The Future of Dermatology: GLP-1 Face, XERF & The New Science of Skin Tightening

[00:00:00]What is Zurf and how is that different from your RF micro needling?

[00:00:03]>> So, everyone's talking about Zerf.

[00:00:04]>> Of course they are. You really want to know what I think about Z?

[00:00:07]>> I want to know. [music] >> Welcome to Glow Lab. We're going to have a lot of fun and learn a lot together.

[00:00:13]>> There's a new trend in the cosmetic industry along the lines of longevity.

[00:00:17]And it makes a lot of sense because we're seeing this boom just in general.

[00:00:20]Longevity and wellness is just a really big topic these days. So, I decided to bring in Dr. Sheila Farhang. She is a board-certified dermatologist and also a cosmetic surgeon. She practices both in Tucson and in Beverly Hills. And she practices something called longevity dermatology. So, we're going to talk to her about that in this episode. And then she's going to also answer questions about popular treatments like radio frequency micro needling. All right.

[00:00:42]Very excited to have you on the pod.

[00:00:44]I've had you on the channel before on mixed makeup, but this is actually our first time meeting in person.

[00:00:48]>> Yes. Which I'm so excited about. I feel like we've like headed off. I know.

[00:00:52]>> We're giries.

[00:00:53]>> We are. And I was just on your podcast, so you know, people can go over there, too, and and see what we had to say over there.

[00:00:58]>> Yeah. Dermaproved.

[00:00:59]>> I love it. So, something that really caught my attention is that you're starting to practice longevity dermatology.

[00:01:07]>> Tell us about this.

[00:01:08]>> Okay, so obviously everyone's like longevity, longevity, longevity.

[00:01:12]And in my world of like dermatology, I feel like longevity, like the anti-aging world, it's inevitable to not even target longevity. So, what does longevity even mean? People are like, "What is longevity derm?" It's not only anti-aging and making your lines go away or stimulating collagen with certain retinoids or lasers, but it's actually like on a cellular level with the tools we already have. I wouldn't say that there's more tools, but it's like tools that we've had as far as the devices and the injectables is like on a cellular level just like if you're biohacking or whatever, how can you optimize those cells in your body? So, you're thinking skin barrier improvement which every every you know that's so important so many ways in dermatology. You know, we have these things called scinesscent cells, these dead cells. And so the more of those you get, you kind of think of it as like you're aging more or you know, we have these little tieumirs that like it's like kind of the ticking clock. You know, the more they go away, the more aging you get. And now more and more they've seen a lot of the hormones in your body contributing to aging. So it's kind of just not surface level.

[00:02:23]It's going on a deeper level to make sure we're decreasing inflammation.

[00:02:27]We're promoting activating the cells, decreasing the dead cells, the zombie cells, improving your skin barrier, and just making your cells work better. So, you not only feel good, but you look good. And in derm, that's everything because our our health is on the outside as far as like derm is concerned.

[00:02:45]>> When you did the integrative functional dermatology uh course, was there anything interesting that you learned that you're like why don't we learn this in dermatology?

[00:02:53]>> Literally everything. And you want to know the biggest problem as a physician that a lot of doctors face that want to go in and do some of this like alternative type of care is like you cannot do this alternative go out of your way to help patients type of care with insurance.

[00:03:11]>> Ah and with the way my practice is thankfully I can do a little bit of both. So my practice in Tucson, Arizona is like your big medical surgical cosmetic practice. We take insurance plans which is good cuz we do surgeries.

[00:03:23]We do all the skin checks your acne.

[00:03:25]That's all under insurance which is amazing because a lot of people can't afford concier spend 30 minutes with your doctor go through everything that they're eating. You know I wish I wish I could but basically the insurance companies delegate how much time we spend with the patients and even like so many we're like handcuffed. We're so handcuffed and although I try my best and I give them a lot of t pamplets and I have them come back especially if we're going through like what could be exacerbating your hormonal acne which sometimes we may not have a good answer but there are different things that we can kind of trial before getting spirolactone which again is an amazing medication >> but I would say the biggest thing from the integrative dermatology route is sitting down and talking to the patient and a lot also I would say is all of the gut >> microbiome stuff >> microbiome relationship connection with the skin.

