All right. Why don't we get started?
Mm-hmm.
two minutes after, so good morning, good evening, everyone. Um, our guest today is Dr. Adrian House, and we'll be talking about a very, very interesting topic that I'm sure, uh, you've all seen the invite and were intrigued enough to come attend, and I think you're going to enjoy it.
So before we do that, couple of quick housekeeping. Uh, ask your questions in the chat window, and we'll make sure to get to them at the end of the conversation and ask them of Adrian. And, um, if you're not already a member of The Longevity Lab, you it's free, it's fun, it's, uh, insightful, and, uh, it's easy to join.
The speaker for next week is Dr. Chaya Mureja. She's an endocrinologist and, uh, uh, she focuses on, uh, hormones, as most of them do. But she has a very interesting take on things, and I think you'll find the conversation with her quite fascinating. So if you're free next week at this time, definitely join this call.
All right. On to our guest for today. I took a short sort of a summary of Adrian's background. I don't think it does it justice, but more
I got to meet, uh, Adrian about, I think two years back at a lunch. And it was a small lunch, and we didn't know each other, but that lunch was quite a fun one. We got to know each other. We had some fascinating conversations. And then, again, about maybe eight, six, eight months back, we met again, and I asked Adrian whether he would be willing to do this, uh, podcast conversation for the community, and he was absolutely open to it.
And so here we are. Um, and I think what I find just amazing about what Adrian does is, you know, we all, in our minds, at least in my mind, when I think plastic surgeon, because of all the TV shows I've watched and all of that, uh, I have a certain image.
And, uh, what you'll hear in today's conversation is, it's not what we have seen on TV. There's a lot more to it, and I think by the end of today's call, you'll all sort of appreciate it a lot more. So without further ado, uh, I want to welcome Adrian to the Community Podcast.
Thank you very much. I appreciate you having me here. It's, it's been great to get to know you over the years too. I learned a lot from your blogs.
. So, so Adrian, let's, uh, start with, you know, what got you into, like, as a doctor, you could have chosen any profession. You specifically chose this. What was the driver for that?
Yeah. It it's kind of an interesting path, because I never thought I'd be doing what I'm doing now. Um, I had originally gone into, you know, go through in the US, university, then medical school, then you kind of choose what specialty. And so I went into head and neck surgery with the plans to do head and neck oncology, so head and neck cancer surgeries.
Uh, so the first, a five-year program, and I was about three and a half years in. I, I just took a, I'm very... I consider myself an empath, so I took a lot of the, um, the sadness home, I guess, with me, uh, in those cases. It's very tough cases, and it really requires a certain type of person, particularly with pediatric, uh, oncology.
Um, and I did a rotation on plastics and fell in love with it. We had one of my first patient was, uh, this young lady who had got a surfboard hit on her nose, broke it. She became depressed, lost her job, lost her relationship, became an alcoholic. We were able to fix her nose in two, three hours, and next time we saw her, she was wearing brighter colors and happier.
It was very, it was just, it was, it's like a life-changing thing that, that really brought a lot of joy to my life. So I figured that might be my calling.
Yeah. I mean, and what a great first, uh, patient to have, right, who you could actually see the impact of.
Exactly.
Yeah. So, you know, going to the point I made earlier, Adrian, when you explain what you do to the common man, right, we are, we are all examples of those. How do you describe what you do? Because, like I said, people have a certain image.
.
It immediately goes to, all right, you are the, uh, you are the doctor to the Hollywood stars, right? That's
Right.
... image. But as you, as an example that you just gave, there is much more to it. So how do you describe what you do?
Yeah, it's one of those things I'm reluctant to share with people sometimes when they ask what I do, because of this initial judgment. But, um, really, I kind of view it as the, majority of my patients that I see are really just wanting to look normal. Uh, they, they don't want to be, you know, turning heads when they're walking down the street because of some deformity they have or some accident they went through, um, or even some aging that they feel like, "I feel so young and spry, but yet I look in the mirror and see this old man or old woman." So there's a lot of, um,
really making people feel like, making them how feel inside is really what it is, which gives a lot of confidence. And for better or worse, in our society, that's just a big part of it. If I had a giant pimple on my forehead right now, I wouldn't want to be on camera and I wouldn't want to be doing this interview, you know?
So it's, there's a lot of things that, um, aesthetically, again, for better or worse, really affect our own mood and our own confidence. And there's been a lot of studies showing that patients who feel more confident and look more objectively attractive, I guess if you want to say, um, get better jobs and higher pay.
And so there's, it's just, it's just the way we are as humans. We certainly pass judgment very quickly on people by their appearance.
Yeah. And I think the point you made is so critical, that
confidence is not something anybody else can give us. It has to come from within. And for each of us, that is a different thing. And whatever that is, that needs to be addressed. Everything else
Very true.
place.Right. Um, uh, you know, one thing that, um, I know gets discussed a lot is, um, um, we go out in the sun, um, so sun protection, hydration, sleep. These are the three things that are most often, uh, three words that are almost always often seen, uh, associated with, you know, your skin.
Mm-hmm.
Uh, your quality of how you look. How much do these matter and what can one do about these things?
Uh, uh, all three of those things are probably the biggest impact. You know, I get asked all the time, "What supplements should I take? Should I be doing whatever these certain massages or exercise?" It's like, really what it is, is taking care of sun damage, which is probably the number one, that probably accounts for about 80+ percent of your aging, uh, from the skin standpoint.
Um, and getting enough sleep, which has a huge impact on cortisol levels and even collagen production. Um, and staying hydrated, which you don't have to be drinking, you know, 10 glasses of water a day to be hydrated, but it's, uh, you know, your kidneys do a pretty good job at regulating it.
But I'd say the majority of patients really don't drink enough water or have enough fluids in their diet. So, the skin is the largest organ in your body, it's gonna take the biggest hit when those things are all compromised. So they're all very important and they're all very
simple things. I think a lot of people want some miraculous, uh, exercise or pill to make it better, but really, just sleeping and eating right and putting some sunscreen on is probably the easiest thing to do. It's the biggest impact.
So when it comes to, uh, sunscreen, Aidan, what is your recommendation? Is it... Does it depend on, uh, skin color? What is the rule to think about when thinking about sunscreen, for example?
Yeah. So for sun burns, which could obviously lead to skin cancer and things like that, I'm much more prone than you are for those things. But, uh, with certain we call it Fitzpatrick scale of
Right.
... pigment. Um, the... Even though that there's more melanin in higher Fitzpatrick skins, uh, that means you don't burn as much. But the actual effects of the sun and and the radiation from it, still affects, uh, the aging process. And so, um, wearing sunscreen all the time is probably the best, easiest thing you could do.
Just put it next to your toothbrush in the morning, put some sunscreen on your face and neck. You're supposed to apply it every two hours, which I don't think anybody does, but, um, but just knowing if you're gonna be outside, you know, at the beach or something like that, that reapplying sunscreen is probably the most important thing that you could do, um, regardless of your skin type.
Right. Hey, um, there are the SPFs, 30, 60, anything that you recommend?
