I am thrilled to connect with my friend and colleague, Dr. Tony Youn today.
Dr. Youn is a nationally recognized board-certified plastic surgeon and the author of many best-selling books. He has a massive social media presence and hosts the widely acclaimed podcast The Holistic Plastic Surgery Show.
In our conversation today, we dive into Dr. Youn’s new book, Younger for Life, and he offers valuable insights on skin health and overall well-being. We explore the aging process and address oxidative-free radical damage, chronic inflammation, autophagy, and the impact of processed foods. We also get into helpful supplements for skin support, examine the concept of greenwashing, and discuss sunscreen, exfoliation, in-office treatments, breast implant illness, and the power of lifestyle choices.
IN THIS EPISODE YOU WILL LEARN:
How to avoid aging too quickly through nutrition and lifestyle changes
How sugar and seed oils impact skin aging
The benefits of collagen supplements for healthier skin
Hormonal changes that affect the metabolism and skin health after menopause
The importance of screening the ingredients in skincare products
How chemical sunscreens differ from physical sunblocks
Using Retinol for anti-aging and skin health
Non-invasive fat reduction treatments and their potential risks
Dr. Youn discusses breast implant illness
What you need to look out for when using Botox
"There are five main causes of aging of the skin.
I believe that food takes part in all of them."
-Dr. Tony Youn
Connect with Cynthia Thurlow
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Anthony Youn
On his website
Buy a copy of Younger for Life
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with friend and colleague, Dr. Tony Youn, known as America's holistic plastic surgeon. He's a nationally recognized board-certified plastic surgeon and the author of multiple bestselling books including most recently, Younger for Life. He also hosts the popular podcast The Holistic Plastic Surgery show, and he has a massive social media presence. Today, we dove deep into his new book, Younger for Life, we discussed key roles in the aging process, oxidation, free radical damage, chronic inflammation, the role of autophagy, the impact of processed foods, key supplements that can be helpful for skin support, the role of green washing, sunscreen, exfoliation, in-office treatments, breast implant illness, and the role of lifestyle. I know you will enjoy this conversation as much as I did recording it.
[00:01:29] Welcome, Dr. Youn. I've been so looking forward to our conversation and I thought we could talk about the aging process. I know that in plastic surgery, there's a lot of focus on aesthetics, but what are some of the less common reasons why we will age more quickly or more slowly, some of its genetics, some of its environment, but in your clinical experience, what are some of the big, less known things that can be impactful?
Dr. Tony Youn: [00:01:54] Yeah. Thank you so much for having me on, Cynthia. Well, we do believe that about 80% of our aging is environmental and 20% of it is genetic. Now, there is a concept of epigenetics where it's this belief that really how your genes express themselves will depend on what you do, your activity, what you eat, your lifestyle, and all of that. And so much of aging definitely is within our control. As far as some of these outside sources of aging, it's funny, I went through traditional medical training just like you did. I went through, I got my MD, I did four years of medical school at Michigan State University. I did three years as a general surgery resident, two years as a plastic surgery resident, then I did a year fellowship, and throughout all of this kind of general medical training as a plastic surgeon, really, if you were to have asked me, “Hey, what causes our skin to age after I finished,” I would have said, “Oh, gravity and don't smoke.” [Cynthia laughs] So we were never really taught. It was really more like the interventions, like, “Oh, what can you do if you've got sagging skin? You can lift it. What if you do if you have excess skin, you can remove it. If you've got puffiness under the eyes, you can remove the fat.” But we've never really looked at that root cause of aging.
[00:03:08] And there are a lot of theories as far as why certain people age more quickly than others. What I like to do is I like to focus on, really, in general, the skin and what are the true causes of aging of the skin, and what are these causes can we actually have an impact on? And so, I would argue that there are five main causes of aging of the skin that we can technically change and impact and that is nutrient depletion, collagen degradation, chronic inflammation, free radicals or oxidation, and then the buildup of cellular waste. And so, these are kind of the things that I mainly focus on as a way to kind of explain aging and turn the clock back on aging.
Cynthia Thurlow: [00:03:49] It's interesting because I think many individuals think of it as this kind of predetermined, no matter what they do, the aging process is inevitable. But in many instances, it's our modern-day lifestyles that are contributing to a lot of the changes that we're seeing, whether it's eating a highly processed diet, eating too frequently, just exposure to toxins in our environment, our personal care products, and our food. And so, as your evolution from a traditionally trained plastic surgeon to this more holistic minded, embracing both the best of allopathic and a functional integrative approach, what was the impetus for that? Was it, over time realizing that you could help your patients from, I guess, a more comprehensive level, as opposed to just turning to surgery for options.
Dr. Tony Youn: [00:04:39] That would be nice if it was that. [Cynthia laughs] It was, unfortunately for me, a lot more traumatic and the kind of conversions. So, for many years Cynthia, I practiced as a board-certified plastic surgeon, performing a ton of surgery. And as you know, as surgeons we take pride in the operations that we do. And in general, the bigger and more complicated operations that you do, the better you feel as a surgeon. So, if you're a general surgeon, that operation that you long to do and to be successful at is the Whipple. And this is a 10-hour massive cancer operation that if you're so lucky as a resident that you can scrub into a Whipple, then you really have made it. In plastic surgery, that is probably the facelift. Patients may pick almost anybody to do a bit of LiPo on them, but, you know, if they're going to trust you with their face, that you've got to be really good. And so, for years, I gauged the success of my practice on how many facelifts I was doing and I thought that I'd hit the pinnacle of success after I was in practice, maybe about 10 years or so, where I was having patients fly in from all over the country. I had a one year waiting list.
[00:05:40] And then I had a patient who completely upended all my thinking. She was a woman in her mid-60s. She came to see me for a facelift surgery. And the surgery I performed on a Thursday was very smooth surgery, no problems at all. Prior to the operation, I had her cleared by her internist and by a cardiologist. She had a stress test. Everything looked great. I see her Friday morning in the hospital, which at the time, I was keeping them overnight, and she looked fantastic. I sent her home, had a nice weekend, and came back to the office the following Monday. And I had a note on my desk from her daughter. And the note was one sentence, “Why did my mom die?” And it absolutely floored me. I had a sick feeling in the pit of my stomach. I felt like I was going to throw up. My head got really hot and I was speechless. So, I called the patient's daughter and I asked, “What happened,” and she said, “She was doing fine.” And then Saturday afternoon, she had left her for a few hours and came back and she was dead. This was just a couple of days after my operation.
[00:06:45] So as a physician, the first thing you do is you figure out what happened. And so, I look back at it. Is there a medication thing? Did I give her a wrong medication? Was there a medication interaction? There was nothing. And going, I poured through her chart, poured through everything. Nothing that I found that was abnormal. And it turns out at her autopsy later on that she had a massive heart attack. And even though she had a negative stress test, even though she was cleared by her internist and her cardiologist, this happened. And so, for months and months, I was absolutely devastated and I considered leaving medicine altogether, I really reconsidered my practice and was I doing the right thing as a plastic surgeon? I mean, we take the Hippocratic Oath of do no harm and was I doing harm?
[00:07:27] And so, I finally-- as I hit rock bottom, I came to a realization that what I was taught about being the goal of a surgeon was wrong. My goal should not be to bring patients to the operating room. My goal should be the opposite. It should be, “How do I keep my patients out of the operating room yet still help them to look and feel amazing and feel their best and hopefully feel like they don't need to go to surgery.” And so, then I started really taking thousands of hours, years I spent studying the works of holistic health practitioners, nutritionists, alternative medicine doctors, dermatologists, and started figuring out what I call now autojuvenation. But it's a different way of looking at aging, a new way of looking at aging from a truly integrative perspective. And that's the basis of my book, Younger for Life. And it focuses on five main things. It's what you eat, when you eat, nutritional supplements, skincare, and noninvasive treatments. And I firmly believe that the vast majority of people, maybe 80%, 90% of the population, if you follow those principles, you can look and feel amazing and hopefully never feel like you have to go under the knife to get to where you want to be.
