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

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believe you deserve real education

from real experts, delivered

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in a way you can actually use.

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I'm Dr.

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Kelsey Vick, your board-certified

orthopedic doctor of physical therapy, and

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this podcast was built for the girl who

is done feeling overwhelmed and frustrated

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by conflicting health noise and is ready

for something she can actually trust.

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Every week, we have honest, science-backed

conversations about your health,

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your hormones, your brain, your

body, and everything in between.

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No fluff, no fear-mongering,

just the truth.

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Because understanding your

body is the most powerful

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thing you can do for yourself.

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A table full of experts built for

the curious girl who wants the truth.

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So welcome.

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Your seat is waiting for you.

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Kelsy: What's actually happening

within our skin as we age?

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Biologically, what are some of the

drivers of the changes that we see

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in our skin throughout each decade?

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It's interesting that you talk about skin

healing because I talk with patients a

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lot, and usually in their 30s they're

saying like, I'm just noticing my body

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is not recovering well after exercise."

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And that's like their first sign

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

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My body isn't able to exercise and

drink and sleep, stay out late with

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minimal sleep, all of these things.

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The first thing I noticed was

my skin not healing as well.

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I kept telling my friends, I was like, I

have this acne scar or something, and I

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

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And I noticed it the most in my skin.

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That was like my very first thing

where I was like, it wasn't the

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exercise, it wasn't the recovery,

it wasn't the injuries, it was like

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my skin, where I was like, it is

not healing as quick as it once did

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

It's wild the things we

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used to get away with.

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And it's interesting to see what

it is now, but obviously when I'm

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in my 40s and 50s aging is real.

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And used to- I went to school in New

Orleans undergrad, and would go out

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until God knows what hour of the night

and drink have a great time, and wake up

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and go to organic chemistry at 8:00 AM

in the morning and be absolutely fine.

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Now, if I have that second glass of wine

at night, it trashes my entire next day.

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So I think, yeah, you just…

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your body is not as good at

doing what it normally does.

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Skin cell turnover slows.

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Wound healing, it takes

a little bit longer.

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There are other inflammatory

processes that kind of get

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aggravated as you get older.

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And yeah, you're just overall not as

good as you were when you were 10.

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Kelsy: are there any things that we can

do at each decade to help support that

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collagen production, that hydration,

that architecture of the face?

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Like, all of those signs that you were

saying change as we age, are there things

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that we can do with either fueling or

supplementation or skincare, anything

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like that helps at each different decade?

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And even, different treatments and

procedures, just broadly that we should be

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looking at for prevention and maintenance

of some of those things as we age

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

Yeah.

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So I always say an ounce of

prevention is worth a pound of cure.

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And it really starts when you're young.

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That's when you have great

collagen and you wanna protect it.

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And so things that are really simple

and effective are sun protection, like

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I've been saying every like almost

every second of any time we talk.

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Retinoids are really great when tolerated.

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A nice like antioxidant and something

that keeps the barrier healthy.

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Your 20s are when prevention

has the highest return.

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Daily sunscreen has randomized trial

evidence for slowing photoaging.

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Retinoids improve photoaging by

increasing epidermal turnover

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and supporting collagen biology.

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And so I think in your 20s, the most

important thing is to just prioritize

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the things we have the most evidence

for that are going to keep you the way

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that you are, at that point in time.

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Really nothing that's aggressive,

just pretty conservative topicals.

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And if you're starting to see maybe like

fine lines and wrinkles, you can think

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about doing a conservative neuromodulator.

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Although I usually say if the lines

are not static, that means they're

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just there when you're not expressing,

they're dynamic, you have good collagen.

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Like it's not necessarily something that I

would run to go do in terms of procedures.

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For 30s, I think important

thing is collagen banking.

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So can do things like maintenance

neuromodulators, like BOTOX and Dysport.

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But like at that point, even if you're

really judicious about sunscreen,

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like you may have some pigment,

whether it's related to sun exposure

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or genetically or hormonally, driven.

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so priorities I think shift and then

you can maybe add in a little bit

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of BOTOX and Dysport really just

to prevent fine lines and wrinkles

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from forming and becoming static.

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And adding like a little IPL or

vascular laser to address any type

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of redness or pigment is really nice.

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Maybe considering small volume filler

if there's any type of anatomy that's

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changed, but I usually don't have patients

run to chase those types of things.

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And then you have to keep in mind your

30s are when most women are either

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planning pregnancy, a lot of women get

p-pregnant in their late 20s, but I

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think women are starting to get pregnant

later, and you have to keep in mind,

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like, all of these things have to be

safe during pregnancy and postpartum.

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So really tailoring the approach

to be appropriate for the stage

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of life that a woman is in.

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And then your 40s are really the time, I

think, when you start to see structural

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changes and skin quality really changing.

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That's at perimenopausal time.

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And so this is when patients often say,

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

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there's just this not so tangible thing.

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They can't put their finger

on it, but there's a change,

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and they want to improve it.

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That's when I think neuromodulators

to really treat the way that the

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muscles pu-pull are very effective.

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Lower face Botox especially in the

platysma will help with releasing

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any downward pull and lift the

face up a little bit without

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needing to necessarily do filler.

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Are patients that will see real signs

of bony changes in their face, although

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

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But mid to late 40s, patients will see

their pyraform starts to hollow out.

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There's usually some bone loss

on the chin here, or the temples

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become a little bit sunken in.

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And so those are areas that

can be considered for volume

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repletion, and I think it

certainly makes patients feel good.

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It restores a little bit of the support

that they normally had in their face,

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and it's a really effective treatment

to use either a biostimulator or an

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HA-based filler to treat those areas.

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then at that point in time, patients

tend to start getting a little bit

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more aggressive with their treatments.

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They have a more serious pigment strategy.

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They're using a tinted SPF.

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They're probably using a little bit

higher dose of a retinoid to really

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get the skin cells turning over.

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And then incorporating in whatever

Topicals are targeted for them,

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so azelaic or hydroquinone when

appropriate and like carefully

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selected and very targeted lasers.

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And that's, like I said, the point

in time when, you really have to

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think about how perimenopause is

changing the skin, and estrogen is

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really one of those things I think is

biologically relevant for aesthetics.

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And women will see like real changes in

the quality of their skin, like crepiness

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and dryness and doing some treatments

to address that can be really helpful.

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And then 50s and is when I, try

to get patients to embrace the

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aging process a little bit, right?

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

we're in our 50s but tackling some of

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the age-related changes to get hydration

back in the skin is really nice.

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Obviously, the mainstay of every decade

is gonna be SPF and still using a

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retinoid, they can, use a more aggressive

resurfacing laser if it's appropriate.

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Things like CO2 lasers that ablate

the top l- layer of the skin

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will really lift off pigment.

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It's aggressive, and there's significant

downtime, but it does wonders for like

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fine lines and wrinkles and pigment.

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and then still at that point in time,

like incorporating a little bit of

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filler bio-stimulator for patients

and treating areas not just like the

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face, but really the neck, sometimes

even the hands and other areas on

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the body that show signs of aging.

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So we always say like in aesthetics,

the biggest giveaway of someone's age

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is not their face, it's their neck and

their hands 'cause usually patients

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are really focused on treating their

face, and they forget those areas.

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And then the-- at every point in

time in the decade or at every point

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in time in each decade, you should

be having an annual full skin exam.

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That means you're completely naked head

to toe in a room with a dermatologist or

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someone who is very skilled at evaluating

the skin and looking at any new lesions

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or any enlarging pigment or, anything that

could be a suspicious lesion to make sure

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that you're staying healthy and catching

basal cells or any type of melanomas or

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things that are going to eventually turn

into skin cancer, precancerous lesions.

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So that's what I would give

for guidance at each decade.

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Kelsy: let's zoom in a little bit

on, you mentioned neuromodulators,

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and you use that term.