Yeah. So this, this scale, the way those SPFs work is, it's kind of a, almost like a sigma curve. So very low SPFs of five are probably gonna be doing nothing. Um, as you get to 15, it's a little bit better. Once you get up to about 35, I recommend about 45, 50-ish.
But once you go past... The difference between 50 and 100 is pretty minimal. So as long as you're within that like 30 to 50, depending on your skin type, again, and sun exposure, that's kind of the sweet spot. So the sunscreen I carry has 45 SPF. Um, and I also get asked the difference, you know, should it be mineral sunscreen versus chemical sunscreen?
I think they both, they both cover different bases. Um, the one I carry has both in it. Uh, I think the mineral... The mineral sunscreen is great because it's a physical barrier, uh, that's protecting. But the issue with that too is that physical barrier can fail in the sense that if you're sweating, you can get streaks and then that area is now not covered.
There's some sunscreens out now that are powder, which seem really convenient, you just pat it on your face. But if you look at the actual insert, the thickness of the powder that needs to protect you is pretty thick so you'd have to be basically wearing a face of makeup from it.
Um, so yeah, so the combination, I don't think that there's one that's better than the other, but, uh, I do like the combination, I feel like it covers all the bases.
Great. You know, uh, I have an interesting anecdote to share. I always thought being of darker skin color, I don't have to worry about uh, sunburn. And then, uh, I was on this trip to Tahiti and we are out all day in the water and I was like, "You know what?
This is great." And that night... Uh, and then, it was overcast, so it didn't feel like it was
Yeah.
... and that I realize is the biggest misconception when it comes to people thinking, "Oh, if there isn't sun that is visible and it's overcast, the, uh, problems are much fewer."
Mm-hmm.
I was so badly sunburned, I couldn't sleep on my back for three days after that.
Uh-huh.
And was like, "How is this happening to someone like me, especially when there is... there was no sun?" And that's when I learned the concept of the UV index, so...
Yes, yes.
Can you talk about the UV index, Adrian, how that matters?
Yeah, the UV index is important to us, and it's basically published on any weather app that you use on your phone. But, um, there's certainly some impacts, in a certain time of year, uh, just the way the sun and Earth obviously are rotating. But, um, but even when it's overcast like that, UV can get through clouds.
Maybe some of the bright light is not come in through, but... And particularly too what you were saying on, on the water, there's a lot of reflection off the water.
Mm-hmm.
So patients all want to sunscreen on your face, you have to put on your neck too, because there's a lot of reflection up that can cause, um, you know, sunburns that way too. So, uh, yeah, it's important to check the UV index every day, but, I also just wear sunscreen every day, so it's probably easier than anything else.
Yeah.
Um, even, even during COVID, I was wearing sunscreen indoors, so...
Uh, no, but I think, uh, I have now become a fan. I mean, I use the, uh, the Apple
Mm-hmm.
every day. I don't almost care what the temperature is going to but I look at the UV
Yeah.
so I don't ever have that again. And I've not been that good about putting sunscreen every day, uh, but, but then it also sort of brings up another question for, you know, especially, uh, South Asians, uh, because of the darker skin, uh, we tend to be lower on vitamin
Mm-hmm, yeah.
... average, uh, person. And so then we... on one hand you're told, "Go out in the sun, you require more sun," but on the other hand, if you put sunscreen, it's that sun is not really getting through. What's the balance there?
Yeah, that's tough. Um, it's tough for some these recommendations, uh, because it also depends on your skin color and, and latitude that you live on and everything else. But, um, in general, I mean, if you're getting 10 or 15 minutes a day in like a moderate to low UV index without any sunscreen, you're probably getting enough vitamin D.
Uh, but it's... At this point, honestly, supplementing it is probably the best option. So you just wear sunscreen every day, um, and take a vitamin D supplement. They're very easy to get, they're cheap, they're benign, they're very well studied. Um, there, there's... As far as the recommended dose on that, there's a big range.
I, I trained at Boston University with, uh, the godfather of vitamin ... and he recommended some crazy high dose. I think it's, it's the source of all the problems that we experience, uh, which it probably can contributes to a lot of it.
Yeah.
... supplementation with that is great, um, a little bit of sun here and there is fine. But, uh, you don't want to get sunburned and certainly don't want to have extended sun exposure daily for years and decades on end. That's really what leads to a lot of the aging I see.
And is there such a thing as, you know, uh, someone like me may never have put on sunscreen for the first 50 years of my life, but now I'm starting. is there such a thing as, "Oh, well, it's too late now," or it's never too late?
No, it's never too late. It really isn't. Uh, the, the aging process happens every day, so if you can slow it down even starting now, as far as the appearance is concerned, then I think it's worth starting. Never too late at all. Um, and, and then, you know, a lot of the things...
I see, I see many patients that are in their, you know, 60s, 70s, who, uh, when they were kids, you know, they were sitting with tinfoil and trying to
Mm-hmm.
get as much sun as possible, um, and you don't see the... You know, you're nice and tan for that summer and everything looks great, and then you fast-forward 20, 30, 40 years, you really do see the impact on the... on the skin and the aging. And there's certain things that we can do to help, um, you know, treat that, like lasers and peels and whatnot, but, but really the damage is there even on a deeper level.
Um, but, uh, but again, because you have, uh, higher Fitzpatrick scale, you'll probably have a little less of that, of that sun damage long term than who's from, you know, Northern European, someone like that.
Yeah. So you know, about, uh, I think maybe a year or so back, I wrote a post because of my Tahiti experience.
Yeah.
I wrote a blog post on, um, on sunscreens. And in that, as... when I was researching that, uh, piece, I found this interesting photograph of a truck
Yes.
and I'm sure you've seen this.
Yeah, the exact one,
It absolutely photographed because for the, for the members of the, uh, audience, uh, it was a photograph of a truck driver and, you know, the sun hit the left part of his face, uh, because that's closer to the window and the right part wasn't, and it showed the sun damage to his...
the left part of his face versus the right part. It was staggering because for 30, 40 years, he had been a, a truck driver and he had faced that. And so if anyone ever wants to see the slow, but, uh, gradual decay of, uh, or, or the impact on the skin, that photograph will make people think about putting sunscreen more than anything else.
Exactly. The hard part with... mean, all of these things especially that you talk about on your blog is... I mean, there's such incremental changes you don't see every day, um, but that add up. Even simple things like, you know, one of the reasons I didn't go into cardiology is, you know, you prescribe blood pressure medications to a patient and they're supposed to take it every day and they do, and you may have extended their life by a decade.
Neither of you know, and they don't feel any different. You don't c-... you can't tell your blood pressure's high or low. Um, and so it's, it's this... but there's these little incremental things that we do every day that really add up over the decades, for sure. Like that sun exposure is a great example of every physical one that you can see.
Yeah, yeah. We will, we'll make sure to post that, uh, in the show notes, the link to that specific article and blog post. I think it was quite a fun one for me to even research, uh...
Yeah. Very impactful.
When, when you, uh... You know, you spoke about hydration and you said, you know, you don't have drink 10 glasses of water. Uh, what do you... How many glasses water do you drink, Adrian, and what's the
Uh...
