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Episode 816th December 2025 • The Beauty Equation Podcast • Dr. Christelle Oliver-Dussault, Dr. Harpreet Lotay & Amanda Manholt
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In this episode of The Beauty Equation Podcast, Dr. Christelle Oliver-Dussault, Dr. Harpreet Lotay, and Amanda Manholt dive into one of the most common (and most frustrating) changes women notice in their 40s, 50s, and beyond—the sudden feeling that the face has “melted.” Using their signature relatable analogies (including the unforgettable bed-frame/mattress/duvet comparison), the hosts break down why sagging happens, how hormones and bone loss accelerate the shift, and why it can feel like it happens overnight. They explore the full spectrum of treatment options—from skincare and sun protection, to collagen regeneration, to dermal fillers, to when a facelift might be worth considering. Most importantly, they highlight the power of individualized assessment, the role of genetics, and how subtle, strategic treatments can restore lift, light, and confidence without changing who you are.

Disclaimer: The Beauty Equation is for informational purposes only and not medical advice. This podcast does not create a doctor–patient relationship. Always consult a qualified healthcare provider before making medical or aesthetic decisions. Information may change as the field evolves.


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About the Hosts:

Dr. Harpreet Lotay is a family physician specializing in aesthetic medicine. She is the founder of Sona MD in Kamloops, BC, and serves as Chief Medical Officer at Bios Wellness Clinics. Known for her artistic approach and comprehensive non-surgical treatments, Dr. Lotay combines medical expertise with an eye for natural results. She is also an educator, a national trainer and holds academic appointments where she shares her knowledge in clinical dermatology and aesthetics. You can get in touch with her on Instagram @hlotaymd


Dr. Christelle Oliver-Dussault is a family physician specializing in aesthetic medicine, women’s health, and psycho-education. She brings a holistic, whole-person perspective to her clinical work, blending science with a deep understanding of the mind-body connection.

She is also the founder of Reclaim The Pink Within, a movement that empowers women to rediscover themselves during life’s most transformative stages. In addition, she is passionate about medical education and mentors the next generation of family physicians through her work with the department of Family Medicine at the University of British Columbia.

You can connect with her on Instagram @drchristellemd


Amanda Manholt is a clinic manager, patient consultant, and co-host of The Beauty Equation Podcast. With over 30 years of experience in beauty, aesthetics, and leadership, she has guided patients and teams alike toward confidence, growth, and empowerment. Known for her ability to connect with people and simplify the often-overwhelming world of aesthetics, Amanda brings a warm, practical, and relatable perspective to every conversation. You can find her on Instagram @crowsfeetandconfidence.

Websites

https://sonamd.ca/

https://www.getyourpinkbackproject.com/

Transcripts

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One of the misconceptions that people have is that facelift is permanent. It's

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a permanent solution. It's not. There's expiration

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date to facelifts too. So many people will have

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a revision of a facelift, you know, five to seven

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to 10 years down the road. So it's not forever. So

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you want to ask yourself, if you want to have surgery,

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will you want it again in 10 years? And the surgery is really

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just lifting and pulling the skin. It's like, you know, you've

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washed your sheets, you iron them, and you pull them on the bed, but you

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haven't fixed the mattress and you haven't fixed the bed frame. So it's

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important to keep those structures in mind. And oftentimes it

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can be a useful procedure to do as an add on if you want to,

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while addressing other things. And if you're going to start from the outside in

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the skin, the first thing you can address is that collagen loss, that

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elastin loss, all the changes that happen in your deeper skin layers.

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Welcome back to the beauty equation. I'm Dr. Christelle Oliver Dusseau.

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And I'm Dr. Harpreet Lotte. And I'm Amanda

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Manhole. Last time we spoke about

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the sad face, and today we're moving on to

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the saggy face that sometimes women will come into us and tell

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us, I woke up and I felt like my face had

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melted off. Like there was a candle and it just,

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you know, burnt all night. And now everything is hanging down.

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I think you've had a lot of those. Oh, the joys of getting

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older. You have a fantastic

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analogy that I've heard you use many times about

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the mattress and the bed frame. Do you want to share that with everyone

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today? Yeah. Well, I think it's important for people to understand

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that, you know, aging is not one dimensional. It's not like

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one thing typically is making

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them feel like they woke up and went, oh, my gosh, what happened? It's not

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just their skin. So if we think about the

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structure of the human head, I think about

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bone. And bone is that, you know, if you think about a bed and you've

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got a bed frame, you know, you went to Ikea or wherever, you

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got your Allen key and you put it together. So the hard part that the

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mattress sits on, you can sort of think of that as representing the

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bone or the skull. Then we have the mattress,

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and the mattress is that nice squishy thing that you get to lay on.

