July 15, 2025 • 58 mins
The mirror doesn’t lie, but it doesn’t have to be your enemy either. As wrinkles, dryness, and sagging skin become a part of your reality, it’s easy to feel betrayed by your reflection. But what if midlife skin changes weren’t a crisis but a chance to evolve your skincare game?
In this episode, board-certified dermatologist Dr. Mary Alice Mina joins us to share what actually works for skin over 50 – and trust me, it’s probably not what you’ve been hearing on social media. With her extensive training from top institutions like Harvard and Memorial Sloan Kettering, Dr. Mina cuts through the noise with refreshing honesty, tackling everything from the sunscreen debate to the viral trend of putting vaginal estrogen on your face (spoiler: it works!).
We dive into practical tips for navigating midlife skin, including how to use tretinoin without the peeling nightmare, why evening out your complexion is a game-changer, and whether those pricey red light masks are worth it. Plus, Dr. Mina shares why having a positive mindset about aging can actually improve your skin and health.
Whether you’re dealing with thinning hair (we’ve got oral minoxidil covered), thinking about your first cosmetic procedure, or just looking for a skin routine that really works, this episode offers straightforward, expert advice. Get ready to improve your relationship with the mirror and start feeling confident in your own skin.
Like what you hear? Subscribe for more midlife health tips!
You can find Dr. Mary Alice Mina at https://www.theskinreal.com/
https://www.atlantadermsurgery.com/
The Skin Real Podcast https://podcasts.apple.com/us/podcast/the-skin-real/id1638619358
https://www.instagram.com/drminaskin
_________________________________________
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https://www.fasterwaycoach.com/?aid=MicheleFolan
Have questions about Faster Way? Please email me at:
mfolanfasterway@gmail.com
After trying countless products that overpromised and underdelivered, RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com
*Transcripts are done with AI and may not be perfectly accurate.
**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michele Folan (00:00):
Let's be real for a second.
If you're over 50 and stilltrying to eat less and move more
, that strategy expired withyour 30s.
The weight won't budge, theenergy is gone and your doctor's
side-eye at your annual checkupyeah, that's not going away on
its own either.
Enter the Faster Way, theprogram that actually works with
(00:22):
your midlife metabolism, notagainst it.
We're talking strategicworkouts, real food, and, no,
you don't have to give up yourwine or your social life.
This is not a quick fix, though.
It's a grown woman reset.
So if you're tired of startingover every Monday, do something
different.
Check the show notes for thelink or reach out with your
(00:43):
questions.
I'm here to help you make thisyour last start over Health,
wellness, fitness and everythingin between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
(01:04):
Wrinkles, dryness, thinningbrows, sun damage, sagging skin
Sound familiar.
If you're a woman in midlife,chances are you've stood in
front of the mirror wondering isthis normal or which product is
actually worth it?
This week, on Asking for aFriend, I'm joined by Mary Alice
(01:26):
Mina.
She is a board-certifieddermatologist, dermatologic
surgeon and the host of the SkinReal podcast.
She's here to help us cutthrough the noise and finally
get clarity on what our skinreally needs after 50.
We're going to cover thebiggest skin concerns for
midlife women how to tackle themhead on.
The common regrets Dr Minahears from mature patients the
(01:51):
truth about sunscreen debatesand how to use it smartly.
Because this is a definitequestion I have why your
skincare order matters, whatingredients and treatments are
worth the money and what's not.
And yes, we even talk about thetrending use of vaginal
estrogen on our face.
If you've been overwhelmed byconflicting advice on wasting
(02:12):
money on miracle creams, thisepisode is your no-nonsense
guide to smarter skincare inmidlife.
Welcome to the show, Dr MaryAlice Mina.
Mary Alice Mina, MD (02:22):
Thank you so much, Michele.
I'm super excited to be hereand have this discussion.
Michele Folan (02:27):
Well, this is right up my alley.
I love this and I know myaudience also loves this topic,
because anytime we talk aboutdermatology or skin treatments
anything in that realm thoseshows always do very well, and
you have a podcast of your ownand I want to talk about that
too.
But I'd love to know a littlebit more about your background,
(02:50):
where you're from, where youwent to school, to give us a
sense of your roots.
Mary Alice Mina, MD (02:54):
Yeah, Well, it's great to be here and yeah,
I feel like people women, right, Especially really all ages it
seems like we like to talk aboutskin right, it's right there,
it's fun, but it also can bechallenging.
So I'm glad we're here havingthis discussion.
Let's see my background.
I am from a family of doctors,but I did not decide to go into
(03:15):
medicine until I was about 21.
I actually was a ballet dancerup until then.
I realized I wasn't going to bethe prima ballerina at an
amazing company and that maybe Ishould look to do something a
little more stable and secure,and so I guess medicine
dermatology was my plan B.
(03:37):
But it worked out, and itworked out great.
Let's see, I went.
Were you asking where mytraining?
Michele Folan (03:43):
was yeah, like yeah, undergrad, and then yeah,
where were your training?
Mary Alice Mina, MD (03:47):
Yeah, so I went to Vanderbilt for medical
school and then I traveled up toNew York Memorial Sloan
Kettering Cancer Center for myinternship and then I was at
Harvard for my dermatologytraining and then I moved south
to Atlanta at Emory to do myMohs surgery fellowship and
(04:07):
that's where I met my fabulousbusiness partner, Dr Baucom, and
I've been working.
First I joined him, worked withhim, and now we're business
partners and I can't believeit's already been like 13 years.
It's crazy.
Michele Folan (04:21):
Oh wow, so you got a little later.
Start with everything too,which you know.
You're the second doctor in amonth I've interviewed who was a
dancer and then kind of veeredoff the path and it's just
fascinating that.