... that you've come up with?
So doctors are traditionally the worst
Okay.
when it comes to that. I think, I mean, for me, like we were talking about before we were signing on here is like for surgery days, if doing an eight or nine-hour case, I can't be drinking 10 glasses of water running to the bathroom all day. Um, but there certainly is, uh, benefits to that.
I mean, the recommended, uh, amount was eight glasses. It's... The data behind it's not, you know, that strong. But in general, I think if you're staying hydrated enough, uh, I kind of go basically off urine. Like if you've got dark brown urine, it's like, man, you're not getting enough water and we could individually see that, that's the best probably test.
Um, and there's certain things that, that... If there's toxins or if you're really sick or whatnot, your body's going to be using, um, more water and you're trying to flush out a lot of that. particularly if you have a lot, a lot of mucus and runny nose and things like that, you're losing a lot of water that way.
We lose water, a lot of water just breathing. Um, so if you're exercising a lot through sweat and breathing, I mean, you need to have some replacement of that. Um, yeah.
Yeah, no, I think the urine color test is the one we keep talking about on
Yeah.
community. That that... I don't think there's a better test than that.
No.
Right? Where other people try to force eight glasses down their throat and it's not pleasant if you can't take that much in.
Exactly.
Um, and then with sleep, any
specific recommendations around... I mean, we all want to sleep better, but I, I found that any blog post I write about
Hmm.
gets the most number of, uh, views simply because I think most people suffer from poor sleep.
Yes.
And
when you think about your sleep hygiene, how do you... What are the couple of things you do to improve the quality of your sleep?
Yeah, I mean, and there's a lot of the things you've talked about on your blog, but the... probably the biggest thing is having consistency. Um, and, and the hour two leading up to sleep, uh, really has an impact on how that sleep's going to be. Whether you've had a late meal that's very large or spicy or lots of protein, whatever it is, um, if you've been drinking alcohol, you know, all those things are going to have an impact on, on your sleep throughout the night.
Um, but if your your body... Humans are very much, um, you know, creatures of habit. And so when we say, okay, it's, you know, 9:00 PM I'm going to start winding down, maybe read a book, turn the TV off, get your phone screen out as a lot of that blue light has impact too.
Um, and just getting into a routine where you can go to sleep and naturally wake up at the same time. Which is, I mean, a good proof of that is jet lag. When you fly anywhere else in the world that's more than a couple of hours time difference, you feel it.
Um, and so your, your body does have a circadian rhythm that, that, that flows with the sun and a lot of, uh, other impactful... has a lot of other impactful, uh, things on our health. So, yeah, the biggest thing, consistency and then taking it easy and kind of winding down toward the end of the night.
But we live stressful lives and busy lives, it's really hard to do that sometimes. If you have a big exam or some big meeting the next day, it's... You're going to be stressed and ruminating on that. And again, surgeons are the worst example of this because we're up until 10:00, 11:00 doing stuff and then up at 5:00 go to the OR, which is why, you know, as residency we...
you know, two, two weeks of that and you'd spend almost a weekend sleeping and catching up. Which is a real thing you do, you do. Your body does catch up sleep when you miss it.
Yeah. Yeah. Yeah. Um,
you know, the other thing that, uh, we didn't, uh, touch on is exercise.
Mm-hmm.
exercise of course is cardio, there is strength training, there's the different, uh, varieties of exercise. From a skin perspective, does it matter, Adrian, which variety or as long as you're exercising, it's all the same?
From a skin standpoint, that's a good question. I'm not sure how much if one would be better than the other. I don't know the data behind that. Um, but there certainly is... Um, muscle mass and, and strength training has a big impact on your metabolism. You, you burn more calories lifting weights than you do running or, or, uh, on a, on a bicycle.
Um, but then obviously there's some, uh, cardiovascular benefits. So there's, there's even... We always talk about cardiovascular, we talk about the heart, but it's the entire circulatory system. There's capillaries in your skin of your face and there's blood supply to the face and things like that, that, that, uh, bring nutrients and oxygen.
Um, and so doing cardio and strength training is really the best balance. And it doesn't need to be ... a lot. You don't need be running for an hour or two every day, every day. But, like, doing enough to really get your heart rate up, blood pressure up, get the circulation going, um, and, and the strength training is, I think very important, even for a lot of the muscle mass that you see, uh, is in your face, too.
So, when you're
Hmm.
as you're lifting weights, that also has an impact on the thickness of those muscles and how the real volume of your face is. Same with running. I'm sure you know runners who run, you know, 10 miles a day and they look very gaunt, and they, they lost a lot of facial fat, um, and they tend to look older, even though cardiovasculally, they're probably very healthy.
Right.
Um, so there's, it's all about balance and everything in moderation, really.
Yeah. Yeah, no, that, that is a, that is very true. Um, the, one of the things, and this is more a, I remember reading or watching a show once. And, again, I'm, it's hard to tell whether these things are real or just made for TV, but, uh, actors, uh, I heard, before they, uh, sort of their warmup is they contort their face, uh, in various ways to, uh, make their face ready for the type of
Mm-hmm.
... they need to show. Uh, is that, is that, uh, you know, just a fun thing or is there any real science behind doing any of that?
So, that's a, that's a good question. There's basically the impact of that is a lot less about the facial structure and the long-term appearance of your face, and more, um, kind of like the neural pathways that are firing those muscles. And so, just like you see for sprinters in the Olympics, they'll jump up and down and kind of run in place, you're, you're, you're creating those or, or, um, reinforcing those neural pathways of the nerve firing that muscle and the impact you have.
And on, more important for acting is a lot of things people don't talk about is there's a facial nerve that creates motor impact of how you move your face, but there's also nerves that, that come out that give you sensations to face. And there's a feedback loop, so you can feel where your face is.
It's called proprioception. So, just like athletes running, for actors like that, the proprioception, knowing how your face looks without actually seeing it in the mirror, is probably the biggest impact that they're having. Um, there's a lot of things that are online, especially on social media, like certain facial exercises that's gonna, you know, affect your jawline and stuff.
Most of that is
not
data-based at all, um, and very misleading on some of those accounts. And for, I've, I've... So account has over a million followers and the stuff that's on there, I'm just like, "None of this is actually legitimate." But...
But it gives the feeling of legitimacy and so you're not, "I want to look younger. I'm going to do these exercises even if there's-"
Yes.
"... no science behind it."
Exactly.
And many ways, I'm glad you brought that one up because that's the type of stuff we want to, uh, increase awareness about, that there is stuff you can do and you should
Yeah.
and there is stuff, don't waste your time doing because it doesn't help.
Yeah.
It just makes you think that you're doing something for yourself.
Yeah, exactly. Yeah, a lot of this, this, I'd say the vast majority of the facial exercise social media accounts this year are really, um, just kind of pandering to, to, to a lot of people. It's, I don't think has a bunch of an impact. If anything, may even age you worse because you're using those, or quicker, because you're using those muscles, which then create wrinkles, which is the whole reason that we use Botox to soften those muscles.