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And it, I think, represents the

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fat of the face. And. And I guess it would also have to do

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with muscle, but it's the soft. You know, the squishy. The part you can squish.

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And then on top of that mattress, we have a duvet, and that would

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be the skin. So when we've

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lived a life and been in the sun and lost weight, gained

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weight, our head's shrunk because we're getting older, all of these things can

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be affected. And when, you know, we've lost

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underlying support or the bed frame has shrunk, it can change how

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the mattress sits. And when the mattress gets a little lumpy and squished

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down, it can change how the duvet looks. And then, you know, the duvet,

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you can. Your dog can jump on it, like at my house, and there might

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be paw prints on it, dark spots. So

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that's kind of a global thing. That's

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the dummies version of what you guys do.

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I think that's a great analogy. It is, yeah. And it really

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highlights. Oftentimes we'll see that in women who have just gone through the

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menopause, and it really highlights that shift when you have that estrogen

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drop off. When your ovaries are no longer producing estrogen, you stop getting

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periods, your collagen drops off by about 30%.

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So it's no wonder that you wake up one day and you

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feel like everything has changed, because it has.

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Totally. And, you know, we have gradual volume

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loss in all the structures, like you said, Amanda. So we do lose

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volume in our skull, like a significant amount.

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And. And then on top of it, as we're losing

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that collagen, it's kind of like you do hit a tipping point where

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you're kind of holding it all together until that last

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little needle drops, and all of a sudden it looks very

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different. So all those factors contribute. You've got that

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underlying bone loss, the soft tissue loss,

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and the loss of elastin and collagen in the

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skin itself. Yeah.

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And again, ain't no one getting away from it. I mean, it's going

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to happen to everybody, you know, so what can people do?

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Does everybody need a facelift? Well,

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it really is a personal decision. Right. So

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if you're looking for a dramatic change and

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it's. And you're at an age where a facelift makes

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sense. So, you know, one of the misconceptions that people have is that

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facelift is permanent. It's a permanent solution.

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It's not. There's expiration date to

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facelifts, too. So many people will have A revision of a

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facelift, you know, five to seven to 10 years down

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the road, so it's not forever. So you want to ask yourself

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if you want to have surgery, will you want it

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again in 10 years? And does that make sense for you?

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And the surgery is really just lifting and

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pulling the skin. It's like, you know, you've washed your sheets, you iron

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them and you pull them on the bed, but you haven't fixed the mattress and

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you haven't fixed the bed frame. So it's important to keep those

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structures in mind. And oftentimes it can be a useful

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tool, a procedure to do as an add on if you want to,

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while addressing other things. And if you're going to start from the outside in

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the skin, the first thing you can address is that collagen loss, that

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elastin loss, all the changes that happen in your deeper skin layers,

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and that really comes down to regular skin

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care. So wearing your sunscreen every day.

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Great point. Yeah, that's a great point. So

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you have different techniques when it comes to facelifting. Right. So

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some of the newer techniques, definitely, definitely. You have

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more of a repositioning of some of the soft tissue as well. And some of

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the surgeons will do things like fat grafting, but

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to your point, if they have better

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skin to work with, your results will be much, much better.

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So I always say, and whether you're starting Botox

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or whether you're doing filler or anything, the best investment you

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can make is really good skincare and

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prevention when it comes to your skin. And you mentioned sunscreen,

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so those are your best investments. And even if you're going to

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consider a facelift, doing things to

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improve the skin quality will make your results better.

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Yeah. And then having said that, not everybody wants

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a facelift. Yeah, that's true. And you know,

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quit putting your face in the sun. People like.

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I, I, it just. Boggles me

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though. I mean, we have some wonderful, lovely, lovely, lovely,

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lovely patients. I love them dearly. But you know, the ones that you, they grew

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up in an era where it was baby oil and iodine for

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color, I think. And you know, they laid out in the sun and they

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baked themselves and the darker they were, the better. I remember being a kid and

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like I'm little, like in the 70s, and seeing those Ben Do

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Soleil ads and thinking, I want to be that color, like I'm ever

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going to be that color. You know, there's this.

