Your skin starts changing earlier than you think, and most of us were never told what actually happens or what to do about it. In this episode, Dr. Kelsy Vick sits down with Claire Schwegel, a nurse injector in aesthetic dermatology at Vollure Medical, to break down the real science of aging skin: slower cell turnover, slower wound healing, and rising inflammation. Then they build a decade by decade game plan, evidence based prevention in your 20s, collagen banking and judicious neuromodulators in your 30s, perimenopausal structural care in your 40s, and hydration, resurfacing, and neck and hand care in your 50s. Claire also demystifies the whole toolkit: neuromodulators versus fillers, hyaluronic acid fillers versus biostimulators like Sculptra, real risks like vascular occlusion and migration, laser categories, PRP and microneedling, at home tools, why annual skin exams matter, and where aesthetics is headed next. Smart, honest, and refreshingly free of hype.

Links/Research Articles:

Dr. Claire’s Booking Link: https://www.myvelour.com/provider/claire-schwegel-del-signore/services?locationType=in-suite

Dr. Claire’s Instagram: https://www.instagram.com/confidencebyclaire/

Dr. Claire’s Tiktok: https://www.tiktok.com/@confidencebyclaire

105:: a doctorally trained cosmetic injector’s guide to bridal skin: what works and what is overhyped: https://youtu.be/3acEZMfw3FI?si=iElrgRrTDJb1uUXX

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Welcome to Wellness Fixes the Pod, a

by Maven Media production, where we

2

believe you deserve real education

from real experts, delivered

3

in a way you can actually use.

4

I'm Dr.

5

Kelsey Vick, your board-certified

orthopedic doctor of physical therapy, and

6

this podcast was built for the girl who

is done feeling overwhelmed and frustrated

7

by conflicting health noise and is ready

for something she can actually trust.

8

Every week, we have honest, science-backed

conversations about your health,

9

your hormones, your brain, your

body, and everything in between.

10

No fluff, no fear-mongering,

just the truth.

11

Because understanding your

body is the most powerful

12

thing you can do for yourself.

13

A table full of experts built for

the curious girl who wants the truth.

14

So welcome.

15

Your seat is waiting for you.

16

Kelsy: What's actually happening

within our skin as we age?

17

Biologically, what are some of the

drivers of the changes that we see

18

in our skin throughout each decade?

19

It's interesting that you talk about skin

healing because I talk with patients a

20

lot, and usually in their 30s they're

saying like, I'm just noticing my body

21

is not recovering well after exercise."

22

And that's like their first sign

of this I'm not in my 20s anymore.

23

My body isn't able to exercise and

drink and sleep, stay out late with

24

minimal sleep, all of these things.

25

The first thing I noticed was

my skin not healing as well.

26

I kept telling my friends, I was like, I

have this acne scar or something, and I

27

was like, it just isn't healing as well.

28

And I noticed it the most in my skin.

29

That was like my very first thing

where I was like, it wasn't the

30

exercise, it wasn't the recovery,

it wasn't the injuries, it was like

31

my skin, where I was like, it is

not healing as quick as it once did

32

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

It's wild the things we

33

used to get away with.

34

And it's interesting to see what

it is now, but obviously when I'm

35

in my 40s and 50s aging is real.

36

And used to- I went to school in New

Orleans undergrad, and would go out

37

until God knows what hour of the night

and drink have a great time, and wake up

38

and go to organic chemistry at 8:00 AM

in the morning and be absolutely fine.

39

Now, if I have that second glass of wine

at night, it trashes my entire next day.

40

So I think, yeah, you just…

41

your body is not as good at

doing what it normally does.

42

Skin cell turnover slows.

43

Wound healing, it takes

a little bit longer.

44

There are other inflammatory

processes that kind of get

45

aggravated as you get older.

46

And yeah, you're just overall not as

good as you were when you were 10.

47

Kelsy: are there any things that we can

do at each decade to help support that

48

collagen production, that hydration,

that architecture of the face?

49

Like, all of those signs that you were

saying change as we age, are there things

50

that we can do with either fueling or

supplementation or skincare, anything

51

like that helps at each different decade?

52

And even, different treatments and

procedures, just broadly that we should be

53

looking at for prevention and maintenance

of some of those things as we age

54

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah.

55

So I always say an ounce of

prevention is worth a pound of cure.

56

And it really starts when you're young.

57

That's when you have great

collagen and you wanna protect it.

58

And so things that are really simple

and effective are sun protection, like

59

I've been saying every like almost

every second of any time we talk.

60

Retinoids are really great when tolerated.

61

A nice like antioxidant and something

that keeps the barrier healthy.

62

Your 20s are when prevention

has the highest return.

63

Daily sunscreen has randomized trial

evidence for slowing photoaging.

64

Retinoids improve photoaging by

increasing epidermal turnover

65

and supporting collagen biology.

66

And so I think in your 20s, the most

important thing is to just prioritize

67

the things we have the most evidence

for that are going to keep you the way

68

that you are, at that point in time.

69

Really nothing that's aggressive,

just pretty conservative topicals.

70

And if you're starting to see maybe like

fine lines and wrinkles, you can think

71

about doing a conservative neuromodulator.

72

Although I usually say if the lines

are not static, that means they're

73

just there when you're not expressing,

they're dynamic, you have good collagen.