You're doing the opposite. You're strengthening them. So, um, yeah, so it's, it's, some of that stuff I don't think is worth it at all. There's certain things like lymphatic massage, for example, where you're actually pushing the fluid and, and using the lymph system to, to remove swelling. That, I think, is an impact.
I mean, you can see a difference, particularly in patients who've had, uh, you know, previous surgeries or traumas or things like that that are gonna be, um, leading to more swelling in the face. But some patients will have just genetically, it's called malar edema or festoons, where there's lots of swelling on this, in this area, um, and doing those massages actually does help.
And so, what's that massage like then? Do you give that to yourself or does, uh, somebody
Yeah. Both, There's, uh, a lot of places around that'll do lymphatic massage. Um, most of the ones I've seen are pretty good. Um, and they'll, and they'll give you exercises that you can do at home. Um, but there's certain, like jade rollers and things like that where you're gonna, you know, roll on the skin or the Gua Sha, uh, little blades that help, uh, remove swelling.
I think that those things are helpful, but they also have to be done every day, um, you know, as, a maintenance. Um, similar to, like, red light therapy I get asked a lot about. Uh, it's, there actually is pretty good data behind that. I mean, this, the, the mitochondria that live in our cells is, is originally evolutionarily was from bacteria that, that ended up in there.
It's the same type of bacteria that led to chlorophyll in plants. So, the plants use photosynthesis to use the sun to create energy. The mitochondria we can activate with, uh, red light therapy. But again, has to be the right strength, the right wavelength. There's a lot of cheap, uh, alternatives out there that aren't doing anything.
And it also has to be something that's done every day, like 15 minutes every single day. The data is behind it, but it's really hard to be sitting for 15 minutes with a red mask on.
Right, right. And I think the one thing that, uh, in one of my posts I'd written about was the fact that red light therapy will help anything that's within the first couple of
Yes,
your skin. Anything that promises, you know, it'll cure your
No, no, no.
is, there's no way it's gonna get that deep.
No.
Those wavelengths cannot get that deep.
Yeah. At, at the, at the most, I mean, a, good example is hair. So, using red light therapy for hair, uh, has been shown to work, but the hair follicles are only a couple millimeters deep, so that's, they're actually getting that stimulation. Anything past that, no, there's no, there's no systemic impact on it, that's
Right, right.
... and true.
Uh, the, uh, you know, there are specific supplements that are discussed a lot, and I know so many people who spend a lot of money buying them. Uh, collagen.
Yeah.
Um, hyaluronic acid.
Mm-hmm.
Um, I think these are the two I hear the most, uh, with people who are spending a lot of money. Is there science, good science behind those two supplements?
Uh, good science is a little bit of a stretch.
Uh-huh.
I think there, there is some data, so I'll, I'll talk about for example, for, since we're talking about hair, like biotin, um, and supplements like that. There, if you're low in those things, just like any supplements, then, uh, replenishing them, like we talking about vitamin D, uh, is gonna have a positive impact on your health.
Um, if you're not low in them, then it's, you're, you're kind of wasting your money and your body's really just going to be clearing those things. They saw some article that Americans have the most expensive urine in the world, which I think is very true. A lot of people are taking massive amounts of supplements, when, uh, in general, the diet is enough to, to give you what you need.
Um, similar to, um, like the, uh, the collagen supplements. There's some data that if you take collagen supplements orally, um, that there's maybe a little bit of, uh, improved GI
uptake and whatnot, but really, collagen, all it is, is a, a string of amino acids, um, which is what's in all of our protein. So if you eat a well-balanced diet or even have a protein shake, that's probably giving you, you know, 95 or higher percent of, of what you'd get from a collagen supplement at a fraction of the price.
Um, so a lot of those things are, again, marketed to, to make money. It's a very, uh, you know, lucrative industry to be in for those, those kind of supplements. Um, and, and again, it's one of those things where you can't feel if it's making a difference or not, so you just keep doing it, hoping that, that it helps.
Yeah. The argument that's often made about supplements is, "Well, what's the downside?"
Yes. Exactly. Yes.
Mm-hmm. and the downside is, it's, uh, wiping out a few thousand dollars every month or every year from your bank account.
Right. And, and forcing your kidneys and stuff to filter it out, which is, I don't know the long-term effects on that. None of this stuff, at least here in this country, is regulated. So it's, you don't even know what's in it, honestly.
Yeah.
Uh, so getting from a trusted source, very simple things, like for protein shakes, if you, if you've taken whey protein, for example, you can get very simple casein or whey protein that probably is gonna give you the majority of the benefits you'd have from collagen. Collagen is a very complex molecule.
It's a very large molecule that's made, um, block by block by your cell. So if you take collagen, it's this big, long thing, it gets in your stomach, it breaks it down into amino acids, a protein, your body absorbs it, and then rebuilds it. So if you just supply the amino acids to begin with, your collagen production's gonna be fine.
Yeah. Actually, you know what? That's really, really good. I had never, I never knew that. And I think that's a good argument for why not just take the raw material that's gonna do the work?
Exactly. And hyaluronic acid is another example, like you mentioned. Uh, that's in a very complex molecule. If I wrote it a chalkboard, it would run off the end of it. mean, it's, it's huge. Um, and so, uh, there's supplements that you could take orally which is just gonna get broken down in your stomach by the acids, and then there's, uh, topicals that have hyaluronic acid in it, which are very good at locking in moisture, much like aquaphor Vaseline or some sort of like, uh, occlusive, um, skincare, but it is so large that your skin is not absorbing that.
It's sitting on top of your skin. So when you say, "Oh, we're going to put hyaluronic acid on your skin. It's gonna make it hydrated and plump and it's gonna get into the cells." It doesn't. It just sits on the top of the skin. Which isn't a bad thing, but it's, it's being used as a barrier rather than an actual hydrating thing.
So you, it would be one of those things where you get out of the shower or bath, with your skin is already wet, putting hyaluronic acid on, then yeah, it would probably lock in the moisture. But otherwise...
So is there any supplement, Adrian, apart from like, putting
Yeah.
... is there any other supplement that's really worth
adding to one's routine?
Topically, topically, ascorbic acid, vitamin C, um, uh, has a really good impact on the skin. It helps a lot with pigment. Um, it's, uh, an antioxidant, so it'll, it'll actually quench a lot of the free radicals. So typically, the best thing for, for, uh, sun protection, I should have mentioned earlier, is putting vitamin C on and putting sunscreen on.
Um, because that vitamin C, if the sunscreen doesn't stop those UV rays and they end up actually penetrating into your skin, the vitamin C that's in your skin will help neutralize the free radicals, which is what leads to a lot... ... the aging, process. Um, taking oral vitamin C hasn't been shown to really increase skin levels that much, um, but it has a big impact on immunity.
Um, so there's, there's, you know, simple supplements like that. Vitamin E is also very hydrating and kind of nourishing, similar to like aloe. If you get a sunburn, putting aloe vera on it kind of makes it feel good. It's a little bit hydrating. Um, certainly not going to do any damage to it.
Uh, but the majority of the things that are sold for like, skincare supplements are kind of foo-hoo. There's really no good data behind it.
