The Best Skincare for Aging Skin: Dermatologist Secrets You Haven’t Heard Before | Dr. Sara Cherem

Dr. Cherem: [00:00:00] We have always thought about lasers in terms of rejuvenation and wrinkles, but what we are learning now is that laser restores skin health. Doing laser resurfacing can decrease the risk of developing normal melanoma skin cancer by 30%. The concept of face yoga is that if you exercise your muscles, you are exercising your skin.

But on the contrary, when we do excessive movements with our faces, we are just pulling down on our faces. So face yoga, there's no science to it. It is just an Instagram trend. 

Dr. Brighten: How often should you be getting screened by your dermatologist? And what can you be looking for yourself for early signs of, you know, perhaps skin cancer detection?

So, you know, to get to the dermatologist, 

Narrator: Dr. Sarah Cher 

Dr. Brighten: is a board certified dermatologist and laser expert transforming the future 

Dr. Cherem: of skin health with science, precision 

Narrator: and innovation trained at world class institutions like Harvard Hospital Clinic in Barcelona and [00:01:00] Hospital General de Mexico. 

Narrator 2: She specializes in advanced laser treatments that work at the molecular level, targeting everything from pigmentation and scars to aging and full skin rejuvenation.

Narrator: As the founder of the Skin Clinic and a member of leading dermatologic societies, Dr. Cher is redefining what's possible in skincare by merging technology, wellness, and evidence-based medicine to help people truly understand and love their skin. 

Dr. Cherem: Everybody should have a full skin check once a year.

Anything that doesn't heal is something we should check. And in terms for mold. We have the A, B, CDA. This is the A, B, C, D of melano A. 

Dr. Brighten: Are there certain things that women can be doing in menopause and what are your thoughts on using topical estrogen on the skin? The LAC of estrogen will make your skin be Welcome back to the Dr.

Wrighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified [00:02:00] menopause specialist. As always, I'm bringing you the latest, most up-to-date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. [00:03:00] Dr. Sarah Cher, welcome to the show. Thank you for having me. So pleasure. Yes, I'm super excited. We are going to be getting into all things skincare, health, anti-aging, covering what menopausal women do, can do, what everybody can do, and we're gonna talk lasers later on.

But my first question is, what is something that we're all doing for our skin that we think is so great, but it actually isn't? 

Dr. Cherem: So number one would be to solely rely on skincare to get actual results. Okay. Uh, when we talk about rejuvenation, this is a word that gets thrown around for everything. 

Dr. Brighten: Mm-hmm.

Dr. Cherem: And a moisturizer won't do it. Okay. Uh, number two would be to. Over utilize skin products and layer very potent, uh, very potent actives one. Mm-hmm. Over the other, because this just leads to inflammation. 

Dr. Brighten: Oh, okay. 

Dr. Cherem: And inflammation is part of aging. So [00:04:00] we speed up the process. Mm-hmm. Number three, skipping sunscreen.

Tanning, eh, sun beds, all of the above. Yeah. Are like the worst we can do to our skin. Um, smoking. Mm-hmm. Smoking is eight times worse than the sun. Yeah. We're always talking about the sun. The sun. The sun. Mm-hmm. Smoking is actually eight times worse. And what it does is our blood vessels, our skin is very smart.

It doesn't want all the toxins from the tobacco to get into your skin. So what it does is it shuts the blood vessels. 

Dr. Brighten: Okay. 

Dr. Cherem: So you don't get all the toxins in. 

Dr. Brighten: Mm-hmm. But 

Dr. Cherem: in the process, you don't get any oxygen in and you don't flush out all the toxins. Okay. So smoking is horrible. And I would also add face yoga to it.

Dr. Brighten: Base yoga. Okay. You're gonna have to give us the why behind that. 'cause I think a lot of people think this is like the latest and greatest thing that can totally reverse aging. 

Dr. Cherem: So the concept of face [00:05:00] yoga is that if you exercise your muscles mm-hmm. You are exercising your skin. Mm-hmm. But on the contrary, when we do excessive mom, excessive movements with our faces mm-hmm.

We are just pulling down on our faces. 

Dr. Brighten: Okay. 

Dr. Cherem: And that creates sagging and that creates loss of gravity and that's what we're trying to prevent. Mm-hmm. It's the contrary to what we try to achieve with Botox. Okay. So face yoga is just doesn't make sense. There's no science to it. Mm-hmm. It's just an Instagram trend.

Dr. Brighten: Yeah. Well, and I would guess this is different than myofascial exercise is something that a myofascial, uh, or like even, you know, some dentists will prescribe for like helping with their jaw and helping, you know, so if people are listening to this, like if you're doing exercises for TMJ if you're doing exercises because your, your dentist is like, this is gonna help your airway.

That's a lot different than what we're talking [00:06:00] about with face yoga. 

Dr. Cherem: Totally. There's actually, um, there are several devices in the market that do all that do. Muscle stimulation. Okay. That are wonderful, but it's not the same as just making weird movements with your face. 

Dr. Brighten: I feel like we need to have like a montage of like weird movements with our face right now.

You said layering on products can lead to inflammation. I know people that like stop some people right there. So tell us more about that because I think a lot of companies will say like, here's our five or seven or 12 steps skincare routine, and it's literally like dozens of products they're asking you to use.

So what's the problem with that? And like what products are like big no-nos? Like don't be layering those. 

Dr. Cherem: So the first thing is you said the company says you should do this 12 step routine. Yeah. The company doesn't know your skin. Mm-hmm. So the one size fits all. I think that's the first problem. Okay.

Every skin is different. [00:07:00] Every skin has different needs. The logo dilemma of our clinic is understand your skin. Mm-hmm. Understand what your skin needs so you know how to treat it. Some people, the most common, uh, mistake we see is over exfoliation. Oh, okay. So exfoliants should be used maybe twice, three times per week.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: This way you maintain a healthy skin barrier. Mm-hmm. Because that's where it all starts. Having a good skin barrier will keep everything we want inside. Okay. Which means hydration, plump, and preventing inflammation. Mm-hmm. Um, when you exfoliate your skin, you get rid of the automo layer. The Strat cord.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And that makes your skin look very nice. Yes. Because you have like texture. The pores look smaller. The, the fine, the fine lines are less deep. I mean, it's very nice. Mm-hmm. But when you overdo it, you inflame your skin. 

Dr. Brighten: Okay. 

Dr. Cherem: So unless this is prescribed by a [00:08:00] physician, because I must say I prescribe chemical exfoliants and retinoids on the same night mm-hmm.

On certain patients that I know can tolerate it or that have a specific need for it. 

Dr. Brighten: Okay. 

Dr. Cherem: But what I would not layer would be exfoliants. Would 

Dr. Brighten: retinoids. Okay. 

Dr. Cherem: So that way you can do two nights retinoid, one night exfoliant, two nights retinoids, one night exfoliant. Okay. This idea that more is more does not apply to the skin.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Less is more start slow, start easy, and. Gradually progress towards harsher treatments. Being red is not a good appearance for your skin and it's probably not good for your health either. Okay. 

Dr. Brighten: When you say Exfoliants, I wanna tease that out. What are we talking about and what is the problem with things like apricot scrubs?

So people will say like, oh, I'm exfoliating my skin. When you ask, they're like, oh, I'm using like, you know, the apricot scrub, which, you know, anybody in that like grew up in the nineties, we were all marketed to nauseam to use this apricot scrub. But what's [00:09:00] the problem with that? And then what are we talking about when, when you say exfoliants?

Dr. Cherem: Okay. So I had a big thing with apricot scrub, and I'm partly blame it from my problems with the skin. So when we talk about exfoliants, we are mainly talking about chemical exfoliants. Okay. Okay. So basically our cells stick together with this little cement. Mm-hmm. That makes them stick together.

Exfoliants, what they do is they dissolve that so the cells separate. And shut off if they don't separate And they don't, if they don't separate enough as to she mm-hmm. They put water inside and you get a very nice hydration. 

Dr. Brighten: Okay. 

Dr. Cherem: And this is something beautiful that glycolic acid does. Okay. This depends on the percentage of the exfoliant.

We have a HHAs b HHAs BHAs. A HHAs is alpha hydroxy acids, and that's mainly glycolic. Then BHS is beta, uh, hydroxy acids. These ones are [00:10:00] particularly, um, interesting because they're lipid solu. Mm-hmm. What does this mean? They can actually go into your po, get rid of the sebum. Exfoliate the pore. Mm-hmm. And this is salicylic acid.

And that will help with acne, that will help with acne. Beta hydroxy acids are lipid soluble. Mm-hmm. This means that they can go into the fat, the sebum in the skin, and they can go deep into the pore and exfoliate the pore. This helps with acne. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And it helps it back head blackheads and with com.

Dr. Brighten: Okay. 

Dr. Cherem: And this is the salicylic acid, which is very popular. And then the PHAs, the Poly Roxy acids Gluc Acton, which is meant for more sensitive skin. And that's actually what I prefer to use on the younger patients. Okay. So those are chemical exfoliants. Mm-hmm. And chemical exfoliants can be super mild or super potent in the kind of treatments that we do in clinic.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Apricot [00:11:00] scrub. So we also have a physical exfoliants that we like. Mm-hmm. Eh, like a magnesium, which you just rub into the skin and it kind of dissolves. Ooh, I like that. I've never heard of magnesium. Yes. Yeah, yeah, yeah. This, this can be wonderful, but the apricot scrub, so instead of having a beautiful sphere 

Dr. Brighten: mm-hmm.

Dr. Cherem: It has les, it has like little, so it's like jagged. Yes. Yeah. 

Dr. Brighten: Okay. 