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Trauma that their skin has been through where it's literally just

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sort of hangs there kind of and has no

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life and no vitality. You know, are those people

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that we can help or should be helping? I think

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so. Like, I, I've seen people with some

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of the bio stimulators that we have now that you guys have been doing

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pretty exciting times. Really. Yeah. I think

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we're seeing a shift in medical aesthetics

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where we went to restoring the volume, addressing the structure and the

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squid quality. But now we're really focusing on

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regeneration, turning back the clock. And

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I think we're going to see a whole lot more than that in the years

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to come. Yeah. Rather than

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just throwing a bunch of filler at it. So sometimes it makes sense if the

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mattress is deflated and you need, you need to support the tissue.

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But it's great what we can do now. Yeah. And I think it

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goes back to understanding the anatomy

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and physiology of aging. Right. So you're not going to use one

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tool to fix all problems. And yes,

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there is a pendulum swing now to use more regenerative things.

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And oh, dermal filler is not great. In fact, I saw a reel

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today where a plastic surgeon was suggesting that the

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worst thing that a person could do in their twenties is to

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have even one drop of dermal filler, hyaluronic

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acid based filler, on the lateral part of their face. And I

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mean, that is hyperbole. And I think we're very quickly

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going to see the pendulum swing back. You

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know, he was a surgeon and suggesting that surgery was better.

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Now, I would argue with that because we just talked about how

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surgery's not permanent. Now you're committing that person to repeated

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surgeries. And I would argue with that.

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So I think similarly we're going to see this pendulum swinging back where

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people will have a better understanding of how to use hyaluronic

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acid base fillers, be more judicious about it and not

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do this overfilling thing or think that you can give people a

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facelift or an equivalent with dermal filler. You can't.

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But you can surely make people look more rested, more

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refreshed, and visually look more

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lifted. And that's pretty impactful and

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pretty significant. And in many cases, people are

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as happy as people who we've had do

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facelifts. So it's really an individual thing and

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it warrants a discussion with the patient. I think it's

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very rare. I can probably count

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the number of times I've had a conversation with someone

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who has been actually open

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to face to a facelift. And I'm not trying to vilify it. I think

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there's some amazing surgeons out there that, you know, like, to your point, that

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are doing a more of a complete treatment with fat grafting and all of the

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likes. But the majority of the people that I talk

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to are like, I'm okay. Like, I, I, I don't

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wanna, I'm not trying to look like I'm 20.

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Right. They just want to feel like more like themselves. And

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I think it's the light and shadow and the, and the,

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and that's where the magic with dermal fillers can happen for

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the right person when the light hits their face

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a different way. It's such a subtle change, but it's so impactful.

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Yeah, that's who we know.

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Wasn't that bought. She was like, she's in her 70s. She's like, I still want

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some wrinkles. I want to show the expression that

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I've had throughout my life, but I just don't want as much of

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that sagginess and drooping. I just want to feel a bit more lifted.

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And that speaks to again, the bony changes that

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you were talking about. Harpreet and the.

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With that will often, in an ideal world, with Magic Wand,

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you would use all the different modalities. You probably use a little bit of filler

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to, you know, help with the bed frame.

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And then you might use some regeneratives to try to help with the

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collagen and the quality of the skin. And that gives a little bit of volume

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as well. And then you may tweak some muscles that are a little bit stronger

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with some Botox. And then, you know, the icing on the

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cake would be the skincare options that we have that really do

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penetrate much deeper now and have a significant impact on the skin.

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Yeah. And I think you summed that up beautifully, Christelle. And

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I'm going to go back to Amanda's point about people

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who've really had a lot of sun exposure and have

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skin that has been challenged over the years.

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You know, you asked the question, you know, is it too late? And

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I would say it's never, never too late. You know, we have

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patients in their 80s, and with the right

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skin care and with the right regenerative treatments,

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we can make a tremendous change. And then, of course, let's not

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forget about our lasers and our technologies, which have been impactful.

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And I'd love to hear from you, Crystal, like, how do you approach that

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in, with the, with the skin that's been so

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effective? Abused. Abused, yeah.

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Oftentimes. Lots of fun.

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I will start with addressing the skin Quality. And

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I'll tell them that what they do at home every day and outdoors is going

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to have a bigger impact than any tool that I can offer them in the

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clinic. And that.