74

Like it's not necessarily something that I

would run to go do in terms of procedures.

75

For 30s, I think important

thing is collagen banking.

76

So can do things like maintenance

neuromodulators, like BOTOX and Dysport.

77

But like at that point, even if you're

really judicious about sunscreen,

78

like you may have some pigment,

whether it's related to sun exposure

79

or genetically or hormonally, driven.

80

so priorities I think shift and then

you can maybe add in a little bit

81

of BOTOX and Dysport really just

to prevent fine lines and wrinkles

82

from forming and becoming static.

83

And adding like a little IPL or

vascular laser to address any type

84

of redness or pigment is really nice.

85

Maybe considering small volume filler

if there's any type of anatomy that's

86

changed, but I usually don't have patients

run to chase those types of things.

87

And then you have to keep in mind your

30s are when most women are either

88

planning pregnancy, a lot of women get

p-pregnant in their late 20s, but I

89

think women are starting to get pregnant

later, and you have to keep in mind,

90

like, all of these things have to be

safe during pregnancy and postpartum.

91

So really tailoring the approach

to be appropriate for the stage

92

of life that a woman is in.

93

And then your 40s are really the time, I

think, when you start to see structural

94

changes and skin quality really changing.

95

That's at perimenopausal time.

96

And so this is when patients often say,

"I look tired," even if they've slept, or

97

there's just this not so tangible thing.

98

They can't put their finger

on it, but there's a change,

99

and they want to improve it.

100

That's when I think neuromodulators

to really treat the way that the

101

muscles pu-pull are very effective.

102

Lower face Botox especially in the

platysma will help with releasing

103

any downward pull and lift the

face up a little bit without

104

needing to necessarily do filler.

105

Are patients that will see real signs

of bony changes in their face, although

106

it's a little bit early in your 40s.

107

But mid to late 40s, patients will see

their pyraform starts to hollow out.

108

There's usually some bone loss

on the chin here, or the temples

109

become a little bit sunken in.

110

And so those are areas that

can be considered for volume

111

repletion, and I think it

certainly makes patients feel good.

112

It restores a little bit of the support

that they normally had in their face,

113

and it's a really effective treatment

to use either a biostimulator or an

114

HA-based filler to treat those areas.

115

then at that point in time, patients

tend to start getting a little bit

116

more aggressive with their treatments.

117

They have a more serious pigment strategy.

118

They're using a tinted SPF.

119

They're probably using a little bit

higher dose of a retinoid to really

120

get the skin cells turning over.

121

And then incorporating in whatever

Topicals are targeted for them,

122

so azelaic or hydroquinone when

appropriate and like carefully

123

selected and very targeted lasers.

124

And that's, like I said, the point

in time when, you really have to

125

think about how perimenopause is

changing the skin, and estrogen is

126

really one of those things I think is

biologically relevant for aesthetics.

127

And women will see like real changes in

the quality of their skin, like crepiness

128

and dryness and doing some treatments

to address that can be really helpful.

129

And then 50s and is when I, try

to get patients to embrace the

130

aging process a little bit, right?

131

We don't wanna look like we're 20 when

we're in our 50s but tackling some of

132

the age-related changes to get hydration

back in the skin is really nice.

133

Obviously, the mainstay of every decade

is gonna be SPF and still using a

134

retinoid, they can, use a more aggressive

resurfacing laser if it's appropriate.

135

Things like CO2 lasers that ablate

the top l- layer of the skin

136

will really lift off pigment.

137

It's aggressive, and there's significant

downtime, but it does wonders for like

138

fine lines and wrinkles and pigment.

139

and then still at that point in time,

like incorporating a little bit of

140

filler bio-stimulator for patients

and treating areas not just like the

141

face, but really the neck, sometimes

even the hands and other areas on

142

the body that show signs of aging.

143

So we always say like in aesthetics,

the biggest giveaway of someone's age

144

is not their face, it's their neck and

their hands 'cause usually patients

145

are really focused on treating their

face, and they forget those areas.

146

And then the-- at every point in

time in the decade or at every point

147

in time in each decade, you should

be having an annual full skin exam.

148

That means you're completely naked head

to toe in a room with a dermatologist or

149

someone who is very skilled at evaluating

the skin and looking at any new lesions

150

or any enlarging pigment or, anything that

could be a suspicious lesion to make sure

151

that you're staying healthy and catching

basal cells or any type of melanomas or

152

things that are going to eventually turn

into skin cancer, precancerous lesions.

153

So that's what I would give

for guidance at each decade.

154

Kelsy: let's zoom in a little bit

on, you mentioned neuromodulators,

155

and you use that term.

156

Can you describe what they are,

what they do, what might be like

157

the terminologies that we know for

neuromodulators and how they can be

158

used like preventatively and reactively?

159

I think you've talked about both

160

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah.

161

So neuromodulators is like the

big umbrella for things that

162

most patients have heard of are

called Botox, Dysport, Xeomin.

163

There are lots of them on the market.

164

And they essentially, patients think of

them or use them to treat wrinkles, but

165

what they do is actually treat the muscle.

166

And it prevents the muscle from

either pulling or creasing the

167

skin in a certain direction.

168

And by knocking out or causing a

little bit of paralysis in that area

169

that maybe they have a complaint

about they smooth out the area.

170

Botox, Dysport, all these neuromodulators

actually modulate the signal that's going

171

to the nerve to tell it to contract.