[00:04:17]Like everything in your gut is related with the skin and it's insane as far as even wrinkles, you know, even like the foods you eat which we know but you know there's something called ages which are in you know like processed meats and things like that and they literally these glycation you know uh molecules basically break down your collagen faster. And so it's a lot of this that we kind of hear about, but the gut really taking a big place in how your skin and health and your nails are is was like incredible to me. So a lot of what they taught us were like gut testing and lots of labs, lots of supplements. Supplements are great.

[00:04:54]There's just not a lot of >> data because no big pharma is going to spend that much money on a supplement brand. But little by little there are coming out. You just have to be careful with obviously looking at studies like who's paying for the study. So I would say that in the perfect world I would love to talk to my patients in detail inside and out and we do and I would say my Beverly Hills if anyone wants to come and see me at the Beverly Hills office it's all concier so I spend an hour with you. It was like $300 but like come on you spend that on just for sure >> a top sometimes. And I have this one patient I'm just thinking of right now who is just dealing with the worst uh hormonal acne, but she has a lot of gut issues and she wants it gone like quick and she doesn't want to be on any oral medication. So I'm doing like every little thing with her and then she's seeing progress and we love that cuz she was like I don't want to get on Accutane cuz you know basically if you have any GI issues like IBS or irritable bowel disease like Crohn's disease things like that it could get worse. So that's like a really important thing that I kind of keep in mind for my patients. But there there is a way. There's there are definitely options with a lot of these things.

[00:06:02]>> Yeah, I know. That's I love that. I love that. I you know I I deal with peroral dermatitis a lot and I'm like constantly on doxycyc and I keep thinking you know what I need to just start like tackling the the the gut.

[00:06:13]>> I know it really that one especially rosacea and paralerm which they're like cousins of each other. I'm sure you know this. And that's the thing with parallel derm is you literally have to be like a little mystery like MacGyver because it it's usually like for you traveling testing out new skin care and then like probably a few other things that we don't know like yeah like your gut you said you've had autoimmune. Yeah, I completely stopped doing tininoan because like every time I would try to do that cycle of tininoan where like you get your skin used to it, I would just get the worst >> perioral dermatitis and it wouldn't go away. And then I'd get on the dox of cycling. So it was like this crazy cycle and then at that point I'm like girl >> we got to quit the tre.

[00:06:52]>> We have got I can't even do it. I like Alrino. Do you know about Alino?

[00:06:56]>> You know all my derm friends tell me to do it and then I never get on it cuz I'm scared.

[00:06:59]>> It's a brand name tininoan. It's a lotion instead of a cream and it's formul it's a 0.05% but it's formulated with collagen glycerin hyonic acid I think some really great ingredients.

[00:07:12]Yeah. Hyonic acid.

[00:07:13]>> So it's just a little bit more gentle elegant.

[00:07:16]>> Yeah. Wait. Okay. Is there anything that's like overrated in longevity dermatology?

[00:07:20]>> I think that people are really focusing on like optimization in like a way that's stressful and FOMO. So I took off my Aura ring. I had a baby, you know, I had a baby last year, a 13-month-old, and thanks. And I mean, when I was pregnant, I was just like, boom, took off my order ring, and I loved it. And it really kind of showed me what was what were my stressors throughout the day and everything. And it's been really liberating not having it on. I don't know, right? I'm with you on this. I I weirdly lost my aura ring. Like, I don't know what happened to it. I like lost it. I think I either took it off for some reason, like I was at like maybe I was like doing something. I was about to I don't know. And I took it off. Maybe I like to I don't even know why I took it off to be honest.

[00:08:03]>> It was like >> But it disappeared. I was like, I'm going to get a new one. I look actually I still have the charter sitting at my my table. Yeah. And I'm like, should I get another one? And I look back and I'm like, no. It just felt like it was yelling at me like telling me I'm not sleeping enough or like doing these things. And it's like I already know.

[00:08:18]>> We already know. Come on. Yeah. We already know. And it's like when did the art of like just intuition and feeling your body out go away? And that's the thing with like the biohacking culture, which you know as a longevity germ. I love that. And I love I mean I check my labs >> I also like every like eight weeks or so.

[00:08:37]>> We talked about this.

[00:08:38]>> Uhhuh. And I think it's an amazing thing if you can find a doctor and I do this for my patients too is like I check their inflammatory markers.