Dr. Cherem: So when you rub them against your skin, you are scraping the skin surface. 

Dr. Brighten: That doesn't sound good. That 

Dr. Cherem: doesn't sound good. That breaks up the skin. You inflammated the skin. And when you create too much inflammation, that can lead to post-inflammatory hyperpigmentation.

Okay. Which makes everything just worse. So that's where you'll get dark spots on your skin? Yes. Okay. Nobody wants that. No, no, no. Yeah, because copies have really bad idea. Uh, and getting into the. Like home [00:12:00] remedies, uh, sugar and salt can be fine. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: But anything that involves seed that are like broken down, it's a really bad idea.

Dr. Brighten: Okay. Okay. So, you know, I'm gonna ask you this question then, and skip ahead. We had talked about this before, but what are some DIY treatments that people are doing at home that are completely sabotaging their skin? 

Dr. Cherem: Well, number one, the homemade sunscreen. Oh, yes. That's scary. Okay. That is scary. Um, number two, lemon.

Lemon is a very bad idea for your skin. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So lemon is an acid. 

Dr. Brighten: Yeah. 

Dr. Cherem: Uh, well, we call lemon in Mexico and lime in the states. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Um, but any kind of citrus Yeah. Eh, citruses have a specific substance that makes your skin more susceptible to the sun. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: They're called ens. Yes. And they're photos sensitizers.

Mm-hmm. So if you put sun, uh, if you put any [00:13:00] kind of citrus on your skin, your skin can literally burn. Yes. And you can blisters from it. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Baking soda. Baking soda is a very bad idea. It's harsh. It has a very Alka pH. Um, not good for the skin. 

Dr. Brighten: Well, I wanna just for people listening, 'cause you said limes, Limon in, uh, Mexico, but the green ones the green.

These are the ones that if you're ever making a margarita, right. People go to the beach, they make margaritas, and then they're like, why are my hands breaking out in blisters? They're like, and that's because of the reaction that's happening with the lime. It increases the photo sensitivity. You have to wash your hands really well.

So what I'm hearing from you is don't be putting that on your face and then going out in the sun, which if you're getting your vitamin D right, you're out in the sun every single day. We should be outside. 

Dr. Cherem: We should be outside, but this is an interesting topic. Um, so the amount of vitamin D you produce from the sun 

Dr. Brighten: mm-hmm.

Dr. Cherem: Depends on a bunch of things. Yes. Your [00:14:00] age, your gender, your BMI, um, many things. And the color of your skin. The color of your skin, whether you're in Mexico or in nor region or whatever. Yeah. So, and we do know that the sun is responsible for skin cancer. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So the rec, like the final evidence-based recommendation for vitamin D is to take it orally.

Mm-hmm. Because that's the only way we can actually be sure that you're getting the right amount. Yeah. And, and, and measuring your levels. 

Dr. Brighten: Totally. Yeah. So we wanna measure the levels. And if you're taking vitamin D three, you wanna couple that with K two because we don't want to be pulling calcium into the arteries.

Of course. I wanna ask you though, because people who are anti sunscreen. But, and pro Sun, um, they will say, you know, some of the highest incidences that we see of skin cancer are coming from Nordic countries and they're getting less sun exposure, so therefore it's not the sun causing skin cancer. What do you say to that?

Dr. Cherem: That is [00:15:00] not true. That is just simply not true. Okay. Okay. Australians are getting, like the number one country that has is the, like the higher incidence of cancer in the world mm-hmm. Is in Australia. Absolutely. And they're not Nordic. You'll never meet an Australian that doesn't use sunscreen. They understand the risk because, so the thing with cancer, uh, skin cancer is the number one, uh, cancer in the world.

Mm-hmm. We are seeing it in a much younger population. The non-melanoma kind is a kind that can be treated more easily. Yeah. But the melanoma kind, if we don't catch it early, we do not have a treatment. Mm-hmm. And people are dying of melanoma every day. Yeah. So to be. Going against some precautions. It just doesn't make sense.

I can understand people not wanting to use sunscreen. I can respect that. Mm-hmm. But then wear a hat. Yeah. Stay in the shade and don't go in the sun. 

Dr. Brighten: Mm-hmm. Well, and there's also SPF clothing now, so living in Puerto Rico, like you won't [00:16:00] catch me outside without a sun shirt and a giant sun hat. And my husband and I, it's so funny 'cause we would be out with friends and we'd be the only ones like sun shirts.

My kid's like in a full sun jumper. We've got like big hats on. Um, and people, you know, everyone else is in their bikinis and people are like, why are you guys so covered up? And I'm like, I'm friends with too many dermatologists. That is why. Um, so you, you brought up skin cancer and I think. Some people that's gonna raise alarms for them.

How often should you be getting screened by your dermatologist and what can you be looking for yourself for early signs of, you know, perhaps skin cancer detection, so you know, to get to the dermatologist. 

Dr. Cherem: So everybody should have a full skin check once a year. 

Dr. Brighten: Okay? 

Dr. Cherem: If you are in a particular susceptible population, if you have a history of cancer or familiar history of cancer, then we should look at you maybe more frequently.

Okay? Anything that doesn't heal, anything that. Grows that ulcerates, [00:17:00] that like it opens and it doesn't, like it doesn't repair itself. Mm-hmm. It's something we should check. 

Dr. Brighten: Okay. 

Dr. Cherem: And in terms for mos, we have the A, B, C, D, A. This is the A, B, C, D of melanoma. A is a symmetry. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: When you look at a mo, it doesn't have to be a perfect A, it doesn't have to be a perfect circle.

Yeah. But it should make a mirror image when you fall in half. Okay. B is for borders. The borders should be well-defined. You have a little legs sticking out of it. A little bite, like a little Pacman. That is something to look at. C is for color. Mold should be one color. If they have many colors in it, we look at it.

Mm-hmm. These four diameter, diameter, um, if it's above five millimeters, which is the, the size of the razor on a pencil. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: That is the mold we look at. And E is the most important one, which is evolution. A mold that changes a mold that does something is a mold that we should always look at. [00:18:00] Tumor rules are the Aldi ducting.

So some patients have minimal moles and they're all very ugly, but they'll look Aldi equally ugly. Mm-hmm. When one is different, we look at that one. Okay. And the other one, and I had this recently happen at the clinic and it really struck me, is when a patient says, this mold concerns me, that is the mold we have to look at twice.

Okay. A girl came in with a mole that she didn't like. She didn't know why she didn't like it. She just didn't like it. And I looked at it in with my dermatoscope and it looked totally fine and we removed it and it was melanoma. 

Dr. Brighten: Oh my gosh. So wait for everybody listening. Did you just catch this? Doctor said believe your patient that if your patient says something's not right, then that should be listened to.

Because a lot of women experience gaslighting in medicine. It's a very common phenomenon. And so I just wanna like underscore believe your patient. If your patient says, I don't know why, but something is not right [00:19:00] to twice. Is the D number of times that you're gonna look at that? You said younger people are getting skin cancer, like we're seeing more in younger people.

What's going on? 

Dr. Cherem: Well. Part of it is the early diagnosis. 

Dr. Brighten: Okay. 

Dr. Cherem: Um, we have a machine at the clinic, which is called the photo Finder. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Which is a skin mapping, uh, system that photographs your entire body and then takes Dermatoscope pictures of every mole. Yeah. And it has an AI system, which has basically took away my piece because it's diagnosing things that I would've never diagnosed.

Mm-hmm. And we are catching very early melanomas Okay. On early stages. And if we catch it early, we cut it off and that is it. Mm-hmm. And that is it. And that patient's life was saved. Yeah. Uh, so yeah, I think there's a change in diagnosis. Um, and also on the practices in the sun. People like the sun a lot.

Dr. Brighten: It's true that, [00:20:00] uh, I love that you're using artificial intelligence. You know, we're also seeing that with imaging where radiologists are reading an image and then they're putting it through AI to like double check themselves. Like they're, it's a way of like having a second opinion, like built in. And I think that's just absolutely brilliant.

I wanna shift the conversation to talking about things that people can do, you know, as their aging care for their skin. We have a lot of listeners that are in their thirties approaching their forties or maybe beyond. What advice would you give them to start caring for their skin? Because maybe they don't wanna go the route of using Botox or fillers.

They just wanna do things naturally. And I think there's a lot that can be said of having a good foundation, even if you do go that route of Botox and fillers. 

Dr. Cherem: So before the podcast we were talking about how much habits impact. Life Health and the skin health. Yeah. So I know this is super repetitive, but no sun.

Yeah, we're done dude. Wait, are you 

Dr. Brighten: saying no sun ever? [00:21:00] Uh, I say no sun ever? Yes. Oh, okay. Well, I'm gonna disagree with that because I do like to get out in the sun, but so be in the sun, but like 

Dr. Cherem: be 

Dr. Brighten: smart. Be smart in the sun. Yes, yes, yes. Be 

Dr. Cherem: smart in the sun. Use sunscreen. Um, stress. Stress informs our skin.

Mm-hmm. Eh, so when we're stressed from back when we were at the savanna and lions were chasing us, we release cortisol. Yeah. And cortisol makes our skin get, be pro inflamed. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: That pro-inflammatory state makes our skin age faster. Yes. Number three, sugar. So there's this concept of glycation. Mm-hmm.

Imagine our collagen is like a beautiful freshly made spaghetti. And it's super flexible. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And you dip it in caramel and you let it dry and then you try to move it around and it's gonna break. Yeah. Glycation, which is what happened when we ingest sugar, makes our collagen [00:22:00] fibers break much more easily.