Cynthia Thurlow: [00:08:30] No, I first want to acknowledge I can just only imagine how devastating that must have been, not only for you as a clinician, but as a human being. Because what I know of you as a friend, is that you have an enormous heart, you really care about your patients and so, my heart goes out to you, because I know how devastating that must have been. But what an incredibly powerful shift in your perspective in terms of how you viewed your patients moving forward, getting them to a point where they were optimizing the lifestyle piece so that perhaps they might not feel like they need to end up on an operating room table. And for some people, that might be their choice, and there's absolutely no judgment.
[00:09:08] So, let's kind of talk about, let's start with food, what are some of the foods that you think are most beneficial for optimizing health and looking at our bodies from the inside out, so not just helping our bodies de-inflame inside, but things that will show up on our skin that can impact the aging process, accelerating it, etc.
Dr. Tony Youn: [00:09:28] Yeah. So, I mentioned that there are these five main causes of aging of the skin and I do believe that food really takes part in all of them. So just starting with one of them, which would be chronic inflammation, which is a huge ager of our skin. Now, I think it's important to realize that there's a difference between chronic inflammation and acute inflammation. Acute inflammation can actually be a really good thing. When you get a cut on your skin and your body sends a lot of macrophages and healing and immune cells around it, you're creating acute inflammation to heal that cut. And that's a good thing, because otherwise we wouldn't heal, we may get infection and that type of thing afterwards. When we do laser treatments, when we do chemical peels, when we do microneedling, these are all treatments that can create an acute inflammation of the skin causing the skin to actually look and be younger afterwards.
[00:10:13] It's chronic inflammation that is a problem. And the number one cause of chronic inflammation of our skin is sugar. So, sugar is the main cause, and I would argue, probably the great ager of our skin. And it ages our skin in two main pathways. The first is glycation. Sugar will actually bond to the collagen of your skin, causing the collagen to become kinked. So, 70% to 80% of our skin is made up of collagen. And collagen is that part of the skin that makes our skin feel tight, feel smooth and strong and youthful. And we lose about 1% of the thickness of collagen every year. And that's one reason why our skin feels thinner and rougher and more wrinkled as we get older. So, what sugar does is sugar will actually bond to that collagen and cause that collagen to become kinked. The way I describe the collagen in our skin, it's like the logs of a log cabin. And when we're younger, those logs are nice and tight, they're smooth, they're strong, and as we get older, those logs start to fall apart. Well, what does sugar do? Sugar comes along and it takes those logs that are falling apart and it kinks them even more causing premature aging. And those sugar collagen hybrids, those connections are called advanced glycation end products, appropriately called AGEs. So those are prematurely aging.
[00:11:29] And then the second way that sugar causes our skin to age prematurely by chronic inflammation is by chronic spikes of insulin. There is evidence that these chronic insulin spikes can actually cause acne and other types of inflammatory skin conditions as well. So, if I were to make one change to the diet, or remove one food from the diet, that would be truly anti-aging to your skin. It would be getting rid of unnecessary sugar.
Cynthia Thurlow: [00:11:54] Yeah. It's really interesting to me. I'm in the process of preparing for another podcast after this one. And Gary Taubes is a science writer and just reading the research on how much sugar was consumed 100 years ago versus now is unbelievable.
Dr. Tony Youn: [00:12:08] Yeah.
Cynthia Thurlow: [00:12:09] And so, with the understanding that our modern-day lifestyles or modern-day diets are really up regulating this inflammatory process that's going on in our bodies. And what I find interesting is when you add into that, the fact that it seems like it's not that when you and I were growing up, we didn't see people with pimples and acne. But I feel like more and more when I'm talking to peers, they've got more kids on Accutane, they've got more kids on oral medications to address their acne. And the diet can play such a huge role, especially in the midst of puberty. So, for individuals that are consuming a lot of sugar or just being aware, bringing awareness to their diets can be helpful. How about seed oils? I know that seed oils are hugely problematic. I think soybean oil is the number one consumed fat in the United States, which is staggering to imagine. Are seed oils particularly impactful for our skin as well?
Dr. Tony Youn: [00:13:01] Yeah. And the way that I would look at that, basically is I mentioned, okay, five main causes of aging of the skin. One of them is chronic inflammation, sugar being a big cause of that. But another one is oxidation or free radicals. Okay, so what does that mean? Well, the act of being alive, our body by being alive it has metabolic rate and metabolism and it creates, as a waste product, these molecules called free radicals. Free radicals are these molecules that can essentially damage the DNA of your cells. And free radicals are neutralized by antioxidants. So, you've heard everybody who's listening to this have probably heard the term antioxidant, but many people may not understand exactly what they are. So, antioxidants basically will neutralize these free radicals before they damage the DNA of your cells.
[00:13:43] And so our body has kind of a homeostasis between the antioxidants and free radicals. So, if you live a lifestyle like Cynthia Thurlow, then you may have your antioxidants and your free radicals in pretty good homeostasis, because you're living a healthy lifestyle. You're not smoking, you're not eating horribly unhealthy foods, you're exercising and all of that. But when there are too many free radicals and your body does not make enough antioxidants to essentially fend them off or to neutralize them, then you can get in a state that we call oxidative stress. And that's when the free radicals are so numerous that they will then attack your cells, and they can actually then damage your DNA. And that can cause premature aging. And there's even belief that eventually things like cancer can even result from that type of thing.
[00:14:27] So what are the foods that contain a ton of free radicals? Well, they are ultra-processed foods and foods that are deep fried. And what do people deep fry their food in? oftentimes, seed oils. And so, this is really a direct correlation between just what you mentioned, seed oils and these ultra processed foods, like, you go to the store and you've got the package of muffins or cakes or cookies that have been premade and prepackaged, they look nothing like their original plant that they came from. Those are going to be filled with free radicals and once again then contributing to that oxidative stress and the premature aging of your tissues. So yes, definitely, if I were to say the number one cause of aging of the skin would be sugar. And there was actually a survey that found that 20% of the calories in the standard American diet comes from sugar, sweetened drinks, soda pops, energy drinks, fruit juices. So definitely reducing sugar would be the number one thing.
[00:15:19] The number two thing would be reducing or eliminating ultra-processed foods. And as you've talked about on the show, ultra-processed foods, very easy to figure out what an ultra-processed food is. If it's a food that does not look anything like the plant that it came from, then that's ultra-processed. And so, a Twinkie is ultra processed. It may be vegan, but it's ultra processed, because God knows what plant these Twinkies came from. They came from some type of plant, but I have no idea what they came from. Whereas let's say, one of my favorite dishes that my mom makes when I go visit her bibimbap, it's like, it's rice, it's vegetables, you have some meat, like you know exactly what it's from. That's kind of that big difference.
Cynthia Thurlow: [00:15:59] I think it's so important because for anyone that's listening, it may seem a little less tangible, like oxidative stress, what does that mean? Inflammation, what does that mean? But helping people understand that these things, when they are not properly supported/balanced can really accelerate this process. One thing that I found really interesting is in the book, you talk about other things that can upregulate this oxidative stress and things like overexercising, how many women that are listening, that are in perimenopause and menopause and it's all finding a little bit of that hormetic stress, so beneficial stress in the right amount. And many people take it to an extreme. They think if I'm weight loss resistant, I need to exercise harder, longer, more intensely. But understanding it's all a fine balance. It's one of those things, unfortunately, that I feel like for women that are more susceptible to this at this age range, the things that used to work 20, 30 years ago are no longer working efficiently. So, they'll really lean into things like fasting, overexercising, restricting more food intake when it's all about finding balance for each one of our bodies.