Yeah. Um, and then you, uh, briefly mentioned, and I want to get back to that, Botox.
Hmm.
Uh, what's the use case for Botox from your perspective? Like who should be doing it and for whom is it not necessary?
Yeah. So Botox is an interesting, has an interesting story behind it too. Um, it was, uh, discovered here at UCSF in San Francisco. Um, and it was, uh, there was a doctor that was dealing with strabismus where, you know, one patient's eye is, is kind of, the muscle's pulled to the side.
So he went in to, try to look in nature and see what things can relax that muscle and Botulinum toxin work causes complete flaccid paralysis. Uh, he diluted it a bunch and injected in his muscle. It actually corrected the strabismus, and then patients were also ... and this is the thing with, with medicine is like, you have to be observant, noticing that they had less wrinkles around their eyes, and now it's like a multi-billion dollar industry because of it.
Similar to Viagra, I mean, that was, that was a, a heart medication and men would come in with this side effect that is now, it's marketed for the main, main purpose of it. Um, but yeah, so Botox in general, all it does is weaken the nerve connection to the muscle temporarily.
Um, and so at certain doses and at certain locations, it can soften that muscle. So similar to, like if we're talking about crow's feet around the eyes, those creases happen because that muscle contracts, the orbicularis muscle, and if we can stop that muscle from contracting or at least soften it, then those creases will be less.
Just like when you're sitting down, the back of your pants can get creases in it. So it's essentially softening those things before it happens. Now somebody like that truck driver photo that you post has a ton of deep wrinkles along the side of the face. You can put as much Botox in the world on that and it's not gonna make that go away.
So there is a certain amount of it, um, as far as planning that's preventative. Um, and, you know, there's patients coming in, you know, asking for Botox at 22 years old. I mean, you don't need it. Um, but when you're in your, you know, mid-30s into your early 40s and stuff, it's probably not a bad idea to do it.
It doesn't need to be done every three months. That's about how long it lasts. Um, but just doing a little bit even every six months. I do my own Botox every six months 'cause I also want to age a little bit. I've got a young looking face for a doctor so got to want wrinkles.
Um, but yeah, so there have been, most patients are candidates for it, but it has to be done right. I think things are definitely overdone a lot when it comes to aesthetics, just like these supplements. Um, it's the same thing with volume, like fillers and things like that. Some patients certainly benefit from a small amount of volume replacement.
We lose about a cc of volume in our face every year. Um, so
Wow.
that is probably ... And that, that's, that's a, um, a comprehensive loss. That's, you're losing fat, you're losing muscle, and you're actually losing a lot of bone. The bone is very dynamic in our faces. So the way I approach, um, kind of trying to restore some youthfulness or maintain it is, is placing that, that volume, whether it's fat grafting or filler into areas that we know lose volume, like particularly inside the nose, and that's where the smile lines get deeper, the eye sockets get larger.
If you look at our grandparents, they have kind of sunken eyes. That's actually the bone that is resorbed. Um, so there's a lot of changes that happen that we can help gently mitigate but certainly in general, it's, it's overdone. Uh, so just going to the right provider and knowing that they have the right kind of natural aesthetic is, is probably the best recommendation for that.
Right. Right. Um, you know, on that topic of losing fat, losing muscle, the big thing that's obviously been happening for the last few years has been these GLP-1 medications.
Yes.
And that crosses across, not just the face, everywhere. Right? Um, what's
your take on it? Uh, not as much, I mean, I'd, love to hear your take on every aspect, but for people who go through it, uh, and then they lose a lot of this weight and a lot of it is muscle, right, not just fat.
Yeah.
Um, how do, how do you deal with that? I mean, do, do you have patients coming and saying, "All right, now..."?
Tons.
"...
Yeah. They, they call it ozempic face, but it's, it's losing the, and certainly one area that really ages patients is the temples. Uh, again, if you look at our grandparents, temples tend to sink in, um, and, and it looks, it, it looks like, it's kind of an indication on a subconscious level for us of like chronic disease and things like that, um, and aging.
And so when patients come in and they're like, "I was on these GLP-1s that inhibitors that work great. I lost a ton of weight," which has a lot of its own benefits, like in the cardiovascular system with diabetes and all the rest of that. Um, but it certainly has, uh, a lot of weight loss that's, that's in the face, which can age the patient, which then leads to kind of a difficult challenge because, uh, my favorite way to restore volume is fat grafting.
So I'll take some fat from the belly and put it in areas of the face like we talked about that lose volume. Um, and when you have somebody who's lost a massive amount of weight like that, there's no fat to take. I guess, you know, that was the point.
But, um, so restoring volume is really the kind of number one goal, but also the number one challenge in those, in those cases. Particular, there's, there's certain patients have certain volume loss, uh, like you mentioned, that, that's more muscle and, and fat and, and it's challenging to, to, um, to restore.
Yeah. I mean, you're not the
That's
recommending GLP-1s, but
No.
... people come to you now saying, "Well, I didn't realize these are going to be the side effects. What should I be doing differently?" For example, you know, everyone who takes GLP-1 should ideally be doing strength training.Right?
Mm-hmm. Mm-hmm.
Keep up with that muscle that they are losing, so, so regain some of it. Uh, but what I've seen, at least based on anecdotal evidence, is
very rarely are they told all of this upfront.
Mm-hmm.
uh, GLP-1s are being handed out like candy and then, uh, afterwards they realize all the side effects.
Yeah.
And, and it's one of those things that if you get off it, all that fat comes back, but the muscle doesn't. And so it's a pretty... I mean, if it's not done well, it's a big problem. If it's done well, you get all the benefits. But most of the time I don't see it being done well.
Do people come to you and do you end up acting like a therapist for how to
Oh.
... all of this?
It's... I always joked that about half my clinic, uh, is like a psychiatry therapy clinic. But yeah, I mean, it's, it's, it's very challenging. Uh, we don't... I mean, a lot of these things, they're are relatively new, um, as far as studying them, uh, long term. We don't really know the long-term effects on it.
We think it's pretty safe. Uh, but like we're seeing, like you mentioned, there's, um, a lot of volume loss that happens both in fat and in muscle. Um, and it's, it's tough to get that muscle back. I mean, there's even, uh, companies that are working on doing, uh, to pairing, uh, electronic muscle stimulation with the GLP so that you can at least maintain the muscle while you're losing the weight.
Um, but strength training is going to be definitely the best way to do that. Everybody, again, we, everybody wants the shortcut. Just sit there with a suit on that vibrates all your muscles. But really, the best thing is just to go to the gym.
Yeah. Um,
the, um... One thing that I keep seeing is, uh... I mean, I, I... maybe this question is more for you, Adrian. Men versus women. Do you see a difference in the types of things that work well for one, or does whatever... what did, whatever you suggest work for everybody equally, both males and females?
Hmm, that's a good question actually. Um,
you know, I think going back to people's perception of my practice or, or like of, of my field, um, I, I just looked back at all my patients and I've got about, uh, there's about, I think 68%, almost 70% of my patients are women. So it means 30% of them are men.