Okay. So, as much as possible, take care of that. And antioxidants. Mm-hmm. Antioxidants in the form of topicals. Um, for the people that really don't like sunscreen, um, this is more of a philosophical, no, I don't wanna say that. I don't wanna say that publicly, but we could argue that if you just use the antioxidants, you could skip sunscreen, which I'm not gonna say because there's not enough evidence to say that, but.

When you use antioxidants, you make you help your skin repair from the outside damage. Mm-hmm. That's in the morning and at night you repair what had happened. So it defends us in the morning and it repairs us at night. And antioxidants should be topical, but also orally. Mm-hmm. And it can be in the form of like supplement or orally in the form of food.

Yeah. Like berries, vitamin C, all of that. Having a good diet is a foundation to healthy skin. [00:23:00] 

Dr. Brighten: What's an ideal skin routine then, that you're saying, you know, during the day, we want the antioxidants at night, we wanna be repairing. 

Dr. Cherem: So you would be layering antioxidant then whatever targeted treatment you need for your specific concern.

Mm-hmm. And sunscreen. Okay. The moisturizer. It depends. It depends on your skin type. It depends on where you live, eh. For example, in Mexico that can be a little bit humid. Not everybody needs a a, a moisturizer. Mm-hmm. And at night, eh, you would be looking into OIDs, which are the gold standard for anti-aging.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And peptides. Okay. 

Dr. Brighten: And when you say peptides, like what are people looking for? Because there's a lot of peptides out there on the market promising a lot of things. So peptides, 

Dr. Cherem: eh, this is, you feel, and as you said, it's a word. It's a word that gets thrown around very easily. Mm-hmm. Peptides are like glue messengers.

Then go and tell your skin what to do. [00:24:00] So it's, it goes and says act in a certain way. There's one brand that, that is called Elastin, that has a, I love 

Dr. Brighten: this brand. We love Elastin. Oh my gosh, I'm so glad that you said that. I'm like winning. I'm winning. Yay. We love 

Dr. Cherem: Elastic. So the Trix technology that they invented, it's really revolutionary because what it does is like, it clears old collagen.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And leaves space for new collagen, which is very good. Like as a maintenance treatment, it can go very well with injectables. And there's a particular one that is made for laser. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: That has really changed the way I perform lasers. Mm-hmm. Because it cuts down recovery time by half of what it used to be.

That's amazing. 

Dr. Brighten: It's, we're gonna talk about lasers in a bit, but before we get there, I wanna ask. Are there considerations for menopausal women? Because we know that once we're entering into menopause, we have a drastic reduction in our [00:25:00] collagen. Some are losing 30% of their collagen within five years, and then it just keeps plummeting.

It's the worst. It's super lame. Um, you know, I'd like to hear like, you know, are there certain things that women can be doing in menopause and what are your thoughts on using topical estrogen on the skin? 

Dr. Cherem: So the hormonal shift we have to embrace when we get to menopause mm-hmm. Um, is very important. Uh, the lack, estrogen will make your skin be, as you said.

30% in the first five years. That's a lot. Mm-hmm. And losing collagen col. Losing collagen means sagging. Deep wrinkles. Yeah. But it also means that without estrogens, our skin barrier is impaired. So we start losing water and our skin gets super dehydrated. Mm-hmm. Our skin becomes more fragile and more susceptible to damage.

Yes. So [00:26:00] what should we be doing? Eh, number one, anything that will stimulate our collagen topically. We have vitamin C, retinoids and peptides, and then in office treatments, it can go anything from. As simple as peelings or microneedling all the way to lasers and radio frequency. Fu. We have a bunch of, most of the technologies we have are directed towards that.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Number two is thick, heavy moisturizer that will help lock in the water. Yeah. Not let things go out and not let anything come in, which will help prevent inflammation and dermatitis. Antioxidants and sun precautions are very important in this age group. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Because since your skin cannot longer repair itself, it is more susceptible to damage.

Yeah. Topical phytoestrogens have, are very interesting. Mm-hmm. Uh, I do not [00:27:00] have enough evidence-based, uh, information to make. A proper recommendation for my patients. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: But this is something very, very promising because we can restore the use of the skin. Yeah. By giving it mm-hmm. Vito estrogens. 

Dr. Brighten: And so phytoestrogens, we're talking about plant-based compounds, putting those into creams, moisturizers, those potentially having promise.

What do you think about? So people are doing bioidentical estrogen if they're a candidate for it and doing, you know, it's a very small amount, putting that on their skin as a way to support the anti-aging process, but also the integrity, the health of their skin. 

Dr. Cherem: To be honest, I do not know enough about that subject to discuss that.

Dr. Brighten: Yeah. Okay. That is fair. But what I do wanna ask, uh, is that, you know, so women listening, as soon as you said dry skin, they're like, I know because they're itching all the time, as they are in late stage perimenopause entering [00:28:00] into menopause. They've got itchy ears like crazy. The back of their scalp is itchy.

You said a really great moisturizer, like a really thick, heavy moisturizer. What are people looking for? Ceramides. 

Dr. Cherem: Okay. Lipids, cholesterol. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: But you know what? It's also very good. That's fats. Fats, eh, it has been proven that oral, uh, omegas mm-hmm. Help the skin barrier. Yes. So if you are very brave, that directly the, like fish oil or if not a capsule will certainly help with that.

And then there are a bunch of things that we do normally that. Destroy our skin barrier. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Which is hot water. Yes. Long baths, hard soaps. Uh, the soap, we as dermatologist, we like the, which are synthetic soap. It's soap without soap. Mm-hmm. Because that doesn't get rid of your lipid barrier. Yeah. So part of [00:29:00] it is restoring it, but a big part of it is keeping it safe.

Mm-hmm. From the, the environment. 

Dr. Brighten: Let me ask you, there's like a big controversy that has happened on the internet with, uh, there's been a few celebrities saying, I only wash with soap, my armpits, and then like my genitals, and that's it. And then the rest I will scrub with like a washcloth and just water.

And people are like, that is super disgusting. You have to use soap on your whole body. I wanna hear it from a dermatologist. What do you have to say? 

Dr. Cherem: Okay. So my teacher in dermatology school said that we need to clean our body like an airplane. Okay. Under the wings. He was a man. I like this. Under the wing in the motor.

Yeah. He was a man. Uh, and in the, in the switch. Okay. So yeah, soap, uh, we only have glass that produce bad smell mm-hmm. In our axi and our Is the genitals. Yes. This does not miss soap. Mm-hmm. But it doesn't need a [00:30:00] washcloth either. Mm-hmm. Because if you go like this with a washcloth, as gentle as it might be, you're gonna get rid of your, the lipid barrier.

Okay. So what I would recommend is soap. Nothing else. The foam and the water is more than enough. Okay. And it's not disgusting. 

Dr. Brighten: No, I, so I'm out myself. That's actually how I wash myself. And it is because of the research on the microbiome of the skin and reading that about how soaps are so disruptive to your microbiome and how that leaves you susceptible.

So if you think that's gross, imagine that you don't have your own microbiome fighting what you're coming into contact with in the rest of the environment. So you get on a plane, you're picking up someone else's microbiome, and you don't have your own to be like, you don't belong here. And now you've got other people's invaders.

And that I find more gross and icky than, than anything else. 

Dr. Cherem: Uh, our microbiome is a perfect system that works in a perfect hemostasis just as is. Mm-hmm. We do not. Need to [00:31:00] disrupt it because when we disrupt it, the bacteria that live in our, in our skin, that our friends can overgrow and become our enemies.

Yes. 

Dr. Brighten: So thinking about like staph. Yes. That's the first one that comes to mind. Staph infections. Yeah. Yeah. So how can people care for the microbiome in their skin? Do they need to, do they need to do anything different other than Don't just like scrub yourself down and be lathering on all the soaps, probiotics?

Mm-hmm. 

Dr. Cherem: Either be food, okay. Kimchi, kafi, or oily, and. In terms of oral probiotics. Yeah. They're very important for our skin, for our gut health and our skin health. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And the gut brain skin axis has been very well established. It is important to have a healthy microbiome all over. 

Dr. Brighten: Yeah. And as we know, 'cause I think that always throws people off.

Uh, 'cause we'll say the same thing with like vaginal health and we'll say, we'll take oral probiotics. And people are like, how is it getting from my gut? There is so much communication, there's so much we don't understand. [00:32:00] But there's also so much communication. The communication piece is important, but also they're sharing of the microbiome.

It gets shared. Um, the gut serves as a reservoir for the lacto ba sole of the vagina. Whenever I say that, people are like, Ew. And I'm like, I know it sounds kind of icky. And yet we need a, you're perfectly designed. Like this is just the way it is. So I wanna shift the conversation to fillers. 'cause this is a, there's been so much coming up.

On social media about fillers, and one thing we're seeing is that a lot of celebrities are starting to dissolve their filler. Like we saw, do you know Demi Moore? Yeah. Complete transformation. Like, let's talk about like what even happened in that situation to begin with, and then why the trend of dissolving these fillers.

Dr. Cherem: So I must start by saying that I love fillers. Mm-hmm. Fillers are amazing. Okay. Why do you love fillers? When done right. Okay. Okay. In moderation. Mm-hmm. Um, a little filler here and there for [00:33:00] beautification, for repositioning tissue, for enhancing certain aspects. A little bit on the lips, a little bit on the chin, really gives amazing results.

Mm-hmm. What has happened is that. The social media face, the Instagram face has distorted the way we see beauty. Yeah. We are normalizing this alien nice look. Mm-hmm. The cheeks, the jawline, the chin, the lips. And we're starting to think that that's beautiful. Yeah. When it's not. Um, there's something very interesting that I read recently that whenever there's like an like of scene over the top result with fillers on Instagram that gets a lot more views, share saves.