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Number one, they need to start wearing sunscreen and a hat. I have no issues

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with people being. Out in the sun. I love the sun. Me too. But I

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wear sunscreen every day. I didn't in my twenties because

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who did? And I will probably have some sun damage in a couple years

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time, but I would start with the sunscreen and the regular

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skin care and addressing more the skin

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quality because that's where they'll notice the biggest difference. And

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once we're on that and we've kind of pre treated the skin,

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going back to what you were saying about our lasers or light based therapies can

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have a significant impact on addressing the pigmentation

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changes that you see. So the dark spots that you might see, also some of

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the redness you might see. And depending on

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their goals or how aggressive they want their treatment, you may go with something

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that's a bit more ablative like a halo which has a bit of downtime

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or you may go with something like a broad based broadband light like

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your BBL which can target. It's kind of like a jack of all

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trades. It can target multiple different pigments in your skin. So

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they can be a really good starting point.

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When you have that, that skin that has just had a

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beating and it brings. It reminds me of a patient that we discussed on this

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a few weeks ago. Remember when you two. It wasn't one of mine but

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you mentioned that she'd had some. You noticed

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volume loss but the more you spoke to her it was actually the

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skin quality that was the issue and she ended up doing a BBL halo and

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was delighted with her results. So yeah, when Skills has had a beating,

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I tend to focus more on the at home skin care

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and then maybe adding a life based treatment.

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And once we're on top of that, then we can address the other issues because

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that tends to have more of an impact than going into the deeper

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treatments of the underlying structure. Yeah,

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and I'd love to hear from you, Amanda. When you have people who have

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that type of skin, what are they often interested in

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or what do they usually commit to doing? Because they might not be

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used to taking care of their skin and it's a whole, that's a whole nother

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story. I'm not, I'm not going to lie. I kind of

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use skin care and education to

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see how committed they are because I think when it comes to

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somebody that has progressive

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skin atrophy damage, I don't even know what you want to call it.

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You know, obviously, they. It's a lifestyle they've inflicted

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on their skin, and you really have to make sure that

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they're not thinking we have a magic wand. Because

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none of this, I always say, look, anything to do with changing

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the. Improving the skin,

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it takes time. Like, nothing is fast.

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Filler is fast. Yeah, it's. It's. It's immediate. It's.

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That's why it's so darn exciting when it's the right tool to use.

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Even boat detox is like, ba bam. In a couple of weeks, you can already

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see lines are starting to soften. Right? Yeah. And

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I. And then I said, oh, you know, this is what we need you to

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do. These are the steps. And then come and see me again in six weeks.

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And really, at that point, I just sometimes decide if they get to pass,

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go and collect $200 and do the next thing.

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Right. Because the last thing you want to do is disappoint

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somebody. So it's really about understanding kind of what do they

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expect to see. And sometimes they're completely reasonable

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and they are committed to making that change. And that's my daughter.

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Duke, you need to, as Duke is bringing you

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kiss our free. What's your approach?

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Well, I wanted to touch a little bit on Amanda's point

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around. People being

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patient or using the skin care and time,

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and it takes time. So we have to remember that our skin

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is our body's largest organ. Right.

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And just like every organ,

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there's physiology behind it. It works a certain way.

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And anytime we try to make any changes in our skin,

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it takes skin cycles for us to actually manifest or see the

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change. What I mean by that is our skin isn't inert. It's alive.

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And it rejuvenates itself in a cyclical

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basis. So we have cells at the bottom of our skin

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that sort of create new cells, and they migrate to the top

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of the skin, and then they slough off, and that cycle continues.

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And when we're younger, that cycle is fairly short. And,

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you know, if you're an esthetician or in this industry, you might know it

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to be about 21 days. However, we forget that that

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cell cycling cycle does lengthen

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as we get older, too, so that by the time you're in your 50s,

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that cycle might be up to about 90 days. And if

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we say that, well, if we put stuff on our skin, it's gonna take three

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skin cycles or four skin cycles? You know, when you're 50, you're

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talking. It might take a year for you to see a change.

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Yeah. So it takes time. So I think people need to

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understand that when it comes to skincare, and to the

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point about a magic wand, I think that's. That that's quite

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true. People often think of things like lasers

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as a magic wand, and they think they'll see immediate results

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and you'll see faster results. 100%. But any

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of our technology is actually stimulating the skin

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through heat or through ablation. Right. And

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with the halo, I often will say it's kind of like aerating your

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lawn. Right. You're punching little holes in the skin and you're creating

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a stimulus, and it's the reaction to that

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stimulus that creates the change, not the actual

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laser. Yeah. Right. So some of our lasers

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will target pigment and sort of blow up the pigment. But when we're talking about

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collagen induction and some of the regenerative things that our lasers do,

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it's literally stimulating your skin. So your commitment to your

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skincare never goes to waste. Your commitment to a healthy

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lifestyle, healthy nutrition and all those things, good sleep

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never goes to waste. And so it will all make your laser

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and technology work better. You'll have better effect.