Um, and a lot of them are coming in for different reasons. Some of it's, it's like this, like volume loss, like we're talking about, and Botox and whatnot. But, um, a big part of it's hair, so hair
Mm-hmm.
hair thinning and things like that. Um, both men and women experience it, but they experience it for different reasons and in kind of different ways and different patterns. Um, and so there's certain things that will be more impactful for men than women in that, uh, a lot of it, you know, just medication-wise, simple things like minoxidil, which is the, the active ingredient in Rogaine, which can be taken orally, or which is also, by the way, it was a blood pressure medication, um, uh, or, or put topically on the hair.
Those things have an impact both in men and women. Uh, the recommended concentrations are a little bit different and, and the dosage is a little bit different. But for the most part, it still has, has an impact on both. So there's, there's... I can't really think of, off the top of my head, things that would be radically different as far as treatments.
There's certainly things in causes, like menopause, obviously, men don't experience. And so, um, you know, there's certain things that, that have different patterns. But for the most part, most of it's pretty universal.
Yeah. Uh, you know, you just mentioned minoxidil. This is a word I had not heard until maybe a year back.
Mm-hmm.
Uh, just because that was not probably on my radar. It has been talked
Yeah.
for a while. But all of a sudden, this is a thing that I'm hearing all over the place. Is minoxidil, as far as you're concerned, an effective treatment for hair loss?
Yeah, very. Um, it, it, it has its own potential side effects. Uh, again, so it was a blood pressure medication, so it lowers your blood vessel... blood pressure. Um, but the, the way it works, we don't fully understand it for the hair, but, uh, the main theory is that, um, there's vasodilation, or, or kind of opening up of the blood vessels to the hair ...
follicle so more nutrients and oxygen are getting to the hair. Um, it's absorbed through the skin, so you can put it topically, uh, and it's taken in orally, um, you know, increases hair growth, but hair growth everywhere. So men will experience kind of thicker beard growth, um, know, have women who are put on minoxidil and they come in and they've got, like, they're saying they're growing hair on their toes and they don't want to be on it anymore.
So it's, uh, again, one of the differences between, um, the sexes. But, um, but yeah, it's, it's a safe and effective way to, to help. There's other, uh, medications that are a little bit, uh, stronger that target the DHT, which is what the, the hair on the top of the scalp is sensitive to, um, so like, uh, finasteride, or dutasteride is a, is a newer, kind of more potent one.
Um, but yeah, so there's certainly options for, for
hair loss and hair restoration. Um, even things like, uh, mechanical things like
Mm-hmm.
pairing that with things like PRP, which is platelet-rich plasma, or exosomes, which are kind of a more synthetic, uh, growth factor, um, those all have, have an impact, but, but require a level of maintenance, which particularly
Yeah.
are bad at, putting on minoxidil every day, twice a day. It's
stuff to do.
There has been this, uh, uh, movement again in the last year that I've suddenly heard a lot more about is, uh, men making trips to
Mm, yeah.
... for hair implants and hair grafts. Uh, is there a difference, uh, Adrian, between, you know, using minoxidil and ways to regrow hair versus these hair grafts? Like, if you had to recommend something to someone who cared about it, which one would you recommend and why?
Starting with the topical, so I would say if, if you're experiencing hair loss, which men can experience even in their 20s, um, but let's say 30s into early 40s, uh, doing topical minoxidil daily is really gonna have, uh, a positive impact on the hair growth, um, because you're really slowing down that process of, of hair loss.
Um, taking biotin if you're deficient in it, things like that that are easier, um, and then starting on other medication like oral medications, that's kind of the gradient before I would go to a hair transplant. Um, I kind of look at a hair transplant as once you've failed all medical management and, and the hair loss is there, which can be not your fault.
It's totally genetic, it's a lifestyle thing. Um, but the, the reason that hair transplants work is because the hair on the top of the head is DHT sensitive, meaning... And, and men have higher testosterone levels which converts to DHT, so you lose hair on the top of the head.
You know, as you see the male pattern baldness is usually, is still present on the back and sides. And so we're using that DHT insensitive hair and moving it forward. So it's, it works, it's effective, for sure.
Wow.
Um, but, uh, but it's not a small procedure to go through, uh, and it takes a while to recover from it.
Oh, yeah. I heard that.
Yeah.
does take while. Um, when it comes to nutrition, Adrian, is there anything that you think about from a skin perspective, um, that matters, or just have a good balanced diet and that's
good enough?
That's, that, that's, that's again going back to the first question. It's like, the easiest answer is just, just have a well-balanced diet, stay hydrated, and sleep. But that's, that's hard to do. So depending on where we are in the world and depending on what our diet is, you know, and dietary choices, if you're, if you're vegan versus carnivore, whatever, um, is gonna have, uh, varying levels of, of deficiencies depending on, on what you're eating.
So a well-balanced diet is a very easy thing to say, but it's hard to actually have that. Like, how much grain should you have, how much greens? And, and, uh, if you eat meat, like how much meat and what kind of meat and where's it from? And there's a lot of impact on that.
Um, but yeah, as far as for the skin,
I mean, the, the biggest thing that probably, uh, you know, like biotin, like we talked about, um, hydration is huge. I mean, if, if you find that you're dehydrated after a long flight, if you're flying 16 hours somewhere and you, you land and look in the mirror, your face just, the skin looks beat, a, a big part of that's the hydration.
Mm-hmm.
And so, yeah, as far as like any, like, quick supplements that are gonna help, not, not any that I can really think of. The topicals, like I mentioned, like vitamin C, vitamin E, like those are, those are good,
Yeah. But topically, right? Not
Topically, topically, yeah.
Yeah. Um, I, I, I know there are quite a few questions coming up from the audience. I want to get to them,
Sure.
one question that I said I wanted to ask you at the beginning is, um, uh, in the field, in the field you are in, is AI making a...
Mm-hmm. Yeah, think, uh, so medicine in general, AI, uh, is, and already is having a, a huge impact, um, from anywhere from, like, for radiology as a good example. When I was in medical school, uh, part of the reason I went into surgery is I sat down with my advisor and he's like, "AI is gonna take over reading X-rays and CT scans and radiologists won't be needed anymore.
If you're touching a patient, you'll never be, you know, out of a job." Um, and, uh, and yeah, it is. There's, there's, uh, a lot of... I think
I don't think there'll ever be, um, a time where just, at least in our lifetime, that AI is just gonna completely be your doctor and that's it. Uh, there'll always be some human impact and, and human oversight to it. Um, but it's, it's catching things that humans miss. I mean, we're human, we make mistakes.
And so having that as a backup, um, uh, is, I think, really impactful, will improve patient care overall. Um, there's a, I'd say the worst part... If you ever ask the doctor, "What's the worst part of your job?" "Documentation." It's the worst. You know, we, we didn't go into this to become, you know, clerks and sitting down in front of a computer.
That's one of my biggest pet peeves is sitting in front of a computer when a patient's in the room. So I just don't even have a computer in the room anymore. Um, but it's tough, then you spend a couple hours documenting. So AI can listen to the conversation, can put together a beautiful note that's accurate, that's, that's more accurate than you ever could, um, and share it with the patient so that they're more aware of their care and, and the, the conversation.