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Can you describe what they are,

what they do, what might be like

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the terminologies that we know for

neuromodulators and how they can be

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used like preventatively and reactively?

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I think you've talked about both

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

Yeah.

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So neuromodulators is like the

big umbrella for things that

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most patients have heard of are

called Botox, Dysport, Xeomin.

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There are lots of them on the market.

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And they essentially, patients think of

them or use them to treat wrinkles, but

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what they do is actually treat the muscle.

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And it prevents the muscle from

either pulling or creasing the

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skin in a certain direction.

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And by knocking out or causing a

little bit of paralysis in that area

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that maybe they have a complaint

about they smooth out the area.

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Botox, Dysport, all these neuromodulators

actually modulate the signal that's going

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to the nerve to tell it to contract.

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So that's why I call it a neuromodulator.

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So not all injectables

are neuromodulators.

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Neuromodulators are your Botox,

Dysport, Xeomin, if that makes sense.

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And the two that are most common

that most people think about

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are like Botox and Dysport.

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They're very well studied.

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I will say that Botox has broader

published evidence overall, largely

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because it has more FDA-approved

indications and it's been studied like

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extensively across aesthetics but also for

treatment of like migraine headaches and

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hyperhidrosis, spasticity like um in MS.

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It's used for I think bladder dysfunction.

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It can be injected to

treat palatal myoclonus.

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There are so many therapeutic uses,

but obviously specific to me, I use it

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to diminish the strength or paralyze a

portion of a muscle that is either for

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me pulling down, for my patients pulling

down in a direction that we don't want.

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Most patients want to feel more

lifted for aesthetic treatments

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or to smooth out a wrinkle.

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So like when the muscles are, say for the

frontalis, when you raise your eyebrows

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upwards, it causes a crease in the skin.

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So when you place Botox in an area

that's pulling up and creasing the

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skin, it doesn't pull up anymore

and it smooths out the skin.

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so yeah you can use it preventatively.

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And I see that for patients that are

like on a Zoom, and they say, "Whenever

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

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

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And they may not have those like clear

demarcated areas, and w- we can use

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it preventatively to make sure that

they don't develop those indentations

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or tho- those wrinkles there.

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And then obviously, whenever I see

static lines, that means somebody

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comes into the office and they're just

sitting there, and they're not making an

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expression, and they just have these lines

that are going across their forehead.

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We can treat them with a little bit

of Botox or just for a neuromodulator

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so that they can either be

smoother or completely go away.

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And I, I usually will tell

patients, who have static lines

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on their face, think about these

lines as wrinkles in a bedsheet.

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You've had a bedsheet that's been

folded up in your closet for months

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on end, and now you're finally

pulling it out to put it on to the

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bed, and you can't expect that those

wrinkles are gonna be smoothed out the

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second that you pull out the sheet.

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00:17:05,665 --> 00:17:08,746

It really takes a little bit of

time of not making that repetitive

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00:17:08,766 --> 00:17:12,306

movement, not creasing the bedsheet,

and having it stretched out over

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00:17:12,306 --> 00:17:15,606

the mattress for those wrinkles to

smooth out, but eventually they do.

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

for when I talk to patients about

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treating dynamic versus static lines

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00:17:23,961 --> 00:17:27,300

Kelsy: And for something like forehead

lines, and then you mentioned the

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00:17:27,300 --> 00:17:33,471

platysma, where in my head that seems

a little bit more of a, dramatic

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00:17:34,031 --> 00:17:37,121

gravity is like pulling on this area

a little bit more than just like your

218

00:17:37,131 --> 00:17:38,971

forehead raising up and the lines there.

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00:17:39,051 --> 00:17:43,571

is there different, levels of

effectiveness depending on the area

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00:17:43,571 --> 00:17:48,471

you're treating, different dosages,

different lengths of time that they

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might, that neuromodulator might

stay effective or wear off quicker?

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00:17:53,741 --> 00:17:55,511

Does it wear off quicker in certain areas?

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Is there basically differences in where

and how you use it across the whole face?

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00:18:01,902 --> 00:18:02,072

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

Yeah.

225

00:18:02,072 --> 00:18:06,472

So those are really great questions,

and pretty much yes to all of them.

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The areas that tend to wear off quickest

are the areas that get used the most.

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and the areas that have the lowest dosing.

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00:18:14,432 --> 00:18:18,482

So for example, a lip flip, which is

commonly used to paralyze a portion

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of the orbicularis oris here and evert

the tissue on the top lip to show more.

230

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Mouth is constantly moving, and because

of your need to speak and kiss and

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drink and sip from a spoon, we don't

wanna over paralyze that muscle.

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So it's a muscle that gets a very low

dose of neuromodulator, and it's gonna

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be in an area that's super active, so

it lasts a very short amount of time.

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Whereas when we do much higher

doses in muscles like, say, the

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masseters, I find that tends to

stick around for a little bit longer.

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I have some patients that say that

they feel the effects for almost

237

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six months, which is not necessarily

in line with what the makers say.

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00:19:04,992 --> 00:19:09,512

They say that Botox is supposed to

last 12 weeks, or all of the clinical

239

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studies looked at the ramp-up period,

how long the effects last, and when

240

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patients reported seeing wrinkles again.

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00:19:15,512 --> 00:19:19,512

But I think because the doses are much

higher, you're getting a more sustained

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paralysis, and you're actually weakening

the muscle so that it's not able to be

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used as strong as it would baseline.

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So maybe some of those effects are

prolonged, not necessarily because the

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00:19:30,552 --> 00:19:34,622

paralysis is maintained, but you've

actually physically, shrunk the muscle a

246

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

not able to grind or bite down as hard.

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So yeah, I think the length of time

and how paralyzed the area is really a

248

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function of how much movement that muscle

has and the dosing that you're using

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to treat it, amongst some other things.

250

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But yeah.

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Kelsy: What about other injectables?

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00:19:54,653 --> 00:20:00,383

Do you have other favorite injectables

that you get a lot of, bang for

253

00:20:00,383 --> 00:20:01,993

your buck with your clients?

254

00:20:02,023 --> 00:20:05,253

And what are they, and what

would you use those for?

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00:20:05,683 --> 00:20:06,063

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

So there are lots of

256

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injectables on the market.

257

00:20:08,273 --> 00:20:12,563

Most commonly used are

HA-based injectables.

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Those are hyaluronic acid gels.

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00:20:14,843 --> 00:20:18,443

HA is a water-binding molecule

that is naturally present in

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00:20:18,443 --> 00:20:20,043

your skin and connective tissue.

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00:20:20,483 --> 00:20:26,873

And when you talk about or filler,

hyaluronic acid gels and fillers,

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they're all pretty different.

263

00:20:28,963 --> 00:20:34,223

They have different firmness, different

elasticity the cohesivity of the gel,

264

00:20:34,223 --> 00:20:37,743

and what they call the lifting capacity

of the gel is all very different.

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I would say that those are, like,

one of the things that I have in my

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tool belt other than biostimulatory

injectables, and those are

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things like Radiesse or Sculptra.

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so fillers should be placed

according to the anatomy.

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So for deep structural support, like in

the cheek and the chin and the jawline,

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00:20:58,879 --> 00:21:03,269

and that can be to give someone an

anatomy that they don't naturally have.

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So someone who may be contemplating

a chin augmentation, that they h-

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00:21:07,309 --> 00:21:11,819

they're a little bit recessed and

their chin falls behind, the area

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00:21:11,819 --> 00:21:15,439

where they would, maybe the nose is a

thing that projects the most maximally.

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Those are patients that come to me a

lot of the time and want projection

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in their chin and improvement of

their appearance from a profile.

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00:21:23,049 --> 00:21:27,129

And HA fillers are really effective,

especially things like Voluma

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are extremely effective at giving

that type of anatomy to a patient

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who doesn't necessarily have it.