Mm. Then a beautiful natural result. Yeah. And I realize it happened to me if I see like this, there's this [00:34:00] trend called the Russian lips, which are like enormous. What 

Dr. Brighten: are the eruption lips? No, tell us Russian lips. They're huge. Yeah. They do columns. They like completely change. So like the anatomy of the lip is this like the hot dog Look where you got like two hot dogs flapping.

Like, have you seen those lips that are like just big roles? 

Dr. Cherem: Unfortunately, we have very bad injectors that have other things other than the best, um, the best thing for the patients in their minds. Okay. That overdue fillers. Mm-hmm. So we have all of these faces that are very recognizable, that were deformed with fillers.

Mm-hmm. Yeah. So I started by saying, I love fillers, but in moderation. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: You cannot do everything with fillers. You cannot refill every single line, every single fold with fillers. Mm-hmm. And this is something we have learned over time. This is one thing. And the other thing is, in order to have a good result [00:35:00] with filler, it depends on the right technique.

When we do fillers, there are a bunch of things we need to take into consideration. The face we are treating mm-hmm. It's an individual. We always have these diagrams of how to put on fillers. We have patients, we are not treating diagrams. Yes. So individualize each treatment for the patient's needs, number one.

Number two, choosing the right product. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And the right technique. So it has become evident that fillers do not dissolve completely. Mm-hmm. Over time. And we're starting to understand a little bit more of why this happens because in reality, fillers do dissolve. Yeah. Like in the lab, but in the face it doesn't.

Mm-hmm. So ever, so what it has been shown Yeah. Is that certain aspects are making fillers stay there longer. 

Dr. Brighten: Okay. 

Dr. Cherem: And the number one is the biofilm. [00:36:00] So when we apply fillers, it's not a completely sterile environment. Mm-hmm. We don't do it in an OR to starters. When we open the, the syringe, the box itself is not a sterile Yeah.

What's inside is a sterile, but it's not a completely sterile technique. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So when a bacteria enters and it coats the filler, okay. It creates a biofilm. 

Dr. Brighten: Mm-hmm. And 

Dr. Cherem: that doesn't allow our body to dissolve the filler. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Um, fortunately we have an insight that we can inject on the face that rebirths this process.

And this is something I'm doing very often in the clinic. I actually started myself, I went to a course on injectables because. I always like to keep updated and looking around the room and seeing all the other doctors, I got dys, morpho, phobic, and I was like, please take everything off my face. And I injected yellow on the ice [00:37:00] all over my face.

Mm-hmm. To see what happened. Yeah. And it was very interesting. The only thing that went away was a filler I had on my under eye that had been there five years ago. Mm-hmm. I didn't 

Dr. Brighten: even thought it was there. Yeah. So. Right. Because the manufacturers tell us it's like 18 months, like two years max. But that's not true.

That is a true in the idea situation. 

Dr. Cherem: So true in a lab. True. If everything's perfect. True of everything's perfect. Okay. In terms of technique, product, a selection, and the biofilm thing. 

Dr. Brighten: Okay. So why are celebrities now we're seeing more and more getting their fillers dissolved? 

Dr. Cherem: So the thing with fillers is you need to know when to stop.

Mm-hmm. Because if not, you get the overfilled face. Yeah. What is the problem with ha fillers? Ha fillers pull water? They highly, they, they're highly 

Dr. Brighten: hydrophilic. Mm-hmm. 

Dr. Cherem: That means 

Dr. Brighten: that they would love one, which is why people use them. 'cause then you plump up and they're like, have [00:38:00] a more full look. Yes.

Dr. Cherem: Yeah. But as women, we tend to retain liquids just because, yeah. And then you add that you ate sushi for dinner and you drank alcohol and you didn't sleep very well. Mm-hmm. And you're dehydrated because you're at the beach, all of your fillers. Yeah. So the thing with the overfilled phase is using too much product.

Mm-hmm. Not waiting for the product to dissolve and. Again, trying to fix everything with fillers. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: That's where we get into the energy based technologies. Yeah. Because when we use energy based devices, we can reposition tissue increase like the screen quality, do a lot, and then just sprinkle filler here and there.

Okay. When you say energy based 

Dr. Brighten: technologies, are you talking about laser? 

Dr. Cherem: So lasers are the ones that involve light. Mm-hmm. But we also have radio [00:39:00] frequency fu, which is high intensity focused ultrasound, EH, LED therapy. So there's a bunch of ways we can use energy-based devices to rejuvenate our skin.

Dr. Brighten: Okay. Well, I definitely, I wanna talk more about that, but you had said like the injector matters. I feel like everybody and their mother is like an injector now. Right? Like you're just seeing and, and it's so many different, um, licensed practitioners can do these injectables and I don't even know that the license matters as much as the skill, the technique, the training.

So what can people look for? Like if they're like, okay, I do want just a little touchup of fill, I do want this moderate amount to get a little, you know, a little plumpness, a little bit of more volume, but I don't want that overfilled look. So how can somebody navigate finding an injector? 

Dr. Cherem: I would say always look for doctors.

Okay. Um, the world in Mexico is a little bit different than in the States. Mm-hmm. [00:40:00] So I'm gonna talk specifically about how it works in Mexico. Perfect. Find either a plastic surgeon, a dermatologist, or um, an aesthetic doctor. Mm-hmm. Look up their credentials. Unfortunately, there are a lot of people pretending to be doctors that are not.

That's wild. It's wild. It's wild. Make sure of what they're using. Mm-hmm. Look at the, so whenever we, we open a syringe, we show the patient like, this is new. Yeah. This is the box. This is, it's a Allergan. Yeah. 

Dr. Brighten: Even when you get a blood draw in Mexico, they're like, this is like, see, and I'm like, Claro, like every time they want you to know that it is ver brand new that the needle that they're going to use, it 

Dr. Cherem: happens to be with patients that are, they have been with me for a very long time that they don't even turn it out.

And I'm like, no. Yes, please turn it out. Yeah. Looked at, see that it's like. Like, do your job, do your homework. Yeah. Do your job, do your homework, and make [00:41:00] sure to know what it's being injected. Mm-hmm. And number two is the informed consent. Yes. Eh, there's nothing sadder for me than to see a patient come in and say, I got an inject.

Something injected into my face, and this happened to me and I didn't know that it could happen. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Informed consent is one of the most important things that came after World War II and all the horrible experiments that were done in the concentration camps. It's a human right to have an informed consent.

Dr. Brighten: Agreed. 

Dr. Cherem: And so make sure, read it, make sure you understand it, ask questions and make sure you're being with someone that is worth your trust. Hmm. Trustworthy. 

Dr. Brighten: Yeah, I think that's important. Vet your injector for, you know, people who are like, well, I don't like, I don't even, maybe they don't even know what fillers are.

You said choose the right material. So let's talk about what fillers are and what's like the pros and cons of it. So 

Dr. Cherem: when we say injectables, [00:42:00] there's a big gap. So we have bottle and toxin, which paralyzes muscles. Yes. Eh. And that should be used specifically to target the muscles that pull down. 

Dr. Brighten: Mm-hmm.

Dr. Cherem: And decrease the negative emotions in our faces. Botin. But negative motions like frown, frown, 

Dr. Brighten: skyling, 

Dr. Cherem: frowning. Okay. Uh, Botox is not meant to erase every single line or to completely fro freeze your app. Or to completely freeze your forehead. Yeah. It's meant to decrease the negative expressions of our faces.

Mm-hmm. There's a very interesting, there's abundant, there's abundant evidence re uh, regarding this, using bottling toxin can help in the treatment of depression. Interesting. So if you don't look sad mm-hmm. And if you don't look angry and you look at yourself in the mirror and you don't see that, [00:43:00] that creates a feedback to your brain that says, I'm not that angry.

Wow. I'm not that sad. And it helps with the way you feel. So smile every 

Dr. Brighten: time you get in the mirror. 

Dr. Cherem: Yes, yes. And I always tell, tell my patients we need to speak nicely to ourselves. Totally. 

Dr. Brighten: Well, there's uh, research that shows that people who engage in negative self-talk, it actually raises inflammatory cytokines in their blood.

So there's a lot, uh, in the medicine of just talking pretty to yourself. So that's, uh, Botox. That's Botox. We're gonna talk more about that, but yeah, fillers, 

Dr. Cherem: eh, fillers. Um, we mainly have ha fillers, which is yic acid. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Eh, yic acid is a natural part of our skin, which in theory, the inte disintegrates over time.

Yeah. And what it does is it pulls water and we have different products made for every indication. So we have like super soft products for just hydrating or what they're called, [00:44:00] skin boosters, which makes your skin look very nice. Mm-hmm. And then we have everything in the middle towards. Um, fillers that resemble bone.

Mm-hmm. So we have everything in the middle. Um, I would seriously dis encourage people into going into anything that is permanent. 

Dr. Brighten: Okay. 

Dr. Cherem: Eh, so is the bone like one permanent? No, no, no. A bone one can be an, it's like the one from G from Allan's called ux. It's just a very firm gel. Okay. That there's something called the G Prime, which is basically like, imagine it's jello, it can be like a firm jello or like a softgel.

Oh, okay. So this is like a firm jello that like really plumps, like, gives you very nice projection. Mm-hmm. Then we have Kaha, which is calcium hydroxyapatite, which is wonderful because it can be a filler, but it's also a bio stimulant. Mm-hmm. I personally prefer it as a bio stimulant because we can inject it into the skin in a diluted way, which makes it a lot, a lot safer.