But you know what, when youthink about that, there's
artistry involved in what you do.
(04:42):
That's that aesthetic, and so Ican see that?
Mary Alice Mina, MD (04:46):
Yeah, I definitely think so, and I
didn't realize that I would getto pair the artistic side so
well.
But I think a lot of peoplethink, oh, medicine, it's so
data, analytical and all this.
But we can do amazing things inmedicine, but there is still an
art to it.
It's not cookie cutter.
Not everyone responds andbehaves the same way.
Michele Folan (05:09):
There's still so much we need to learn and know,
and so yeah, there really is anart to practicing medicine as
well, yeah, and then there's theoff-label uses for things that
we know work for certain things,so it's fascinating.
A lot of it is intuition andexperience.
And then I'd also love to knowwhat the path was to becoming a
(05:35):
double board certifieddermatologist and dermatologic
surgeon, because that had to beextra time as well, right.
Mary Alice Mina, MD (05:43):
Yeah, the nice thing about medicine for
people who might be listening,who are younger, have children,
right, like sometimes I'll thinklike how do people become these
jobs that are beyond, liketeacher, doctor, nurse?
You know these like jobs inbusiness, but at least in
medicine it's like once youdecide you want to be a doctor,
it's very laid out for you whatyou have to do.
(06:05):
You've got to do first twoyears and you've got to take
step one, board exams, and youdo your clinicals and you take
step two.
It's very sequential and youknow what's kind of expected of
you.
And pretty early on I knew thatI liked dermatology and probably
a couple of things, probably mybackground in dance and the
(06:26):
arts.
I'm very visual, I love to well,I don't do it so much now, but
I used to love to draw andvisual arts.
And then probably also becauseI'd really only been to a
pediatrician and a dermatologistin my 20 some years and I just
I had acne when I was growing upand it wasn't as bad as some
(06:48):
people.
I didn't really have scarringfrom it, but it was really
embarrassing and I'm normally anoutgoing person and I wanted to
fade into the background.
I wanted no one to look at me.
I did not want to put myselfout there, so I knew what it
felt like to have a skin issuethat made you just want to
(07:09):
disappear.
And what I enjoy aboutdermatology is not everything is
life or death right, but it isvery impactful when you can help
someone with their skin,because it's so visible and I
think that's why a lot of womenin this midlife phase can be
struggling, because we noticethe skin changes before a lot of
(07:29):
the other changes.
And it's not just we notice.
The outside world notices,right, and we might start being
treated differently.
We show up differently, right.
Michele Folan (07:39):
So that's why and I'm in my midlife now yeah, it
interests me more and more, youknow and here's the thing it's
not about looking like someoneelse, it's not about making
yourself look like not thatperson that you are, but it's
just having that baselineconfidence.
(08:00):
You know, to feel good aboutyourself.
I get Botox in my forehead.
I know that I am not going tolook like I'm 24, nor do I care
to look like I'm 24, but I lookmore awake and that is what
helps me feel better.
So everybody's different and onthis show we are open-minded
(08:26):
and we don't judge anybody foranything that they wish to do to
their bodies.
We're all open about that.
But most of my audience is 50plus and it'd be good to know
what are the most commonmisconceptions that you hear
from women in that age groupabout their skin.
Mary Alice Mina, MD (08:48):
I think there's a lot of insecurity and
a lot of self-hate in thisperiod, a lot of negativity we
speak really unkindly toourselves, a lot of maybe shame
and feeling like you're unworthy.
And it's just.
I do think, and I'm hopefulthat this is improving, as we're
(09:09):
actually talking aboutmenopause and perimenopause and
it seems like there's finallythis movement where women are
like wait a minute, just becauseI'm 45, 50, 55 doesn't mean my
life is over, I'm going to beput out to pasture, I'm no
longer worthy or beautiful.
So I do think things arechanging and I am hopeful about
that.
We're finally talking about it.
(09:30):
I think that's really the firststep, right, because for so
long I think people just feltthis sort of shame inside,
dreaded every birthday coming up, and I think you sort of have a
great perspective right, likeyou're not trying to look like
you did at 24, but you just wantto feel good, because when you
look good, you feel good, right,and vice versa, when you feel
(09:52):
good on the inside, it also isreflected on the outside.
So I think helping kind ofreshape the stage of life that
this is not.
You know, menopause is not adirty word.
It doesn't mean you're, youknow, worthless and no longer of
value and no longer beautiful.
We have to kind of reframe it.
(10:12):
It's different, yes, right, butit doesn't have to be bad, it
doesn't have to be negative, andI think, just embracing this
stage of life, studies haveactually shown if you have a
positive view about aging,you're healthier and you live
longer and you have fewerchronic diseases.
(10:34):
So this isn't just like thinkhappy thoughts, right, like this
actually does work, and so whyI started my podcast and what I
really love to do is just helpwomen feel confident, right, get
your confidence back.
Yes, you look different than youdid at 24, but it doesn't mean
bad.
And I'll just say I had abeautiful woman as a patient the
(10:57):
other day.
She was 94 years old and thiswoman she did not look 24.
She didn't look 50, right, youcould tell she was 80 plus, but
she had this elegance to her andshe had wrinkles, right, she
didn't have no skin laxity andno blemishes and all that.
(11:20):
But it reminded me that you canstill be beautiful and elegant
and graceful and still look ageappropriate and not look like an
alien, right?
So there's just lots of ways tothink about beauty and aging
and we need to sort of shift ourmindset that we want to totally
prevent aging at all costs andactually learn to embrace it and
(11:43):
try to do more likepreventative stuff.
Really I think is like so keywith so much.
Michele Folan (11:51):
You know, and, like I said, I don't judge, but
I did see a woman today at thegym who had had a lot of work
done and I'm thinking, wow, Icould tell underneath all of
that that she was a very prettywoman.