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I like them, and I choose to use

fillers in my practice that are

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00:21:35,539 --> 00:21:37,709

reversible, and that's for two reasons.

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00:21:37,719 --> 00:21:40,499

One is an aesthetic one and

the other is a safety reason.

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And it's mainly because,

these are aesthetic things.

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00:21:43,429 --> 00:21:47,609

as aligned as we can be and as good

as I am at giving someone something,

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00:21:47,659 --> 00:21:51,809

there's something nice about being able

to reverse it, whether that's a patient

285

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just decide "I don't want this in my

face anymore," for whatever personal

286

00:21:54,789 --> 00:21:58,619

reasons, or, maybe somebody says, "I

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

287

00:21:58,659 --> 00:22:01,639

I thought maybe if I liked this, I

would get a chin implant, but maybe

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00:22:01,639 --> 00:22:04,999

this is not the right thing for me

aesthetically," and you can dissolve it.

289

00:22:05,289 --> 00:22:07,209

So I think aesthetically,

that's really nice.

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00:22:07,239 --> 00:22:11,579

And the other reason is because with any

of these HA-based fillers, they're meant

291

00:22:11,579 --> 00:22:14,049

to be injected not into the vasculature.

292

00:22:14,059 --> 00:22:19,739

So either on periosteum, above periosteum,

or within the tissue to augment it.

293

00:22:19,829 --> 00:22:23,949

But if there is a rare complication

called vascular occlusion, if the

294

00:22:24,079 --> 00:22:28,059

filler is injected into a blood vessel,

it can block or occlude the flow

295

00:22:28,059 --> 00:22:32,609

through that vessel, and that can lead

to some very serious problems that

296

00:22:32,609 --> 00:22:34,939

require urgent or emergent treatment.

297

00:22:35,169 --> 00:22:38,529

So obviously, when you don't get

blood flow to the tissue, it can

298

00:22:38,659 --> 00:22:40,359

cause the tissue to die or necrose.

299

00:22:40,729 --> 00:22:45,399

So usually these things present pretty

immediately and you need an enzyme called

300

00:22:45,399 --> 00:22:50,129

hyaluronidase to break down the HA-based

filler and restore blood flow to the area.

301

00:22:50,479 --> 00:22:54,309

And I always talk to my patients

about, risk versus benefits for

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00:22:54,309 --> 00:22:57,029

doing these treatments because

this is not a haircut, right?

303

00:22:57,229 --> 00:23:01,749

It's a true medical procedure, and

someone needs to be affected enough

304

00:23:01,769 --> 00:23:05,119

by their appearance or want to

change their appearance enough that

305

00:23:05,119 --> 00:23:06,679

they're willing to take this risk.

306

00:23:06,689 --> 00:23:11,649

Even though it's extremely rare, I've

never in my practice-- and it's just

307

00:23:11,649 --> 00:23:14,149

a matter of time, because if you've

been doing it long enough, it will

308

00:23:14,149 --> 00:23:17,109

happen, but I've never personally

had an occlusion in my practice

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00:23:17,389 --> 00:23:21,719

or for me personally, but I have

assisted in dissolving two occlusions.

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

be scary for patients and for providers.

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I think the thing that, gives

me comfort is knowing that there

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is something that you can do.

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00:23:32,669 --> 00:23:37,577

It is reversible and it is treatable,

and there is a, an algorithm

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to manage these complications.

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So that's why I personally choose to

use reversible fillers in my practice.

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So they can be used for obviously

treating deep structural support,

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like I said, the cheek, the chin, the

jawline, and aging p- the pyriform,

318

00:23:51,657 --> 00:23:53,847

fossa and temporal hollowing.

319

00:23:54,157 --> 00:23:59,157

And then nasolabial folds for more

soft tissue blending and helping

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00:23:59,187 --> 00:24:02,427

blend out some of this line that

you see when the cheek descends.

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00:24:02,857 --> 00:24:06,287

Or areas like the pre-jowl sulcus

where you can start to see a little

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00:24:06,287 --> 00:24:09,147

bit of jowling and an indentation

that comes in before the chin

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00:24:09,147 --> 00:24:10,737

just to give a smoother jawline.

324

00:24:11,157 --> 00:24:15,757

Or for things like superficial refinement

in the lips for fine lines and wrinkles

325

00:24:15,767 --> 00:24:19,207

somewhere that are pretty etched in

they can be really powerful tools.

326

00:24:19,907 --> 00:24:24,197

I always say the key is that fillers

should not really simply chase a crease.

327

00:24:25,017 --> 00:24:29,787

a nasolabial fold, for example, may be

caused by cheek descent or midface volume

328

00:24:29,787 --> 00:24:33,837

loss, so it's really important to address

the reason why that crease is occurring.

329

00:24:33,857 --> 00:24:39,047

And only filling a fold or an area

where there is a shadow can make

330

00:24:39,047 --> 00:24:40,857

someone look really heavy and unnatural.

331

00:24:41,177 --> 00:24:44,097

So yeah, those are, in my

opinion, the areas that are

332

00:24:44,097 --> 00:24:45,857

best suited for using filler

333

00:24:46,278 --> 00:24:47,948

Kelsy: I've heard of filler shifting.

334

00:24:48,008 --> 00:24:49,428

W- what is that happening?

335

00:24:49,478 --> 00:24:52,808

I know some people are very cautious

about under-eye filler and things

336

00:24:52,808 --> 00:24:54,228

like that where it can shift.

337

00:24:54,608 --> 00:24:55,958

What is actually happening with that?

338

00:24:56,008 --> 00:25:01,348

Is that HA just moving, HA-based

filler moving somewhere else?

339

00:25:01,728 --> 00:25:03,328

Can you describe that a little bit to me?

340

00:25:03,717 --> 00:25:05,607

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

Yeah, so filler can migrate.

341

00:25:05,877 --> 00:25:11,687

I tend to feel that the fillers that

migrate or appear migrated whether

342

00:25:11,687 --> 00:25:15,207

it's a filler or something else that's

happening, are the ones that draw in

343

00:25:15,207 --> 00:25:19,567

the most water, are injected the most

superficially, and are the thinnest.

344

00:25:19,707 --> 00:25:23,757

That's probably more of my personal

opinion than there's any real guidance

345

00:25:23,847 --> 00:25:26,777

or real evidence to guide me saying that.

346

00:25:26,817 --> 00:25:30,277

But when you classically think of

like poor filler, I think everybody

347

00:25:30,277 --> 00:25:33,757

gets this like image in their head

of I think like Jennifer Aniston

348

00:25:33,767 --> 00:25:36,317

or one of the Kardashian sisters.

349

00:25:36,317 --> 00:25:37,367

I can't remember her name.

350

00:25:37,837 --> 00:25:41,777

But like this area right around the

tear trough that's like really bulky

351

00:25:41,777 --> 00:25:46,907

and large and looks just funny and

strange, and that's more likely than

352

00:25:46,907 --> 00:25:48,937

not because filler was placed there.

353

00:25:49,657 --> 00:25:53,187

may have looked incredible that the

day that it was placed or even for

354

00:25:53,187 --> 00:25:58,077

weeks after that, but shifts in fluid

volume can change how filler appears.

355

00:25:58,307 --> 00:26:01,407

So that filler may provide

great support for her under

356

00:26:01,407 --> 00:26:02,887

eyes, right after it's injected.

357

00:26:02,887 --> 00:26:08,107

But if she has seasonal allergies, she

may be drawing more water to the area.

358

00:26:08,397 --> 00:26:11,417

If the product spreads a tiny bit,

then it's gonna attract water to

359

00:26:11,417 --> 00:26:12,967

that area and make it more apparent.