So those, those areas of AI are certainly helpful. Um-The dark side of that is I get a lot more patients coming in saying, "Well, according to ChatGPT, this is the problem I have and this is what surgery I should get." Okay, ChatGPT is not a doctor a surgeon for that matter.
So, um, you know, it's a balance to any new technology. And, and like you said, it's, it's progressing so rapidly that we're, we're not even able to understand it ourselves
Yeah.
and keep up with it.
Yeah. You know, I, I do want to highlight one thing that we were talking about before the call started for everybody else's sake is, some of the surgeries you do can last up to nine hours, like you were saying.
Mm-hmm.
Typical value more like two to three hours, which is still a long time, but a nine-hour surgery, I mean that's something that requires not just great great hands, but also people to focus for that long. Because a small mistake here or there, I'm sure will show.
Yeah. It's, it's, like we were talking about too, it's, it's, it's stressful but the stress is kind of leading up to it. When you're actually in it, it seems you get, you get focused. Um, and there's, you know, there, there was a great, uh... I forget what the brand of it is.
Not, not Fitbit, but there's little, uh, bands that, that track your, uh...
Whoop?
Yes, yeah, yeah. Um, and so one of the, uh, athletes that sponsors it is a, is a football player, the quarterback, um, wore it during a game and, uh, during the, uh, fourth quarter right at the end he had to make this, this play to win the game. You'd see his heart rate, it goes up, up, up, up to 150 as he's on the sidelines and he gets in the huddle and it just drops to like 55.
It's like this flow state of just calm that you're able to just shut things down, focus. And, um, uh, athletes are, are great examples of that. I mean, like Tiger Woods, people are yelling at him and stuff like that and he can just focus and just do it.
Yeah.
Flow state is really what it is, which is, it's something if, you haven't experienced it's hard to really, hard to explain.
Yeah. Uh, I'm going to now be calling you, you're the Tiger Woods of the plastic surgeons.
Uh, so, uh, okay I'm going to questions that have been asked.
Sure.
So Usha asked, "Any particular brand recommendations for the combination SPF?"
Um, no, it's, well, uh, Elta MD is one, uh, E-L-T-A, that I think is fairly affordable and, and clean products that you can get it on Amazon and everything else. Um, I carry some... I have my own, uh, skincare line that I use in the clinic that, that has...
it's very similar to that, that makeup. Um, but it doesn't need to be an expensive one. Like they sell these ones at Sephora and medical offices that are hundreds of dollars or something. I think Elta is maybe $35 and it's... it'll last you a whole month or two.
Yeah. Um, I think Aniket's... first part of Aniket's question we answered, which is how do we balance the need for exposure to the sun for vitamin D and your answer was, you know, put on the sunscreen and take the supplement, you get the best of both worlds.
Exactly.
and he also said, "Heard about getting five to 30 minutes of direct outdoor morning sunlight in the eyes, not through a window or sunglasses, within the first hour of waking, is the single most effective way to anchor your circadian rhythm, boosting alertness, mood and all that." Is that true?
Yeah. I'm, I'm not sure the exact amount of time, but, uh, certainly, um, having sun exposure to the eyes, like actually seeing sunlight, um, is, is very helpful in the morning. That's, that's one of those things that really tells us to wake up. Even with your eyes closed, if you've ever gone camping or whatnot, you wake up at dawn because the sun starts coming up and it...
your, your brain starts to become more alert with those, uh, certain wavelengths. There's a lot of great... We didn't talk about sleep. Um, there's, uh, I think it's called like a hatch. Um, but there's an alarm clock that, that has a light on it. There's a couple of them now, but that will slowly and gradually brighten the light and slowly, you know, bring in some bird chirping.
And I tell you, it's the most peaceful wake up, rather than blaring.
Do, you use it?
Oh, yeah, yeah, every night.
Wow.
Um, these blaring alarms are just like... Yeah, it's so startling. But yes, having, having sun exposure, uh, to the eyes, at least seeing some sun, is helpful. There's, there's certain wavelengths, particularly like blue wavelengths that, that, that cause your ... pineal gland to start waking you up. Similarly, why you shouldn't be on your phone before bed, 'cause that blue light
Yeah.
tell your pineal gland that it's time to wake up.
But you've just given me a great idea for my daughter. Uh, I'm going to get that, uh, that alarm clock, because ... I, she gets this, "Wah, wah, wah" that
Yep.
and then she turns it off, and you know, she doesn't wake up and she has the same thing happen eight times and I definitely wake up.
Yes.
It's a better solution for you.
Um, Usha's other question is, "Can we use the same sunscreen for the face and the body?"
Yeah. Yeah. Some of the body sunscreens can be a little harsh and thick and sting your eyes and whatnot, so the really, the face sunscreens are just more mild in that sense, but I, the face sunscreen I have I put on my body. There's certainly a little bit class difference.
I mean, it's cheaper to get body sunscreen, so um, if I'm going to be out at the beach or traveling or whatnot, I carry both.
Hmm.
Just more from a cost reason.
Yeah. Uh, "Do you recommend sunscreen for kids as well?"
Yes. Absolutely. Yeah.
No, I mean, how early to start?
Um No, and, and for a kid, like even babies, you just use mineral sunscreen. If you're worried about the chemical sunscreen part of it, at least sun protection, um, and especially for younger kids, I mean, it's a little bit easier to control as far as, um, you know, being in the shade and having some covers and wearing a big hat at a beach and those kind of things, but um, you know, as kids get a little bit older it's, it's very tough to, tough to control and guide them.
I remember when I first moved here, uh, I went skiing with a friend and, uh, I'm from Canada, and so, you know, sunscreen while you ski was just like, "What are you talking about? It's always a blizzard." Um, and, uh, so this, this, my friend of mine, you know, his mom was like, "Put sunscreen on," and he like slaps it on his face like that, ended up getting a sunburn but he had a little heart from, uh, his two were protected.
So yeah, no matter the age, sunscreen's helpful.
Yeah. Um, Trudy's question is, "Is it good to catch up on sleep during the daytime?" I mean, you know, this is maybe a little bit off, but ...
Yeah. To, a degree. You know, if, you've had a lot of lack of sleep and then you sleep six hours during the day, you're gonna have a tough time sleeping at night.
Yeah.
Um, and so, uh, small naps are helpful. Um, there's some good studies, I'm, I'm sure you've probably seen them at some point on your blog of like napping, uh, is a good topic. Um, uh, and we all have kind of a sweet spot. Mine is 24 minutes. I've got it down to a science.
Um, and there's even some, uh, some people that'll do like a, drink a cup of coffee, go lay down, you nap for 24 minutes, as you're waking up, the caffeine's kicking in and then you're alert again. But, so sleeping for long hours during the day is gonna really, it's just like jet lag, it'll, it'll play with your circadian rhythm.
