dressed ideally start with your decollete in your neck and go in an upward direction because your chin creates a shadow that's always going to protect. If you walk around and you look at other women who may not have makeup on, you'll often see a line and you'll see a line where the chin shadow wears off and the skin above that line and the skin below that line is very different skin. So the skin under is going to be redder and more crepey. So you go in an upward direction because you get the most sunscreen at the base of the neck and you get the best protection.
Then you'll do the face. Now I already said this area around the mouth is the same as neck skin. So you'll do there the neck in an upward direction then around the mouth and then the whole face and then do another layer. So your morning layer of SPF should be a double layer. A double layer of SPF.
Yeah. I I wanted you on today because I went Iron and I went away for the weekend and I was out I was out in the sun but I did have sunscreenscreen on and I woke up the next day and I had rings around my neck where I had like the wrinkles. I look like a old tree you know like right here it was like ring ring it was like lighter darker and I went oh my gosh I got to talk to Doris about that. And it's because you had your chin down and then where you had your chin down you created little folds. So within the folds where you saw the white was where you didn't get sun and the red was where you got the sun.
Yeah. Well, it was just like it was like a little wrinkle fest under my my chin. Okay. So that's a typical daytime routine. What is an ideal nighttime routine look like?
At night your skin is going to have two issues. One, it's going to lose more water, so we have to protect it better. And two is we want to give activives for that rejuvenation effect. So, you need a little bit more of a solid cleanser because and sometimes even a double cleanse. Like you could use a myicellar water or an oil and then a cleanser because it's so important to remove that double layer of sunscreen that you reapplied throughout the day and all the makeup and get everything off really well.
And then next would be your retinol. And then you can do either one of many things. So if you're on the oilier side, you can use a hydrating serum. And for that, I like ingredients like squaline. That's a little bit different than hyaluronic acid.
Squaline is natural to the skin. It's a great hydrator and it's a it's part of the layers that make up the skin and help with the skin barrier. And it feels really good going on. So squaline is a great ingredient. And then the moisturizer is going to be thicker and heavier.
So it should contain ingredients like ceramides and even peptides. You want a multitasking moisturizer at night. And then some companies make really cool things like cooling mists. So, if you get hot flashes, you can just sort of leave it by the bedside or put it in your fridge or in a glass of ice water by the bed. And if you wake up at night and you're either not doing or not able to do hormone therapy and you're having a hot flash or if it's just hot, you can just spray a cooling mist and it it really cools off nicely.
So, you have options of what to do. But these are your simple nice things to do. Now, if you want to add in the nice to have, I would add in something like Exosomes or an anti-aging serum that your dermatologist might pick out for you. But nothing and that would be under the moisturizer. That would be before the retinol.
Oh, before the retinol after cleansing, always apply the most active first. Okay. If you're in midlife and you've ever felt dismissed or talked over or simply told just to deal with it when it comes to your health, you are far from alone. For years, women's serious midlife symptoms have been ignored or minimized. We've been handed vague answers, outdated treatments, or worse, nothing at all.
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Let's go into Botox and filler because I do think you know I honest about what I do or don't do. When I first came to you, you said I'm not doing anything to you. You need to let all that crap go out of your face, right? Yeah. And I did.
You were nicer about it, but that's what you said. And I did I said you're beautiful. You You did say that, too. But you essentially said like you've got too much going on in your face and we need to let it go back to the starting point and then we can see where we need to make any adjustments. Do you think women are going too far with cosmetic treatments just to kind of survive in a very ages society that we live in?
It's such a good question. I think about it a lot when I think about why we do things. Everything really functions around fertility. Being fertile is a sign of health and vitality and usefulness in the world. I mean, in the end, we're a species.
We're here to propagate. So, we our instinct, our thinking fast side instinctually is towards youth and fertility because it's about making more of us, right? So what happens when we hit this age until we come to terms with the idea that it's no longer about making more humans? It's about celebrating life for the sake of life itself. And it takes women a minute to get to that.
Many times they will do things that are inappropriate either because they see something on social media and they buy into it or they're just afraid of their own mortality. The conversation I have with people when it centers around the idea that older is better, that we have so much more to offer, that beauty is there, but it's different. And I kind of like the idea of becoming invisible to people who only want to be around me because I think that I would be a good carrier of a baby, even if it's subconscious, right? But that I have something different to offer. I don't mind being invisible to some people or a group of society that has a different intention than I do because the people I become visible to are people that I find way more interesting.
And I'm with you with you. I'm with you on that. And there's more of us than you realize. So, it's just a matter of getting over it. And I think age helps do that.
Yeah. And there's acceptance that comes with and I talk about it all the time. That's why in my social media I always say my age because I I think that age doesn't mean old. You can be I have my mom is 93. She still lives lives by herself and does everything for herself and she has a great social circle.
It's it's your it's your outlook on life. And so as your physician, cheerleader, scientist, director of your aging process, I'm here to help you understand that it is all good and there's so much to look forward to. Are there alternatives if women say like, "I don't want to do Botox and filler, but I still want to look good." What are some of the options or a few alternatives? Well, there's devices. There's laser resurfacing.