360

00:26:12,977 --> 00:26:15,877

And the most common place that I

see this is like the lips, right?

361

00:26:16,187 --> 00:26:20,247

Especially when lips are overfilled

and the anatomical boundaries are not

362

00:26:20,247 --> 00:26:24,287

respected, you get migration of filler

outside of the border of the lip,

363

00:26:24,547 --> 00:26:29,487

which gives this really unnatural kind

of shelfed appearance and projection.

364

00:26:29,897 --> 00:26:36,637

And it's worsened, when a patient will

have a meal that is salty or, they just

365

00:26:36,637 --> 00:26:38,887

have a little bit more fluid volume.

366

00:26:38,987 --> 00:26:43,597

I'm pretty sure that my filler got

a, like just felt a little heavier to

367

00:26:43,597 --> 00:26:46,727

me when I was pregnant, just 'cause

I was holding onto so much fluid.

368

00:26:47,047 --> 00:26:50,917

So the real shifts that happen in the

body can make filler more apparent,

369

00:26:51,167 --> 00:26:53,217

whether or not it's migrate, migrated.

370

00:26:53,217 --> 00:26:56,457

So if your filler is like in your lip

but you're pulling more water to that

371

00:26:56,457 --> 00:26:59,457

area, you may see some prominence

around the outside of the lip.

372

00:26:59,457 --> 00:27:01,517

So would say yes and no.

373

00:27:01,517 --> 00:27:05,927

Is migration is it always migration that

people are saying when filler looks bad?

374

00:27:05,937 --> 00:27:06,797

Not necessarily.

375

00:27:06,797 --> 00:27:10,457

Sometimes it's just how the product

is holding onto water and smoothing

376

00:27:10,457 --> 00:27:13,537

it out or dissolving it a tiny bit,

not necessarily getting rid of all

377

00:27:13,537 --> 00:27:15,327

of it can make it appear better.

378

00:27:15,847 --> 00:27:17,447

But yeah, migration is a thing.

379

00:27:17,547 --> 00:27:21,587

I would say like overwhelmingly, if you

respect the boundaries, you're not placing

380

00:27:21,587 --> 00:27:25,997

excessive amounts of filler in the area

and you're respecting the anatomical

381

00:27:27,157 --> 00:27:29,017

filler migration is pretty uncommon.

382

00:27:29,307 --> 00:27:33,587

But there are some things that can

make it happen more than other things.

383

00:27:34,112 --> 00:27:37,162

Kelsy: That makes total sense,

especially with the fluid changes,

384

00:27:37,162 --> 00:27:41,172

especially throughout, like you said,

pregnancy and hydration as we age.

385

00:27:41,192 --> 00:27:42,172

All of those things affect it.

386

00:27:42,172 --> 00:27:43,122

Seasonal allergies even.

387

00:27:43,122 --> 00:27:46,832

I never even thought about all of

those things affecting how it looks

388

00:27:47,362 --> 00:27:49,212

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

my big things that I screen for in

389

00:27:49,212 --> 00:27:53,916

patients is I get patients who come in,

I think under eye filler is overdone in

390

00:27:53,916 --> 00:27:57,886

general, there are other things that you

can do to help treat that area to make it

391

00:27:58,216 --> 00:28:00,456

appear more rested, like your under eyes.

392

00:28:00,526 --> 00:28:04,096

Just treating the medial cheek,

will give support to the under eye.

393

00:28:04,386 --> 00:28:07,616

Going in, just putting filler in there is

never like the first thing that I run to.

394

00:28:07,936 --> 00:28:12,766

But I won't inject someone if they tell

me, "I get really bad seasonal allergies,"

395

00:28:12,796 --> 00:28:17,386

because more likely, especially like

itchy, swollen eyes, because it may look

396

00:28:17,386 --> 00:28:22,836

good when we place it, in the wintertime,

but come spring, their eyes like blow

397

00:28:22,836 --> 00:28:24,826

up and it can be a nightmare to manage.

398

00:28:24,846 --> 00:28:29,156

In the right person, in the right

candidate, it can be a very powerful

399

00:28:29,166 --> 00:28:32,706

tool and it can look great, but in the

wrong person it can look really terrible

400

00:28:33,287 --> 00:28:35,037

Kelsy: Can you talk a little

bit about the difference between

401

00:28:35,097 --> 00:28:36,877

HA and something like Sculptra?

402

00:28:36,887 --> 00:28:40,367

I think you categorize

Sculptra under biostimulator.

403

00:28:40,767 --> 00:28:42,647

How are those different?

404

00:28:42,677 --> 00:28:45,367

How do they work within

our skin differently?

405

00:28:45,437 --> 00:28:49,137

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

So yeah, so HA fillers you can see

406

00:28:49,137 --> 00:28:50,697

immediately when they're injected.

407

00:28:50,707 --> 00:28:52,787

They are a gel that is meant to volumize.

408

00:28:53,707 --> 00:28:59,347

Sculptra and biostimulants, Sculptra

is PLLA, so it's reconstituted in

409

00:28:59,670 --> 00:29:03,970

saline and it's injected, and it

relies on the body's ability to

410

00:29:03,970 --> 00:29:06,240

be stimulated to produce collagen.

411

00:29:06,660 --> 00:29:10,800

So you don't necessarily get an

immediate result from Sculptra

412

00:29:10,850 --> 00:29:12,500

or any of these biostimulators.

413

00:29:12,800 --> 00:29:16,240

Some of them are like Radiesse is,

it has a gel carrier where you can

414

00:29:16,250 --> 00:29:20,290

see some result from it, but that

gel carrier tends to get absorbed

415

00:29:20,400 --> 00:29:21,760

around three mon- like it take…

416

00:29:21,800 --> 00:29:24,790

it peters on out like around

three months post-injection.

417

00:29:25,050 --> 00:29:30,670

But the main difference is that one

is in a naturally occurring, HA is

418

00:29:30,670 --> 00:29:34,510

a naturally occurring thing in your

body and volumizing it immediately.

419

00:29:34,510 --> 00:29:39,050

And the other one, apart from what with

the saline when it's reconstituted,

420

00:29:39,160 --> 00:29:40,610

you don't get an immediate result.

421

00:29:40,640 --> 00:29:44,340

It relies on your body stimulating

collagen and elastin to either

422

00:29:44,370 --> 00:29:49,310

improve the quality of the

skin or to volumize an area.

423

00:29:49,570 --> 00:29:55,130

And I believe that Sculptra was originally

developed to treat HIV patients a long

424

00:29:55,130 --> 00:30:00,000

time ago who had, gauntness in their

face and they wanted to revolumize the

425

00:30:00,000 --> 00:30:01,710

area, and it was incredibly effective.

426

00:30:01,710 --> 00:30:05,260

And then now it's been, I think the

dilution has changed a little bit in the

427

00:30:05,260 --> 00:30:09,610

amount that we do, but now it's really

used for more cosmetic aesthetic purposes.

428

00:30:09,630 --> 00:30:13,840

And it's a really powerful tool, but

it relies, like I said, on your body

429

00:30:13,960 --> 00:30:19,040

producing that collagen and filling

or improving the area over time.

430

00:30:19,583 --> 00:30:23,993

Kelsy: So switching gears a little bit

to lasers and different like energy-based

431

00:30:24,003 --> 00:30:29,653

treatments, describe some of your favorite

lasers and what you might use them for in

432

00:30:29,653 --> 00:30:31,763

clinical practice and who they're best for

433

00:30:31,998 --> 00:30:35,178

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

so lasers are just a huge area, and

434

00:30:35,178 --> 00:30:40,478

I'm gonna try to do it justice in just

a small amount of time and simplify

435

00:30:40,478 --> 00:30:43,948

it because when I started learning

about lasers, I got very overwhelmed.