[00:08:45]>> I check everything. And although we don't have to like obsess over some of the things that are like, you know, we we'll like watch them, >> but I think it's an amazing way to just like show you that your body's doing all right or like, hey, this is why you're tired, your feritin is low, your vitamin D is low, even though it's like in the normal, it's on the lower end. So, it's like little things like that. But, I think, yeah, people just really need to, they're getting obsessed, stressfully obsessed over biohacking. I have patients coming in and they're like the latest and the greatest. Tell me like this. I saw this on the internet like Dr. Sheila tube injectable peptides. We need you to offer it because I need to be on it ASAP. And I'm like hold your horses. Safety safety first when I feel like it's ready for my patients to be on an injectable peptide other than JLP ones cuz that one is like FDA approved.

[00:09:32]We know all the data right now. And I'm not saying like maybe two weeks from now I will change but like right now I feel like yeah, you're like kind of the test patient which you're okay with.

[00:09:40]>> Yeah, I'm I'm very aware of it.

[00:09:42][clears throat] And of course, you're getting it from a credible source versus like getting it on the internet. And >> I think there's a big difference. Also, I have the privilege of being monitored regularly. I can text message my provider and she's spends all her time doing all the research on on wellness and longevity and everything. So, she's not she's not >> giving me anything that she hasn't tried herself, hasn't, you know, or at least like done the research on, you know. So I think I think there's a huge difference in that than getting something from someone on TikTok that you found.

[00:10:11]>> Yeah. Cuz at the end of the day, these things are not regulated and I wish they were and I wish people knew more about them, but the not only the efficacy of them, but the impurities in them. And >> you know, I could care less about some of these trends on TikTok as far as skin. Like if you want to put beef to on your skin, like please do that. Like if you love smell like a barbecue, do it.

[00:10:32]Yeah. If you want to smell like me, do it. If you're breaking out from it, then stop it. But where I draw the line is like when people are injecting themselves and they don't know where the source is. If they don't know if it's coming from a 503b pharmacy, you know, some of these things are [music] >> it's it's scary for sure.

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[00:12:31]Some of them incredible, some of them I'm like, where'd the body go? Where where'd that face go? You know, like that kind of thing. How is this kind of affecting your practice?

[00:12:38]>> Yeah. So, I was one of the first adopters of providing my patients GLP1s >> because I saw a need and and I'd rather they come to me than get it from the internet. M and I have kind of like two, you know, I do lipos suction. I'm I'm a big lipos suction cosmetic surgeon and there are some patients that would do better if they actually were on a GLP1 first. So that's like number one, like the medical. And then two, of course, there are people like in the aesthetics world where they want to lose about like 20 pounds this or that and we micro dose them. And micro dosing, I know everyone's like micro doing everything and I love to micro dose for my patients. micro dose GLP1. So that means that it's maybe even like half of the starting dose, not every week, but everyone's different. There's no like amount that's the nano. Nano or micro is just like a small amount. So basically, if someone's starting off like 25 units of towards appetite, we would do half and they would do it like once a month cuz it's kind of in your system for two months. You kind of like feel the effects. So, we just want them to get the least side effects as possible because if they're like wanting to lose like 15 pounds, like why be why suffer and why lose that all in one month?

[00:13:49]Because you will actually get the consequences of the facial fat loss and things like that way worse than like slowing it down. But I also like to micro >> do why is that? Why is that actually?

[00:14:00]Cuz actually that's a really good point.

[00:14:01]I I feel like because I've only like really ever micro dosed tepatide and I don't see that effect on my face and my body, but I I do see some of my friends that are like they're losing weight fast and then you can see it everywhere. Why is that?

[00:14:16]>> So, not only with these GLP1s or people losing weight fast, but there's also studies to support that the actual GLP1 targets facial fat specifically.

[00:14:28]>> I know, insane. I think it's gotten published. Sabrina Fabi was a dermatologist who really kind of talked about this and her team I think published it. But in any case, we're seeing that targeted facial fat pads.

[00:14:40]And if people don't know already, facial fat pads are what gives like really nice contour. Like when I'm going Yeah.

[00:14:46]That's what keep the the fat in my face as much as I'm putting it in.

[00:14:51]>> Exactly. And that may be why obviously like when you get fat transfer, some of it sticks. Some of it it you know goes through apoptosis kind of dies off. That could also be a reason why a lot of these patients that are getting facial fat transfers that are on GLP ones aren't seeing as a good result. There's so many factors that go this is like literally my hypothesis that I just said right now, but it makes sense, you know, it really makes sense. We don't know though if it's like that from anywhere else, but facial fat is facial fat, you know. So, if anything, it's getting rid of the facial fat that was there, you know. So, so that's a really big one.