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I find that when you're talking about those ablative lasers

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that will stimulate that collagen, it'll be really good for

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more of those superficial lines and

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the skin quality, but maybe not as impactful

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on sagginess as other tools that we have.

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Yeah. Then we start to get into the bioregenerative

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treatments that can give you some volume. And

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when I look at skin itself, we already talked about the bone, Right. We get

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bone resorption. We already talked about soft tissues. We get soft tissue

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resorption, and we can do dermal fillers. But when we look

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at the skin, there's a pattern to the skin aging, too.

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So the epidermis gets thinner, the dermis gets thinner, it

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starts to slip on itself. You get this crepiness that

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happens. And we get dyspigmentation within the skin

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itself. So those are aspects of the skin that we can change

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as well. And we can thicken up the skins using. Using growth

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factors, because it does thin. So if you look at

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people in their 80s, they so often complain of, you know, I bumped up against

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something and I got bruised, and I don't even know how

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my skin sloughed off. They'll abrasion super easily

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because the skin is thinning. So that thinning aspect of

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skin aging we can treat with bioregenerative

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treatments like Sculptra. We can use growth factors, we

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can use platelet derived growth factors.

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We can use prp, retinol and retinol

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too. Yeah, good old retinol and sunscreen. Just

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wear some damn sunscreen. Oh my God. All I'm saying is, you

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know, the whining over, just find one you

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like and put it on. It's not that hard.

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We see people lucky nowadays with the. Amount of choice we have with sunscreens. Because

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that was definitely choices like whether you want a powder

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or a liquid or a cream or. But you know, Harpreet can

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speak to this. We've had patients that have come through on the, you know, the

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skin cancer screening side of things that we've got. Just wearing sunscreen, like

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we're talking basic and year after year, just

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from adding sunscreen, nothing else, they don't do anything else. Their skin

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starts to look better. It makes a huge difference. So

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here's the thing with our, with our, any patient, once

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they have skin that's been damaged, sometimes they feel pretty

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despondent. At least I see that sometimes

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they do feel like it's too late and they feel like the sunscreen

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is a waste of time because what is that going to do? They feel like

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it's only going to prevent future damage and how is it going to

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affect them currently? But what I like to explain to them is that

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UV radiation is damaging on a daily basis.

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And whether it's cloudy and whether it's winter,

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the ball of radiation is in the sky.

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And so there's visible and non visible radiation that our skin is

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exposed to. And every time our cells get hit by that, their

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DNA gets damaged slightly. And then it's the job

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of our immune system and scavenge ourselves to go

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and clean up all that mess. And so we have old

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stuff sitting there as well as new damage that comes in every day. And

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if you wear sunscreen, what you're doing is you're preventing

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new stuff, new damage so that your cells, your

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immune system cells can go around and scavenge

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what's been done before better they're not distracted by

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the new stuff that's going on. And sometimes when I explain that

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to them, they, they get a little bit more hopeful and they understand.

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And so then when you have that. Commitment to wear the sunscreen every

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day, it allows your body to protect itself and to repair

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itself and you see it and that's, you know, feels

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really good for them. So I try to give them that encouragement.

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It does make a difference. Try it out.

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Yeah. Amen. I totally agree. You know, it's like

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there's a little battle that's going on all the time. Your skin's kind of

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trying to protect itself and, you know, you're just putting in

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the troops in the very front so that, you know. Yeah.

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I gotta think of another analogy that's better.

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But back to saggy, because that's what we were talking about. It was. But

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I mean, the sunscreen does impact it because it'll

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impact the city if it's very sun damaged and it will

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sag because if it's lost its elasticity. Anyways, going back to

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that patient you wanted to mention. Oh, yeah, I was just. It's. But again,

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other than you should all be wearing sunscreen every day, don't even, like, talk to

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the hand if you're not going to, like, find a new channel because I'm sorry,

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it's just easy. You just got to find a good one and you. Your

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skin will thank you for it. But we. It is

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still very.

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Unique to everybody in terms of how that Sagi kind of comes on.

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So we had a patient a couple weeks ago

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and she was a bit tricky because she was

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70, 71, had done nothing.