Dr. Tony Youn: [00:17:06] Yeah, completely. And I think that people don't make it easy on women as they get older, especially after menopause. I mean, how many times do you see people online? And I see this all the time because I'll post something about, hey, it's difficult. 90% of my patients are women. I have so many women come to see me and say, “After I had kids, I've got 20 pounds I just cannot get rid of.” And you have people online, they're typically men who will start saying, calories in, calories out. You obviously are eating too much or you're not being active. And it's like people don't understand how hormones can affect the metabolism and that you get people who are doing the exact same thing that they did 10 years ago and it's not working. And it's not because they're being weak. It's not because they're snacking at night or something like that. It's just that their body is very different.
[00:17:55] And so just like you said, things have to change as you get older, especially after menopause. Just for example, with the skin, we lose about 1% of the thickness of collagen every year. But after menopause, women tend to lose about 2% of the thickness of their collagen every year. That's why some women, you see, they're 60, they're 70, they're 80, and their skin is tissue paper thin. So, there are these changes that people go through that unfortunately, a lot of laypeople don't understand these changes that women go through. And they just assume that it is as simple as calories in and calories out and you're eating too much or you're not exercising enough. There's so much more to it than that.
Cynthia Thurlow: [00:18:31] Yeah. Unfortunately, our bodies don't work like a recipe. This is the input, this is the output, and this is how it should work very efficiently. I know that collagen is a very popular topic, supplemental collagen. Can we talk a little bit about how we navigate purchasing collagen? I know you mentioned in the book there're multiple types which [crosstalk] what's most effective for helping support our skin. And let me just dovetail this and say if you're a menopausal or perimenopausal female, supplemental support from collagen can be helpful, so can things like hormone replacement therapy, if that's appropriate for you that may also very much bolster things. But a lot of questions came in around pro-collagen foods and collagen peptides in terms of supplementation that could beneficial for improving skin turgor and appearance.
Dr. Tony Youn: [00:19:22] Yeah, so that's a huge question. There are traditional doctors who are against collagen supplements. I have posted about it on social media and then you get comments of like, “Well, my family doctor says it doesn't work, so I'm not going to take it.” So, the issue with collagen [Cynthia chuckles] supplements really is that there are people who don't believe in them and they'll tell you that the research is not clear and they are wrong. The research is actually very clear and there's a lot of research around collagen supplements and the health of the skin. So, for example, there was a 2021 meta-analysis of over 1100 patients. They took a hydrolyzed collagen supplement for 90 days and found a statistically significant improvement in wrinkles, hydration, and skin elasticity.
[00:20:03] There have been studies performed, prospective, randomized placebo-controlled clinical trials where they take a person, they put them on hydrolyzed collagen supplements and then they actually will biopsy their skin a couple of months later and find an increase in the amount of collagen in their skin. There are direct correlations in the research. So, when you hear somebody saying that collagen supplements don't work, there's no research to support it. The question is, have you actually done that research yourself? Because one thing I've learned as a traditional physician trained and plastic surgeon is that we get told a lot of things in our training that the research says this and we will even parrot that to our medical students and our residents.
[00:20:45] And the fact is that most of us have not actually done a MEDLINE search and have looked at those studies, at least looked at those abstracts to see whether there actually is a research to support that. This is something that we talk about in breast implant illness and I'm happy to chat about that later, but that's exactly like what it is. So, collagen supplements, tons of research to support that. They do help the skin. But the key with collagen supplements is you can't just take any collagen supplement. Really what you want to find is that it contains hydrolyzed collagen peptides. Now the reason why that's important is that collagen itself is a massive protein. It's a large protein. And the reason why, let's say, collagen creams don't do anything is because you put that collagen protein on the surface of your skin and it's not going to penetrate through your stratum corneum, our skin is a barrier. It doesn't want things to penetrate it, like bacteria and viruses and things like that. And so, it will keep that protein out.
[00:21:38] So collagen creams are a waste of your money other than just moisturizing your skin. Collagen supplements, however, get around that by taking that large protein and breaking it down into individual amino acids or peptides, which are groups of a small number of amino acids. That way you reduce the size of that collagen protein allowing your body to actually absorb it through your gut. That's the key. So, a high-quality collagen supplement is going to contain hydrolyzed collagen peptides to make it more bioavailable so that you can absorb it. And then there are different types of collagens. I think this is super important. There are technically five types of collagen. Type I is hair, skin, nails, and bones. Okay, so if you want to take collagen for any of those hair, skin, nails and bones, you want to make sure there's type I collagen in there. Type II is in the joints. So, if you've got joint issues and you're taking a type I collagen, it may help because it'll help your bones, but it's technically not going to help with the cartilage. Type III is muscle. Type IV and V aren't as applicable to this discussion. Type IV is in the kidneys. Type V is in the placenta. But you want to know that there's those three types, because if you do get collagen, you want to find out what type of collagen it is.
Cynthia Thurlow: [00:22:48] Yeah. It's really helpful because I feel like one thing that I have been diligent about doing is taking collagen on a daily basis. Actually, type I because I have noticed a discernible difference, in particular my hair and my nails, more so than my skin. And I think it's helpful for people to do their due diligence. If they're choosing to consume collagen, make sure that you're looking for these particular characteristics based on what you need. If you have joint pain, then type II is what you're looking for. If you're looking for more hair, skin and nail benefits, then type I is definitely where it's at. When we talk about skincare and this is a hot topic. I got more questions about this than anything else. When we're talking about skincare. I think most people still don't realize that there's very little regulation from the government in terms of ingredients that are utilized in skincare products. And we ourselves as consumers have to be very diligent about screening out certain types of ingredients because they have the ability to worsen the aging process, but also can contribute to endocrine-mimicking chemicals. They can be 1000 times more potent in some instances than the actual hormone that they're disrupting. And so, when you're talking to your patients about navigating good skincare products, what are some of the key things you like to share with them?
Dr. Tony Youn: [00:24:08] Well, it's interesting because my story is that I started out in a traditional practice and there are certain skincare companies that will market to plastic surgeons and dermatologists. And so, if you go to a plastic surgeon's office and let's say you go to 12 different plastic surgeon’s offices, you're going to see some of the same skincare brands over and over and over again because they market to us. And for many years, Cynthia, I was selling thousands of dollars’ worth of skincare products out of my office. And we would take people who come in and they, let's say, lived in a rural area, Michigan, they had a ton of sun damage. And these products were very effective in reversing the sun damage, clearing their skin, smoothing it out. But as we sold thousands and thousands of dollars of these products and we saw some really nice changes with it, I had a secret that I would not tell anybody for years.
[00:24:53] And it was that I could not tolerate those products myself. So, I would put them on my skin and my skin would break out in hives, I get itchy, I get rashes, I get flaky and I could not use them. And so, for many years, I used soap, a gentle cleanser, and a very, very mild moisturizer and that was it. Well, fast forward, all this happens and I start looking into alternative medicine. I started reading about, Geez, natural skincare and I started trying skincare brands that were, “natural and organic.” And I was able to apply them on my skin and actually feel good. And I'd put them on, I'm like, “Wow, it actually feels good on my skin. I'm not reacting.” But the problem with those products I found is that they don't contain anything truly active to actually reverse aging. So, I ended up, as you know, I started working on my own brand of skincare products where the idea is to combine both the natural and the organic with the actual scientifically proven compounds like vitamin C, like kojic acid, like retinol. And I do believe that there is a happy medium in there.
[00:25:54] Now, there are definitely things that you want to avoid in your skincare products. The FDA has banned 11, I think, chemicals for use here in the United States, whereas in the EU it's hundreds, if not thousands. And so there are chemicals that are considered potential hormone disruptors, potential precancerous type of chemicals if you have it too much. And then there's just the whole benign sounding fragrance, which for a lot of people can be really irritating to your skin, and you don't even know what is in the fragrance because it's usually an industry secret. So, what I encourage you to do, now, the term Clean Beauty is one that is kind of like organic. Some people really attack it because it doesn't technically mean anything, but it is used all the time and it is used in general for products that are, “cleaner.” So that's something that I would encourage you to try to look for, is ideally products that contain natural and organic ingredients, but also ones that tout, ideally Clean Beauty, even though like the term organic, it's kind of signifying something, but it's not accurate all the time.