[00:15:24]And not saying that that's a terrible thing, but what I really kind of bothers me is when someone they're at their goal weight, but they're on like a high dose though and they are on it for like the anti-inflammatory. I know you're like, "Wait, this sounds like me."

[00:15:40]>> No, no, no. Not a high.

[00:15:42]>> Yeah. Yeah. Yeah. So, so high high dose where they're not having someone like really decrease them in a way where they're like maintaining because at that point if you're not getting benefits and you only want it for like fat loss like what what benefits are we seeing if you're not seeing any other benefits? We know that it's anti-inflammatory. So, if your body feels good, your joint pain, your gut, like there's so many benefits to it and which is why at my office we love it. It's FDA approved and we know all the side effects from it. So if anything bad happens, that's kind of one of the things everyone needs to be kind of like tweaked a little bit. But yeah, I think that the reason why also like one friend looks amazing, another one doesn't is people's based on their facial structure, if they lose weight, someone can look really nice and chiseled just based on their facial structure really like they're like, "Oh my god, did you get a facelift?" Like I think Lindsay Lohan like she lost a lot of weight and did amazing lasers. I don't think she necessarily got like so much plastic surgery or face lip. I think she lost so much. So, some people can just look way better with that facial fat loss >> and some just >> and some just look gaunt and sagging and so it really kind of depends on your genetics. That being said, if someone wants to be on it, do it slow because the amount of time that you're losing it, your muscle, and obviously everyone already knows this, like you have to be on a high protein diet, you got to work out in order to maintain your muscle, but not only that, just to maintain your like laxity cuz that's the one huge thing that I see in my office both from not really my patients cuz I start them on this journey of like rejuvenation early that we can get into, but when I see a patient who like lost so much weight, you know, number one, I say congrat, you know, if they lost an incredible amount of weight and they were had diabetes or you know other issues. First they say congrats and then I'm say all right let's figure out a plan for you because it it may be surgical at that point like there are very little things that actually remove skin other than s you know surgery is like the thing for that but I do have some devices in my office like alo core which is a non-surgical skin removal device that I have things like that we want to contract the tissue so there are things but if you start earlier in your journey of like weight loss and you do it slow you won't have a lot of those issues and I will say a lot of My patients aren't dealing with like looking gaunt older or anything like that. They look they look fire. They look great at the office.

[00:18:03]>> I love it. I love it. I love it. Besides like the longevity dermatology and the GLP1s and stuff, there are some really popular go-to treatments in the office, right? I think radio frequency micro needling is one of them. We actually didn't we do a video and we talked about, you know, cuz at the time it was like people were saying with Morpheus specifically a lot of issues >> like a top Morpheus. Yeah. And and you were kind of like, well, it's kind of in the hands of the provider, right?

[00:18:30]>> 1,000%. So, let's talk about the the drama, the drama girl, which is Morpheus or just radio frequency micro needling.

[00:18:37]So, >> what is it first off for people that don't know?

[00:18:40]>> Yeah. So, radio frequency microning, it is not a laser actually. It's a energy based device. Um, and micro needling is similar to micro needling. So in this way it is micro needling in the skin just as micro needling would but it's actually micro needling in the skin emitting radio frequency energy which does what? Yeah. And radio frequency energy is like electric energy, right?

[00:19:01]So it makes heat, right? So it's a heat based device. So when you get that heat on the skin, it does a few things.

[00:19:07]Number one, it immediately contracts the skin, which is why you immediately look amazing even with things like Zurf when people look amazing right afterwards. My thing is let's see the data three to six months later because when you're having something like radio frequency micronine that's emitting a little bit deeper and contracting that tissue is something on the skin that's less intense going to do that. I'll talk about that later. So number one you get with the heat and your depending on the depth of how deep it goes and depending on the device you can go like half a millimeter all the way down to like 7 mm for the body. So it contracts the tissue uh collagen actually shorten them shortens them in the immediate form. So I love to do this like pre red carpet for my patients with the formula without needles. Number two it activates those fibroblast cells. So those cells that stimulate collagen >> elastin the structure of your skin bounce of your skin. It stimulates that.

[00:20:05]It can also remodel fat which we'll get into and we know it does. It's not like some crazy surprise like we've known that radio frequency has ability to remodel and it's not like melting fat.

[00:20:17]It's just um killing off the fat.

[00:20:19]>> Yeah.

[00:20:20]>> But it is it's killing the fat. But this is actually one of the big issues that had come out was that people were doing it wrong and then melting fat where they didn't want it. Right.