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And I'm looking at her and I'm thinking, what, like you've done

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nothing? Because her cheeks were so darn good. And

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so it was interesting that she didn't actually have much

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the bed frame. The bone was really well

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preserved. I don't know, I guess it's just genetics. Lucky. Right.

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And really it was more kind of soft tissue that

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needed to be, you know, plumped up in a few areas and

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then again, work on the skin. So.

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Sagi can look very different for different people. Yeah,

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yeah. So various genetic factors. Right. She may

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not have had much bone loss, so she's not prone to things like

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osteoporosis. She might have a high calcium diet and. And

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that type of thing that impacts bone resorption. And then

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going back to the structural issues that we sort of talked about last

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episode, some people have shorter chins. And when you have

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shorter chins, you are going to look saggy and jowly

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faster. You'll start

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looking sad and then the sadness will turn into sagginess.

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Yeah, totally. My family all over.

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Yeah. And chins are not something we're

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used to looking at unless you're in aesthetics. Right.

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And so restoring chin length and

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chin structure can be really impactful when we're Trying to prevent

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sagi and treat sagging. And the one caveat

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I will say there is that when you are an injector

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and you're doing chins, make sure your chins are

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three dimensional. Oh, yeah, please, yeah.

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Oh, I can go to this injector and they're going to put one syringe right

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here. Yeah. That looks awesome. Not.

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We've seen it, right? Yeah.

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It's got to look good from every angle.

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There's a lot of sculpture involved in the chin and in the jaw when

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you restructure that, especially if there's been a lot of bone resorption

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and you're starting from a point where there wasn't that much support in the first

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place. And then

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you still have to look like you. I was thinking we

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have a patient that she's lovely, she's, I

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think she's got to be pushing 70 now, but a very kind of heart

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shaped face. And she's tricky.

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Right. Because you have to maintain like you're not going to give her a big,

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wide, feral chin, you know, so you,

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you can improve it, but you have to always be thinking about, well, what do

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they look like? Like 10 years ago. Right.

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So chins. I could talk about chins all day long. I could

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wag my chin. About to do an episode on that. Yeah.

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If you want to hear more about. Chin, maybe send us an email or

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write a comment down below and we'll make sure we'll get some stories for

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you about chins and factors that we consider before we

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wrap up today. Is there any advice that you'd give your, your 30 year

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old self if you could speak to your 30 year old self?

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Oh God, don't go out with that guy.

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Do not skin chips.

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Oh. That'S another

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podcast. That was my 20 year old self. I guess I married the 30

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year old, the one I now worked out. Okay, but

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30. Oh. Get

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Botox sooner, Kat

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Harvey. That's what I would have said. Uh,

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yeah. I started Botox when I was in my 30s. Cause I started

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doing botox when it first came out like for other people.

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But I think being more diligent about sunscreen,

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oddly enough because there weren't that many options for people who were

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highly melanated like myself, so things would

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turn me blue. Right. So but finding a good sunscreen, that would be

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one for sure.

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And the other one, and I feel like this is another show is

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learn about lasers and people who

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do have pigment like myself. Not all

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lasers are the same. And I can tell

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you a story. About an IPL burn that I had on myself and how

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my interest in laser start and so started. So,

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yeah, I would say don't do the ipl. That would be my other

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advice, I think. Unless you're me, and then

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you can light me up. Yeah, you're me. That's just to

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me. But if you've had melasma, you probably don't want to be. You want

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to be careful, too. I think lasers is in a whole episode in itself.

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So we've got chin and lasers. Maybe we'll take

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a vote as to what you would like to hear us talk about

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first. And for me, I think it would be sunscreen as well. I

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was the one who had the sunscreen in her foundation because, well, I never burn

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and sure, it'll be fine. And

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I have pigmentation because I was in Ireland. All on my driving side

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because we drive on the other side of the road. And

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again, there weren't that many good options. They all I have. You know,

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I'd be on the oilier side, and they just made that a whole lot worse.

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And, you know, when you're battling shyness, that's not what you want. And. But I'm

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happy to say that there are so many really, really good options that we have

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nowadays. Yeah. That weren't really available 10 years ago.

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So, on that note, I hope you enjoyed today's episode.

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And next time, we'll be potentially talking about

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your aging Achilles hill, unless there's a huge push for us to talk

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about either lasers or your chin.

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And if you're feeling saggy, come on down, give us a call. Bye

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for now. Until next

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time.

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