172

So that's why I call it a neuromodulator.

173

So not all injectables

are neuromodulators.

174

Neuromodulators are your Botox,

Dysport, Xeomin, if that makes sense.

175

And the two that are most common

that most people think about

176

are like Botox and Dysport.

177

They're very well studied.

178

I will say that Botox has broader

published evidence overall, largely

179

because it has more FDA-approved

indications and it's been studied like

180

extensively across aesthetics but also for

treatment of like migraine headaches and

181

hyperhidrosis, spasticity like um in MS.

182

It's used for I think bladder dysfunction.

183

It can be injected to

treat palatal myoclonus.

184

There are so many therapeutic uses,

but obviously specific to me, I use it

185

to diminish the strength or paralyze a

portion of a muscle that is either for

186

me pulling down, for my patients pulling

down in a direction that we don't want.

187

Most patients want to feel more

lifted for aesthetic treatments

188

or to smooth out a wrinkle.

189

So like when the muscles are, say for the

frontalis, when you raise your eyebrows

190

upwards, it causes a crease in the skin.

191

So when you place Botox in an area

that's pulling up and creasing the

192

skin, it doesn't pull up anymore

and it smooths out the skin.

193

so yeah you can use it preventatively.

194

And I see that for patients that are

like on a Zoom, and they say, "Whenever

195

I'm like on Zoom, I'm scrunching my

face, and I see the- these 11 lines."

196

And they may not have those like clear

demarcated areas, and w- we can use

197

it preventatively to make sure that

they don't develop those indentations

198

or tho- those wrinkles there.

199

And then obviously, whenever I see

static lines, that means somebody

200

comes into the office and they're just

sitting there, and they're not making an

201

expression, and they just have these lines

that are going across their forehead.

202

We can treat them with a little bit

of Botox or just for a neuromodulator

203

so that they can either be

smoother or completely go away.

204

And I, I usually will tell

patients, who have static lines

205

on their face, think about these

lines as wrinkles in a bedsheet.

206

You've had a bedsheet that's been

folded up in your closet for months

207

on end, and now you're finally

pulling it out to put it on to the

208

bed, and you can't expect that those

wrinkles are gonna be smoothed out the

209

second that you pull out the sheet.

210

It really takes a little bit of

time of not making that repetitive

211

movement, not creasing the bedsheet,

and having it stretched out over

212

the mattress for those wrinkles to

smooth out, but eventually they do.

213

So that's like how I-- that's my consult

for when I talk to patients about

214

treating dynamic versus static lines

215

Kelsy: And for something like forehead

lines, and then you mentioned the

216

platysma, where in my head that seems

a little bit more of a, dramatic

217

gravity is like pulling on this area

a little bit more than just like your

218

forehead raising up and the lines there.

219

is there different, levels of

effectiveness depending on the area

220

you're treating, different dosages,

different lengths of time that they

221

might, that neuromodulator might

stay effective or wear off quicker?

222

Does it wear off quicker in certain areas?

223

Is there basically differences in where

and how you use it across the whole face?

224

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah.

225

So those are really great questions,

and pretty much yes to all of them.

226

The areas that tend to wear off quickest

are the areas that get used the most.

227

and the areas that have the lowest dosing.

228

So for example, a lip flip, which is

commonly used to paralyze a portion

229

of the orbicularis oris here and evert

the tissue on the top lip to show more.

230

Mouth is constantly moving, and because

of your need to speak and kiss and

231

drink and sip from a spoon, we don't

wanna over paralyze that muscle.

232

So it's a muscle that gets a very low

dose of neuromodulator, and it's gonna

233

be in an area that's super active, so

it lasts a very short amount of time.

234

Whereas when we do much higher

doses in muscles like, say, the

235

masseters, I find that tends to

stick around for a little bit longer.

236

I have some patients that say that

they feel the effects for almost

237

six months, which is not necessarily

in line with what the makers say.

238

They say that Botox is supposed to

last 12 weeks, or all of the clinical

239

studies looked at the ramp-up period,

how long the effects last, and when

240

patients reported seeing wrinkles again.

241

But I think because the doses are much

higher, you're getting a more sustained

242

paralysis, and you're actually weakening

the muscle so that it's not able to be

243

used as strong as it would baseline.

244

So maybe some of those effects are

prolonged, not necessarily because the

245

paralysis is maintained, but you've

actually physically, shrunk the muscle a

246

little bit by not using it, and so you're

not able to grind or bite down as hard.

247

So yeah, I think the length of time

and how paralyzed the area is really a

248

function of how much movement that muscle

has and the dosing that you're using

249

to treat it, amongst some other things.

250

But yeah.

251

Kelsy: What about other injectables?

252

Do you have other favorite injectables

that you get a lot of, bang for

253

your buck with your clients?

254

And what are they, and what

would you use those for?

255

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

So there are lots of

256

injectables on the market.

257

Most commonly used are

HA-based injectables.

258

Those are hyaluronic acid gels.

259

HA is a water-binding molecule

that is naturally present in

260

your skin and connective tissue.

261

And when you talk about or filler,

hyaluronic acid gels and fillers,

262

they're all pretty different.

263

They have different firmness, different

elasticity the cohesivity of the gel,

264

and what they call the lifting capacity

of the gel is all very different.