But I don't know if you everhave patients that come in and
they say, oh, I regret this, orwhatever.
(12:13):
But do you have a particularregret that you continually hear
from your more mature patients?
Yeah, Well.
Mary Alice Mina, MD (12:21):
So I think the number one regret that I
hear is that they wish they hadworn sunscreen and that is it.
Now I do treat a lot of skincancer, but it always comes up.
They'll tell me we didn't know,this was back in the 70s and we
had baby oil and iodine in thefoil and they'll say I wish I
(12:46):
had known.
I wish we had known to sunprotect.
That's the number one thing Ihear.
I don't hear too many peoplecoming in regretting,
necessarily, cosmetic proceduresand stuff like that.
But I also think patientsgravitate towards me based on
kind of, I think, what I looklike where I do cosmetic
(13:09):
procedures.
But my goal is always a verynatural approach and for some
they don't want that, like somepeople actively want a more
exaggerated full look, and so Idon't tend to see those kinds of
patients because that is justnot.
I'm not really the best personfor them.
Okay, yeah, so I think there issome self-selection with that?
Michele Folan (13:32):
Oh, absolutely, I definitely do, and we're going
to take a quick break and whenwe get back, since we started
talking about sunscreen, I wantto dig into that topic.
How many drugstore products areyou going to try before you
finally decide?
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(13:53):
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(14:15):
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Okay, we are back.
(14:38):
Before we went on the break, Imentioned sunscreen, and If you
are on social media right now,you are hearing a lot of
conflicting advice about sunexposure, and we all know that
getting light in the morning isgreat for resetting our
(14:58):
circadian rhythm.
But there seems to be someinformation out there, dr Mina,
about the fact that eliminatingsun exposure is actually
detrimental to our health.
Can you talk about that alittle bit and what you're
actually hearing and what youropinion is Right?
So?
Mary Alice Mina, MD (15:18):
I feel like there are people who you know.
I remember when I was aresident, like I do feel like
there were days I probably neversaw the sun.
But depending on where you liveat least here in Atlanta, like
I'm sitting by a sunny windowthe sun is coming in.
So my view is you should wearsunscreen every day, because it
(15:40):
might be cloudy, it might beraining, you might forget, but
it's like brushing your teeth,it's just a habit, and to me my
sunscreen is like my moisturizer, so it kind of like kills two
birds with one stone.
I'm also very pale, so my skincannot tolerate any sun.
Versus someone who has moremelanin, they can handle a
little more without burning andI've been burned before plenty
(16:03):
of times.
I've tried to tan and it didn'twork out well.
I think the I'm not saying don'tever like expose any part of
your body to the sun and likelive in a basement, right, but
we get sun through car windows,we, you know.
So if you have a commute 30minutes a day, you're getting
sunlight.
If you know most people, theymight do a quick walk with their
(16:25):
pet outside or water theirplants.
They're outside.
So I think most people aregetting more sun than they
realize.
And if you don't think you are,you can look at your stomach or
look at the inside part of yourarms.
And look at the outside part ofyour arms, and if you see a
difference, that's the sun doingthat to you.
So I think a safe bet is towear sunscreen.
(16:49):
You're still going to getexposed to sunlight.
No one, including myself, wearsas much as we should.
I have to say I'm notreapplying before I get in my
car to drive home, you know sowe're not, as we're not as
diligent and good as we say wedon't wear it, we don't apply it
enough.
So what we do know, though Imean I see this thousands of
(17:10):
patients with skin cancer, and Isee how some are very easily
treated and then others aresometimes life-threatening.
So I just think it's not worththe risk, and if you just get in
the habit of wearing sunscreen,great.
Other options are to like Idon't love to slather sunscreen
on, you know, multiple times aday either, but what I'll do is
(17:33):
if I'm going to be outside withmy kids or taking a walk, I wear
a hat, and that's a great way,and I just try to never feel
like I'm like a rotisseriechicken roasting in the sun,
right, yeah.
And if you're not worried aboutskin cancer, then premature
aging right.
Like, one of the biggest thingsthat causes premature aging and
(17:55):
accelerates aging in us is UVradiation.
So if you are like I'm aminimalist, I don't want to do
anything then if you just sunprotect and don't lay out, go to
tanning beds and get tan,you're going to look way younger
when you're older than someonewho doesn't.
So, yeah, I mean, if you want tolook at the UV index and go
(18:20):
outside when it's lower thanthree or not, I mean I think
there are some people who takeit too far.
Right, you see their outfits,they wear in the car and all
this and that, but it's justhard for people to know what's
this.
We don't really know what is asafe amount of sun, Okay and
yeah.
So that's kind of it.
Michele Folan (18:37):
Do you have a preference on sunscreen?
I mean, you've got kids, yeah,so do you pick a particular
brand based on safety and that?
So mineral versus, I guess,physical sunscreen?
Mary Alice Mina, MD (18:51):
Yeah, yeah, so chemical versus physical.
So there's a lot of.
There've been studies in ratsnot in humans where the rats ate
it.
They licked it, they ate.
You know, you'd have to wearsunscreen for 200 years to get
anywhere close to the amountsthat they were exposed to.
But there have been no studiesin humans showing harm from
(19:13):
sunscreen and there are copiousamounts of studies showing the
harm of sun damage.
For my children they're 10 and11 now.
I really try to get them towear hats and we wear rash
guards at the beach and I'm finewith mineral or chemical
sunscreens.
So the main issue with thephysical sunscreens the zinc and
(19:34):
titanium is that it's uh, has athicker feel a lot of the times
, a chalkier like residue.
So people with darker skin, um,can look almost like gray or
purpley you know, the worst lookever.