There's devices that use ultrasound energy that can tighten and give that lifting effect. There's there's so much that we can do, but there's very few women that by the time we're done having the conversation about the true safety and efficacy of Botox and fillers and when when we understand exactly what value they're providing, most people will come around and I never want to talk anybody into anything. So, sometimes we'll have the whole conversation. I'll talk about how I think that neurom modulators like Botox are the safest drug known to mankind. We know down to the molecule how it works.
I put it where I want. I know exactly what it's doing, which I don't know for most other things that we use and that it's the single most powerful reliable rejuvenator and it's not about freezing, but it's about redirecting movement. And then they go, "Okay, can we do it?" I'm like, "Nope, you got to come back and ask me for it." Because I don't want to talk anyone into it and I don't want it to be an impulse decision. But when you see a doctor, I think it's important to have an open mind about what the options are, understanding what they can do and not base it on fear. So the the sometimes the fear for someone is what could go wrong?
What could happen to me and am am I asking for too much or should I just live with what I have? And then the second fear is that people will set this line in the sand. They'll say, I've said I'm never going to do this and I don't want to cross that line. I'm like it's okay. Cross the line.
That was then. This is now and it's okay. So you were there when you said that. Exactly. Okay.
Let's talk about hair. This is the one question that I get constantly and I don't know that most women realize dermatologists are the ones to go to to talk about hair loss, but it really is a topic I know that people come to you day in and day out. I see it on social media. And I and I think it's important because when we talk about hair loss, you know, we're not talking in any of these things about vanity. We're talking about confidence.
We're talking about how you feel. We're also talking about health. So, if we talk about hair loss, what does hair loss actually happen in pmenopause and menopause? It's both a depletion of estrogen and testosterone. So that first start with why we care about hair and it's tied to our DNA.
We don't choose to care about hair. So I never judge anyone for anything. But especially when it comes to hair because let's say you see this animal and it has mangy hair. Are you going to think this is an adorable thing I want to adopt? No.
But if it's been fluffed up and it has great hair and a thick fur coat, you're like, "Oh yeah, this is this is the one. I want to cuddle." Exactly. So, it's hardwired to our DNA to think of hair again as a sign of health and fertility. So, we can't help that. But in reality, we know that it's it's not the case that lots of people have hair issues and it's no big deal at all.
We can address many of it. Sometimes it's hormonal around pmenopause. Natural aging of the hair can happen and sometimes it's driven by genetics where it can be male or female patterned hair loss. To always say I fight for every hair on your head. There's a lot that we can do between topical or oral minoxidil PRP which works where we take some blood spin it down and then inject the platelet rich plasma back into the head.
I have a laser called fetona hair lays that works wonders for helping to grow hair and support hair growth. There's for men there's some pills that work. Women do it sometimes but I don't like it as much for women and they all they can have side effects that are serious like libido and liver side effects. So we have to be careful there but there's so much we can do. There's supplements that can help as well.
Yeah, that's what I want to go into. So, when does hair thinning actually start? It depends. It can start as early as in your teens, but then at 30, we start to really see a change in hair. And the change can be both in hair itself.
So, each hair fiber can become thinner and that can change the texture of hair and even the color of hair. And then the density can also go down. So, what happens is that the follicle is there, but it becomes miniaturized. And again, this goes around that same pathway of mTor. And I'm actually working on something that can affect mTor in very specific ways that can help reverse or slow down aging both in the hair and in the skin.
So, there's a lot of people doing very serious work on hair growth. And I think this within the next 5 to 10 years will either have permanent solutions or lasting solutions for hair loss. So my advice to my patients when you look at hair the problem is that hair naturally sheds because your hair has cycles. You have a growing phase which is 2 to 10 years then it rests and then it falls out which takes a few months. So you're always losing about 10% of your hair.
How often do you lose 10% of your hair? So you lose about 100 hairs a day. Wow. So at any given time 10% is shedding resting or shedding and 90% is growing. And it's random across your scalp.
When you go through a physiologic stress, which could be a hormonal shift, you can have a tiloggen oflouvium, which is a stress shedding. So the hair shifts from the growing phase, then sits in that resting phase, transitions out, and falls. And pmenopause is one long stress period. Some months you get too many eggs, some months you get no eggs. And that physiologic hormonal up and down.
Even though you may not be necessarily consciously feeling things because the the symptoms are so non-specific, we just tend to write them off and go, "Yeah, I'm a little tired this month or I'm a little bit more irritable or I'm a little this or that or I didn't sleep as well." So, we have all these excuses, but your hair will show it by that stress shedding. And then that can accelerate a female or male pattern hair loss. And there's nothing more distressing than seeing hair everywhere. People aren't seeing what's growing. They only see what's falling out.
And it's like getting caught in a riptide. All you see is that you're losing ground. Losing ground. Losing ground. And it's horrifying to women.
So having options to help that. There's lots of products. The hair caps help too. Yeah. Let's go through some of the products.
So hair caps. The wavelength is FDA approved, but there's many different caps. There's a few that I've researched that I think are better. There's one by Revian, one by Caractor. I think those are the two best I've seen on the market.