265

I would say that those are, like,

one of the things that I have in my

266

tool belt other than biostimulatory

injectables, and those are

267

things like Radiesse or Sculptra.

268

so fillers should be placed

according to the anatomy.

269

So for deep structural support, like in

the cheek and the chin and the jawline,

270

and that can be to give someone an

anatomy that they don't naturally have.

271

So someone who may be contemplating

a chin augmentation, that they h-

272

they're a little bit recessed and

their chin falls behind, the area

273

where they would, maybe the nose is a

thing that projects the most maximally.

274

Those are patients that come to me a

lot of the time and want projection

275

in their chin and improvement of

their appearance from a profile.

276

And HA fillers are really effective,

especially things like Voluma

277

are extremely effective at giving

that type of anatomy to a patient

278

who doesn't necessarily have it.

279

I like them, and I choose to use

fillers in my practice that are

280

reversible, and that's for two reasons.

281

One is an aesthetic one and

the other is a safety reason.

282

And it's mainly because,

these are aesthetic things.

283

as aligned as we can be and as good

as I am at giving someone something,

284

there's something nice about being able

to reverse it, whether that's a patient

285

just decide "I don't want this in my

face anymore," for whatever personal

286

reasons, or, maybe somebody says, "I

tried it and maybe I'm glad I tried it.

287

I thought maybe if I liked this, I

would get a chin implant, but maybe

288

this is not the right thing for me

aesthetically," and you can dissolve it.

289

So I think aesthetically,

that's really nice.

290

And the other reason is because with any

of these HA-based fillers, they're meant

291

to be injected not into the vasculature.

292

So either on periosteum, above periosteum,

or within the tissue to augment it.

293

But if there is a rare complication

called vascular occlusion, if the

294

filler is injected into a blood vessel,

it can block or occlude the flow

295

through that vessel, and that can lead

to some very serious problems that

296

require urgent or emergent treatment.

297

So obviously, when you don't get

blood flow to the tissue, it can

298

cause the tissue to die or necrose.

299

So usually these things present pretty

immediately and you need an enzyme called

300

hyaluronidase to break down the HA-based

filler and restore blood flow to the area.

301

And I always talk to my patients

about, risk versus benefits for

302

doing these treatments because

this is not a haircut, right?

303

It's a true medical procedure, and

someone needs to be affected enough

304

by their appearance or want to

change their appearance enough that

305

they're willing to take this risk.

306

Even though it's extremely rare, I've

never in my practice-- and it's just

307

a matter of time, because if you've

been doing it long enough, it will

308

happen, but I've never personally

had an occlusion in my practice

309

or for me personally, but I have

assisted in dissolving two occlusions.

310

And so you know, it's a, it's-- it can

be scary for patients and for providers.

311

I think the thing that, gives

me comfort is knowing that there

312

is something that you can do.

313

It is reversible and it is treatable,

and there is a, an algorithm

314

to manage these complications.

315

So that's why I personally choose to

use reversible fillers in my practice.

316

So they can be used for obviously

treating deep structural support,

317

like I said, the cheek, the chin, the

jawline, and aging p- the pyriform,

318

fossa and temporal hollowing.

319

And then nasolabial folds for more

soft tissue blending and helping

320

blend out some of this line that

you see when the cheek descends.

321

Or areas like the pre-jowl sulcus

where you can start to see a little

322

bit of jowling and an indentation

that comes in before the chin

323

just to give a smoother jawline.

324

Or for things like superficial refinement

in the lips for fine lines and wrinkles

325

somewhere that are pretty etched in

they can be really powerful tools.

326

I always say the key is that fillers

should not really simply chase a crease.

327

a nasolabial fold, for example, may be

caused by cheek descent or midface volume

328

loss, so it's really important to address

the reason why that crease is occurring.

329

And only filling a fold or an area

where there is a shadow can make

330

someone look really heavy and unnatural.

331

So yeah, those are, in my

opinion, the areas that are

332

best suited for using filler

333

Kelsy: I've heard of filler shifting.

334

W- what is that happening?

335

I know some people are very cautious

about under-eye filler and things

336

like that where it can shift.

337

What is actually happening with that?

338

Is that HA just moving, HA-based

filler moving somewhere else?

339

Can you describe that a little bit to me?

340

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah, so filler can migrate.

341

I tend to feel that the fillers that

migrate or appear migrated whether

342

it's a filler or something else that's

happening, are the ones that draw in

343

the most water, are injected the most

superficially, and are the thinnest.

344

That's probably more of my personal

opinion than there's any real guidance

345

or real evidence to guide me saying that.

346

But when you classically think of

like poor filler, I think everybody

347

gets this like image in their head

of I think like Jennifer Aniston

348

or one of the Kardashian sisters.

349

I can't remember her name.

350

But like this area right around the

tear trough that's like really bulky

351

and large and looks just funny and

strange, and that's more likely than

352

not because filler was placed there.

353

may have looked incredible that the

day that it was placed or even for

354

weeks after that, but shifts in fluid

volume can change how filler appears.

355

So that filler may provide

great support for her under

356

eyes, right after it's injected.

357

But if she has seasonal allergies, she

may be drawing more water to the area.

358

If the product spreads a tiny bit,

then it's gonna attract water to

359

that area and make it more apparent.

360

And the most common place that I

see this is like the lips, right?