[00:20:27]>> 1,000%. And so I'm not going to sit here and pretend like radio frequency microning or morphia specifically is not a treatment without side effects. Like I have published papers on radio frequency microning and even in there there are very specific settings that we say you know use these settings for skin tightening use these settings for fa you know uh remodeling fat melting fat you know and we would do those in certain areas like the cemental area things like that it's the user and I will say you know we have three radio frequency microings at my office and they're running like all day and we've probably done thousands of patients and I don't even think we've had one patient that came in was like I have facial fat loss from this treatment. Perfect.

[00:21:04]>> So it literally does depend. I I was on a board where I would see all the complications. So I know all the complications that can happen and why >> from things like radio frequency micro needling and and it really does come and you know there was that FDA note that came out that basically said like yes these are the side effects. Make sure you're going to a good provider. Like it wasn't anything new but it depends you know that fat layer. So here's a little biology really quick. So you have like the top layer of the skin obviously some of the important ones. So like your oil glands are about like 0.5 to 0.9 mm and then you have like the dermis and then you have like the deeper dermis and then you have like the hypodermis and you have the fat you know at around 4 mm and then beyond that you have the smleer which is like >> what they pull up for the faceelifts. So you have all those other structures beneath that. So like the muscles and things like that. So it really kind of depends on how the depth of the micro needling is. So 100% the reason why some of these issues happen with the facial fat loss is they were going too deep. So they were targeting the fat layer which is 3.5 to like 4 mm. And this machine can do that. And that's 4 mm for Morphia specifically is like the most you can go. So maybe they were thinking was the best results cuz it's going down to the deeper level. Number two, high energy. I believe it's like 45° is when you are getting into the melting the fat, >> you know, territory versus before that you're just contracting that collagen.

[00:22:36]You're contracting that skin and stimulating collagen. So, that's really important. The thing is a lot of these devices don't is proprietary. So, they don't tell you what temperature you're at specifically. They just tell you like the energy or maybe it's an arbitrary number.

[00:22:47]>> Oh, interesting. Okay. when a med spa or office, even derm office, whatever. If you buy a laser from a laser company, they give you, you know, like a little quick training, you know, usually not with a doctor because we don't we ain't got time.

[00:23:03]>> Yeah. They have like a nurse and they're good and they'll go through and they give you conservative settings. They even give you a guide that are very conservative.

[00:23:10]>> But then some, you know, places will be like, well, I don't want to do it that way. So I think it's with a lot of these issues because too much energy was applied. It was too deep and then there's something called fixed mode which is the amount of time the heat is in the skin for. So the needle's going in and staying there for a bit.

[00:23:28]>> That is what caused it. And I have seen facial fat loss photos of it from like a colleague who's like been dealing with it and like a company would send it to me and we we could clearly see it but that is like not the norm. and the benefits that you can get from radio frequency micing, it's like what I do all the time. Also, I got a I got a huge resurfacing laser last week, which we can talk about. I was like puffed up to here last week. Yeah.

[00:23:51]>> But um with radio frequency mic, the benefits that you can get from it, I'm just so sad cuz people hear about the few, you know, the side effects that you can get and they don't do it. But the fact that you can it's radio frequency is color blind. I can treat deeper black skin types if they have acne scarring or they have laxity. I can help the festunes. So there's a lot of people where this junction here even if volume is there, it's like this under eye and where the fat pad is and then you get this like line.

[00:24:21]>> Oh yeah. Actually a girlfriend of mine was just just asking me about this.

[00:24:24]>> It's where kind of like the fat pads.

[00:24:27]You have two different you have like the sou and the mid cheek fat pad. So it's like a different fat pads there and there's like a little ligament in that area and so you see that little line from them being separated almost and when you age you see them in more pe and people one way is obviously to build support volume both of those things but one other thing if I feel like the volume's not there and like more filler or anything like that and this is why a lot of filler issues have happened because there's a point where like more volume is not going to help stuff. You really need to contract that tissue. And although I love CO2 and I do it, I actually stack radio frequency for around the eyes, especially the feston, like crepey skin around the eyes, like under eye skin, if the volume's there, and then that fesune radio frequency mic first and then I stack it with the CO2 on top. You're kind of approaching it from like deep and then like superficially kind of going like down to up and then up to down and they kind of like meet in the middle. stimulating collagen in a way that really supports and contracts because all these lasers like everyone loves CO2 but it doesn't go down very deep. It's a it's a resurfacing thing. It's like helps with the overlying top part of the skin that you see. There's only a few things like ultrasound which is softwave analapy and radio frequency which is like a million companies you know there's like secret RF morpheus genesis profound like there's so many different companies that are radio frequency micro needling and those are the ones that work on a deeper level and that's why people have to be a little bit more careful about some of these devices but I personally think the ones that are on top of the skin like CO2 can do more damage as far as like scarring the skin >> I've seen some insane scars bars that are permanent on the skin from CO2. So, it really I think like Morpheus just got really popular.