Yeah. [00:45:00] Um, and. Helps build beautiful collagen. So we have this protocol ellan. This is another type of filler slash biosim that is very nice, that gives very nice projection and creates beautiful collagen. Mm-hmm. And the newer one we have, eh, it's called Armonica. I don't think it's available in the stage yet.

It's by Allergan, which is Kaha with IC acid. Mm-hmm. So it is a very nice filler that we can use to reposition tissue. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Created by a stimulant effect. And in the early stages it gives you that fill effect, but it lasts up to 18 months. And over that time, what it does is it improves your collagen. Mm.

And there's this very nice thing with them, which is the pinch test. Yeah. Which is how much your sink can retract before and after. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Uh, and then we get into PLLA, which is sculpture. S Sculptra, it's a powder that we dissolved in lip, [00:46:00] in, in saline. Mm-hmm. We inject into the skin and what it does is it increases the collagen production up to 30% in the next three months.

Oh, wow. So it creates a beautiful foundation for healthier looking skin. Mm-hmm. We place it very strategically in the periphery of the face where we have the fixed face, so we pull back. Okay. And it's a great, um, way to prepare the skin for lasers. 

Dr. Brighten: I really appreciate you spelling all that out because I think a lot of times when people think fillers, they just think replacement.

And yet you just outlined all of these biostimulants, which these are injectables that will encourage your body to replenish its collagen and to rejuvenate itself. And I don't know that that is talked a lot about. I think it's because in part, not all of these are available in the United States, which I find very interesting because you will see products go through rigorous testing and the EU will approve them, Mexico [00:47:00] will approve them, many countries will approve them, and the United States seems to fall behind, and I almost feel like it's maybe on purpose so that you're just getting these like not to be a conspiracy theorist, but I don't think it is conspiracy when we live in a capitalistic market as if maybe these companies want to corner the market and make sure that they are most profitable before something comes in that could actually help your body do it itself.

Well. 

Dr. Cherem: And PLLA is available in the states. Okay. Um, the, the, the thing is the FDA, it's a very, very strange route because fillers get in, uh, approval for specific indications. Mm-hmm. Like the one that I said that resembles bone, it's only, uh, has, he only has the indication for jawline. 

Dr. Brighten: Okay. 

Dr. Cherem: Okay. Uh, so navigating the US uh, regulatory, re regulatory, uh, system is extremely complex.[00:48:00] 

Mm-hmm. Um, but I think all of these products will be available, like, and Monica is by council. Yeah. It will be available soon. I think you said something very interesting because you said reposition. So in the history of fillers, uh, before my time, first, they would just fill the lines. Mm-hmm. So they would fill the nasal labia fold, fill it, fill it, refill it, refill it, and then you would get the Yeah.

Face. And then it was reposition tissue, eh. But if we rely solely on the filler to reposition filler, you get the over fill face. Mm-hmm. And that's where energy-based devices and different types of technology can really help lift the face. Mm-hmm. And body, and then allow us to use the fillers in a very strategic way.

So how are you using these then with filler, these energy-based 

Dr. Brighten: techniques? 

Dr. Cherem: So. What I like to do is [00:49:00] prepare the skin with sculpture. Mm-hmm. PLLA is one of the most studied, uh, biostimulants. It started in the nineties as a treatment of the lippo dystrophia associated to AIDS medicine. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Uh, so it's a product that has been around for a very long time and we know how it works and we're still learning all of the amazing things It does.

Yeah. So if we do, if you use A-P-L-L-A Sculptra a few months before we do any kind of laser, we are kickstarting the collagen production. Mm-hmm. And then the way energy-based devices work in a very minimalistic manner is they create micro injuries, controlled micro injuries in the skin. Mm-hmm. That will make your own skin repair itself.

Yeah. And by doing that, it will increase the production of collagen and mm-hmm. Which means. You make your own 

Dr. Brighten: [00:50:00] skin be healthier. A lot of people know what collagen is, but maybe not elastin. Can you explain that? Yes. So 

Dr. Cherem: collagen is the big hero of the youthful face. Yes. But elastin it's the robin of the Robin, the Badman and Robin, the face.

Oh, Batman, Robin. I love it. I was like, Robin Hood. Who's Robin? No. Who's Robin? Yeah. No, no. So, um, lasting collagen gives you firmness. Yeah. But elastin is what makes your skin come back. Mm-hmm. Tonight go and check your skin, your baby's skin. When you go like this, it immediately comes back. 

Dr. Brighten: Yeah. Yeah. 

Dr. Cherem: That 

Dr. Brighten: is the last thing.

I don't know if I wanna do this side by side. I, I might be in the mirror going 

Dr. Cherem: so when we lose, when you think of another person, you go like this and it comes with you quickly. Yeah. So that is the last thing. Lasting makes our skin sag and. The only topical product that has shown to increase the elastin production [00:51:00] is the Trix from Elastin.

Okay. So, um, producing elastin will make your skin bounce back. Mm-hmm. And so it, that is very important because we want collagen. We certainly want collagen, but we also want elastin. 

Dr. Brighten: Mm-hmm. And so you were saying using these like laser techniques, this energy technology, so you're using the bio stimulator and then a couple months later, that's when you come in with the laser, correct?

Yes. Okay. 

Dr. Cherem: So I first prepare the skin with the TRI has the elastin skin connector. Mm-hmm. Which is a complete game changer. When we talk about lasers. We prepare the skin for about two or three weeks and then we perform the laser. Um, and after the laser you continue with that, which helps the recovery process like the study.

Takes down downtime by time, by half. Okay. So instead of going to 10 days, we're talking about like five days. Mm-hmm. Um, the beauty about lasers is that [00:52:00] we have always thought about lasers in terms of rejuvenation and wrinkles. Mm-hmm. But what we are learning now with, uh, biopsies and further animal studies is that laser restores skin health.

Mm-hmm. It re makes the skins. So we have the cells in our skin that are called senescent cells. Mm-hmm. Because they're like little zombies. Yep. They consume energy. They don't allow the, the cells to act the way they are. They should ask and they create a bad environment in the skin. Mm-hmm. That makes everything age these cells are particularly susceptible to laser.

Mm-hmm. So when we apply. I like to call them magic bullets because light is elections. They're like magic bullets are super specific for certain things in the skin. Yeah. We can create these micro injuries that will make, will [00:53:00] destroy the bad cells. Mm-hmm. And make the bad the good and make the good cells reproduce.

So the main thing about aging is losing function. Mm-hmm. And accumulating damage. So by doing this, we restore the function of the skin and we eliminate the damage. And when I talk about eliminating the damage, there's this very interesting study. It's talking about non-melanoma skin cancer, but doing laser resurfacing can decrease the risk of developing non-melanoma skin cancer by 30%.

Wow. That's significant. Yes. Because we are eliminate, we are eliminating all of that damage. Mm-hmm. All of that. Um. All of those mutations. So misbehaving cells, kick 'em out. Exactly. We're evicting. Mm-hmm. The bad cells, the zombies. 

Dr. Brighten: When you're talking about laser treatments, like what should people be looking for in terms of like, are [00:54:00] there specific devices, specific therapies?

So 

Dr. Cherem: there, there's a specific laser for each need. Okay. So for example, we have specific lasers that are for vascular things. Uh, part of aging is having a lot of redness and lung dictation, like the broken capillaries. Mm-hmm. So pulse eye laser is the go-to treatment for that. 

Dr. Brighten: Okay. 

Dr. Cherem: Um, in terms of pigmentation, we have the picosecond lasers, which are specifically directed toward pigment.

Endogenous our own pigment or isogenous, it can be done. So this is like 

Dr. Brighten: melasma what women get in pregnancy if they're on birth control pills or if they've been using their apricot scrub. Am I correct? So the like dark pigment, you got into kind 

Dr. Cherem: of a tricky subject because, okay. Okay. Melasma is a disease we do not understand.

Mm-hmm. We do not know what causes it. We have a bunch of ideas around it. Uh, it was thought to be more about estrogen. Now it's thought to be more about progesterone. [00:55:00] It's thought to be a, a, a disease of photoaging of like the cumulative, uh, sun in your skin. But since we don't know exactly what causes it mm-hmm.

We don't have one specific way to treat it. Okay. Uh, I'm gonna start by saying that melasma should not be solely treated with laser. Okay. Because it can really go bad with lasers because if you heat melasma it can turn much worse. What about vitamin 

Dr. Brighten: C, glutathione, those kinds 

Dr. Cherem: of topicals. Those, okay.

Those are amazing. There are protocols. I do a specific protocol in the, in the clinic where we use LED therapy, then the B bim laser with a pul puls eye laser, and then picco toning for Mela, which is a great way to really bring the, the pigment down really fast. Mm-hmm. But it has to be in conjunction with, um, topicals.

Okay. And. Sunscreen, that's sunscreen, sunscreen, [00:56:00] sunscreen, sunscreen, sunscreen. I mean, melasma 

Dr. Brighten: is definitely one. I mean, if you're, if somebody's listening to this right now and they're like, yeah, I don't know, like sunscreen good or bad, if you have melasma, if you want it to get worse, don't wear sunscreen and you will have worse melasma.

Like that's the only guarantee. I think that's like definitely one that I have seen people online and it's raised concern where people are like, well, isn't sunscreen toxic? And it's like, you are also talking about how you got in the asthma. You used to get really bad sunburns and you have all these skin issues.

And so that's where it's like friends go see a dermatologist, have an individualized conversation rather than the one size fits all. Sensational, like, you know, thing that the influencer gave you in a 15 second reel. 

Dr. Cherem: Um, I have two things to say about this. Say it. So the thing about sunscreen being toxic, this was based on a rat model where the sunscreen was inject.