436

00:30:44,708 --> 00:30:49,058

are so many lasers on the market

and it's really hard to understand

437

00:30:49,088 --> 00:30:52,078

who is best suited for them and

what they're most effective for.

438

00:30:52,368 --> 00:30:55,698

So I like to think of lasers

as like a very specific cloth.

439

00:30:55,808 --> 00:31:00,248

Like different lasers are attracted

to different things in the skin, be

440

00:31:00,248 --> 00:31:04,618

that brown for pigment and melanin,

red for it to treat things like blood

441

00:31:04,618 --> 00:31:09,588

vessels or redness, water in the

skin, which is, when you use a laser

442

00:31:09,588 --> 00:31:13,018

for resurfacing and wrinkles and

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

443

00:31:13,318 --> 00:31:17,828

And heat will also cause collagen

stimulation, which a lot of lasers deliver

444

00:31:17,908 --> 00:31:20,018

heat to the skin or right below the skin.

445

00:31:20,258 --> 00:31:24,988

So the key is really choosing

right laser for the right target.

446

00:31:25,358 --> 00:31:29,258

So for things like your brown

pigment, those are lasers like

447

00:31:29,298 --> 00:31:31,748

pico lasers or Q-switch lasers.

448

00:31:31,788 --> 00:31:37,538

1927 fractional lasers can be good

for it, or even IPL and BBL, which

449

00:31:37,538 --> 00:31:38,908

is, I don't believe a true laser.

450

00:31:38,908 --> 00:31:40,378

I think it's actually just light.

451

00:31:40,408 --> 00:31:43,268

It's that's used to treat

some browns and reds.

452

00:31:43,588 --> 00:31:48,308

And they're good, like I said, for

sunspots, freckles, lentigines sometimes

453

00:31:48,328 --> 00:31:49,988

post-inflammatory hyperpigmentation.

454

00:31:50,228 --> 00:31:50,768

And like your…

455

00:31:50,898 --> 00:31:54,868

The picos and the Q-switch can pull

out tattoo pigment, which is the

456

00:31:54,868 --> 00:31:58,498

primary laser that's used in all of

these tattoo removal cl- clinics.

457

00:31:58,508 --> 00:32:04,904

So Think of the pigment like

browns and are-- this is the

458

00:32:04,904 --> 00:32:06,404

best lasers to treat them.

459

00:32:06,404 --> 00:32:09,924

They break up the pigment, and your

body clears out that pigment either

460

00:32:09,934 --> 00:32:14,274

by, taking it out internally or it

coming to the surface and flaking off.

461

00:32:15,284 --> 00:32:19,344

category of lasers treat the reds

in the skin, and those are things

462

00:32:19,344 --> 00:32:23,384

that are caused by like rosacea or

broken capillaries, those little

463

00:32:23,394 --> 00:32:27,054

like telangiectasias that people get

around the nose, even like cherry

464

00:32:27,074 --> 00:32:29,394

angiomas, those like little red dots.

465

00:32:29,394 --> 00:32:31,544

I got them all over my

body when I was pregnant.

466

00:32:31,894 --> 00:32:35,934

Some red scars, facial veins can

be treated with pulse dye lasers,

467

00:32:35,934 --> 00:32:39,054

vascular lasers like Vbeam and Excel V.

468

00:32:39,434 --> 00:32:43,894

And they target specifically blood cells

and help collapse them or reduce them.

469

00:32:44,434 --> 00:32:48,204

And then there are the lasers that

are meant to treat things like texture

470

00:32:48,204 --> 00:32:50,124

and pores and fine lines and scars.

471

00:32:50,154 --> 00:32:56,804

And these lasers work by making tiny

controlled injuries in the skin, so that

472

00:32:56,804 --> 00:32:59,584

the skin repairs itself with new collagen.

473

00:32:59,624 --> 00:33:03,444

And there are two kind of

broad types of these lasers.

474

00:33:03,444 --> 00:33:06,984

There's non-ablative, so it spares

the surface of the skin, and

475

00:33:06,984 --> 00:33:10,214

ablative, which means it takes

the surface level of the skin off.

476

00:33:10,214 --> 00:33:13,874

And the non-ablative lasers are things

that a lot of people have heard of.

477

00:33:13,874 --> 00:33:16,894

They are like your Moxie laser,

Clear and Brilliant, Fraxel.

478

00:33:17,144 --> 00:33:20,794

These heat the skin without fully

removing the surface, and they're

479

00:33:20,804 --> 00:33:25,084

great for treating mild texture

and pigment and early aging.

480

00:33:25,444 --> 00:33:28,774

They have like low to moderate

downtime depending on the settings.

481

00:33:29,094 --> 00:33:33,324

And then your ablative fractional

lasers are like your CO2 lasers or

482

00:33:33,324 --> 00:33:37,794

your erbium YAG lasers, and these

remove those tiny columns of skin.

483

00:33:38,124 --> 00:33:44,374

And they're incredibly effective for

deeper wrinkles, acne scarring more severe

484

00:33:44,384 --> 00:33:49,984

sun damage, and like just a really more

dramatic kind of resurfacing effect.

485

00:33:50,324 --> 00:33:53,374

So because they're more effective,

there's more downtime, and because

486

00:33:53,374 --> 00:33:55,064

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

487

00:33:55,064 --> 00:34:01,124

So risks are things like

hyperpigmentation, infections, and so you

488

00:34:01,124 --> 00:34:06,054

really need to select patients carefully

before you just use this laser on anyone.

489

00:34:06,394 --> 00:34:10,543

Fractional lasers induce collagen

remodeling over time, and that usually

490

00:34:10,554 --> 00:34:13,324

peaks around three months post-treatment.

491

00:34:14,174 --> 00:34:17,974

finally, I will say that fractional

resurface lasers also have some evidence

492

00:34:17,984 --> 00:34:22,524

for reducing non-melanoma skin cancers

in high-risk like photo-damaged patients.

493

00:34:23,014 --> 00:34:27,494

So while a lot of patients are doing

these to improve the appearance of

494

00:34:27,494 --> 00:34:30,484

their skin, there are really some

nice health benefits for them.

495

00:34:30,931 --> 00:34:34,152

Kelsy: I think that was the perfect sort

of like overarching description because

496

00:34:34,161 --> 00:34:36,681

it sounds like different wavelengths

affect different parts of the skin

497

00:34:36,681 --> 00:34:40,192

and different depths of the skin and

different colors that you might find

498

00:34:40,192 --> 00:34:42,922

on the skin, whether it's, like you

said, the brown, the or the reds, the

499

00:34:42,922 --> 00:34:44,121

hyperpigmentation, things like that.

500

00:34:44,121 --> 00:34:47,492

And I know it can get very confusing,

but I've heard all of these terms

501

00:34:47,492 --> 00:34:51,902

like BBL and MOXI and all sorts

of these different, energy-based

502

00:34:51,911 --> 00:34:53,362

treatments or light-based treatments.

503

00:34:53,362 --> 00:34:57,242

So I think it was a very helpful sort of

like umbrella perspective of them all.

504

00:34:57,632 --> 00:35:01,672

The other thing I had questions

on was PRP and microneedling.

505

00:35:01,672 --> 00:35:07,715

Where does that all fall within the realm

of aesthetic dermatology and just things

506

00:35:07,725 --> 00:35:09,165

that you can do to improve your skin?

507

00:35:10,393 --> 00:35:12,493

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

Yeah, I'm sure PRP like being

508

00:35:12,493 --> 00:35:15,033

injected for joints, I think.

509

00:35:15,043 --> 00:35:16,923

It's used in other places in the body.

510

00:35:16,923 --> 00:35:18,933

I think there was like some weird…

511

00:35:19,263 --> 00:35:19,723

Not weird.

512

00:35:19,793 --> 00:35:20,513

I shouldn't say weird.