Michele Folan (19:49):
Let's just admit that white ghosty look.
Mary Alice Mina, MD (19:52):
Yeah, again , we don't apply it enough.
There've been zero studies inhumans showing any harm, even
the studies about reef issuesand all that.
It seems it's more globalwarming than anything else.
But if you are worried, thenjust stick with zinc and
titanium.
You may have to shop around alittle more to find one that you
(20:14):
really like.
I actually.
I just got this from my office.
It's the Elta MD spray and Ibelieve, yeah, this is 100% zinc
and I do really like this onebecause I can spray it, it's
really light and it rubs onreally well.
So it is possible to find thephysical blockers that are nice.
It just takes a little moretrial and error and I would just
(20:35):
tell the audience, like, don'tgo crazy, you are okay if you
use chemical sunscreens.
The only people I wouldn't useit on is maybe a teeny, tiny
little baby.
Then we recommend just usingreally we use truly physical
blockers.
Like put the awning up, put ahat on stuff like that.
Michele Folan (20:52):
Yeah, so what is the cutoff age for using
sunscreen on babies?
Mary Alice Mina, MD (20:56):
So really six months and older is when we
recommend it.
But I actually was just doing apodcast with a pediatric
dermatologist and he was sayingwe put a lot of diaper rash
creams or zinc oxide, which issunscreen, right, and we do that
at one day old.
So really we say six months andolder, but really the most
(21:20):
important thing is that you'reprotecting their skin.
Michele Folan (21:23):
Okay, I'm asking because my listeners have
grandkids and I figure theyoften have to chime in on those
things, so all right.
So we did touch on menopause alittle bit and that estrogen
loss does show up on our skin aswe age.
Huge trend right now of usingvaginal estrogen on our faces,
(21:48):
and there's even some brands outthere now that are including
estriol in their formulation.
What's been your experience andhow are you feeling about the
science behind it?
Mary Alice Mina, MD (21:59):
I am loving it.
So I have, and I've beentalking to some of my older
patients and they'll say, ohhoney, we've been using this for
decades.
Right, like they've been using.
This is nothing new for a lotof ladies.
They've been using theirvaginal estrogen cream on their
face, on their chest, on theirhands, so they've been doing it
(22:20):
for a long time.
We know it's very, very safeand actually super protective,
decreases risk of UTIs in womenand helps hydrate the skin, the
perineum, the vulva, and so itmakes sense.
Our skin has estrogen receptorsto put it on skin of your face,
your hands, your neck, and nowcompanies are making it,
(22:41):
formulating it specifically forthe skin.
I haven't tried vaginal estrogento know the difference between
the facial one and the other one, but I do know the facial
creams that I've tried arewonderful.
I think of them as like amoisturizer, so I have been
getting a lot of requests for itto use and I think it's great.
I would say the only people Imaybe would use a little caution
(23:04):
with is someone who has really,really bad melasma.
Where they flare, they getthose brown discoloration on the
face.
The data is sort of like hit ormiss on that, whether it truly
does exacerbate it, but we doknow estrogen can make melasma
flare, along with sunscreen orsun.
(23:25):
So if someone had really severemelasma I would definitely just
talk with them about that.
But otherwise super safe.
I think it's wonderful.
I think if you're inperimenopause or menopause you
should be putting it on yourface.
Whether you get one that's justfor your face or you use your
vaginal one, it doesn't matterto me one.
Michele Folan (23:52):
It doesn't matter to me.
Okay and this is my plug kindof off the topic but for women
that are not on vaginal estrogen, I don't care how old you are
and if you haven't had a sexualrelationship in 20 years, the
data really shows that probablyevery single woman should be on
vaginal estrogen after menopauseand it's preventative for so
(24:13):
many things.
And I've had this discussionwith my friends and they're like
, nah, I'm fine, I'm like no, no, you say you're fine, but
things get shriveled up downthere and it causes all kinds of
issues.
So, anyway, that's okay, I'llget all kinds of issues.
So, anyway, that's okay, I'llget off my soapbox, but anyway
all right, yeah, and it's sosafe.
Mary Alice Mina, MD (24:33):
It's so safe.
So I think, yeah, use it onyour face, use it in the vaginal
area.
It's wonderful.
Michele Folan (24:43):
So for women that are experiencing skin changes
in midlife okay, we're talkingdryness, dullness, loss of
elasticity, because I thinkthose are the main concerns I
always hear.
Where should they focus theirattention first?
Mary Alice Mina, MD (24:58):
Gosh, I would say your best bet if you
want to save time, frustrationand money is see a dermatologist
.
I think a lot of times peoplesort of piecemeal well, I'm
going to go here for this, I'mgoing to go here for that.
I got a group on for this.
So I would say see yourdermatologist.
Like this is a skin, your skinexpert.
If you've never had a skincheck, you should get a skin
(25:19):
check, because this is when westart to see skin cancers pop up
and you may have things thatare more medical.
You may be struggling with acnebelieve it or not, it happens.
You may be having rosaceaflares.
Again, get the skin checks.
So I would start with yourdermatologist and then they can
help you come up with a plan onwhat really should be the first
(25:40):
thing I do, if anything right,Like maybe it's just getting on
a skincare regimen, Maybe it'sadding estrogen cream, estriol
cream, Maybe it's addingtretinoin.
So I just feel like, ratherthan kind of shopping it out to
lots of different people whoyour friend went to and all that
, I would say start with theskin experts, like a
(26:01):
dermatologist.
And a lot of times if a patientasks me like well, what should I
do, what should I do?
I started off with saying, well, what bothers you?
Right, Because what I see mightnot be what bothers you, and
this happens all the time.
So I like to hear what bothersthem.