God, we have, let's not do that. You're not a rat and you're [00:57:00] not injecting it, so I think you should be fine. Number one. Number two, eh, the study was made thinking of people using the right amount in the entire body surface over a long period of time. Mm-hmm. If we have a problem is that people bab their sunscreen here and there.

Nobody uses sunscreen in their entire body every single day. Yeah. So. I think the New York Times was kind of irresponsible with that article. And I love the New York Times, but I, okay. That's the first thing. And the second thing is for the melasma patients, unfortunately you cannot solely rely on sunscreen.

Hmm. It's sunscreen. It's your hat. It's the sun visor and it's oral antioxidants. Okay. So there's one called Poly. Okay. In Mexico, it's called EL Caps. Uh, I think it's available in the States. It's, um, but I don't know the name. So poly [00:58:00] was developed for people with skin cancer. Mm-hmm. And it's an antioxidant that repairs whatever is happening in the skin.

Mm-hmm. With the sun. So that No, this is an oral antioxidant. It's an oral antioxidant. Okay. Okay. And it's, or on sunscreen. Okay. It's not sunscreen. I never say sunscreen, but it's oral sunscreen, 

Dr. Brighten: astaxanthin. 

Dr. Cherem: It's another one. Oh, okay. Okay. It's another one. This is poly S. Then you have salt super oxidase.

Mm-hmm. Which is an amazing antioxidant. Uh, there's a brand called Gris ine and they have DSB formula, which is specifically made with, for melasma. It also has a lycopene, which is another form of oral sunscreen. You have Goode, you have a bunch of oral antioxidants. Mm-hmm. So when we're talking about melasma is some precaution, which is sunscreen and avoiding the sun, oral antioxidants, your skincare routine.

And then we can talk about lasers. The very interesting way [00:59:00] in way PCO toing works is so pickle lasers, uh, deliver the energy in super, super fast manner. Mm-hmm. So it creates very little heat, which is something that MEMA doesn't like. So, um. The melanocyte is like a little octopus. Okay. It's a dendritic cell.

So when we pass the laser, we shorten the dendri dendrites, which makes the, the, the spot itself become smaller. Mm-hmm. And it breaks down the melanin particles, which makes the, the tar spot become lighter much faster. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Um, and this is a wonderful way to make, to keep melasma. Clear. I personally have melasma.

Mm-hmm. And to be honest, I do all of it. 

Dr. Brighten: Yeah. So I had melasma, I actually, I'm gonna tell this story. I had melasma, I had bought this device that was supposed to be like this skin rejuvenating light laser device. [01:00:00] And I was using it on my forehead. And, um, it was like, oh yeah, like, use it the more, the better.

And I, it wasn't even subtle, it was almost like an overnight thing. I woke up and I had, yeah. Just this horrible melasma on my forehead. Um, and then I moved to Puerto Rico and like, that's not good because there's so much sun. But it was sunscreen, definitely wearing hats. I've always done lots of antioxidants, but I, whatever I did to my skin, I overdid it.

But it was topical glutathione and vitamin C that like really took it away. Um, I didn't know of any lasers. No one was talking to me about laser. My dermatologist that I had there didn't talk to me about lasers. But, um, I stopped the glutathione because that can bleach your skin is, am I correct? Yeah. So I stopped the glutathione after that, but I am like religiously always about the vitamin C and I'm always afraid that's gonna come back.

So in some cases it can be reversed, but I think, um, the worst thing you can do is try to go at yourself and try to figure out how to reverse [01:01:00] melasma yourself. Am I correct? Like, I feel like just the more DIYI mean D IY is like how I got there to begin with. So 

Dr. Cherem: inflammation leads to. Post-inflammatory hyperpigmentation.

Mm-hmm. So if you have me, you're prone to it. Yeah. So if you fla your skin by pieing, God knows what we are gonna do. That. Uh, it's interesting what you said about the light. So LED therapy is very in fashion and I really like the masks. Yeah. 99% of the cases, if you have melasma, do not put red LED therapy on it.

Mm-hmm. Because it will make it worse. 

Dr. Brighten: That is really solid advice. So, um, but we were talking about lasers. We took this in like melasma little journey and I love that we did. 'cause I think it's gonna help a lot of people. But I feel like I stopped your role in talking about all of the ways that lasers can help our skin.

Dr. Cherem: So, um. The micro injury created by laser 

Dr. Brighten: mm-hmm. 

Dr. Cherem: Will stimulate collagen. Yes. So that gives us [01:02:00] firmness, which helps with wrinkles and so on. And then by killing the senescent cells and by getting rid of all that damage, we improve our skin's health. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And with the pigment and vascular laser, we can reach this term, I love this term, normalization, bringing the skin back to normal.

And there is a normal to the skin, which means less red, red, brown, rest this coloration. There's this, this term in in dermatology. In dermatology called Eria. Mm-hmm. Which is white, brown, red. When you have all those three colors combined, and then underneath we get a little yellow that makes skin look really old.

Okay. And with laser. We can get rid of all of that. Mm-hmm. 

Dr. Brighten: Um, when it comes to laser, are people using this, is this like every three months? Is it once a year? Like what are the [01:03:00] protocols typically? 

Dr. Cherem: So it really depends on the patient's needs. Mm-hmm. And this kind of treatments really need to be individualized for each patient.

Mm-hmm. Um, the way I like to start is, as I said, PLLA Trix a s Sculptra elastin connector. We do a laser treatment and I usually never do resurfacing before three months because we need to let our own body react to the laser. Yeah. So we do as many sessions as necessary mm-hmm. To achieve, let's say, the result that we want.

And after that we have maintenance, uh, therapy, maybe once or twice a year. 

Dr. Brighten: Yeah. Um. 

Dr. Cherem: Choosing the right type of laser depends on the patient's needs, but also on their lifestyles because we have the ablative, the ablative lasers, which literally disrupt a column of skin, which are the most effective. [01:04:00] Mm-hmm.

But with the most downtime. And we have the non ablative ones, which are very beautiful. They're a little bit slower in showing results, but have less downtime and are more compatible with people with like very busy schedules. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: I actually have a device, the, um, hybrid, which has both in the together.

Okay. So we can syn synergistically synergistically use the two energies to target different aspects inside the skin to tailor the treatment for the skin of the patient. Are lasers painful? I'm gonna say that. With a good topical cream. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Oral AIA analgesia. Mm-hmm. Analgesics. Yeah. Okay. Pain, oral painkillers.

Uh, and we have this beautiful device that cools the skin. It is very tolerable. Mm-hmm. I do not do, I personally do not do laser under the anesthesia. 

Dr. Brighten: Well, I will say I think [01:05:00] Mexico does pain management, right? I've seen it in so many ways. In so many, you know, I've, I've, I've done a lot. But, um, you know, you offering, uh, oral pain meds, making sure that there's a cream that's gonna help reduce the pain, and then doing the cooling after is something that people should be looking for or talking to their provider about if they're going to have a laser treatment.

Um, because, you know, people will, uh, people have shared online like how excruciatingly painful their laser procedure was and how they'll never go back. And that's always my thought of like, was pain management discussed ahead of time? And so I think it's always a good question to ask, will this be painful?

And how can we mitigate that? 

Dr. Cherem: Well, I must say that pain variate from patient to patient Sure. It's totally subjective 

Dr. Brighten: to tolerance. It's so 

Dr. Cherem: subjective. Uh, yeah. And the pain threshold of different people is very different. So what I might say is not that painful. Might be very painful for a patient, eh? I don't like to do anything that is very painful.

Yeah. I, I literally [01:06:00] suffer with a patient while I'm doing it. So I always try to have patients be as comfortable as possible. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And I also think it's important to raise your hand and say, Hey, this is too painful. Can you please? Yeah. And what, what we do is we decrease the energy. Um, 

Dr. Brighten: does that make it less effective?

It depends. Sometimes it does. Okay. 'cause I think maybe that might be why a patient's like, well I don't wanna say anything 'cause I wanna, I wanna get my money's worth right now. I'll suffer through it. 

Dr. Cherem: Well, there was an interesting article published recently that said when we said more is more, more is not necessarily more when it talk in terms of the energy we use and the results we get with laser.

And then in that same article, they talked about patient satisfaction. Yeah. So if it was very painful and they had a beautiful result, but the patient had suffers through the pa, through the process. They didn't appreciate the treatment. 

Dr. Brighten: Oh, 

Dr. Cherem: and we also have the country, no pain, no gain. [01:07:00] Bring it strong. I wanna feel it and everything in the middle.

Dr. Brighten: Yeah. No. I wanna go back to the Botox conversation because there's a lot of people who have concerns that it's a toxin and that it's going systemic and that maybe it's affecting their brain health or it's affecting them in some other way. What does the research say? 

Dr. Cherem: The number one aesthetic treatment in the world is S.

Okay. But it is the safest in terms of less complications and it lasts for four months. Mm-hmm. It only lasts for four months. Yeah. So the botin toxin we inject to this muscle has a diffusion halo of one centimeter. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: No more. What I inject here doesn't go here. It doesn't drop your eyelid. We know that Botox, it's very.

Target specific, if we have a problem with OSE is that it's lasting less because since we're doing it more frequently, we get more [01:08:00] antibodies and it's lasting less. 

Dr. Brighten: Okay. So you said every four months it lasts, but if somebody's doing it more frequently, they can actually, their immune system will break it down faster.

They can over time. 

Dr. Cherem: Yes. So there's a curve of antibodies. Yeah. So you inject it And we do the touchup always before day 21st, because at that, after that. Your antibodies start peaking. 

Dr. Brighten: Okay. 

Dr. Cherem: If you apply toxin while your antibodies are are high, you're gonna produce more antibodies. Mm-hmm. Which means that your next application will last less.