513

00:35:20,573 --> 00:35:22,833

there were some trials maybe

where they were looking at

514

00:35:23,833 --> 00:35:26,763

ovarian like anti-aging purposes.

515

00:35:26,833 --> 00:35:31,553

But it's used like in other places in the

body, which I find, really interesting.

516

00:35:31,863 --> 00:35:38,593

We more commonly use it in hair

restoration and for PRP microneedling

517

00:35:38,593 --> 00:35:40,023

to help stimulate collagen and elastin.

518

00:35:40,953 --> 00:35:44,423

I think there is some evidence

out there to support its use, but

519

00:35:44,423 --> 00:35:48,453

I think the protocols for it are

a little bit lacking personally.

520

00:35:48,663 --> 00:35:52,383

I think there's more evidence there

for hair restoration, both with

521

00:35:52,413 --> 00:35:54,513

microneedling and PRP injections.

522

00:35:54,773 --> 00:35:58,473

But there's some data to support

that it, it helps improve

523

00:35:58,473 --> 00:35:59,973

the results of microneedling.

524

00:36:00,213 --> 00:36:04,843

Microneedling works similarly to lasers,

that it's creating these columns or these

525

00:36:04,873 --> 00:36:09,443

areas of trauma within the skin, and the

hope is that the body, tries to heal that

526

00:36:09,503 --> 00:36:14,793

area and fill it in with new collagen and

elastin, so it remodels things over time.

527

00:36:15,093 --> 00:36:18,653

And then I explain to patients

that by putting PRP in there,

528

00:36:18,673 --> 00:36:22,093

in theory, that you're putting

in all of the growth factors or

529

00:36:22,133 --> 00:36:25,943

platelet-rich fibrin or platelet-rich

plasma, whatever, is being used.

530

00:36:26,033 --> 00:36:30,093

It is meant to put in growth factors

so that it stimulates collagen

531

00:36:30,093 --> 00:36:31,523

and elastin a little bit better.

532

00:36:31,783 --> 00:36:36,773

I still think there's a lot of work to

be done in that area just to standardize

533

00:36:36,783 --> 00:36:38,903

protocols to have the best outcomes.

534

00:36:39,203 --> 00:36:44,953

But, all this pointless in my

opinion if are not doing the basics.

535

00:36:44,953 --> 00:36:47,823

So collagen is degraded by UV exposure.

536

00:36:48,113 --> 00:36:51,263

The biggest mistake I see people making

is that they come, and they get their

537

00:36:51,263 --> 00:36:55,133

PRP microneedling facials, and then

I see on their Instagram stories they

538

00:36:55,133 --> 00:37:01,063

are at the beach in full sun, for the

entire day not applying sunscreen.

539

00:37:01,073 --> 00:37:04,493

And it kills me inside because what's

the point of doing all of these things

540

00:37:04,743 --> 00:37:07,963

if you're just going to go then do

the things that degrade your collagen?

541

00:37:08,203 --> 00:37:09,803

So I think they're nice.

542

00:37:09,823 --> 00:37:14,073

They're a nice tool to help support

and slow the aging process, and I think

543

00:37:14,083 --> 00:37:17,493

in the next coming years, hopefully

we will see lot better evidence

544

00:37:17,493 --> 00:37:19,493

for them in terms of the protocols.

545

00:37:19,743 --> 00:37:22,223

But, they're just one of

the tools in your tool belt.

546

00:37:22,884 --> 00:37:26,011

Kelsy: What about any sort

of non-invasive treatments?

547

00:37:26,031 --> 00:37:29,641

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

know if this is considered non-invasive,

548

00:37:29,641 --> 00:37:31,731

but like gua sha and dermaplaning.

549

00:37:31,851 --> 00:37:32,281

What…

550

00:37:32,381 --> 00:37:33,741

Where do those fit into things?

551

00:37:33,791 --> 00:37:37,981

Are those over-hyped, or is there

some merit to actually some of

552

00:37:37,981 --> 00:37:40,531

those non-invasive treatments

or any other non-invasive ones?

553

00:37:40,885 --> 00:37:43,085

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

Listen, I think they, the most

554

00:37:43,145 --> 00:37:44,675

part, they do very little harm.

555

00:37:44,745 --> 00:37:48,485

If it's something that you enjoy

to do at home, by all means do it.

556

00:37:48,735 --> 00:37:52,495

I think supporting the lymphatic

system is incredibly helpful.

557

00:37:52,525 --> 00:37:55,285

It's something that you have to be pretty

consistent with and make a part of your

558

00:37:55,285 --> 00:37:57,355

lifestyle if you like the results from it.

559

00:37:57,805 --> 00:38:00,715

I, used to work with Shelly Marshall.

560

00:38:00,755 --> 00:38:06,275

She's Beauty Shamans on Instagram, and

she used to inject, She said she was a

561

00:38:06,275 --> 00:38:11,205

person who started doing my Botox when

we worked together as nurses, and she

562

00:38:11,255 --> 00:38:17,145

stepped away from injectables and really

went full in on these holistic methods to

563

00:38:17,455 --> 00:38:23,965

treat congestion in the skin like acne and

to help the different layers of the skin.

564

00:38:23,965 --> 00:38:27,045

And she primarily does that

through things like gua sha.

565

00:38:27,375 --> 00:38:32,265

And I think there's a lot of mixed

information out there about it,

566

00:38:32,285 --> 00:38:37,355

but from a scientific standpoint,

you'll always benefit from

567

00:38:37,355 --> 00:38:39,175

supporting your lymphatic system.

568

00:38:39,255 --> 00:38:43,165

So I don't think there's any downsides

to it, and if, somebody is seeing

569

00:38:43,175 --> 00:38:47,945

benefits from it, I tell the patients

to keep doing it, the exception that,

570

00:38:47,995 --> 00:38:52,655

patients who do have facial fillers

need to be careful about really not

571

00:38:52,655 --> 00:38:56,845

doing anything super aggressive to

manipulate the tissues of the face if

572

00:38:56,845 --> 00:38:58,625

we've injected filler in that area.

573

00:38:58,875 --> 00:39:00,155

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

574

00:39:01,215 --> 00:39:03,165

Dermaplaning is n- I mean it's nice.

575

00:39:03,165 --> 00:39:06,235

It's a nice treatment to lift

off some dead skin cells off of

576

00:39:06,245 --> 00:39:08,025

the very top surface of the skin.

577

00:39:08,305 --> 00:39:12,085

And it can shave off that

peach fuzz, which is nice.

578

00:39:12,085 --> 00:39:14,655

It helps makeup lay a

little bit more smoothly.

579

00:39:14,915 --> 00:39:17,885

So I think if you enjoy the

results from it, definitely do it.

580

00:39:17,885 --> 00:39:21,995

There's, low risk to it, with the

exception that I think some patients may

581

00:39:21,995 --> 00:39:26,485

get congested get some skin congestion and

breakouts from dermaplaning just because

582

00:39:26,485 --> 00:39:30,445

it can cut the hairs, and then those can

get a little bit stuck underneath the

583

00:39:30,455 --> 00:39:34,895

skin, or it can cause these superficial

kind of openings in the surface of the

584

00:39:34,895 --> 00:39:36,705

skin that can make patients break out.

585

00:39:36,995 --> 00:39:41,635

So you know, see somebody who's qualified

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

586

00:39:41,645 --> 00:39:44,575

really, understand the process to do it.

587

00:39:44,575 --> 00:39:47,765

I tend to not advocate too much

for doing things at home that are

588

00:39:48,435 --> 00:39:51,755

borderline medical procedures just

because of the risk for infection.

589

00:39:51,775 --> 00:39:55,955

But I say there are like few downsides

to it if patients wanna try it.

590

00:39:56,311 --> 00:39:59,411

Kelsy: And then lastly, I know we've

talked a lot about face, a little bit on

591

00:39:59,411 --> 00:40:00,671

the neck, and you mentioned the hands.