361

Especially when lips are overfilled

and the anatomical boundaries are not

362

respected, you get migration of filler

outside of the border of the lip,

363

which gives this really unnatural kind

of shelfed appearance and projection.

364

And it's worsened, when a patient will

have a meal that is salty or, they just

365

have a little bit more fluid volume.

366

I'm pretty sure that my filler got

a, like just felt a little heavier to

367

me when I was pregnant, just 'cause

I was holding onto so much fluid.

368

So the real shifts that happen in the

body can make filler more apparent,

369

whether or not it's migrate, migrated.

370

So if your filler is like in your lip

but you're pulling more water to that

371

area, you may see some prominence

around the outside of the lip.

372

So would say yes and no.

373

Is migration is it always migration that

people are saying when filler looks bad?

374

Not necessarily.

375

Sometimes it's just how the product

is holding onto water and smoothing

376

it out or dissolving it a tiny bit,

not necessarily getting rid of all

377

of it can make it appear better.

378

But yeah, migration is a thing.

379

I would say like overwhelmingly, if you

respect the boundaries, you're not placing

380

excessive amounts of filler in the area

and you're respecting the anatomical

381

filler migration is pretty uncommon.

382

But there are some things that can

make it happen more than other things.

383

Kelsy: That makes total sense,

especially with the fluid changes,

384

especially throughout, like you said,

pregnancy and hydration as we age.

385

All of those things affect it.

386

Seasonal allergies even.

387

I never even thought about all of

those things affecting how it looks

388

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

my big things that I screen for in

389

patients is I get patients who come in,

I think under eye filler is overdone in

390

general, there are other things that you

can do to help treat that area to make it

391

appear more rested, like your under eyes.

392

Just treating the medial cheek,

will give support to the under eye.

393

Going in, just putting filler in there is

never like the first thing that I run to.

394

But I won't inject someone if they tell

me, "I get really bad seasonal allergies,"

395

because more likely, especially like

itchy, swollen eyes, because it may look

396

good when we place it, in the wintertime,

but come spring, their eyes like blow

397

up and it can be a nightmare to manage.

398

In the right person, in the right

candidate, it can be a very powerful

399

tool and it can look great, but in the

wrong person it can look really terrible

400

Kelsy: Can you talk a little

bit about the difference between

401

HA and something like Sculptra?

402

I think you categorize

Sculptra under biostimulator.

403

How are those different?

404

How do they work within

our skin differently?

405

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

So yeah, so HA fillers you can see

406

immediately when they're injected.

407

They are a gel that is meant to volumize.

408

Sculptra and biostimulants, Sculptra

is PLLA, so it's reconstituted in

409

saline and it's injected, and it

relies on the body's ability to

410

be stimulated to produce collagen.

411

So you don't necessarily get an

immediate result from Sculptra

412

or any of these biostimulators.

413

Some of them are like Radiesse is,

it has a gel carrier where you can

414

see some result from it, but that

gel carrier tends to get absorbed

415

around three mon- like it take…

416

it peters on out like around

three months post-injection.

417

But the main difference is that one

is in a naturally occurring, HA is

418

a naturally occurring thing in your

body and volumizing it immediately.

419

And the other one, apart from what with

the saline when it's reconstituted,

420

you don't get an immediate result.

421

It relies on your body stimulating

collagen and elastin to either

422

improve the quality of the

skin or to volumize an area.

423

And I believe that Sculptra was originally

developed to treat HIV patients a long

424

time ago who had, gauntness in their

face and they wanted to revolumize the

425

area, and it was incredibly effective.

426

And then now it's been, I think the

dilution has changed a little bit in the

427

amount that we do, but now it's really

used for more cosmetic aesthetic purposes.

428

And it's a really powerful tool, but

it relies, like I said, on your body

429

producing that collagen and filling

or improving the area over time.

430

Kelsy: So switching gears a little bit

to lasers and different like energy-based

431

treatments, describe some of your favorite

lasers and what you might use them for in

432

clinical practice and who they're best for

433

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

so lasers are just a huge area, and

434

I'm gonna try to do it justice in just

a small amount of time and simplify

435

it because when I started learning

about lasers, I got very overwhelmed.

436

are so many lasers on the market

and it's really hard to understand

437

who is best suited for them and

what they're most effective for.

438

So I like to think of lasers

as like a very specific cloth.

439

Like different lasers are attracted

to different things in the skin, be

440

that brown for pigment and melanin,

red for it to treat things like blood

441

vessels or redness, water in the

skin, which is, when you use a laser

442

for resurfacing and wrinkles and

texture, that's what it's attracted to.

443

And heat will also cause collagen

stimulation, which a lot of lasers deliver

444

heat to the skin or right below the skin.

445

So the key is really choosing

right laser for the right target.

446

So for things like your brown

pigment, those are lasers like

447

pico lasers or Q-switch lasers.

448

1927 fractional lasers can be good

for it, or even IPL and BBL, which

449

is, I don't believe a true laser.

450

I think it's actually just light.

451

It's that's used to treat

some browns and reds.

452

And they're good, like I said, for

sunspots, freckles, lentigines sometimes

453

post-inflammatory hyperpigmentation.

454

And like your…

455

The picos and the Q-switch can pull

out tattoo pigment, which is the

456

primary laser that's used in all of

these tattoo removal cl- clinics.