Dr. Brighten: Okay. So you can build up tolerance basically to bo Well let resistance, let me say that You can build up resistance to Botox. Um, what are some things that people can do to make their Botox last longer or have a better effect? 

Dr. Cherem: Zinc supplements. 

Dr. Brighten: Zinc? Yes. Okay. Tell us about it. 

Dr. Cherem: You start before mm-hmm. Eh, and you continue it throughout and that helps the toxin, eh, lock it, lock itself better to the receptor.

There's another study that says that [01:09:00] when you get the injections, you make face facial exercises. Mm-hmm. Wait, face yoga, but only on the upper third. Yes. You do face yoga for that week. It latches better. Okay. Um, and avoiding heat. Heat, it breaks down the, the toxin. Okay. So hot yoga. 

Dr. Brighten: Hot yoga, hot showers, sun exposure.

Sun exposure, saunas, saunas. And that's good to know 'cause I'm a big sauna fan. 

Dr. Cherem: Continue to be, saunas are very good for our health. 

Dr. Brighten: Yeah. So, uh, so it's just in that first week that you would avoid the heat exposure? 

Dr. Cherem: No, it should be throughout the entire duration 

Dr. Brighten: for four months. Sorry. Sorry to my sauna.

People who are also doing Botox. Keep your sauna, keep 

Dr. Cherem: your sauna. Keep your sauna. Just. Realize that. Well, there's also something very interesting. So we all like the soft Botox. Mm-hmm. I like soft Botox. Well, what do you mean when you say soft Botox? Well, we call baby Botox, right? Yeah. So [01:10:00] it's Yeah. 

Dr. Brighten: Like not Kardashian Botox.

Dr. Cherem: Exactly. Yeah. For you to move your entire face. Mm-hmm. And it's specifically on the forehead. I like to only sprinkle it here and there to have a lot of movement. Yeah. And when we do that, so duration is directly proportional to dosage? Yes. Okay. So we do very little. It's gonna last very little. Mm-hmm. And it's something you need to evaluate.

Do you rather have the goal in. Just twice a year and have a super frozen effect. Mm-hmm. Or maybe do it a little more frequently, like four months, which is a recommendation, but look more natural. 

Dr. Brighten: I wanna talk about face taping because people you giggle. Okay. I think I know your answer, but I'm gonna ask it anyways.

People are like, don't do Botox face tape and said, does face taping give you the same effect? 

Dr. Cherem: Of course not. So I must say we are living under two realities. The social media reality and the. Evidence [01:11:00] based science, 

Dr. Brighten: reality, the real world versus like the social media where, where I have to say, sometimes you see people saying, oh, just, you know, use X, Y, and Z.

And I'm like, I can see you have a filter on, you literally have a filter on right now. Um, like, I don't know, I'm not savvy enough to figure out how to take a filter. Like TikTok puts a filter on my face and it'll be weird 'cause I have like this little mustache where I'm like, what is that? Like, it's a filter.

I don't know how to get it off of me. And I'm like, the default of TikTok, if you record a video there is to have a filter. But you will see like influencers saying like, oh, I just did these things and now look at my skin. And I'm like, you clearly have a filter on. And no shame if you wanna use filters.

But don't, don't act like the, the, you know, your face, your face yoga, your face taping is doing what the filter's actually doing. 

Dr. Cherem: I think something that. Has always happened. But now with social media is more evident, is that we always want one week fix to all our problems. Of course. Yes. So instead of [01:12:00] diet, exercising a healthy mind, a good skincare routine, going to your dermatologist three times a year, so on and so on, they duct tape and put it on your face.

Yeah, we, but duct tape works for wards. Well, that is, that is different. That is different. And that is, that is a very interesting study because apparently it's more like a placebo effect thing. Yeah. Eh, but yeah, no, no. If your child has words and. Removing words from children. It's so horrible. Yeah. Because they suffer and we all suffer with them and it's not nice.

Uh, yeah. Duct tape for words can work. Yeah. But not on your 

Dr. Brighten: face. No, no, not on your face. And for people that are like placebo, it's because you draw so much attention to it. The thought is that then your immune system follows and throws down on that virus. But face taping, does it have any benefits? No. No.

No. 

Dr. Cherem: Okay. No. No. Good to go. You can use it like if you wanna do your makeup and you wanna do like the little tapey thing for the eye. Yeah. [01:13:00] But yeah. No taping your face. No. 

Dr. Brighten: And what about when you see somebody that is like, I had Botox and it caused severe headaches, or I ended up having like drooping eyes, like I had these side effects.

Are those side effects that we expect or is there something more going on? 

Dr. Cherem: No, those are side effects that can happen. Okay. So the thing with headache, eh, I said that doing face yoga can make your toxin latch on faster. Mm-hmm. But that can also create a headache because as you start, stop moving your forehead, you start moving your face with your scu Ah, the muscles in your skull.

Yeah. And then you get a headache. So yeah, eh, it headaches through after Botox can happen tends to be transitory eyelid, ptosis. So this is one of the most fear effects of toxin that is, that it migrates. So we have this, well, very, very, very, very thin, very, very tiny muscle that lifts mm-hmm. The eyelid and, and we inject right.

[01:14:00] There for the corrugator so the toxin can migrate. I always explain to patients that it is a risk. Yeah. Um, I've been injecting people for 10 years and it has happened to me twice. Mm-hmm. Eh, complications are part of doing something many times. Eh, but there are things we can do to make it better. Eh, there are specific eye drops that help, eh, stimulate another muscle that pulls up.

Okay. Eh, and then we have this amazing technology called Ultra former, which is a high, full, high intensity focused ultrasound, and we can use it to lift the eyebrow. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So it has happened to me twice. The, both times we did that and the results were almost unnoticeable except for the patient because when you know your face, you see it.

Yeah. But yeah, this is not, it's not your injector's fault. Eh, it can be techn, it dependent on the technique. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: Eh, and we always try [01:15:00] to take safe margins, but as I said, we treat individual patients. 

Dr. Brighten: Yeah. 

Dr. Cherem: That may not match the anatomy on the book. 

Dr. Brighten: So you were saying touchups happen about three weeks later, like within that three week window?

Yes. So if somebody was concerned about this, could they ask for less and then always come back two weeks later if they're like, okay, think I need a little more. 

Dr. Cherem: Whenever I treat a patient for the first time, I always act like that. 

Dr. Brighten: Okay. 

Dr. Cherem: I, I hate when patients come back. I see. And say I feel frozen. It's a horrible effect.

Yeah. Uh, I much rather they come in and say, give me a little more than to feel that they had too much. Okay. 

Dr. Brighten: Botox fillers, and I think laser as well. We can't be doing these in pregnancy. Correct. So, um, 

Dr. Cherem: nobody will perform a study on a pregnant woman. Yeah. So there's not one single study that says that any of this is safe.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And as a mother, the most important thing is [01:16:00] your child's wellbeing. Yeah. So having a little wrinkles for nine months is just a thing you have to deal with. Mm-hmm. 

Dr. Brighten: What can, well, let me just say this. If people are like, why are they not studying pregnant women? 'cause sometimes people are like, that's not fair.

And I say, A baby can't opt in. A baby can't say, okay, sign me up for this trial. And maybe this ruins my entire existence of being. So we're very, very cautious with that. But for women who are pregnant and you know, they're, so we're seeing more mothers over the age of 35. Like, if I get a pregnant again, I'm gonna be 44.

No retinol, no nothing. Right? Like, none of that stuff to help me out. And because of our age, collagen's already declining elastin. We're not snapping back the same, what can pregnant women do to care for their skin? 

Dr. Cherem: So we have a HA. So the exfoliants are safe. Ha and BHAs are safe. Peptides are safe. 

Dr. Brighten: Okay. 

Dr. Cherem: Eh, and it's just, it's a pregnancy pause.

Mm-hmm. It's nine [01:17:00] months. I always tell patients the moment you all have a baby inside of you, come and see me. Yeah. And we can do everything. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: It's just nine months patients realizing what matters and what comes first. Mm-hmm. Which is your babies and your own health. 

Dr. Brighten: With these exfoliants, can you be more sensitive in pregnancy to them?

Well, this is very interesting. 

Dr. Cherem: So the skin changes with pregnancy. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: The dry becomes oily. The oily becomes dry, and everything in the middle, our immune system has to like navigate pregnancy in terms of accepting the baby. Yeah. And in terms of increasing the immune response to other things. Mm-hmm.

To protect the baby. So yes, the skin can become a lot more sensitive with pregnancy. So just it solely. 

Dr. Brighten: Mm-hmm. And when do you recommend, so if women are pregnant, should they have a dermatology appointment to help with their skin? Because you know, all kinds, so melasma, we talked about that, that can [01:18:00] come up.

Some women get reding, some women get rosacea. Like we can see things that, uh, can make women feel very distressed. And so what would you recommend in terms of care? 

Dr. Cherem: So for only patients? The minute they're pregnant, I, because they always text. Mm-hmm. I'm pregnant, what should I do? Come in? Yeah. So they come in and we first discuss their skin.

Okay. We review all their ingredient, all the products, review all the ingredients, make sure that everything they have is safe. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: We, how much of whatever we apply on the face is being absorbed and can cross the placenta and get to the baby. I don't know. Yeah. But I won't risk it. Mm-hmm. That's number one.

Number two, I explain all the changes so they know what to expect. For example, you're gonna have beautiful hair. Yeah. But nobody's doing that, so I love that. It's like, love that you're doing that. Um, you're gonna have beautiful hair. Yeah. Afterwards you won't. Yeah. So let's start with a good shampoo to, is to encourage you hair growth.