Cynthia Thurlow: [00:26:52] Yeah. I think the concept of greenwashing is what you're probably referring to, is that we see those words and we're like, “Oh, it must be safe, therefore it's going to be effective.” What are your thoughts on sunscreen? Because there are people, for example, in the carnivore community, that will say if you eat enough meat and your vitamin D is high enough, you don't need to worry about UVA, UVB rays. And yet I'll be the first person to say, I eat a lot of meat, and I still am very conscientious about sunscreen because I will burn. What are your thoughts about sunscreen and managing photo aging?
Dr. Tony Youn: [00:27:26] Yeah. So as a plastic surgeon who's done a lot of reconstructive surgery, I will tell you do not want to have a skin cancer of your face, period. I've had patients who came in to see me with a little dot on their nose. They go to a dermatologist, they get Mohs surgery, and half their nostril is gone afterwards. Like, no joke, half the nostril. I've seen patients who've had a skin cancer on their eyelid. The only way to get rid of skin cancer is you cut it out. And to lose a good portion of your eyelid, it can be so devastating. One of my favorite actors, I think he is the most talented person in Hollywood, Hugh Jackman, has had multiple skin cancers removed from his face. And I fear for him one of these days that skin cancer can show up in the worst place eyelid, nose, lip. And he's going to not look the same. So, I hear what you're saying. I hear what a lot of our colleagues will say, “Hey, I like to get sunlight in the morning.” By all means, do that. The sun is low. You're not getting high levels of UV radiation. So do what you need to get your circadian rhythms going. Do what you need to feel good to start out the day. But when it really comes down to it, you need to avoid getting skin cancer, especially of your face.
[00:28:30] So what are the types of sunscreens that are available? There are two general types. There's sunscreen and sun block, which is chemical sunscreens or physical sunblock’s. Physical sunblock’s sit on the surface of your skin, and they essentially block the rays, the UV rays, from getting into your skin. Traditionally, these are those pasty substances that lifeguards wear on their nose. Now, they're micronized, and so they're not quite as pasty and not quite as thick. But still, if you're a person of color, you may find that if you apply a physical sunblock on your face or on your body, it can discolor it a bit and make it look whiter or almost ashy looking. So, the other group are chemical sunscreens. These need to be absorbed through the skin. And when the sun then hits your skin, it creates a chemical reaction as a way to basically neutralize that UV radiation. But in order for it to do that, it has to be absorbed through your skin. And there are reports and studies that show that it can't even get into your bloodstream.
[00:29:27] The benefit of a chemical-based sunscreen is that they can be made fairly light on your skin. And so, if you want to wear something every day, you don't want it to discolor your skin, then a chemical-based sunscreen is usually going to be much easier to use than a physical sunblock. But there are two of them that I would encourage you to try to avoid oxybenzone and octinoxate. These are chemical sunscreen ingredients that are used in a ton of sunscreens. And there's a belief that they may be potential hormone disruptors and they may even disrupt coral reefs. And so, if you go to certain beach communities, you may not be able to use that anyway. There are some what I believe to be safe sunscreens that are chemical. Those would be avobenzone and Mexoryl XL. Those two I think you can buy them and they usually can be fairly light. They're definitely effective. That's what I would recommend. And so, in general, what I recommend is, yes, if you're going to be out in the sun, definitely I'd encourage you wear sunscreen, do not get burned, that's only going to increase your risk of skin cancer. What do you do for your children? Well, children don't care if they look white and pasty in general, if you're at the beach, use a physical sunblock on them. And God forbid, don't spray them. Because you spray that stuff, they start breathing in the stuff into their lungs. You don't want to do that.
[00:30:35] If you've got a sunscreen spray, spray in your hand and apply it to your child or use that mineral based, that physical sunblock, because once again, they don't care. My kids, when they're a young and they go to the beach, we paste them all up, they don't care, they're having fun. If you are a person of color and you want to wear sunscreen, then probably you want to look at those chemical sunscreens, avobenzone and Mexoryl XL for your body ideally, I try to encourage you to use a physical based sunblock, but once again, use your judgment. If you just don't want to be discolored, then by all means do what works for you. If you are Caucasian, then I try to encourage you to go more with that physical sunblock if you can tolerate that because once again, you just have less of the chemicals going into your body overall.
Cynthia Thurlow: [00:31:11] Yeah. It's such an important point, just being conscientious about the chemicals that we're exposed to. And thank you for validating the fact that there is value because you see the extremes. You see people that come in that have had Mohs. I have a family member that sadly lost her nose, had to be resected from her forehead, and she will be the first person to say she had to just accept that her nose would never look normal ever again because she had so much skin removed during her Mohs procedure. Now, one of the things that starts happening to us as we get older, one of many things, is that our skin cells don't turn over as quickly as they once did. So, the role of exfoliation can be very, very important. Can we talk a little bit about options here. There were a lot of questions that came in about retinoids, topical retinoids, things we need to be looking for. Let's perhaps start from the most mild things, options that are available all the way up to prescriptive options.
Dr. Tony Youn: [00:32:04] Yeah. So, when you look at exfoliation, I do separate exfoliation from antiaging cream, okay. So, what is exfoliation? Exfoliation is getting rid of the upper layer of essentially dead skin cells. And the benefit of exfoliation, number one, your skin is going to feel and look a bit smoother afterwards. But number two, actually exfoliating that upper layer of skin will actually send a cellular signal to the deeper layers of skin cells to cause them to turn over more quickly. Now, when we're younger, our skin cells turn over every about six to eight weeks or so. But as we get older, that process slows down. It starts taking 10 weeks, 12 weeks and even longer for our skin to turn over. So, what happens is our skin starts building up on the surface and you start feeling rougher in texture, you start getting more wrinkled and dry your skin. So, getting the skin turning over by regular exfoliation can help to get that process going back up again.
[00:32:55] And so, what I usually recommend for exfoliating to do once a week if you've got sensitive skin, twice a week if you've got “normal skin.” And there are technically two ways to ideally exfoliate your skin. You can use a gentle exfoliating scrub and typically they have little particles that help to kind of gently exfoliate your skin. There are some doctors and dermatologists who are not quite as fond of that because they don't like the physical aspect of a scrub. But it's been done for centuries. And so, it's something, I think, that for the right person, can definitely work well for them. The other option is to use, let's say, an alpha hydroxy or a glycolic acid type of a peel. These are available through-- most skincare brands have them where you can use that once or twice a week, and that can help chemically, basically, to exfoliate your skin. So doing that will definitely help to smooth the skin out. I think it's super imperative to keeping your skin looking young, but I do think that's a little bit different than, let's say, the retinoids and the retinol. Okay, so that's a bit different. So, the way I look at those, those are antiaging ingredients. And every night, ideally, you want to apply some type of antiaging ingredient to your skin.
[00:33:58] The number one most popular and really the most tested is a retinoid. Retinoids are derivatives of vitamin A. They come in prescription strength, which is Retin-A or tretinoin, and non-prescription strength, which is retinol. Most big skincare companies have a retinol available and it's usually not that expensive. The benefit of using a retinoid is it can cause the cells to turn over more quickly. So, you do get exfoliation from them. You can smooth out fine lines, you can thicken the dermis or the collagen of the skin, and you can even reverse early pre-skin cancers. And so, anybody who I know of, any of my patients who've had a history of skin cancer, I encourage them to use Retin-A or at least a retinol on their skin because you never know what it reverses because they just don't show up. But you know you're doing something to actively prevent new skin cancer from forming. And so, if I were to pick one antiaging cream that's usually the one we start out with is a retinol every night.