And if it's that, they justfeel like their skin's not
bright or they've got some looseskin here or there, you know.
(26:23):
So it's helpful to know well,what bothers you, Because if it
doesn't bother you, you don'tneed to fix it.
Michele Folan (26:28):
You brought up tretinoin and I know I've tried
it in the past and my skin gotsuper dry and they say, oh, just
use it every three or four days, whatever, give us your
strategy for using tretinoin andhow people can be more
successful with it.
Mary Alice Mina, MD (26:45):
Right, and I hear this a lot too.
In fact, I had thisconversation a couple hours ago,
so I'm a big fan.
I mean, I think it's probably,other than sunscreen, the most
powerful potent topical creamthat we have, especially for
anti-aging.
I mean, the data is abundant.
It increases your collagen 300%versus know, versus collagen
(27:08):
powder we're debating does itwork, does it not?
We don't know, we do know.
Tretinoin does it and retinoids.
So the main issue is it isirritating, especially if you
have real sensitive skin.
It's wintertime all thesethings can make it harder.
So my trick is you can startwith over-the-counter like
that's going to be weaker.
(27:28):
You can start withover-the-counter that's going to
be weaker.
You can start withover-the-counter adapalene or
Differin that's a little bitstronger if you want.
So those are ones you can startwith.
I recommend using it on cleanskin at night.
I like the skin to be reallydry, because the more moisture
it has, it's going to absorbmore deeply and cause more
irritation.
So this is a time where weactually don't want you to put
(27:49):
it on your skin wet, so let itdry.
Sometimes what I'll do is afterI shower, I will wait even like
30 minutes or so, because Itend to have oily skin.
So within 30 minutes my skinalready has a little oil to it
and then I put it on.
But you could also put amoisturizer on and then wait a
(28:10):
little bit and then it's justone little P on your finger, not
big at all.
Dab it across your whole face.
I do my neck, tops of my hands,you could do your chest too, if
you want, and then you can puta moisturizer on afterwards.
So the sandwich technique ismoisturizer, tretinoin
moisturizer, and sometimes Iwill do for that second
(28:32):
moisturizer.
Like my eyelids tend to getreally dry, I will just put on
Vaseline or Aquaphor in thoseareas, or like around the
corners of my mouth.
I'll add what the kids callslugging and I will put the
Vaseline or Aquaphor there, andthen I still get dry.
I mean, I'll tell people I'vebeen using tretinoin, except for
(28:52):
when I was pregnant, since Iwas in my 20s and you know,
because I had acne and then Ikind of stopped it for a few
years but then got back on it assoon as I became a dermatology
resident.
So I still get dry.
So I don't use it every night.
I used to use really strongstrengths, but now we realize,
(29:13):
even the lowest strength is good.
It's not like you have to getto the top layers or at the top
highest percentage.
But if you really really can'tyou know, if you really can't
tolerate it doing all thosethings, then try
over-the-counter or try.
My patient today was telling meshe uses Bacushiol, which is a
(29:34):
plant version that acts similarto retinoids and we don't have
as much data on it but it'scertainly gentler to the skin,
gentler to the skin.
So those are just some tips andtricks to try, and usually by
(29:55):
using less and really bulking upthe moisturizer I can get most
patients, most of my patients,to tolerate it?
Michele Folan (29:59):
Do you use it at night or in the morning?
Mary Alice Mina, MD (30:02):
So tretinoin or retinoids you want
to use at night, got it Allright?
Yeah, so you want to use thoseat night and then you want to
use your sunscreen and maybevitamin C in the morning.
Michele Folan (30:12):
Okay, and then in the evening you use your
Tretinoin, and then what elsewould you use at night
Moisturizer?
Okay, all right, so you keep itpretty simple.
Mary Alice Mina, MD (30:21):
I keep it very simple.
Now I know there's a lot oftalk and I have to say I've been
doing that for like decades,but in the last like six months
I have gotten really excitedabout exosomes and so I am using
a product called Plated, whichI really do love.
So I do, I wash my face, I usemy Plated, then I use my
(30:42):
Tretinoin and moisturize.
So I would say, at night, tryto be on a retinol, retinoid of
some sort.
You can use your Estriol creamas your moisturizer if you like.
I think that's a great idea.
And if you are someone whoreally enjoys skincare and you
want the latest, greatest andall that and you want to play
around with stuff, then try somepeptides or exosomes or growth
(31:07):
factors.
So that's something you canthrow in in the evening.
But it can be as simple.
I mean, my mom just usesmoisturizer okay, so it can, and
she has beautiful skin, so itcan be simple.
Michele Folan (31:19):
All right, where are exosomes derived?
Mary Alice Mina, MD (31:22):
Yeah.
So exosomes are little, thinkof like a little envelope.
So the exosomes get littlemessages from stem cells and
deliver it to other cells of thebody.
So an exosome can be good orbad.
Just saying this is an exosomedoesn't really tell us much.
What you care about is what'sthe little message in that
(31:44):
envelope?
So you don't want the messageto be cell death or, you know,
cancer growth, right, right, orlike pro-inflammation.
So what I so you, you know withwhat people are looking at with
skincare is little messages inthe exosomes that tell the cells
to get rid of these thingscalled zombie cells, to
(32:06):
eliminate those that are sendingout bad signals to our other
healthy cells.
You wanna stimulate things todecrease inflammation, to
increase collagen fibroblastactivity.
So I think we're gonna hear.
Your audience should know we'regonna be hearing a lot about
exosomes in the near future ifyou haven't already heard about
them.
And I would say, take it with agrain of salt, because there's
(32:29):
going to be a lot of snake oilout there, a lot of people
pushing exosomes as injectionsor IVs and, first of all, that's
not FDA approved, so I wouldn'tgo see anyone for that.