592

00:40:00,691 --> 00:40:02,761

But do you see…

593

00:40:02,841 --> 00:40:04,681

Where do you see this

field going in the future?

594

00:40:04,681 --> 00:40:08,111

Is there anything that you're like,

"Okay, I have a feeling this is going to

595

00:40:08,121 --> 00:40:11,311

be even trendier in the future," or…

596

00:40:11,361 --> 00:40:17,371

I'm thinking one of my goals in 2026 was

taking better care of my full body skin.

597

00:40:17,381 --> 00:40:20,071

I feel like I've had a pretty

good skincare routine in the

598

00:40:20,071 --> 00:40:23,951

face, and I prioritize a lot of

different things for the face.

599

00:40:23,951 --> 00:40:26,431

But I was like, the skin's the

largest organ in the body, and I'm,

600

00:40:26,431 --> 00:40:29,291

like, prioritizing maybe 5% of it.

601

00:40:29,291 --> 00:40:32,031

I am not putting that focus

on the rest of my body.

602

00:40:32,031 --> 00:40:36,751

So in my head I'm like m- I

selfishly wonder, are any of these

603

00:40:36,761 --> 00:40:39,731

things that we talked about today

gonna apply, do you think, in the

604

00:40:39,731 --> 00:40:41,291

future to your full body skin?

605

00:40:41,291 --> 00:40:45,021

Or what are some of the other things that,

that we can watch out for in this realm

606

00:40:45,021 --> 00:40:47,671

that you think are just now up and coming?

607

00:40:48,987 --> 00:40:49,247

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

Okay.

608

00:40:49,467 --> 00:40:51,797

So yes, to full body skin health.

609

00:40:51,877 --> 00:40:53,547

I think this…

610

00:40:54,027 --> 00:40:57,597

Patients already understand

face skincare for the most part.

611

00:40:57,647 --> 00:41:01,967

I'm not doing as much basic level

educating when patients come into

612

00:41:01,967 --> 00:41:04,507

the office about like skincare

and what they should be using.

613

00:41:04,847 --> 00:41:09,217

But like the future I think really is the

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

614

00:41:09,217 --> 00:41:11,337

Like patients are starting

to notice their knees.

615

00:41:11,647 --> 00:41:17,477

And like postpartum for me, my abdomen was

something that I really started to about.

616

00:41:17,677 --> 00:41:21,117

And especially with the use of GLP-1s,

I think post weight loss skin quality.

617

00:41:21,477 --> 00:41:25,547

And the same biology that applies to your

face applies to the rest of the body.

618

00:41:25,547 --> 00:41:31,367

So I think we'll be seeing a focus

on other areas come up a lot more.

619

00:41:31,647 --> 00:41:36,317

I think patients are also very interested

in, and I think the field is shifting

620

00:41:36,337 --> 00:41:38,747

towards more bio-simulatory treatments.

621

00:41:39,137 --> 00:41:39,817

The…

622

00:41:39,987 --> 00:41:45,127

there's really a focus on less filling

and more restoring tissue behavior and

623

00:41:45,127 --> 00:41:49,697

simulating collagen and elastin and

helping along wound healing because all

624

00:41:49,697 --> 00:41:54,097

of these treatments that function by

creating a wound in the skin, whether

625

00:41:54,097 --> 00:41:59,797

that's a laser or microneedling, are

only as effective as how you heal.

626

00:41:59,797 --> 00:42:03,907

And so if you're not babying the

skin and really guiding the skin

627

00:42:03,907 --> 00:42:08,287

to heal truly better than what it

was before, you're doing yourself a

628

00:42:08,287 --> 00:42:11,977

disservice and you're not reaping all

of the benefits of that treatment.

629

00:42:12,317 --> 00:42:17,257

And I think we'll see patients really

trying to manage inflammation, getting

630

00:42:17,337 --> 00:42:21,557

in- like inflammatory processes

under control because you can see

631

00:42:21,557 --> 00:42:22,877

the effects of that in the skin.

632

00:42:23,377 --> 00:42:27,977

I also think there will probably be

a shift towards better skin imaging

633

00:42:27,977 --> 00:42:31,937

diagnostics whether that's like just

plain photography in the office, but

634

00:42:31,957 --> 00:42:37,537

the use of ultrasounds in office to

make treatment safer, so imaging blood

635

00:42:37,537 --> 00:42:40,497

vessels so that when we're injecting,

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

636

00:42:40,497 --> 00:42:45,627

territory, and also to aid in the

reversal and management of complications.

637

00:42:45,627 --> 00:42:49,187

I think there's still a lot

that can be done to improve it.

638

00:42:49,197 --> 00:42:54,217

And when it comes to medical things, I

used to work in radiology a long time ago.

639

00:42:54,417 --> 00:42:58,777

But if I was doing a paracentesis or

a thoracentesis to drain fluid off of

640

00:42:58,777 --> 00:43:03,067

somebody because they had an accumulation

in the abdomen, yeah, you can do that-

641

00:43:03,725 --> 00:43:06,545

Quote, unquote, "blind," where you

place a needle in and drain the fluid.

642

00:43:06,545 --> 00:43:09,915

But there are blood vessels and

bowel and all sorts of things that

643

00:43:09,915 --> 00:43:13,075

are in the way that by just doing

it blind, you don't necessarily see.

644

00:43:13,075 --> 00:43:17,235

And I think in aesthetics, we function

by knowing the anatomy, but going in

645

00:43:17,235 --> 00:43:19,825

blind without using any diagnostic tools.

646

00:43:19,825 --> 00:43:24,255

And I think because now in hospital

you're imaging with ultrasound before you

647

00:43:24,255 --> 00:43:27,715

stick someone to make sure that you're

in the right area, you're not gonna nick

648

00:43:27,745 --> 00:43:32,345

bowel, like for a paracentesis, and I

think that, that will be a shift that

649

00:43:32,345 --> 00:43:34,255

slowly makes its way into aesthetics.

650

00:43:34,635 --> 00:43:39,135

For whatever reason, I think because

these are aesthetic medical procedures

651

00:43:40,025 --> 00:43:42,455

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

652

00:43:42,505 --> 00:43:46,735

And I hope for me as a provider we

now, like at my practice, have an

653

00:43:46,745 --> 00:43:50,495

ultrasound in office, but I hope that

will be a shift for the industry.

654

00:43:51,355 --> 00:43:55,525

then lastly, probably just

like a less one face fits all.

655

00:43:55,635 --> 00:44:00,658

I think aesthetic medicine in general

is moving away from just doing

656

00:44:00,658 --> 00:44:06,578

the same thing to every patient and

shifting towards really respecting every

657

00:44:06,578 --> 00:44:12,458

individual's anatomy, ethnicity obviously

sex because male proportions are very

658

00:44:12,458 --> 00:44:15,998

different than female proportions, but

a lot of males were being feminized

659

00:44:16,368 --> 00:44:20,438

because they needed volume repletion

in their cheeks, but they were-- but

660

00:44:20,438 --> 00:44:22,618

injectors them like a female cheek.

661

00:44:22,988 --> 00:44:27,418

And I think there will be more respect

for hormonal state, whether that's,

662

00:44:27,468 --> 00:44:32,888

around the time that women are pregnant

because, there are a lot of real

663

00:44:32,888 --> 00:44:35,428

changes that happen around that time.

664

00:44:35,498 --> 00:44:39,678

And then perimenopause and then obviously

weight changes with all of these GLP-1s.

665

00:44:39,678 --> 00:44:43,968

I think treatments are gonna be a lot more

tailored to all the fluctuations that are

666

00:44:43,968 --> 00:44:48,658

happening because of either life cycle

or the stage that, that people are at or

667

00:44:48,708 --> 00:44:50,908

the lifestyle that people are adopting.