457

So Think of the pigment like

browns and are-- this is the

458

best lasers to treat them.

459

They break up the pigment, and your

body clears out that pigment either

460

by, taking it out internally or it

coming to the surface and flaking off.

461

category of lasers treat the reds

in the skin, and those are things

462

that are caused by like rosacea or

broken capillaries, those little

463

like telangiectasias that people get

around the nose, even like cherry

464

angiomas, those like little red dots.

465

I got them all over my

body when I was pregnant.

466

Some red scars, facial veins can

be treated with pulse dye lasers,

467

vascular lasers like Vbeam and Excel V.

468

And they target specifically blood cells

and help collapse them or reduce them.

469

And then there are the lasers that

are meant to treat things like texture

470

and pores and fine lines and scars.

471

And these lasers work by making tiny

controlled injuries in the skin, so that

472

the skin repairs itself with new collagen.

473

And there are two kind of

broad types of these lasers.

474

There's non-ablative, so it spares

the surface of the skin, and

475

ablative, which means it takes

the surface level of the skin off.

476

And the non-ablative lasers are things

that a lot of people have heard of.

477

They are like your Moxie laser,

Clear and Brilliant, Fraxel.

478

These heat the skin without fully

removing the surface, and they're

479

great for treating mild texture

and pigment and early aging.

480

They have like low to moderate

downtime depending on the settings.

481

And then your ablative fractional

lasers are like your CO2 lasers or

482

your erbium YAG lasers, and these

remove those tiny columns of skin.

483

And they're incredibly effective for

deeper wrinkles, acne scarring more severe

484

sun damage, and like just a really more

dramatic kind of resurfacing effect.

485

So because they're more effective,

there's more downtime, and because

486

there's more downtime, there's more risk.

487

So risks are things like

hyperpigmentation, infections, and so you

488

really need to select patients carefully

before you just use this laser on anyone.

489

Fractional lasers induce collagen

remodeling over time, and that usually

490

peaks around three months post-treatment.

491

finally, I will say that fractional

resurface lasers also have some evidence

492

for reducing non-melanoma skin cancers

in high-risk like photo-damaged patients.

493

So while a lot of patients are doing

these to improve the appearance of

494

their skin, there are really some

nice health benefits for them.

495

Kelsy: I think that was the perfect sort

of like overarching description because

496

it sounds like different wavelengths

affect different parts of the skin

497

and different depths of the skin and

different colors that you might find

498

on the skin, whether it's, like you

said, the brown, the or the reds, the

499

hyperpigmentation, things like that.

500

And I know it can get very confusing,

but I've heard all of these terms

501

like BBL and MOXI and all sorts

of these different, energy-based

502

treatments or light-based treatments.

503

So I think it was a very helpful sort of

like umbrella perspective of them all.

504

The other thing I had questions

on was PRP and microneedling.

505

Where does that all fall within the realm

of aesthetic dermatology and just things

506

that you can do to improve your skin?

507

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah, I'm sure PRP like being

508

injected for joints, I think.

509

It's used in other places in the body.

510

I think there was like some weird…

511

Not weird.

512

I shouldn't say weird.

513

there were some trials maybe

where they were looking at

514

ovarian like anti-aging purposes.

515

But it's used like in other places in the

body, which I find, really interesting.

516

We more commonly use it in hair

restoration and for PRP microneedling

517

to help stimulate collagen and elastin.

518

I think there is some evidence

out there to support its use, but

519

I think the protocols for it are

a little bit lacking personally.

520

I think there's more evidence there

for hair restoration, both with

521

microneedling and PRP injections.

522

But there's some data to support

that it, it helps improve

523

the results of microneedling.

524

Microneedling works similarly to lasers,

that it's creating these columns or these

525

areas of trauma within the skin, and the

hope is that the body, tries to heal that

526

area and fill it in with new collagen and

elastin, so it remodels things over time.

527

And then I explain to patients

that by putting PRP in there,

528

in theory, that you're putting

in all of the growth factors or

529

platelet-rich fibrin or platelet-rich

plasma, whatever, is being used.

530

It is meant to put in growth factors

so that it stimulates collagen

531

and elastin a little bit better.

532

I still think there's a lot of work to

be done in that area just to standardize

533

protocols to have the best outcomes.

534

But, all this pointless in my

opinion if are not doing the basics.

535

So collagen is degraded by UV exposure.

536

The biggest mistake I see people making

is that they come, and they get their

537

PRP microneedling facials, and then

I see on their Instagram stories they

538

are at the beach in full sun, for the

entire day not applying sunscreen.

539

And it kills me inside because what's

the point of doing all of these things

540

if you're just going to go then do

the things that degrade your collagen?

541

So I think they're nice.

542

They're a nice tool to help support

and slow the aging process, and I think

543

in the next coming years, hopefully

we will see lot better evidence

544

for them in terms of the protocols.

545

But, they're just one of

the tools in your tool belt.

546

Kelsy: What about any sort

of non-invasive treatments?

547

I'm even thinking something like, I don't

know if this is considered non-invasive,

548

but like gua sha and dermaplaning.

549

What…

550

Where do those fit into things?

551

Are those over-hyped, or is there

some merit to actually some of

552

those non-invasive treatments

or any other non-invasive ones?

553

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Listen, I think they, the most

554

part, they do very little harm.

555

If it's something that you enjoy

to do at home, by all means do it.