But I do think there is somegood science and data behind it.
You just need to make sureyou're not spending a lot of
money for a moisturizer.
Michele Folan (32:50):
All right.
And then my other question iswhen we do microneedling, do you
ever do?
Mary Alice Mina, MD (32:58):
PRP, yeah yeah.
So it's a great option.
That's called the vampirefacial and so PRP is kind of
like one step after exosomes, soyou could think of like stem
cells as being like the mostpotent, and then exosomes carry
the messages from the stem cellsand then PRP are some of those
(33:22):
stimulate growth factors too.
So it's like kind of the nextlevel.
So PRP is wonderful.
It can help with healing.
You can do it after lasers.
You can do like kind of thenext level.
So PRP is wonderful, it canhelp with healing.
You can do it after lasers, youcan do it after microneedling,
you can do it to help with hairgrowth on the scalp.
The only thing where PRP can geta little tricky is there's a
lot of variability.
(33:43):
It's not like you pick up thisjar and you're like okay, I know
what's in there, I know howmany platelets are in there.
I know Our bodies are veryvariable.
So even within month to monthwhen you get your treatments,
you may have more platelets oneday, fewer another.
The older you get, there'sthought are the platelets not as
(34:03):
effective.
Is it better to get platelets,platelets from younger people?
So I do think we're going tosee that evolve.
But certainly, especially ifyou are someone who likes the
idea of a very natural approach,using your own blood and
platelets, is, I think, a greatoption for you.
Michele Folan (34:21):
So for anyone that hasn't heard of this before
and they're kind of grossed outby this conversation because
it's a little different, right?
Yeah, they draw your blood andthey spin out the platelets,
correct?
Yeah?
Mary Alice Mina, MD (34:35):
Okay, yeah, exactly, because the platelets
are the key signals.
If you injure yourself, thoseplatelets are activating that
wound healing cascade, and sowhat we're doing is we're taking
those platelets and activatingthe growth factors, the
messengers stimulating healing.
And yeah, it is.
(34:56):
So I've never done it myself,but when I've done it to my
staff and patients it does feela little bit weird, and you do
have to leave it on for about anhour before you wash it off.
So it's kind of a differentsensation, but in the long run
it does help you heal faster.
Michele Folan (35:11):
All right, I might have to do that I haven't
done microneedling in like twoyears, but I always look like
I'm drugged behind a bumper.
After I have it done, I thinkshe goes kind of hard on me.
But I'm curious what PRP woulddo in my healing process because
yeah, yeah, it should help itheal faster.
(35:31):
It scares the hell out of myhusband when he would come home
and he sees me after I've haddone it, he's like oh my God,
what happened to you?
Mary Alice Mina, MD (35:39):
Like, don't worry about it, I know, but you
know, it seems like do you feelyou heal pretty quickly, like
the next day you're lookingsignificantly better, or do you
have more downtime?
Michele Folan (35:50):
I mean downtime.
Define downtime because I neverhave any downtime and I'm the
one that goes to girls night outafter I have microneedling and
they make fun of me but I don'tcare.
Mary Alice Mina, MD (36:06):
You know that it always makes me laugh
because, just to your point,patients will say well, how much
downtime I'm like.
You know everyone's different.
Yeah, because our staff come towork the next day.
But you may be like oh no, Idon't want anyone to know, I'm
going to hide out at home.
Michele Folan (36:20):
So, yeah, everyone's different, yeah, okay
.
Well, yeah, I'm like whatever,I really don't care.
I want to talk a little bitabout things that are just a
total waste of money, and I'mgoing to ask you first about
beef tallow.
Mary Alice Mina, MD (36:37):
Yeah, so I mean, I've never used it but I'm
like I don't need to use it.
I think this concept of foodfor skincare don't use it on
your skin if you wouldn't eat itis kind of ridiculous, I mean.
I guess I kind of see it doessound appealing like nature and
natural and all that, but wehave amazing products formulated
(37:02):
just for what your skin needs.
So I don't know, you know, whywe're going back and using
something that's never beenmeant to be used on the skin.
It can clog pores, you can haveirritation.
It's just unnecessary, so Idon't recommend it at all.
Michele Folan (37:18):
All right, that was my first one.
What about red light masks thatyou see all over?
Mary Alice Mina, MD (37:24):
Yeah, so we do know.
In dermatology we use a lot oflight therapy.
Lasers are a form of lightamplification, so red light
therapy is helpful.
It does help reduceinflammation and you know, I
think it's cool People like it.
It's relaxing.
The issue with the face maskit's kind of like exosomes it's
(37:46):
hit or miss.
Some can be really good andsome can be really bad.
So you want to find a mask thattruly is red light.
You want to make sure there areenough dots in the mask so that
your skin is adequately covered.
You don't want a mask with likefour dots that you're putting
on, so you want lots of dots tocover your skin.
You want it to form to yourface.
(38:07):
You know I've seen those likelittle wands and I think those
are like ridiculous.
So if you're going to do it,get like the scalp one, get the
one for the face or the neckthat your skin is covered.
They do work.
You just have to do itconsistently and for me I'm like
I could get better results byusing my tretinoin and my
(38:30):
sunscreen and maybe a laser oncea year, once every couple of
years.
So I don't personally do it,but if you want to do it you can
get good results, but you justhave to be consistent, you have
to do it and you have to stickwith it, and I think that's
where people you know they sortof fall off using it after a
certain amount of time.
(38:54):
So this is back to my I don'tcare what people think bucket,
you go to the grocery with it.
Michele Folan (38:56):
No, I would not go to the grocery, but I've
filmed myself on social mediawith it on my husband I'll wear
it when I'm watching TV at nightand he just he doesn't even
blink anymore because he's like,oh Jesus, what next?