Yeah. And I just want to add to what Adrian said, which is, um, the two aspects of a nap are, it can't be too long, so it's good to have taken nap, but it can't be too long where otherwise it starts messing up with your next upcoming night's sleep, and second is, it shouldn't be too close to your bedtime.
So sometime at about, you know, one o'clock, two o'clock in the afternoon, maybe even three if you have to. But short and earlier in the day.
Yeah.
Um, Ashish's question, "What are the issue you mentioned on cheeks? I have dark pattern that have emerged on both sides under the cheeks and sunscreen has not helped."
Hmm. Uh, there's, there's dark patterns on the, on the skin?
Yeah.
That, so, uh, what I was mentioning was called malar edema, M-A-L-A-R. It's swelling that's here. There's a network of this kind of fibrous tissue that's underneath the skin that holds our face to our bones, um, and you can get swelling there. That's different than having pigment here. There can be a couple different causes of pigment.
Melasma is one of them, for example, um, which is extremely sensitive to the sun. So we can treat melasma, you know, for several months with lasers, and then you go out and pump gas in your car and you're out there for five, 10 minutes, and the melasma will come back.
Um, so it's, it's very sensitive. So I'm not sure exactly which, which condition you're talking about, but, uh, sunscreen in that, uh, respect is helpful, but it's, it's very challenging. I've, I've started to refer all my melasma patients to a dermatologist because it's just, it's very difficult to treat.
Mm-hmm. Yeah. Uh, Salil's question, "If you're playing golf for four to five hours in a tropical climate a couple of times a week, is there anything beyond using sunscreen twice during a round of golf?"
Uh, biggest thing is gonna be shade, so wearing a hat, uh, staying out of the sun as much as possible, so like if you're sitting in a golf cart or near tree or whatever it is, um, there's, I have a lot of patients who golf and the, one of the biggest aging is their hands, so your putting sunscreen on, and, and for, for women too, like the décolletage, the neck, so putting sunscreen not just on your face but on the back of your hands and everything else.
Um, but yeah, you can't reapply, especially if you're out and you're sweating, a tropical climate like that, you may need to apply it more than twice during that period of time.
More than once.
After every couple holes you put it on, you know, um, 'cause that's gonna have... Golfing is certainly one of the riskier sports when it comes to the sunscreen. And that's coming from Tiger Woods here, so...
And I know the one thing I've seen, uh, a couple of people who have been playing the game for a while, and I can make out that they have sort of done their research, is they wear those big hats with the big rim around.
Mm-hmm. Yes.
So that, I'm like, "But isn't that weird?" No. I don't care about weird, I just care about protecting my face. And so, because most of us just wear those simple caps.
Yeah.
There, is still sunlight coming from all over. They just protect your forehead, really, and maybe your eyes. Not too much more.
Exactly. Yeah. And, and the ears, too. A lot of people forget to put sunscreen on the ears.
Yeah.
A lot of skin cancer on the, especially on the tips of ears, which is usually found a little on the later side because we don't look back there very often.
Yeah.
So, yes.
Um, Kruti's question, "What can help with dark circles and wrinkles around eyes, preventing from getting worse and also potentially curing them?"
Um, again, it it depends on the cause of it. Um, vitamin C topically helps a lot with complexion. Um, there's certain lasers and whatnot that will help break up some pigment. Uh, it's not a cure. Uh, you know, it's a treatment, so, uh, there has to be a kind of maintenance that's done at home.
But, um, there's also a chemical, it's not available everywhere in the world, it's called, uh, hydroquinone.... and it can't be used long term, but, uh, certainly can help with, um, you know, lightening things to, to help kind of kick off the maintenance of it. I, I use hydroquinone for my patients of darker skin types if we're doing a laser, 'cause a lot of the heat, eh, essentially lasers, at least the ablative lasers like CO2 are, um, like a controlled sunburn.
And so, uh, for patients with darker skin, I put them on hydroquinone, which is a chemical that calms down the melanocytes which make pigment in the skin. Um, it's not a bleaching cream, which some people talk about, but it's, it, it really just calms down the activity, hyperactivity that's in these brown kind of darker areas.
Um, but again, can't be used long term, so, uh, vitamin C topically is probably the best thing.
Yeah. And I think to, uh, Ashish's other question, vitamin C, ascorbic acid, again, as topical is the way to go.
Yes. Yep.
Um, do UV rays damage hair as well?
That's a good question. I mean, it, yeah, it could, because the, the depth of penetration is, is up to at least close to where the hair follicles would be. Um, it's certainly not something that people talk about a lot, mostly because the hair itself protects from the UV. You know, it's just similar to why a lot of animals don't...
well, not, uh... All animals don't really need sunscreen. Like, your dog doesn't need sunscreen. The hair is enough of a physical barrier. It's basically a mineral sunscreen that's protecting them. Um, and so, uh, there isn't a ton of exposure on the top of the scalp, uh, when you have a lot of hair, so those hair follicles don't really get that exposure.
Yeah. And again, that's why we wear caps or hats where possible.
Exactly. Yeah.
Uh, I think, uh, very similar to your question, "Do we need sunscreen in UK gloomy winters day, winter days" too, I think based on the earlier part of the conversation, you look at the UV
Yeah.
in your Apple weather app, and if the UV index I think is above seven or eight, it's considered, you know, dangerous territory.
Yeah.
And I remember when I got sunburnt, uh, it was, the UV index that day was 13. So it was not surprising why I did.
Yeah.
But it's, it's almost independent of whether it's gloomy or not, or overcast or not. All it depends on is what the UV index is.
Mm-hmm.
Uh, what kind of product are you referring to when you say topical vitamin C? Again, is there a brand, uh, Adrian,
No, there's, there's, there's lots out there. Um, just, eh, it's, there's a varying them percentages. Um, the one that I carry is 20%, um, but I think as long as it comes from, uh, some sort of reputable brand, it's, it's fine. There's, there's ones that are very expensive, like SkinCeuticals makes one that I think is, like, over $200.
Um, it doesn't necessarily need to be that. They're not cheap, but, uh, I think The Ordinary is another company that makes it that just has straight vitamin C. Um, but, uh, it doesn't smell very good. It's like a dark kind of brown bitter-smelling thing, but it's, yet it's beneficial.
Like, like most things like that.
Uh, I know we're running out of time, so last comment I'll make is, you know, Ashish question, what is the alarm clock that increases light and bird chirps? And I think it was a Hatch, right? Is that the one?
Hatch. Yeah, yeah, Hatch.
Abhinav uses it. Uh, seems like a fan, so I
Awesome. Yeah, it's great.
something that you should definitely get.
changed my life, yeah.
No, but this was super helpful. I know there's a lot more questions we had planned, Adrian, but I'm just so excited about all the stuff we did cover, and there was so much really practical information you provided all of us. So I'm sure you'll see a lot of love coming your way on the community.
But thank you for taking the
it.
... uh, Adrian. I think we all really enjoyed it and, uh, learned a lot.
Thank you. I, I appreciate you having me on here. It's, it's an honor, honestly. So, uh, thank you very much and I hope it was helpful.
Yeah, absolutely. All right. Thank you all. Good good day and good night.
All right. Thank you.