[00:26:16]>> It got in the hands of wrong people.

[00:26:18]Maybe it was the company that had to tell people a little bit more blatantly like use these settings more of these settings bigger, stronger, deeper, longer does not mean better. And another thing that I saw is like people were applying topicals. They were like, "Oo, let me just like apply some vitamin C or exoomes or all of these products on top of the skin after you have these micro channels." And I've seen some insane rea skin reactions from that like bumps on the skin that last. One thing that I saw actually a well-known surgeon here in Beverly Hills. They were like reusing the the Morpheus tips cuz it's usually a three session thing. You go in every month for 3 months. So it's three sessions and then that's like your session. And then you go in for maintenance. Maintenance can be every quarter, every 6 months, every year.

[00:27:06]Like I get my Morpheus like once or twice a year. Yeah. They were like basically like reusing the tip that was like inside your skin from the month before. That's going to cause reactions.

[00:27:15]That's going to cause really nasty things cuz it's been brewing for a month. So there are so many things that I think people don't realize that maybe your provider is doing that could be harming not knowingly or not. And I think that's why it's just again really important and not necessarily that you need your plastic surgeon or dermatologist. Like I'm not there doing Morpheus for people.

[00:27:34]>> Yeah.

[00:27:34]>> I'm not doing that all day. Yeah.

[00:27:36]>> But I have staff that I have trained that literally have trained with me for like 2 years seeing me do hundreds that like just know it. And when they first started, we would go through and I would pick the levels for them. I will say one thing that I think a full CO2, a blade of CO2, you really need like plastic surgeon or derm because again, you can burn. And I think a lot of med spas don't offer that because again it's a huge deal like that one you need to [clears throat] know science and you need to look at the end points. So when I'm stacking it for my patients especially around the eyes I'll do radio frequency myself the radio frequency microink and then I'll go in with the CO2 on top of that to really tighten the skin.

[00:28:10]>> That makes sense. So what is Zurf and how is that different from your RF micro needling?

[00:28:14]>> So everyone's talking about Zerf.

[00:28:15]>> Of course they are.

[00:28:16]>> Do you really want to know what I think about Zer?

[00:28:18]>> Yeah, I want to know.

[00:28:19]>> Okay. So Zerf I think it came out of South Korea came to the US in 2025. I don't have it. So I'm just speaking broadly about it. My thing is it is it is radio frequency. So the people who hate you can't hate Morpheus and love radio frequency. It's the same technology. Yep.

[00:28:38]>> Like so simmer down people. Like you know when you have a plastic surgeon that's like I hate radio frequency microine. But I'm okay with radio frequency. I understand what they mean as far as like the depth of treatment with radio frequency because again you're using micro needles it's more painful to do the radio frequency micro needling route you need to numb you have some downtime like a week it's not like super intense but this new girl in town called Zurf you know it came to the US last year it's still very new but the reason why people love it and Kim Kardashian even like had it which is why everyone's like I need it >> of course >> so you see that immediate remember we always like radio frequency contracts and you get that immediate tightening.

[00:29:17]So people see that side by side.

[00:29:18]Thermage can do that. Like forma can do that. Those are all radio frequency devices on the skin. It's not painful.

[00:29:24]Feels like heat. You don't need numbing.

[00:29:25]No downtime. So people love that. Right.