Mary Alice Mina, MD (39:12):
Yeah, here she goes again.
Yeah, yeah, like, do it whileyou're journaling or meditating.
Yeah, yeah.
Michele Folan (39:19):
I don't know.
It feels like self-care to me,so whether it works or not, I
don't care.
Yeah, this phase of life isfrustrating because not only do
we lose elasticity in our face,but we're also our eyebrows and
eyelashes and our hair arethinning, and this has come up
(39:40):
on my show before I interviewedDr Bauman, who does a ton in the
hair rejuvenation space.
When patients come to see you,what are their options now in
terms of, you know, rejuvenatinghair, particularly?
I mean, let's talk about thehair on our scalps, because that
(40:01):
is such a source ofconsternation because of our you
know our confidence.
Mary Alice Mina, MD (40:09):
Oh, for sure, For sure.
Yeah, like hair, I think thisone, like women who have breast
cancer, right Like they alreadyare hit with that and then it's
like, oh, you're going to loseyour hair, right Like our hair.
For so many, it's ourfemininity and it can be really
distressing to lose it.
And the thing is, whether youhave thick hair or thin hair to
(40:29):
begin with, if you notice hairthinning, like I noticed, I mean
people would look at me and sayyou have thick hair, but I
noticed I felt like my foreheadwas going farther back and I was
seeing more of my scalp thanI'd ever seen before and I was
like this is different.
I'm like I don't like this.
So the good news is I do feellike we actually have treatments
(40:50):
now that can help.
So if you're noticing hairthinning again, see your
dermatologist because first ofall, it could be a medical
condition, so it could beseveral things.
So vitamin D could be low.
We're reading, learning a lotabout vitamin D and our immune
system and just our overallhealth.
So most people are vitamin Ddeficient, especially people
(41:13):
with darker skin, and if youlive in like climates where the
sun sets really early, you don'tsee the sun.
So get your vitamin D levelschecked, get your thyroid
checked and again, if you havesymptoms, right for thyroid Iron
, you could have low ferritin.
So these are all like commonthings that can be.
Just a quick blood test canlook at it, so your
(41:35):
dermatologist can also assess.
There's something calledtelogen effluvium, where your
hair just falls out in clumpsand you see it.
So that's different from likefemale pattern balding or
androgenetic alopecia.
So telogen effluvium, where thehair is truly shedding and
falling out.
The good news is that isreversible, so it will come back
(41:57):
, but it can really freak youout when you see that, yeah.
So see your dermatologist,perhaps get some blood work,
perhaps supplement as neededwith, maybe iron a multivitamin
work, perhaps supplement asneeded with maybe iron, a
multivitamin vitamin D that canbe super helpful.
Look at your diet.
So if you are vegan or reallycalorie restricting, then you
(42:20):
are probably going to have morehair loss.
So you just need to make sureyou're getting enough calories
and you're getting enoughprotein Protein, I know right,
our hair is protein.
So that is, you know, keratinis protein.
So those are things you can do.
And then there are medicaltreatments and I was just
(42:40):
talking to a patient today aboutit.
So it ranges from topicals.
So minoxidil is super powerful.
Rogaine is the brand name.
I think most people have heardof that, but we can compound
even stronger versions of that.
So your dermatologist can get astrong, compounded formulation
if you don't like the minoxidilor you feel like it's not
(43:02):
working enough for you.
I'm a big fan of oral minoxidiland at really, really tiny doses
just 1.25 milligrams it canmake a huge difference and I
don't know if your audience likeI, have all this little baby
growth from my minoxidil, so ittruly does work.
I know some people are like Idon't want to take a pill, but
(43:24):
it's a half tablet.
It's tiny, very safe, even ifyou're on blood pressure
medicine.
I mean, of course you want totalk with your doctor, but I've
never had someone's PCP orcardiologist say they didn't
feel comfortable with someonebeing on it.
So that's a great option.
Is it prescription?
It is a prescription, yeah.
And then for menopausal women,there are even more choices.
(43:46):
So let's see I'm trying to notuse the trade names, but
dutasteride is an option,finasteride, which is propesia
these are options as well forwomen who are postmenopausal
that they could be on.
So we've got medications.
We've got topicals.
(44:07):
People are looking at exosomesfor hair growth.
So the company I was talkingabout before, plated, does have
a hair product, so that works.
And then PRP we were talkingabout before.
There have been some goodstudies showing that that
increases hair regrowth.
And lastly, hair transplants.
I had a hair transplant surgeonon my podcast and I didn't
(44:30):
really realize women did hairtransplants.
I had a hair transplant surgeonon my podcast and I didn't
really realize women did hairtransplants.
I thought it was just for men,but he was telling me women make
up half his patients and theyeven do hair transplants on your
eyebrows, so I thought that wasreally interesting.
Michele Folan (44:46):
So fascinating.
And Dr Bauman did talk aboutthat a little bit and I was like
, oh wow.
He said it's amazing He'll doeyelash transplants as well.
Mary Alice Mina, MD (44:57):
Yeah, yeah, I'm a bit so Latisse, or what
is the?
Yeah Latisse, it's theprostaglandin.
Yeah, Latisse is great foreyelashes.
I know there are a lot of likeRodin and Fields and other
companies making serums, butyeah, I always had very, very
short eyelashes and I useLatisse a couple times a week.
(45:19):
I was really nervous aboutusing Latisse because I have
green eyes and there have been,when people use it as drops in
the eye, that it can change thecolor of your iris.
But knock on wood, so far sogood.
Michele Folan (45:32):
You know, I think , if you're only using it a
couple times a week.
I know my eye doctor, because Ihave dry eye and all sorts of
things she's so I have to findanother option, A different one.