556

I think supporting the lymphatic

system is incredibly helpful.

557

It's something that you have to be pretty

consistent with and make a part of your

558

lifestyle if you like the results from it.

559

I, used to work with Shelly Marshall.

560

She's Beauty Shamans on Instagram, and

she used to inject, She said she was a

561

person who started doing my Botox when

we worked together as nurses, and she

562

stepped away from injectables and really

went full in on these holistic methods to

563

treat congestion in the skin like acne and

to help the different layers of the skin.

564

And she primarily does that

through things like gua sha.

565

And I think there's a lot of mixed

information out there about it,

566

but from a scientific standpoint,

you'll always benefit from

567

supporting your lymphatic system.

568

So I don't think there's any downsides

to it, and if, somebody is seeing

569

benefits from it, I tell the patients

to keep doing it, the exception that,

570

patients who do have facial fillers

need to be careful about really not

571

doing anything super aggressive to

manipulate the tissues of the face if

572

we've injected filler in that area.

573

So that's my kind of one caveat for it.

574

Dermaplaning is n- I mean it's nice.

575

It's a nice treatment to lift

off some dead skin cells off of

576

the very top surface of the skin.

577

And it can shave off that

peach fuzz, which is nice.

578

It helps makeup lay a

little bit more smoothly.

579

So I think if you enjoy the

results from it, definitely do it.

580

There's, low risk to it, with the

exception that I think some patients may

581

get congested get some skin congestion and

breakouts from dermaplaning just because

582

it can cut the hairs, and then those can

get a little bit stuck underneath the

583

skin, or it can cause these superficial

kind of openings in the surface of the

584

skin that can make patients break out.

585

So you know, see somebody who's qualified

to do it or if you're doing it at home,

586

really, understand the process to do it.

587

I tend to not advocate too much

for doing things at home that are

588

borderline medical procedures just

because of the risk for infection.

589

But I say there are like few downsides

to it if patients wanna try it.

590

Kelsy: And then lastly, I know we've

talked a lot about face, a little bit on

591

the neck, and you mentioned the hands.

592

But do you see…

593

Where do you see this

field going in the future?

594

Is there anything that you're like,

"Okay, I have a feeling this is going to

595

be even trendier in the future," or…

596

I'm thinking one of my goals in 2026 was

taking better care of my full body skin.

597

I feel like I've had a pretty

good skincare routine in the

598

face, and I prioritize a lot of

different things for the face.

599

But I was like, the skin's the

largest organ in the body, and I'm,

600

like, prioritizing maybe 5% of it.

601

I am not putting that focus

on the rest of my body.

602

So in my head I'm like m- I

selfishly wonder, are any of these

603

things that we talked about today

gonna apply, do you think, in the

604

future to your full body skin?

605

Or what are some of the other things that,

that we can watch out for in this realm

606

that you think are just now up and coming?

607

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Okay.

608

So yes, to full body skin health.

609

I think this…

610

Patients already understand

face skincare for the most part.

611

I'm not doing as much basic level

educating when patients come into

612

the office about like skincare

and what they should be using.

613

But like the future I think really is the

neck, the chest, the hands, arms, knees.

614

Like patients are starting

to notice their knees.

615

And like postpartum for me, my abdomen was

something that I really started to about.

616

And especially with the use of GLP-1s,

I think post weight loss skin quality.

617

And the same biology that applies to your

face applies to the rest of the body.

618

So I think we'll be seeing a focus

on other areas come up a lot more.

619

I think patients are also very interested

in, and I think the field is shifting

620

towards more bio-simulatory treatments.

621

The…

622

there's really a focus on less filling

and more restoring tissue behavior and

623

simulating collagen and elastin and

helping along wound healing because all

624

of these treatments that function by

creating a wound in the skin, whether

625

that's a laser or microneedling, are

only as effective as how you heal.

626

And so if you're not babying the

skin and really guiding the skin

627

to heal truly better than what it

was before, you're doing yourself a

628

disservice and you're not reaping all

of the benefits of that treatment.

629

And I think we'll see patients really

trying to manage inflammation, getting

630

in- like inflammatory processes

under control because you can see

631

the effects of that in the skin.

632

I also think there will probably be

a shift towards better skin imaging

633

diagnostics whether that's like just

plain photography in the office, but

634

the use of ultrasounds in office to

make treatment safer, so imaging blood

635

vessels so that when we're injecting,

we know we're, that we're in a safe

636

territory, and also to aid in the

reversal and management of complications.

637

I think there's still a lot

that can be done to improve it.

638

And when it comes to medical things, I

used to work in radiology a long time ago.

639

But if I was doing a paracentesis or

a thoracentesis to drain fluid off of

640

somebody because they had an accumulation

in the abdomen, yeah, you can do that-

641

Quote, unquote, "blind," where you

place a needle in and drain the fluid.

642

But there are blood vessels and

bowel and all sorts of things that

643

are in the way that by just doing

it blind, you don't necessarily see.

644

And I think in aesthetics, we function

by knowing the anatomy, but going in

645

blind without using any diagnostic tools.

646

And I think because now in hospital

you're imaging with ultrasound before you

647

stick someone to make sure that you're

in the right area, you're not gonna nick

648

bowel, like for a paracentesis, and I

think that, that will be a shift that

649

slowly makes its way into aesthetics.