Cynthia Thurlow: [00:34:52] And what is a typical starting dose? So if someone is listening and is interested in utilizing this product, that they see their dermatologist or they see their plastic surgeon, what is the typical starting dose for someone who has, I'm going to put in air quotes, “normal skin,” like someone who's not prone to a lot of dryness, like I know a lot of middle-aged women, they do deal with quite a bit of dryness, but let's say, “someone who has normal skin,” I'm going to put that in air quotes.
Dr. Tony Youn: [00:35:18] So it really depends. So, if you're looking at prescription strength Retin-A, it comes in three strengths. There is 0.1%, which is the strongest, 0.5% and then 0:25% if you are starting out usually the 0.5% for the prescription is kind of the standard. And people would start by using that maybe once every two to three nights and then make sure you use it for at least a couple of weeks and that you're tolerating it before you increase the amount. And there are some people, the way you would want to look at is just how hardy is your skin? If you've got real thick and really oily skin, then there are some people who will do 0.1% every night and get very little reaction from that. Myself, I did that once when I was actually a resident. I had my family doctor prescribe that to me, 0.1% she goes, “Oh, use it every night.” I used every night and it helps with my acne. So, I'm like, “Oh, sure.” I was a resident. I didn't know anything about skincare and I started applying it every night and at two weeks later, my face was on fire. It was literally bright red. I was flaking and peeling everywhere because it was way too aggressive for my skin.
[00:36:16] So, Retinol is over the counter strength and it comes in various percentages. But the problem with Retinol is that the formulation in some ways is more important than the percentage. So, for example, we have a retinol. One of our top products is retinol moisturizer. It's 2.5% Retinol. But we also sell a skincare line in my office called ZO Skin Health. This is a dermatologist named after Zein Obagi and they're well known for being quite aggressive products that really reverse aging but they're aggressive, and they have a Retinol that's 0.1%. Their 1% retinol, it's more aggressive than my 2.5% because mine's made with natural and organic ingredients. It's got a bunch of moisturizers in it. So, it really is, when you're looking at Retinol, percentage doesn't seem to matter as much as the actual formulation. And if you're not sure and you're going to try a new one, my recommendation is don't go for the prescription just yet, start with an over-the-counter Retinol, start by applying it maybe every other night, do that for two weeks, if you're not having any reaction to it, increase that to every night. You don't want to do it more than that, because actually putting it on the morning doesn't do you any good because the sun will actually deactivate it. If after using it once a night and you're tolerating it well and you want to take something stronger, then you want to see a dermatologist or plastic surgeon and maybe get started on prescription strength Retin-A.
Cynthia Thurlow: [00:37:31] It's so exciting. I feel like there're so many things that people can do from the confines of their home that they can tweak and they can play around with which is super exciting. Okay, so the bulk of our questions came in around in-office treatments, starting with lasers. Let's talk about, there're so many lasers that are out there now that it's hard navigating, figuring out, do you need to remove pigment in your skin? Do you need to use the antiaging benefits. When you're working with someone and you're helping them with the milieu of options that are available. When we're talking about lasers, if someone's looking to upgrade from topical choices and they're doing the nutrition, they're getting good sleep, they're managing their stress, and they want to start with an entry level laser, something that's not going to have a lot of downtime. What are you typically thinking of in terms of choices for them?
Dr. Tony Youn: [00:38:25] So if you're doing it at home, then I encourage you to consider red light therapy. I think that's a great treatment for at home. I think bang for your buck, red light therapy, you can't do anything better than that. But if you're coming to the office, you want something more aggressive, then usually a good first line treatment for an actual light-based device is IPL. IPL stands for intense pulse light and it is a great treatment for dark spots. If you've got age spots, sun spots, liver spots, all different names for the same thing, basically it's clumps of melanin in our skin caused by UV radiation. And IPL is a great way to help to target that pigment. It actually will destroy the pigment and then usually within about a week or so, those spots start to slough off. Good thing about IPL is essentially, when you're looking for bang for your buck, a lot of the cost of cosmetic treatments in the office is based off of the cost of the device. So, you can get a fancy, let's say, tattoo-removing picosecond laser that can cost over $200,000. You can get an IPL device that costs about $100,000 or you can get, let's say, a microneedling handpiece that will cost about $4,000 to $5,000. And so the cost of the device will be passed off on to you, the patient. And so, if you've got a device, like I said, like a fancy laser, that's going to be more expensive.
[00:39:39] Now, the interesting thing is you can get sometimes similar results by using something a bit lower tech. So, for example, one of the really popular lasers out there is a fractional laser. This is a laser that burns a fraction of the skin at a time. Another way to describe it is a pixelated laser, where essentially what you're doing is you're burning tiny columns of skin every time it zaps you. That is made to essentially exfoliate your skin a bit and to create some tightening of the skin. You can potentially get a very similar result with a chemical peel, a moderate depth chemical peel, like a TCA peel, that will help to exfoliate the upper layer of skin and the acid of that peel can help create some tightening of the skin underneath it. But the difference in cost is huge because how much does that fractional laser cost? Probably $150,000 to $200,000. How much does a TCA peel cost? I mean, really, the supplies and everything, maybe 20 bucks. And so, you're going to see a very big difference.
[00:40:30] And that's where I think it's really important. If you're having a cosmetic treatment done, you want to do your research and you want to really make sure that the person you're talking to has your best interests in mind. Unfortunately, a lot of cosmetic centers, their aestheticians are paid all on commission. And they are bonused the more money you spend. One of the things that I've always been proud of in my office is that I've got two aestheticians, I've got nurse injectors, nobody gets paid commission. And so, for them, they get paid the same whether you buy a $30 cream or you sign up for $2,000 in laser treatments. Because really, I want to make sure that they're giving you honest recommendations and not feeling pushed that, “Geez, I've got to pay my rent and, oh, maybe she's going to sign up for these laser treatments.” But most places, it's all based off commission. So just do your homework and make sure that whatever that you sign up for, that it makes less sense and that you're familiar with that treatment.
Cynthia Thurlow: [00:41:20] I think that's a really important point. The integrity of the individual that you're working with. If they're working on a salary or per hourly rate, that's going to be very different than someone who's heavily incentivized to encourage their patients and clients to spend more money. Now, when we're talking about other tools in the toolbox, I think something that's really exciting is microneedling. Microneedling is something that my 16-year-old who has had some acne scarring, which thankfully, the acne is all gone on a dairy-free diet and he's also 16. The amount of collagen and elastin that his body is making is instrumentally higher than my own. And it's been amazing just with two sessions how significant that has been. Where do things like microneedling and dermaplaning, which is just removing kind of vellus hair from the skin, where do those fit into a regimen when you or your team are talking to your patients.
Dr. Tony Youn: [00:42:13] I would put dermaplaning in with red light therapy. So, I think if you're looking at a DIY, if you're looking at something that's very inexpensive, but you can get an actual change from. Those are two things that I would consider doing at home. Dermaplaning essentially is taking a specialized blade and you're removing the vellus hair, which is that kind of colorless hair that can get kind of furry on the sides of our face. And also while you're doing that, you're exfoliating that upper layer of skin as well. We do that here in my office with a specialized blade as well. That costs about $100 every treatment. But you can actually do it at home using blades you can buy on Amazon for probably $10 for three of them or something. So that's, I think, a really nice thing to do at home. I mean, it's kind of like, honestly, it's a fancy way of shaving your face. [Cynthia laughs] I mean, really call it what it is.
[00:42:59] Now, that's different than microneedling. And I mentioned earlier that treatments for the skin to tighten the skin are made to essentially create an acute injury or acute inflammation. And like I said earlier, the collagen of the skin are like the logs of a log cabin. And as we get older, those logs start to fall apart, they start to fray. And what can happen then is if you create a controlled trauma to that collagen, it gets damaged. And as it heals, it heals in a tighter fashion. It really is like the concept of hormesis, but for your skin. So, lasers will do that by creating heat in the deep skin, using light energy that damages the skin, and the skin tightens up afterwards. Chemical peels do that by using an acid that once again will remove that upper layer of skin and then impact the deeper layer of the skin by creating a chemical reaction to cause it’s collagen to tighten. Microneedling does that by making a tiny poke with the needle into the skin that creates acute trauma. And that acute trauma, the collagen heals by having it be tighter.