668

00:44:50,968 --> 00:44:55,258

Everybody is now like drinking way

less alcohol and hopefully eating

669

00:44:55,268 --> 00:44:57,928

healthier and maintaining, better weights

670

00:44:58,358 --> 00:45:03,658

Kelsy: I think that individualized nature

of how someone is looking and not having

671

00:45:03,658 --> 00:45:07,358

this copy-paste for every patient also

feeds back into that imaging and that

672

00:45:07,408 --> 00:45:10,148

being on the forefront of imaging because

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

673

00:45:10,158 --> 00:45:13,178

actually tell, the more individualized

you're gonna be able to make some of those

674

00:45:13,548 --> 00:45:15,638

treatments probably is my assumption too

675

00:45:16,557 --> 00:45:18,387

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

Yeah and I always say, when you go

676

00:45:18,387 --> 00:45:22,887

to inject someone you can be the

most trained plastic surgeon and

677

00:45:22,897 --> 00:45:26,507

have dissected the face and know

all the planes and know exactly

678

00:45:26,507 --> 00:45:32,737

where is based off of your training,

but anatomical variants are real.

679

00:45:32,747 --> 00:45:37,077

That artery 95% of the time runs

in this direction, in this plane,

680

00:45:37,077 --> 00:45:41,307

at this level, but in another

percentage of patients it does not.

681

00:45:41,317 --> 00:45:46,507

And so when you inject and you

don't use image-based guidance, you

682

00:45:46,517 --> 00:45:52,187

are making a statistical decision

minimizing the risk, and I think

683

00:45:52,187 --> 00:45:56,187

those tools will help providers

and patients, have better results.

684

00:45:56,887 --> 00:46:00,677

And obviously, the last thing is that

there's gonna be this strong shift,

685

00:46:00,917 --> 00:46:05,507

I think for me personally, not making

patients look wildly different.

686

00:46:06,657 --> 00:46:08,107

like that's always been my philosophy.

687

00:46:08,147 --> 00:46:16,107

My approach is really to understand

which layer is aging and help, help

688

00:46:16,117 --> 00:46:20,777

that along and not necessarily change

the way somebody looks drastically.

689

00:46:21,167 --> 00:46:25,867

So the best aesthetic work is

like not about chasing trends.

690

00:46:25,877 --> 00:46:31,757

It's about preserving patient's identity

while improving or restoring some aspect

691

00:46:31,767 --> 00:46:35,247

of the age- that has been affected by

the aging process, whether that's skin

692

00:46:35,247 --> 00:46:39,827

quality proportions, or like the way

that light reflects off of the face

693

00:46:40,297 --> 00:46:43,687

Kelsy: I had a professor who once

described certain changes, bony

694

00:46:43,687 --> 00:46:46,437

changes that happen within our knees

and joints, like you might have,

695

00:46:46,467 --> 00:46:48,337

degenerative discs or arthritis, whatever.

696

00:46:48,617 --> 00:46:50,647

He described them like

laugh lines on the face.

697

00:46:50,647 --> 00:46:51,987

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

698

00:46:51,997 --> 00:46:54,317

He'd say that, and I feel like

you said, a lot of people are just

699

00:46:54,317 --> 00:46:58,207

starting to embrace that aging process

and trying to maintain a lot of the

700

00:46:58,217 --> 00:47:00,297

things that make them who they are.

701

00:47:00,587 --> 00:47:03,257

And like you said, not trying to

have a 50-year-old look like a

702

00:47:03,257 --> 00:47:06,437

20-year-old, but actually embracing

who they are at that stage of life.

703

00:47:06,437 --> 00:47:11,437

And I really am grateful to, to be

in this time where I'm noticing all

704

00:47:11,437 --> 00:47:14,647

of these women who are, a few decades

older than me starting to embrace that

705

00:47:15,663 --> 00:47:17,543

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

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

706

00:47:17,543 --> 00:47:19,493

just took a trip to Japan recently.

707

00:47:19,503 --> 00:47:22,783

We had to go he had a conference

in Singapore, and we decided

708

00:47:22,783 --> 00:47:24,143

to make a big trip out of it.

709

00:47:24,373 --> 00:47:28,703

And one of the philosophies in Japanese

culture is something called wabi-sabi,

710

00:47:28,963 --> 00:47:33,463

and it really touched me it has to do

with really the appearance of things

711

00:47:34,203 --> 00:47:35,893

and how they look from being used.

712

00:47:35,903 --> 00:47:40,513

So like even a dish that has fallen

and broken that's been pieced back

713

00:47:40,513 --> 00:47:45,313

together, it's like very honored

to see all of the lines and the

714

00:47:45,383 --> 00:47:51,723

imperfections in that item because it

gives meaning and history to that thing.

715

00:47:51,723 --> 00:47:55,783

That a bouquet is not like perfectly

round and every flower is at the exact

716

00:47:55,783 --> 00:48:00,753

same spot on the left and right, but

really to embrace nature and the way that

717

00:48:00,753 --> 00:48:06,053

nature made us, which can seem a little

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

718

00:48:06,103 --> 00:48:08,603

W- your patients don't wanna

embrace their wrinkles.

719

00:48:08,913 --> 00:48:12,143

But at the same time, like there

are certain things that are very

720

00:48:12,143 --> 00:48:14,633

defining to patients' faces.

721

00:48:14,633 --> 00:48:18,273

I always say like each individual

is uniquely beautiful in their

722

00:48:18,293 --> 00:48:23,653

own way, and my job is really to

highlight that and to do that honor

723

00:48:23,673 --> 00:48:25,413

and not remove it and change it.

724

00:48:25,863 --> 00:48:30,363

So a- and that goes for everything,

my husband has like this gap between

725

00:48:30,363 --> 00:48:32,933

his teeth, and I think it's the

most attractive thing about him.

726

00:48:32,933 --> 00:48:36,463

I love it, and the dentist, every time

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

727

00:48:36,463 --> 00:48:38,233

to do Invisalign and close that gap?"

728

00:48:38,473 --> 00:48:42,993

So you know, a little part of what I do

is also giving patients the confidence

729

00:48:43,003 --> 00:48:47,643

to embrace the things that make them

uniquely them and find beauty in that.

730

00:48:47,773 --> 00:48:49,273

Kelsy: I think that's

the perfect place to end.

731

00:48:49,303 --> 00:48:51,313

I learned so, so much today.

732

00:48:51,763 --> 00:48:53,803

Just I had so many questions coming in.

733

00:48:53,803 --> 00:48:56,763

And I had told you I was very excited

to learn all of this because you hear

734

00:48:56,763 --> 00:48:58,273

all of these key terms and phrases.

735

00:48:58,293 --> 00:49:00,413

and I'm like, "Okay, but I

need to understand how they

736

00:49:00,413 --> 00:49:02,703

actually affect, the skin."

737

00:49:02,703 --> 00:49:06,833

And it's not just as

easy as we think it is.

738

00:49:06,833 --> 00:49:08,553

The skin is a very complex organ.

739

00:49:08,553 --> 00:49:12,303

So I appreciate you coming on, chatting

through all of it today, answering all

740

00:49:12,303 --> 00:49:14,273

of my, possibly elementary questions.

741

00:49:14,293 --> 00:49:17,373

But I learned so much, and I

know everyone else did, too.

742

00:49:17,373 --> 00:49:21,743

So I will leave all of Claire's links

below if you happen to be in NYC and

743

00:49:21,743 --> 00:49:24,603

want to book with her at Vollure Medical,

or just follow her on social media.

744

00:49:24,603 --> 00:49:26,183

I learn so much from her there, too.

745

00:49:26,423 --> 00:49:29,223

I'll see you guys again on the next

episode of Wellness Big Sis The Pod.