[00:29:28]My thing is it's so gentle and it does have some like I think really from what I know about it in the papers that I read about it and talking to colleagues, it is very computerized. I don't know if it's AI or what, but it it has a good feedback to it. So, it's more user friendly and safe in that way versus like radio frequency micing. You really need to know and set the settings yourself. It's not telling you like, hey, you're down to fat. Hey, you're like bulking the fat. Like, I wish it did that. That means there wouldn't be any issues. So, Zurf does have a little bit of that feedback where it it knows what it's bulk heating and it'll kind of I think like decrease it. So, that's smart. and it doesn't go deep to the deeper levels, but it being just on the surface of the skin, we'll see. I think it's really new. I think that I do have a few colleagues like derms. Michelle Henry has one in New York. Like some big derms have it. I think that if you are younger, I think if you're in your 30s, 40s, fine. But I think if you're like expecting some craziness, let's see the data. I'm kind of like a skeptic when it comes to this. radio frequency frequency. It's no microning and it's just on top of the skin and it doesn't even you know it's it's not going very deep which safety wise amazing but efficacy wise you know like is it actually going to do something and the immediate fine I can see this being a really good like pre- red carpet treatment which I do with another device that's very similar called forma. Yeah, we'll just have to see like proof is in the pudding. Well, it's still really new and I think >> let's check back in like >> a year.

[00:31:04]>> A year.

[00:31:05]>> Okay, >> that makes sense. That makes sense. For people like me that have mealasma, I've actually stayed away from all RF micro needling because I'm scared of like the heat and and it flaring up the mealasma.

[00:31:16]>> That's a really good point. Did you know that you don't have to be nervous about radio frequency if you have melasma? In fact, there are some anecdotal reports when I published it that can help it because it's vascular.

[00:31:29]>> Yeah. And radio frequency does a few other things. It tightens the skin. It stimulates collagen. It resurfaces.

[00:31:33]Helps with pores. So if we go on the 0.5 millimeter, we're helping. It's kind of like a little mini CO2 or resurfacing laser. So it helps with pores, it helps with texture, fine lines, and then we go deeper. When we're in like the 1 millimeter, then it helps with like acne scarring. And then we can go obviously go deeper to like stimulate collagen.

[00:31:50]And that h that is like a 3 to six month process. But if we are at least 1 millm in depth and we're not in the 0.5 and we're not on top of your skin with the heat. Number one, I tell my patients the mealasma doesn't get worse. And I'll show you photos. It actually it's not a mealasma treatment by no means, but there are some people if they have a very vascular rosacea, I've seen some improvement. I actually did a study, a clinical trial actually in my office on radio frequency marking helping acne, rosacea skin types and it did. Another thing that it does that people don't talk about is it helps improve and increase uh lymph vessels.

[00:32:32]>> Okay.

[00:32:32]>> So my big protocol for when people have really bad under eye filler is I dissolve it. I go in there with uh radio frequency micro needling to help restore that obstructed lymph flow. You know that bogginess that people get which I'm sure you had because just dissolving is not going to help.

[00:32:49]>> I agree.

[00:32:50]>> Yeah. Yeah. And you have to like deal with it. Deal with it. So like my protocol of like dissolving then doing radio frequency micronine to tighten that skin cuz you will get skin laxity from dissolving all that volume that was there. And that's what that's probably why you got the bluff >> also. And so dissolving radio frequency micing to help tighten the skin, but also helps with the lymphatic flow. So then your body can drain that edema and that fluid. And number three, like PRF, I'll go in there and actually heal from the inside. And if I need to refill with filler, I'll do it. Or if we need to do nanofat or something, we'll do that too.

[00:33:21]But I think that just beyond just tightening the skin, like radio frequency microning, it's like a lot of people can benefit from it. Even those with melasma because it is going on a deeper level. Like I would be more worried about obviously the IPL you can't get that but like something on the skin that's creating heat on top of the skin versus like going a little bit deeper.

[00:33:40]>> Obviously in Korea they're doing a lot of interesting like stacking treatments doing them all at like the same time, you know. Are you finding that you're doing a lot more of the stacking?

[00:33:48]>> Yeah, I love stacking. I'm not too crazy. Like I don't like mixing fillers, >> which I know in Canada there's and it's going to be in the US soon too cuz it's like a big company, but they're mixing they mix like a hyaluronic acid based filler with a calcium hydroxy appetite filler like a rad like rad and hyeronic acid kind of mixed together. Um is it different then?

[00:34:10]>> It is diluting it and it's just for me it's like what is that consistency then you know like what is it stimulating collagen like I don't know and like is it blend you know people are doing it without that product right now and you're like how do you know or they'll take a hyaluronic acid and PRP like a a traditional filler and PRP and mix it.

[00:34:29]>> Oh interesting.

[00:34:30]>> And for me it's like I don't like that.

[00:34:32]That's like the one stacking trend that I won't >> that's like the cocktailing it. that is cocktailing. Cuz I'm like, "No, the filler we need to be so precise with it.