Then there's the at home treatments that you can do like minoxidil. There's lots of versions of that. Sometimes like I make one that has added in nyinomide and caffeine for helping absorption. Some people add other things. Then there are supplements that add things like curcumin, ashwagandha, a lot of interesting ingredients that are stress adaptogens that can help.
I was going to ask about supplements because I get a lot of questions about whether or not supplements work for hair growth or for dryness. Right. For both. If you improve the quality of the the scalp and the follicle and you're nourishing it, it will help both factors, the dryness and the itching and the hair quality. Now, we get we lose hair on our head and then it sprouts out on our chin or anywhere else or on the side.
So, wrong. Best way to remove chin hair safely aside from carrying a tweezer around which I did for years. Yes. So, there are little shavers that you can carry that will just take it off. You like carry them in your bag.
If you see one, you can do that. Laser hair removal can work really well unless it's white hair or blonde hair. It doesn't work for that. Or electrolysis, but you need somebody good. But it's the same hormone that makes you lose hair on your scalp that makes you grow it on your body.
It's just so morally, ethically everything wrong. Yeah. It's just wrong. I I remember I asked I Dr. Doris did an interview for my book, How to Menopause, and I asked a bunch of questions.
And you gave me pages back and I thought, "Oh my gosh, I could go on forever with this these questions." So, we're going to do a pass or keep. Okay. All right. Pass or keep? Chemical peels.
Keep for melasma and dark spots, but pass for wrinkles. Oh, okay. All right. Face acupuncture. Keep.
But it's not going to replace other treatments we do in the office. It'll help them work better. Vitamin E capsules on the skin directly. So, if it's a vitamin E capsule you're meant to take by mouth, it's a completely different molecule. Will do nothing for your skin.
Don't even bother. And it the preservatives can cause irritation. So, don't. We talked about this one, but topical estrogen for the face. Keep but need more data.
So, it's a probable keep. Dry brushing. Keep but not all the time. I know. I was saying it all the time.
You know, I was. And then I've now gone back to like just like once or twice a week. And dry brushing is to do what? Is to remove the outer dead layer that's making your skin look dull. But if you over strip it, then you end up, especially around pmenopause where you're already dry, then you end up stripping and then losing more water from your skin.
All right. Red light face masks keep, but they're not all the same. And I like the beds better. The beds to land. Yeah, the red light beds.
Yeah. So, you treat the whole body with red light. I'm not talking UV tanning beds. I'm talking red light. Okay.
No, I know that. I know that much. Dermiplaning. Keep But carefully. Carefully.
Yeah. And and once in a while, like once every few weeks to once a month. Again, it's exfoliating, so you want to be careful. Okay. Ice rollers pass.
Why? I don't know. Why not? I Because Tik Tok told me. What do you mean?
All you're doing is you're overcooling the skin and then you're creating what's called a hypermia. So, if you overcool, you vasoc constrict. You're causing the blood vessels to close down because it's too cold. And then as soon as you stop, then they hyper expand. So, you're creating a disregulation of temperature.
For why? What about ice baths? When you dunk your face in the bath before makeup. Is that the same thing? No.
That's that's not exactly the same thing. That one I don't know that it would do any harm. It just probably feels good. I think that's more of a systemic effect than anything else. But the ice rolling, no, I have like three of them.
Why? I don't know. I I don't think I've ever talked to you about them. It might feel good. Tik Tok told me probably again.
If it's cold, it's one thing, but if it's really ice, then I don't like it. But if it's cold rolling and it just feels good, that can be stimulating. I don't really mind that. Okay. Lip scrubs.
Pass. You don't have oil glands on your lips and it's not the same as face skin. It doesn't need to be exfoliated. I like lip masks. So, if you want to do something a hydrating mask to help protect your lips, but that's fine, but there's no reason to scrub.
Good. That's one thing like off my plate. Collagen masks, keep, but it's just for hydration. That's not putting collagen in your skin. So, don't get it if it's expensive.
Yeah. Wrinkle tape keep. Yeah. Yeah. I mean, not maybe on your first sleepover with your new guy, but you know, it's not it's not the sexiest thing, but I but it does help you learn to not make that expression.
Like if you really frown in your sleep, then a a tape and you can just get paper tape or anything. You don't have to get an expensive thing. Exosomes keep. But exoome is just a delivery mechanism. It's not a thing.
It's not an ingredient. It's a It's a capsule that carries a message. So, it depends on what the exosomes are. So, there are some better than others, but they're not all the same. Two more.
Underey patches. Keep, but they should be good. And if they're too sticky and you're pulling them off and and stretching the skin, not good. Yeah. And micro needling.
Keep for specific issues like acne scars, even sometimes wrinkles or discoloration or mealasma, but don't just do it to do it. Dr. Doris stay. Thank you. I could do this much, much longer.
So much fun. Thanks for having me. Thank you. Okay, I know that was a lot of information in one conversation, but I hope you walk away feeling armed with solutions for whatever you're dealing with right now. Whether it's hair loss, Midi, the care women deserve.