[00:43:56] I would say there are three levels of microneedling to consider. If you're on a very strict budget and you want to go most budget minded, then just getting a general microneedling treatment in an office is a very nice treatment that may cost a couple hundred dollars at the most. Okay, because once again, the cost of the overhead of the product is going to be passed off on to you. And microneedling device costs maybe $400 and the tip costs maybe $25. Okay, so you're not spending a ton of money by performing that treatment. You take that to the next level and you add PRP or platelet-rich plasma. This is where you draw blood from yourself. You don't have to do it. The nurse will do it for you. [laughs] And then you take that blood, you spin it down, you remove the platelets, which are chocked full of growth factors. And then once you make those microneedling pokes in the skin, those little pokes, those tiny holes in the skin, act as channels. And so, if you apply the PRP on the surface of the skin afterwards, that PRP is going to seep into those tiny holes and essentially work their magic or de-age your skin from the inside out. And that's using your body's own regenerative abilities to essentially rejuvenate itself, it's classic autojuvenation.
[00:45:02] So, what is the third way you can do it? Well, the third way is called Morpheus8. Morpheus8 is radio frequency microneedling where that needle goes into your skin, but it's a very specialized needle in that it is insulated all the way up to the tip and the tip emits radio frequency energy or heat. And so, you get the benefit of the trauma of the needle, but that heat will cause the skin, the collagen, to become damaged and it will denature. And as it heals, it will heal in an even tighter fashion than it would without that heat. You want to take that even to the next level, and you do Morpheus8, and then you apply PRP onto the surface. And now you are hitting the aging from many different ways. You can't really get a lot more natural than that because essentially, you're using your body's own natural rejuvenative abilities to rejuvenate itself. You're not using chemicals and stuff like that. It literally is using your body's desire and its want to heal to actually look and feel younger and have smoother skin.
Cynthia Thurlow: [00:45:58] I love that. One of the things that I was asked about Morpheus8 is there any truth to the fact that depending on the setting, that people can lose fat where it's being directed. So obviously, if it's on your neck, some people would probably prefer to lose a little bit of fat underneath their chin in particular, but on your face if the right settings are not being applied, because I would imagine in the hands of a very capable provider with training that's not the issue. But I think that there are a lot of centers that are opening up that probably don't have the same oversight where you just have to be careful and conscientious.
Dr. Tony Youn: [00:46:35] So this has been a concern for many years. Back in 2006, I wrote a letter to our White Journal, The Plastic and Reconstructive Surgery, about this issue with a different treatment called Thermage and they published it. And essentially, Thermage is a radio frequency device that basically bypassed the skin to heat the deep skin using radio frequency energy. And I had a couple of patients that I saw where they felt that their tissues were actually thinner afterwards and that they had lost fat. And I actually did a facelift one of them, and I lifted the skin, and I could see areas of scar tissue. And she had never had surgery before. And so, it made sense that this treatment was going deeper than the skin, deep heating and overheating the underlying fat and causing that fat to essentially die. So, theoretically that is something that's possible.
[00:47:20] Now, interesting with Thermage, this was when they had different settings, they changed them, and supposedly that didn't happen again. And after I published this letter, I actually got a threatening letter from the company, a cease-and-desist letter, which was like, I literally wrote a letter to our scientific journal about this and they sent me a cease-and-desist letter. Now it's in a different company, so I'm not upset about that anymore, but anyways. [Cynthia laughs] So there are treatments now where, yes, you do have to be concerned, because, yes, what we want to do is we want to heat that deep skin to create that tightening, to create that collagen tightening. But if you go too deep, you can theoretically heat up the fat. And we do know that fat is more fragile than the overlying skin, so it's possible that can happen.
[00:47:59] Now we have Morpheus8 treatments. I agree with you. If you do under the neck, most people wouldn't mind losing a touch of fat there anyway, [Cynthia laughs] not everybody, but some. And I do Morpheus8 under my neck probably every four months or so. But, yes, “Would I do it onto my cheeks?” I would, but I would also be very cautious and I would definitely not have them do, like, full settings or go past what would be the recommended settings for something like that.
Cynthia Thurlow: [00:48:22] Yeah. Thank you for sharing that, because that was a question that came up multiple times, and I reassured my community that I would definitely ask it. So, we move on from lasers, microneedling to things like fillers and Botox. And again, this is a very personal choice. I've been very open about the things that I've done. I've done a little bit of filler. I do Botox occasionally to kind of lift up my eyebrows. Let's talk about the things that we want to be looking for if we're choosing to go that direction. And obviously, we're working up stage wise from elementary school all the way up to college. So, we're not yet in the surgical realm, but we're moving our way up to more invasive options.
Dr. Tony Youn: [00:49:02] So Botox is probably the most popular cosmetic treatment in the history of the world. Here in the United States at least five to probably seven million people get Botox every year. And the way Botox works is it's basically a neurotoxin. So, if I were to inject a small amount of Botox into Cynthia Thurlow, you would die within minutes by botulism, okay. But if were to inject the most minuscule amount of Botox into one of those wrinkles of your forehead or one of the muscles of your forehead that create wrinkles, then we can cause the nerve transmission from the nerve to that muscle to be blocked for about three to four months. And so, any wrinkles being caused by that muscle will smooth out. So, there are three main areas that we inject Botox, in general, in the face and that is the frown lines between the eyebrows, the crow's feet, and the horizontal forehead lines. So, what we're doing is we're essentially injecting it into certain muscles that will create wrinkles when those muscles flex and it causes those muscles to no longer be able to flex anymore. And so those areas will then smooth out and you can even get atrophy of those muscles as well.
[00:50:06] One place we inject it are the masseter muscles of the jawline. So, we have a large muscle on the side of our jaw that allows us to grit our teeth and to chew. And some people, especially if they're, like, chewing gum a lot or if they grind their teeth a lot at night, that muscle can get overgrown. And by injecting Botox into it, you can eventually cause it to atrophy or get smaller. So, Botox works for about three to four months. There's a newer one called DAXXIFY that has upwards of a six-month longevity, which is quite exciting. So how dangerous is it? Well, you don't want to do anything like black market Botox. You want to make sure you have it done by somebody who's a good provider. And that it's actually Botox that is made here in the United States that is sold by the actual company because I get ads all the time from overseas offering me bargain basement cheap Botox. And I don't even know what's in this stuff, but we get faxes, I get emails. All these companies overseas selling what they say is real Botox, but God knows if it is.
[00:51:00] And there was even a medical practice out, I think, in New Jersey many years ago that was raided because they were using counterfeit like Botox from overseas. So how dangerous is it? Well, it's super effective definitely in smoothing those lines. We in my practice, I've got five injectors and we inject Botox every day of the week. And I would estimate on the low side, we've probably treated at least 20,000 people with Botox over the last 20 years on the low side, it's probably quite a bit more than that. And I've had maybe two people with very temporary droopiness of the upper eyelid when the Botox migrated into the upper eyelid mechanism. And that's it, I've not had any other type other than little bruising and stuff like that. Never a major complication from Botox.
[00:51:42] Now, if you go down the rabbit hole of Botox and systemic toxicity, there are some Facebook groups with some patients who believe that they have been injured by Botox. They may have neurologic issues and things like that. But on the whole, it's not like, let's say breast implant illness. There isn't huge numbers of people who appear to have, like, there's some real thing going on. Now, there was a study I need to let you know of, though, a rat study where they injected Botox into the muscles, the facial muscles of rats and then they actually sampled their cerebral spinal fluid afterwards and did find some of the botulinum toxin in the cerebrospinal fluid, although didn't find necessarily anything that impacted the rat other than they found it there. So, it's been around a really long time now, probably 30 years it's been used clinically. I've not had any issue with that. I've not heard hardly anything other than a handful of these types of really rare systemic issues. And I don't even know, it's possible that may not even have to do the Botox. It could be potentially coincidental.