Uh, [01:19:00] and I always do a molding. Mm-hmm. So the hormone they tests on your skin, on your blood to see if you're pregnant, structurally, structurally resembles them. The hormone that simulates the production of melanin. Okay. So everything pigments. Mm-hmm. And this is for a beautiful reason. You know how when babies are born, they only see, uh, black and white?

Yeah. Our nipples are supposed to become darker. Yeah. So they can find them easier. So this is, this is a nice, is the justification to understand that you're in the post get, uh, darker. And it's not nice, but it's good. It's for good cost and everything becomes darker, including the malls. Mm-hmm. So I always like to do a mall check at the beginning of frequency.

Dr. Brighten: Okay. 

Dr. Cherem: Uh, we do the photo finder, we map everything. So in case somebody comes in at month six and say, this looks weird, we can objectively see if it's actually weird or not. [01:20:00] Mm-hmm. Because with pregnancy, all the moles change become a little bit like darker, more pigmented, a little bit more scary. 

Dr. Brighten: Okay. All right.

I love that. So, meeting with your doctor, reviewing all the skincare that you have, getting the lowdown on what is going to happen. You brought up postpartum hair loss, everybody. I, I, I, you know, I have heard from patients and they're like, can I just start minoxidil? Can I like start ro gain? Like, because my, my hair's falling out.

What can women do postpartum for that hair loss? It's, and why does it happen? Because it happens to everybody. And anyone that I've seen people say like, no, I didn't have that. I dunno why you had it. I'm like, liar, liar, pants on fire. Everybody has this. Otherwise, like, you're a mutant. Something's wrong. So why does it happen?

What can people do? 

Dr. Cherem: So it's called mm-hmm. Um, to be honest, I did not understand the level of stress it causes till it happened. Yeah. When you're like, [01:21:00] why 

Dr. Brighten: do 

Dr. Cherem: I have receding 

Dr. Brighten: hair lines? Yeah. And you 

Dr. Cherem: take a shower and you have a hairball like this and it's super scared. 

Dr. Brighten: Yeah. 

Dr. Cherem: So. You give birth, whichever way you give birth, that is a very stressful process for the body.

Mm-hmm. And whenever we enter a stress process, uh, a stress moment in our body, our body has to manage the resources. Okay. So what comes first? Brain, heart, kidney, la, la, la, la, la, la, la. And at the end of the list, you have the hair. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So first you have the trauma, the stress of childbirth, and then the stress of producing milk.

Yes. Which is, it requires a lot of energy from our body. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: So our hair cycle has a growth phase, um, a transitionary phase, and then a phase where it falls off. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: What happens? After pregnancy is that all the hairs that [01:22:00] were supposed to fall off enter at the same time into the intelligent phase and everything falls out at the same time.

So 

Dr. Brighten: everybody listening, your hair's cruising around, grow, grow, grow, grow, grow, and then all at once it decides let's just shed 

Dr. Cherem: And it all sheds at the beginning. Yes. What it's very important to understand is the word cycle. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And new hair is down there and it's gonna come out. Yeah. With time and patience.

And there are things we can do to make it. Stronger. So Minoxidil, uh, is not recommended doing lactation. Mm-hmm. I don't know if you saw this as the, this articles recently about babies getting hyper cosis. Oh my gosh. Like wolf babies. Yeah. Wolf 

Dr. Brighten: babies. That, uh, that reminds me, like when I was a kid there, like in the grocery store, there was, um, the magazine and there was always like, bat Boy and like, what Wolf baby?

And like, that's, that's what it's giving me. People can comment, let me know. Do you remember these? 

Dr. Cherem: Um, [01:23:00] and this has been shown with the mother and the father. Like if the father uses topical mono and then hugs the baby. Yeah. Yeah. They get the mono to them. Yes. So, yeah. Um, we usually wait with Minoxidil. Eh, Minal can also be oral.

Mm-hmm. But this should not be used during pregnancy. No. Pregnancy, no 

Dr. Brighten: lactation, no Lac. So as long as you're breastfeeding? No, no monoxide. 

Dr. Cherem: And afterwards, a and. We have a bunch of other things we can do. We can, there are supplements that can help with the hair. Mm-hmm. There's shampoos for it. Uh, and a tip I always give my patient, I did it myself.

It's cutting your hair. Mm-hmm. It won't help with the hair loss, but it does help with the stress of the ball of hairs you see in the shoe. Yeah. Because if you have less volume, you will see less. And I think that stress causes more hair loss. 

Dr. Brighten: Mm-hmm. So when you say supplements, what kinds of supplements can help?

Uh, [01:24:00] 

Dr. Cherem: so the first thing would be to check your iron levels. Mm-hmm. Because after giving birth, you can have anemia. Yes. And if you have anemia, your oxygen doesn't get to where it has to go. So it would be to check that. Uh, it's always good to always check the thyroid function to make sure everything's okay there, because if it's not.

Your hair's not gonna be okay. 

Dr. Brighten: Everybody who has hair loss, those are two things you should be checking anyways, even if you're not pregnant. I just wanna underscore that. What about derma rollers? So derma 

Dr. Cherem: rollers, 

Dr. Brighten: eh, 

Dr. Cherem: micro kneeling. It's an amazing way to stimulate the production of collagen. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And introduce s skin.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: We do it in the clinic with a machine that is set of rolls, it stamps. So instead of having like this shape, you have like nice color hair 

Dr. Brighten: or this is the face for everything. Okay. 

Dr. Cherem: Eh, I am really concerned with urban rollers at home 

Dr. Brighten: and how clean they can be. [01:25:00] Yes. That's my concern as well. Yeah. Of like, if you're not cleaning them between use, like if you don't have the means to clean it, don't use it.

Um, but I wondered is there any efficacy to it? Yes. Will it help? Yes. Okay. It will help but clean it Ladies. Clean it, 

Dr. Cherem: clean it. Be mild with it. So the thing is, the idea is when you create the micro injury. You start the repair process of the skin, which enhances the blood flow. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And this is kind of the similar mechanism in which LED therapy works for hair loss?

Mm-hmm. Eh, so it does work, but I personally do not recommend it for patients because Okay. I know what we are. Stay 

Dr. Brighten: infections in scalp. Yeah. What, and so you just mentioned LED D, so like the ball cap LEDs, those can help with hair loss. Those can 

Dr. Cherem: really help. 

Dr. Brighten: Okay. If you 

Dr. Cherem: use them. 

Dr. Brighten: And if you're not pregnant, then you consider going the udal route.

Do you prefer to topical or oral with women? 

Dr. Cherem: So the study has proven that they're as [01:26:00] efficacious. 

Dr. Brighten: Okay. 

Dr. Cherem: So this is a conversation. Who are you a person that prefers to take a tablet at night or a person that prefers to put on a spray at night? 

Dr. Brighten: Okay. 

Dr. Cherem: As a Minal user, I must say that is kind of, uh, I dunno, bothersome to put it on and you have to put it and massage that, then wash your hands and your face because if now you start getting hair all over.

Yeah. So I think with the oral we have better usage from the patients and better results, but they're efficacious. 

Dr. Brighten: Yeah. So better compliance with compliance oral. Um, if somebody is on oral minoxidil or the topical and they decide to get pregnant, how, when do they have to stop? Is it like as soon as they know they're pregnant?

Is it two months before? Is there, are there actually any guidelines on this? 

Dr. Cherem: I actually do not know. 

Dr. Brighten: Yeah, I think that that's why I was like, are there actually any guidelines? Because I'm like, I actually haven't seen that. Like, you know, we know with like GLP ones, they'll say two months before with retinols, it's like if you're trying to conceive, like you [01:27:00] should stop that.

But I actually haven't seen anything on that as well. But I would imagine you stop, you're gonna see some hair fall. 

Dr. Cherem: Yes. So. For that thing, there's a formula. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: I don't know. I don't remember it from the top of my head. That is the elimination time times a lot. Yeah. Like 40. And that is how off how fast you need to get off there.

So, uh, can cause shedding at the beginning. Mm-hmm. Because it makes the hair cycle go faster. Yeah. So the little hair that was about to fall will fall, but a new one is coming. Mm-hmm. So have no fear. And yes, today all the treatments we have for hair loss are only effective during treatment. Okay. So it's very common for people to come in and say, I stop minoxidil and all my hair fall off.

Dr. Brighten: Mm-hmm. 

Dr. Cherem: And I always have to say, well. It's not that all your [01:28:00] hair fell off, it's that all the hair that was maintained thanks to the monoxide oil over the last 10 years when it stopped having the stimulus of the mono oil had. Didn't have enough oxygen to continue growing. 

Dr. Brighten: Mm-hmm. Okay. So you can expect it to fall out, but you can always get back on it after you're done breastfeeding, but you have a baby in the meantime.

Also, I think like some, I think when you're a new mom, at least it's true for me. Like when I've got a newborn, my hair is up in a bun and I'm not even paying attention anyways. And then it's like a hat and like, it's like I've got spit up everywhere right now. So this has been an excellent conversation.

We have covered so much. I think there's something for everybody in today's episode. Is there anything you wanna leave listeners with that you wish that everybody knew about their skin? 

Dr. Cherem: So we are very fortunate to live in an age where true skin rejuvenation is possible. 

Dr. Brighten: Mm-hmm. 

Dr. Cherem: We have the [01:29:00] science, we have the technology, and we understand how to use all of these devices to rejuvenate the skin.

And it's not about chasing. Youth is about 

 

Dr. Brighten: being healthy, so well said. Well, thank you so very much. Thank you for having me. I appreciate you having Yes. I'm like, we should do this again. I had such a good time. Me too. Thank you for your time. I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.