[@PeterAttiaMD] A Complete Guide to Skin Treatments | Tanuj Nakra, M.D. & Suzan Obagi, M.D.

Link: https://youtu.be/ojwIjJ_x0Sg

Short Summary

Number One Takeaway: Don't blindly chase trends or specific treatments; instead, consult with a qualified professional to determine the best approach for your individual skin type, concerns, and desired downtime, considering ablative vs. non-ablative options.

Executive Summary: The podcast episode discusses various skin resurfacing techniques like lasers, peels, and microneedling. The key is to understand the difference between ablative (penetrating the skin for deeper results with more downtime) and non-ablative (less invasive with less downtime) treatments, and to consult a professional who can tailor a regimen to your specific needs and skin type, rather than simply opting for a trendy procedure.

Key Quotes

Here are four quotes from the provided transcript that represent valuable insights and opinions:

1. "So the bottom line is there's there's a relationship with how aggressive the treatment is and how much of an aesthetic improvement you're going to get. But the more aggressive it is, the more downtime there is. So that's all that's always the kind of balancing act. And that's why there's such a confusing array of options that exist because there's a huge spectrum going from the least invasive with which has the least result to the most aggressive with the best result." - This quote neatly summarizes the central trade-off in skin resurfacing treatments: intensity vs. downtime.

2. "I think the big mistake is to come in and say, 'Oh, all my friends are having moxy. I want moxy.' Let's let's talk about what it is. we might have something that does similar results or maybe even something that does better results and deliver maybe it's not the right choice for you even though your friend thinks you should get it and so the the field is so confusing to consumers and honestly even practitioners because it's a gold rush right there's so much money to be made in this area every company is is getting private equity money and and and getting an FDA approval for some kind of device because they want a piece of the action and they're purposefully confusing everybody because it's like snake oil, you know, everybody wants to sell their product and some of the products work well, some don't." - This quote highlights the importance of personalized treatment plans and cautions against blindly following trends, underscoring the industry's commercial pressures.

3. "No, but I do caution my younger patients, the ones who are under the age of 40, even up to 45 in some cases, to really avoid doing things such as ultrasound tissue tightening, radio frequency tissue tightening at that young of an age because there is some fat atrophy that happens and I would caution against prematurely aging their face." - This quote provides a specific warning about the potential negative consequences of certain procedures on younger individuals.

4. "I would not I should not do a laser peel because I'm a you can have a laser, but you're the kind of person who needs a lot of preparation and caution heading into it. You would need to probably get onto a regimen to control your pigment cells with hydro. And why would I bother? Like why take the risk? Why not just could be better? I see. So, so I guess just to complete the conversation about the the different categories, the most effective uh non-surgical skin interventions are in the category of a blade of lasers and phenol peels because they go the deepest" - This shows the risk assessment involved in deciding treatments and the speaker's awareness of their own skin type and pigment issues, cautioning against procedures that could do more harm than good without proper preparation.

Detailed Summary

Here's a detailed summary of the video transcript, focusing on the key topics, arguments, and information:

Overall Topic: A crash course explaining different skin resurfacing techniques including lasers, chemical peels, microdermabrasion, and microneedling, focusing on ablative vs. non-ablative methods and how to choose the right procedure.

Key Concepts and Arguments:

• Goal of Skin Resurfacing: To intentionally injure the skin in a controlled manner to trigger the body's natural healing process. This process aims to:

  • Increase collagen production
  • Smooth skin texture
  • Reduce pigmentation issues

• Balancing Act: A more aggressive treatment typically yields better aesthetic results but requires more downtime. The choice involves balancing desired results with acceptable recovery time.

• Ablative vs. Non-Ablative:

  • Ablative: Penetrates the skin surface, creating an open wound and more significant changes.
  • Non-Ablative: Doesn't penetrate the skin surface, leading to less downtime but potentially less dramatic results. Surface of the skin remains intact.

Non-Ablative Treatments:

• Topical Skincare: Remodels skin and primes it for collagen production.
• Light Chemical Peels: Affect the epidermis (outer layer) of the skin.
• Non-Ablative Fractional Lasers (e.g., Fraxel, Clear and Brilliant): Deliver tiny fractionated beams of light to the surface of the skin, damaging upper layers of the epidermis.
  • Stimulates collagen production and improves texture/minor pigmentation.
• Vascular Lasers (IPL/BBL): Target dilated blood vessels (e.g., in rosacea) without leaving an open wound on the skin surface.
  • Improvement can be seen after a few sessions, it is recommended to repeat yearly.
• Moxy: Potentially Radiofrequency Microneedling
• Radio Frequency Microneedling: Pierces the skin with needles that deliver radio frequency energy. This generates heat in the skin, causing the formation of heat shock protein, which then causes a cascade of other activity within the dermis of the skin to produce collagen elastin, shrink the overactive sebaceous glands, and reduce some of the dilated blood vessels.

Ablative Treatments:

• Deeper Chemical Peels:
  • Modified TCA peels
  • Modified Phenol peels
• Ablative Lasers

Considerations for Choosing a Treatment:

• Avoid specifying a brand name: Focus on the desired result, and have the physician suggest a product.
• Individual Needs: What works for one person may not work for another. It's crucial to have a consultation with a practitioner to determine the best approach.
• Potential Risks: Laser resurfacing can be riskier for individuals with darker skin tones (higher Fitzpatrick skin types) due to the potential for permanent pigment changes.
• Chemical peels are generally safe for all skin tones.
• Younger Patients (under 40-45): Should be cautious with ultrasound or radiofrequency tissue tightening due to the potential for fat atrophy.

Practitioner's Approach:

• Combination Therapies: A practitioner may use a combination of different treatments in the same session (e.g., TCA peel on most of the face, ablative CO2 laser on perioral lines, phenol peel on lower eyelids).
• Depth Control: Some peels, like TCA peels, can penetrate pores and tighten them.
• Customization: The practitioner will choose the most appropriate treatment based on individual skin concerns and goals.
• Caution with Devices: If you know your physics with these devices, you can achieve so much more than what the company tries to sell you.