Cynthia Thurlow: [00:52:38] Yeah. It's really interesting because this seems like it's a hotbed topic for people. Many people are comfortable with certain things up to a point. I have friends who've used Botox to help with migraines. I've had friends that have used Botox to help therapeutically with TMJ issues. Now, a couple of questions about fillers, a lot of it related to how do you select the right injector? How do you find the person that is going to be able to provide the best results so that no one knows you've had filler placed? Because I think all of us are aware of the extremes, we see people on social media. For anyone that's listening, Dr. Youn has a prolific social media presence and he's always incredibly kind when he's talking about some extremes that we see. But we all know individuals that have gone a little bit overboard with fillers. How do we go about finding the right practitioner, working with someone that's knowledgeable and is able to inject in a way that is natural and not caricatured?
Dr. Tony Youn: [00:53:39] Yeah. So as a holistic plastic surgeon, the first thing I always think about, and just as a surgeon, what's always on my mind is, what's the worst thing that can happen? So, for Botox, honestly, what's the worst thing that can happen other than getting black market-type crazy stuff, is that you can get a droopy eyelid from what we can tell. For filler, what's the worst thing that can happen is you could have an accidental intravascular injection of filler, where the filler is injected into an artery. The tissue supplied by that artery, if enough filler is injected into that artery, can literally die. Like, they can turn black and die and you lose them. So, there have been people who've lost parts of their nose, who've lost parts of their lip. There have been people who've gone blind from injections of filler. So, the worst-case scenario for filler is really, really bad. So how do you prevent that? That's the first thing you want to consider.
[00:54:23] Number one, you want to use a hyaluronic acid-based filler, an HA filler. There are two main brands of HA fillers that I recommend. It would be Restylane or Juvéderm. And then there's another one called Teoxane, which I don't use, but supposedly is really good too, but technically Restylane, Juvéderm more [unintelligible 00:54:38] I guess Teoxane. The reason why an HA filler is important is because it's the only type of filler that is reversible. There is an enzyme called hyaluronidase that we can inject into the area of the filler and it will cause that filler to melt away some of it immediately. So, if you get an intravascular injection and it's an HA filler, we can flood that area with hyaluronidase and hopefully enough of that filler dissolves away and that occlusion essentially clears up. If, let's say you've had a permanent filler injected, like silicone or a non-HA filler called calcium hydroxylapatite or some of these other ones available and you get an intravascular injection, you're basically just screwed. Like, there's nothing we can do other than put warm compresses over the area, put you in hyperbaric oxygen. These are all supporting things, but there's nothing we can actively do to reverse that filler. So go with an HA filler to hopefully prevent that.
[00:55:29] The second thing I recommend is ask your injector to use a cannula if possible. Filler can be injected with a needle or with a cannula. A cannula is basically a long, blunt-ended needle that is unlikely to get into a blood vessel. It still can. There are still instances where it does, but much less likely than a sharp needle that will just puncture whatever is in its path. So ideally, asking them to use a cannula is so important as well. And then the final thing is choosing the right injector. You want to obviously talk with them, you want to see if they do a lot of it, but I think the most important thing is you want to make sure that they're at the office of either a plastic surgeon or a dermatologist because once again, worst case scenario you get a complication. There are places like Medspas and stuff where they have a medical director that is not on site, that can be somebody who has no idea what's going on there. There are practices here in my area in Michigan where the medical director is a family doctor who basically just signs charts at the end of the day and does it to make money.
[00:56:27] And I've had patients come to see me injected by nurses at these types of places with horrifying results. And then I say, “Look, why didn't you go see the medical director?” And they go, “Well, I asked them to see the medical director,” and they said, “Well, the medical director doesn't know what to do, they just sign charts.” Like it is legal for that to happen in most states. And so, make sure you go to the office of a plastic surgeon or a dermatologist, because that way you know if the worst case happens, you've got back up in somebody who knows how to take care of that and you're not going to be going to the ER or trying to call around to see if somebody can help you.
Cynthia Thurlow: [00:57:00] Yeah. That's such a good point. And I think for all of us that have worked in healthcare, we have seen those occasional worst case scenario situations. And you definitely want to be working with a practitioner that can help support you. God forbid that happens. Now, I would be remiss if we didn't at least touch on a very hot topic. We have a colleague who just had her breast implants explanted earlier this week and she's been sharing this all-over social media. So, I'm not disclosing anything that she hasn't already disclosed. Let's talk a little bit about breast implant illness. I know it is a real thing for some individuals in your practice, is there a percentage of women that come back with symptoms? Is it fairly small? What has been your clinical experience? Because this is something I don't know a whole lot about, but I got quite a few questions about it.
Dr. Tony Youn: [00:57:47] So let's go over the history of implants and how all this came about. So back in the late 80s and early 90s, there was a huge hub of silicone breast implants and a lot of women believed that their silicone implants were causing autoimmune or systemic issues and symptoms. And so there was a class action lawsuit. Dow Chemical went bankrupt. And in 1992, the FDA issued a moratorium on silicone implants, basically not allowing them to be used other than in breast reconstruction and an FDA-approved study. So, from 1992 up to 2006 the only implants that we used were saline breast implants.
[00:58:21] Now, I did my training starting in 1998. I graduated medical school and I trained through 2004. And throughout that entire time, I was told that breast implants do not make women sick or people sick, and that if people believe they're getting sick from it's something else. It's psychosomatic. Who knows what it is, but it's not the implants. And I was told that the studies show that implants do not make people sick. So, I believe that this was dogma. This is what I was told. Like I mentioned at the beginning of this conversation. So fast forward 2006, the FDA lifts the ban on the implants allowing them to be used again. The silicone implants. And a lot of plastic surgeons took this as proof that dogma was correct. Look, the FDA lifted the ban. Silicone implants don't make people sick. And now we can use silicone again.
[00:59:05] So fast forward about another seven to eight years and websites start popping up from women who believe that their implants made them sick. They take their implants out and they seem to get better. Facebook groups start getting popular and they start getting populated with tens of thousands of women telling their stories about how they felt their implants were making them sick. They had the implants taken out and they felt better. So, amidst all of this, as a plastic surgeon, I started thinking about them. Like, “Well, I was always told that the proof is that science shows that they don't make people sick.” So, then I started thinking, “What, have I read those studies?” Or was I just told that and I thought, “You know what? I should probably actually read these individual studies.” So, I started reading the studies and I started figuring out that these studies that were performed that allowed the FDA to lift ban on implants really didn't look that closely at all these types of symptoms.
[00:59:56] In general, as surgeons, we are really good at looking at surgical complications. Hematoma, capsular contracture, which is excess scar tissue, implant displacement, ruptured implants, stuff like that. We're not good at looking at whether somebody may have an unexplained rash or thinning of the hair after this. And so those studies were not really all that great at looking at that. And then I started going to these breast implant illness websites and started looking at the studies that they were citing and I'd never heard of most of them. So, I started looking into them, and I'm like, “Well, these are actually in the literature of rheumatology and of internal medicine and things.” And so, I went public after figuring all this out and going, “Oh, my gosh, I was wrong all this time. Implants, I do believe, make people sick. Not everybody, but some.” And so, I went public with it and the backlash was pretty swift. I was one of the first plastic surgeons to be public with a big platform that I thought breast implant illness was real. And I had surgeons call me and say, “You need to be quiet with this. People are getting upset with you.” I was rising in the ranks of one of our huge societies, and from being literally like, somebody who was potentially on the fast track to eventually becoming a board member and president, I lost all my committee assignments in one year and I was persona non grata all of a sudden.