[00:34:40]I don't want to dilute down with like PRP." Like, then how much am I actually injecting?

[00:34:44]>> Yeah. Well, it's like you said with fat transfer, you're not the the biggest fan of it because you it's not predictable and you want predict predictable results.

[00:34:53]>> Exactly. Like of Oh, yeah. Of course.

[00:34:55]Like I think it's a gamble like who you go to. For sure. Basically, you're taking the fat. You have great fat.

[00:35:00]Great. And it just depends on how healthy your body is and is is your body going to take the fat? So you could take the perfect amount of fat and that's like usually the goal if you have someone who does a lot of under eye fat transfer fat transfer. But even you you were like I felt like I had a lot and >> I had a lot and now I want more back.

[00:35:17]>> I know cuz [laughter] you you're so funny. Bring it back. Where did it go?

[00:35:21]>> So using your own fat I think like years down the road it's going to be kind of the norm cuz we're just going to get better at it too. you know, that fat that we're going to put in. You know, people are already doing like uh red light, you know, actual red light masks, you know, like red light on the fat to make it as healthy as possible so we know it's going to lift so it's a little bit more predictable. So, like things like that, but filler is still our friend. Let's not forget about her.

[00:35:44]>> Yeah, for sure. Uh last thing, what is your favorite go-to treatment for somebody in the office?

[00:35:50]>> So, when I do my full facial consultation, we talk about a few things. First we talk about the skin because I'm derm obviously if there's like acne scarring, red vessels, broken blood vessels from rosacea, dark spots, we hit that. If they have acne, we hit that before we do anything. And then hyperpigmentation. So there are different types of lasers, but if I were to do uh a laser first, which I will because if we can get skin tightening from there, that means less filler is needed. So I'll usually like for me for instance, I did a three combo laser last week. Like I looked insane. I'll send you a photo. First I did a vascular laser first. So that did that for those little red vessels around my nose. And then I went in, we hit it hard with the herbium, which is like CO2 basically resurfaces the skin. I did it for like a little texture that I started to see like after I got back to my pre-preg weight. And then we went in with like the Moxy to just kind of help with like some of the discoloration kind of get that like superficial flaking. So I think just stacking and nerding out. And if I needed it, I could have done radio frequency microning that day, too. Like I just love in the best way possible, just like optimizing and nerding out on that. So, I love that. I love injectable bio stimulators. You know, Sculptra is amazing.

[00:37:05]>> Where do you like putting it? Like, what's the most common?

[00:37:07]>> Um, you know what I'll do? Not anything crazy. I'll use usually one vial or if someone has a lot of loss. I don't do it for loss a lot. I do it for like skin tightening. So, upper face, I'll do one vial. lower face. I'll do another. But what I do a lot with Sculpture and Filler is the back of the hairline here.

[00:37:24]>> Yeah.

[00:37:24]>> Because we have this ligament here and everything actually ages in front of this ligament. And so in Europe, in Brazil, you know, we go to these conferences probably in Korea for years now. I've been injecting filler, actual filler back in the hairline kind of like you've had the fat because it does pull up. It's not a facelift. Like it's not a facelift result, but that little bit of like what I call let's do hidden. So I'll have someone come in beautiful facial balance. Like they look gorgeous, the lips, the profile that we don't need more in their cheek. That's how people get alienized. And they're like Dr. Sheila like I've done all the things like is there anything we can do? And I'm like it's hidden filler time. Yeah.

[00:38:05]So I will go in in their hairline back here because that's going to pull up on that ligament and also back here. And that will give you in the right patient the nice lift without making it look like you got filler.

[00:38:17]>> I love it. I'm actually getting that done tomorrow.

[00:38:19]>> Stop it. [music] >> Yeah, I am. I am. So, we're on it. Yay.

[00:38:22]Thank you so much for being here. Of course.

[00:38:24]>> Where can people find you?

[00:38:26]>> Um, so, uh, Dr. Sheila Derm is my Instagram and you can book with me there. But I have my Tucson [music] office of dermatology and aesthetics and I also have a Beverly Hills office and yeah, and of course Dermaprove and that's my podcast. Look.

[00:38:39]>> Oh yeah. Thank you. Of course, thanks for watching this episode of Glow Lab.

[00:38:43]If you enjoyed it, make sure you subscribe, rate and review, and of course, share it with a friend. That way, we can keep the conversation going with amazing guests. [music]