650

For whatever reason, I think because

these are aesthetic medical procedures

651

there hasn't been, that drive to do it.

652

And I hope for me as a provider we

now, like at my practice, have an

653

ultrasound in office, but I hope that

will be a shift for the industry.

654

then lastly, probably just

like a less one face fits all.

655

I think aesthetic medicine in general

is moving away from just doing

656

the same thing to every patient and

shifting towards really respecting every

657

individual's anatomy, ethnicity obviously

sex because male proportions are very

658

different than female proportions, but

a lot of males were being feminized

659

because they needed volume repletion

in their cheeks, but they were-- but

660

injectors them like a female cheek.

661

And I think there will be more respect

for hormonal state, whether that's,

662

around the time that women are pregnant

because, there are a lot of real

663

changes that happen around that time.

664

And then perimenopause and then obviously

weight changes with all of these GLP-1s.

665

I think treatments are gonna be a lot more

tailored to all the fluctuations that are

666

happening because of either life cycle

or the stage that, that people are at or

667

the lifestyle that people are adopting.

668

Everybody is now like drinking way

less alcohol and hopefully eating

669

healthier and maintaining, better weights

670

Kelsy: I think that individualized nature

of how someone is looking and not having

671

this copy-paste for every patient also

feeds back into that imaging and that

672

being on the forefront of imaging because

it's like the more you're able to see and

673

actually tell, the more individualized

you're gonna be able to make some of those

674

treatments probably is my assumption too

675

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah and I always say, when you go

676

to inject someone you can be the

most trained plastic surgeon and

677

have dissected the face and know

all the planes and know exactly

678

where is based off of your training,

but anatomical variants are real.

679

That artery 95% of the time runs

in this direction, in this plane,

680

at this level, but in another

percentage of patients it does not.

681

And so when you inject and you

don't use image-based guidance, you

682

are making a statistical decision

minimizing the risk, and I think

683

those tools will help providers

and patients, have better results.

684

And obviously, the last thing is that

there's gonna be this strong shift,

685

I think for me personally, not making

patients look wildly different.

686

like that's always been my philosophy.

687

My approach is really to understand

which layer is aging and help, help

688

that along and not necessarily change

the way somebody looks drastically.

689

So the best aesthetic work is

like not about chasing trends.

690

It's about preserving patient's identity

while improving or restoring some aspect

691

of the age- that has been affected by

the aging process, whether that's skin

692

quality proportions, or like the way

that light reflects off of the face

693

Kelsy: I had a professor who once

described certain changes, bony

694

changes that happen within our knees

and joints, like you might have,

695

degenerative discs or arthritis, whatever.

696

He described them like

laugh lines on the face.

697

It's a sign of a life well-lived.

698

He'd say that, and I feel like

you said, a lot of people are just

699

starting to embrace that aging process

and trying to maintain a lot of the

700

things that make them who they are.

701

And like you said, not trying to

have a 50-year-old look like a

702

20-year-old, but actually embracing

who they are at that stage of life.

703

And I really am grateful to, to be

in this time where I'm noticing all

704

of these women who are, a few decades

older than me starting to embrace that

705

Claire Schwegel Del Signore, DNP, FNP-BC, MS, RN:

Yeah, there's, we- my husband and I

706

just took a trip to Japan recently.

707

We had to go he had a conference

in Singapore, and we decided

708

to make a big trip out of it.

709

And one of the philosophies in Japanese

culture is something called wabi-sabi,

710

and it really touched me it has to do

with really the appearance of things

711

and how they look from being used.

712

So like even a dish that has fallen

and broken that's been pieced back

713

together, it's like very honored

to see all of the lines and the

714

imperfections in that item because it

gives meaning and history to that thing.

715

That a bouquet is not like perfectly

round and every flower is at the exact

716

same spot on the left and right, but

really to embrace nature and the way that

717

nature made us, which can seem a little

bit in the field that I'm in, right?

718

W- your patients don't wanna

embrace their wrinkles.

719

But at the same time, like there

are certain things that are very

720

defining to patients' faces.

721

I always say like each individual

is uniquely beautiful in their

722

own way, and my job is really to

highlight that and to do that honor

723

and not remove it and change it.

724

So a- and that goes for everything,

my husband has like this gap between

725

his teeth, and I think it's the

most attractive thing about him.

726

I love it, and the dentist, every time

she sees him, is "Hey, do you want us

727

to do Invisalign and close that gap?"

728

So you know, a little part of what I do

is also giving patients the confidence

729

to embrace the things that make them

uniquely them and find beauty in that.

730

Kelsy: I think that's

the perfect place to end.

731

I learned so, so much today.

732

Just I had so many questions coming in.

733

And I had told you I was very excited

to learn all of this because you hear

734

all of these key terms and phrases.

735

and I'm like, "Okay, but I

need to understand how they

736

actually affect, the skin."

737

And it's not just as

easy as we think it is.

738

The skin is a very complex organ.

739

So I appreciate you coming on, chatting

through all of it today, answering all

740

of my, possibly elementary questions.

741

But I learned so much, and I

know everyone else did, too.

742

So I will leave all of Claire's links

below if you happen to be in NYC and

743

want to book with her at Vollure Medical,

or just follow her on social media.

744

I learn so much from her there, too.

745

I'll see you guys again on the next

episode of Wellness Big Sis The Pod.