[01:01:10] I don't know if it had anything to do with that, but I've heard from other people that these things are not coincidences. So, what is the truth? Okay, the fact is that we do not have enough studies. I do believe breast implant is real. We don't have any studies to show what percentage of women may have it. What we do know is that if you've got symptoms and you think they may be due to your implants, if you take your implants out, about 55% to 85% of women seem to get significant improvement of their symptoms. These are women typically who have implants, they have these types of symptoms, brain fog, unexplained rashes, thinning hair, muscle aches, fatigue, joint pain. But they don't have an actual diagnosis of autoimmune disease. 55% to 85% will get better. In those women who actually have a diagnosis of autoimmune disease. If you've got rheumatoid arthritis, if you've got Sjogren syndrome, if you've got scleroderma and you have implants and you're wondering, “If I take my implants out, am I going to get a lot better?” Unfortunately, the majority of cases, that is not the case. And so, this is a diagnosis of exclusion unfortunately, it really is one where there's no test for it. It just comes down to if you are feeling sick and you know you're sick and your doctor cannot figure out what it is and you are open to having your implants removed, then that's what occurs in about 55% to 85% of those cases. If you don't have a diagnosis, there's significant improvement.
Cynthia Thurlow: [01:02:28] That's really significant when I'm hearing that and it seems like there's trends around women explanting and it might be that it's just on my radar and I'm paying more attention to it. But more and more women, especially with this mutual friend of ours who's talking about it publicly, the amount of women that were echoing and saying it was the best thing I've ever done, all my symptoms went into remission, etc. There really is something real there and I'm sorry to hear that impacted your ability to proceed within your professional organization that you were in.
Dr. Tony Youn: [01:03:00] I realized very quickly that doesn't mean anything in the end. [laughter] And I'm like, “Actually, I think they did me a favor.” Because, yeah, you give a lot of your time. I think we're taught as physicians that our time is not valuable. I think it comes down, it starts with insurance companies where you do phone calls and you can't bill for any of that. Your time is not considered valuable. You donate your time to the hospital, you donate your time here and there, and people just expect that that's what you're going to do. And the same thing with these society sometimes, is that you donate all your time and in the end, they pat you on the back like, “Oh, nice job,” and that's okay. But I think the problem with it is we have to be honest with our patients. And I think that with implants what happened especially when the BII stuff really started rearing its ugly head and people were telling stories about it, and there were a group of old school surgeons who were trying to tamp it all down because they saw it as threatening to their livelihood.
[01:03:52] I tell you, my number one most popular operation is breast augmentation. It still is. I don't do nearly as many as I used to, but it still is the number one surgery. And when I talk to my patients, I give them that information of like, “Look, this is the information. I don't think everybody gets sick from implants. I think it's a percentage of women. We don't know if it's going to be you. Make sure you make an informed decision if this is something you decide to do.” But, yeah, there're a lot of other factors involved. Now, I actually do credit the societies in that pretty much every big cosmetic meeting that I go to, they have some type of panel on BII, which is a huge change from just, I mean, literally five years ago where people are calling me saying that I need to quiet down.
Cynthia Thurlow: [01:04:35] Well, I think it's important because I would imagine five or 10 years ago a lot of women were being gaslit over exactly-
Dr. Tony Youn: [01:04:41] Oh, yeah.
Cynthia Thurlow: [01:04:42] -the symptoms they were experiencing. Now, I want to make sure before we finish, we circle back to your book. I love that you have a comprehensive perspective on healthy aging and auto rejuvenation. Let's touch on sleep and stress because I think these are things that many people don't, especially middle-aged women don't prioritize enough, but have a huge impact on inflammaging, oxidative stress, a lot of these principles that you talk about in the book.
Dr. Tony Youn: [01:05:09] Yeah. So, really one big part of the book are lifestyle alterations and even things that I have done myself. And I tell a lot of my own stories of what it has done to change my life. So definitely, you only need to look at the US presidents the day they walk into office and then four or eight years later when they walk out to know that stress is a huge factor in overall aging. You have to argue that they get the best health care in the world. They have chefs and nutritionists and everybody because you got to keep them healthy if they're going to be the most powerful person in the world, but at the same time they age. And so, what can you do? I do recommend getting 6 to 8 hours of sleep every night. The ideal temperature technically, according to studies, your room should be about 68 degrees. There are certain little tips that we give in the book regarding, like aromatherapy that can help some people with better sleeping. Obviously, you want to keep your room nice and dark, avoiding blue light as much as possible in the hours before you go to bed, not eating a huge meal before you go to sleep. So many little things that you can do that can definitely impact that. And as far as reducing stress, I'm a big fan of meditation and of yoga. I think both of those are really, really big in exercising.
[01:06:17] Also, strength training as you get older. This is something that people are now finally talking about, but resistance training being so important, especially women after menopause to avoid sarcopenia. There's so much that you can do that can really help to fight the aging process. The way that I look at aging myself, I think from the healthiest perspective is that you know I turned 51 and I know you're not that that far behind me, and getting older is a blessing, and I always look at it that way. But at the same time, it's not so much fun to look in the mirror and see a face looking back at you that you don't recognize potentially, it's not who you used to be. But at the same time, the fact is that there's so much available for us nowadays to fight that aging process that you can make it actually fun. You can make meals that you know that are going to support the aging process in a healthy way. You can take up some new sports or some new activities, you can try some new skincare products or some new treatments, noninvasive things. And it's such an exciting time because so much of this works and it's available to us and it's noninvasive and it can really help to fight that. So, it's a blessing to get older. So might as well fight it every step of the way while you're there.
Cynthia Thurlow: [01:07:29] Absolutely. And I want to disclose to my community before we end our conversation, I've been using your skincare products, which you sent me, which I very much appreciated. And I went to an event a week and a half ago and one of our mutual friends walked up to me and said, “What are you doing differently with your skin?”
Dr. Tony Youn: [01:07:46] Oh, wow.
Cynthia Thurlow: [01:07:47] Which I took as a huge, huge compliment. And I explained that I was using your products. And so, we'll make sure those links are available. Please let my listeners know how to connect with you on social media. Like I said, Dr. Youn has a prolific social media presence and he's funny and he's informative. He's one of my favorite people to follow. How to connect with you, get your book, get your products, which I highly recommend. And I get a lot of stuff that people send me in the mail and I don't often do a plug and this is a genuine plug,-
Dr. Tony Youn: [01:08:15] Oh, thank you.
Cynthia Thurlow: [01:08:16] -really enjoy the products. Thank you so much for all the work that you do.
Dr. Tony Youn: [01:08:20] So, yeah. Thank you. Yeah, I'm all over. You hust look for Dr. Youn. And I'm on TikTok [Cynthia laughs] and Instagram and Facebook and all that type of stuff--
Cynthia Thurlow: [01:08:25] He’s everywhere.
Dr. Tony Youn: [01:08:26] I have a website called autojuvenation.com and that's a website for my book. We do have a bunch of free gifts if you do order the book, including a companion recipe book, as well as a $30 gift certificate to our online store, younbeauty.com. And this contains my Youn Beauty skincare line. And so, if you do want to try the skincare, it's made with natural and organic ingredients. It's fragrance free, it's great for all skin types, and we're really proud of it. And I would encourage you if you are going to get the book, Younger for Life. One place I try to encourage people to go to is bookshop.org. Bookshop.org is a website that supports your local bookstore. And so, if you order the book Younger for Life through that, they will send it to you. And then you can choose your local independent bookstore and send the profit of that sale to that bookstore. So, for those small bookstores that don't have the money to create a huge website and stuff, this is a great place to do it. It helps to support your local bookstore and then obviously the profit goes to them. But you can find it also on Amazon. You can find it on Costco. You can find at Target, everywhere books are sold Younger for Life. Thank you.
Cynthia Thurlow: [01:09:25] You're welcome. Thank you so much.
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