But you know, I saw someone theother day, of course on social
media.
Yeah, they were using Rogaineor Minoxidil on their eyebrows.
Mary Alice Mina, MD (45:54):
Yes, yeah, you can totally.
Okay, which I like that idea.
Yeah, you can use that.
And I've been amazed too, howyou can get really good eyebrow
tattooing.
You can even get some tattooing, like on your scalp or hairline
, or if you have a scar, theycan tattoo some pigment in, and
(46:15):
there's some phenomenal artistsout there who can do that too in
a very natural way ormicroblading for your eyebrows.
So it seems like there are tonsof stuff we can do nowadays,
and a lot of it.
It's not just one thing, and Ididn't mention supplements, and
your audience probably isthinking about supplements like
Nutrafol, and there's anotherone called Interglow Vitamins,
(46:39):
and I think there's certainly noharm in doing a hair supplement
.
I think if you just do a hairsupplement, you're going to be
disappointed.
But again, a lot of these theyall kind of work together and
it's not like there's one magiccure for it.
Michele Folan (46:56):
Okay Now, thank you for that, because it does
come up and I, you know, in mycircle of friends and stuff
talking about hair thinning andit's really frustrating for some
people and I wanted to makesure we covered off on that.
In terms of professionaltreatments that you offer in
(47:18):
your office or procedures, whatare you most often recommending
and I guess it depends on whatthe patient's concerns are yeah,
but what are you probably doingmost often?
Mary Alice Mina, MD (47:36):
So I think for a lot of people, especially
if they're new to getting thingsdone, evening out the
complexion I think is number islike so key.
I think it makes such a bigdifference and I think why that
patient I told you about earlier, who was in her 90s and she
looked just so beautiful andelegant.
It wasn't that she didn't haveloose skin and wrinkles, but her
just overall complexion wasvery even and uniform.
(48:00):
She didn't have a lot ofdiscoloration.
So to me a beautiful canvasmakes everything look better.
So I usually like to start withthat, whether it's with
skincare products, whether it'swith a chemical peel or laser
treatments.
But I think evening out thecomplexion makes the skin
(48:21):
brighter.
You're gonna look in the mirrorand feel better about yourself.
It's gonna reflect light better.
So that's a great option Forsome people who aren't maybe
quite ready, because there canbe a little bit of downtime.
Microneedling is a great way tokind of have a little pick me up
.
But again, if you have a lot oflike discoloration on the skin,
(48:42):
you really do need like a laseror chemical peel.
But I think a great gatewaydrug, if you will, is Botox,
because it's not reversible butit wears off right, it's not
permanent.
The results, especially if youdo it in the correct way, at low
(49:02):
doses, it can be very natural,very subtle.
You can still emote, but itjust brightens your skin.
Right, like you said you'd havedone Botox.
So it just the light reflectsoff of it, it just gives a
brightness and if you know,every now and then I'll meet
someone who's like no, it's notfor me, you know.
(49:23):
And it's like, okay, you triedit, it wears off.
No harm, no foul, you don'thave to do it.
So I think that's a great onefor, like, dipping your toe if
you want to see.
Michele Folan (49:33):
You know, and back to the Botox thing, and
I've been doing it for 14 yearsprobably and just in my forehead
, but I'm telling you, thatalone is such a pick-me-up in
terms of just looking a littlemore brighter and refreshed.
Mary Alice Mina, MD (49:49):
So, yeah, well, and here's something cool
They've actually done studies toshow that it helps with
depression.
Yes, so you know, we don'tfully know 100% why, but it kind
of makes sense, Like if you'reconstantly scowling and people
think you're angry, they mighttreat you differently.
You look in the mirror.
(50:10):
You feel you look angry, youfeel angry, but when that
softens that, people feel betterabout themselves and they're
happier and they're lessdepressed.
So there's real science behindit.
Michele Folan (50:24):
I think we generally feel less depressed
when we feel confident about ourskin.
I mean, I think there's that'skind of a no-brainer, but I
again.
I saw this on social media.
I hate saying that because itsounds like that's all I do.
I do way more than that.
But there was a woman who isshowing her.
(50:48):
I don't know if she had a lasertreatment or chemical peel, but
from her tip of like herhairline down to her chest here
she looked like a hot mess.
I mean to tell you looked likeshe had been in one of those old
(51:08):
we do you, we used them waylong ago A tanning light.
What did it?
You know what I mean?
Like the foil, yeah.
Like she had been bait, yeah.
So what did she have done?
Mary Alice Mina, MD (51:24):
Well, hard to say.
I would imagine if I mean itcould have been either, and both
can give some pretty.
You know it definitely takessome counseling.
That's why I say it may not bethe right first treatment for
people who have never done itbecause there is some downtime.
But oh my gosh, like theresults are phenomenal.
They can be phenomenal with theright laser at the right
(51:46):
settings, with the right laserat the right settings.
So she probably had either amedium depth chemical peel like
a TCA acid peel, or she had likean ablative laser peel.
So either CO2 or Erbium laserthat really was the chemical
peel is going to take off thewhole top layer of skin and the
(52:10):
lasers that we use nowadays makethese little channels in the
skin with normal skinintervening.
So the lasers tend to heal alittle bit faster because you do
have that intervening skinChemical peels.
I usually tell my patients it'sseven days for the face, a
little bit longer off the face,but the results are phenomenal.
So I usually tell my patientslike on day you know tonight and
(52:34):
tomorrow you're going to bequestioning your life decisions,
but by day four or five for alaser you're going to be loving
me.
And day seven on a chemicalpeel.
I get these smiling picturesand they're so happy and they're
like you know, they're so happyand they're so glad they did it
.
Michele Folan (52:51):
Yeah, why did I wait so long?
It was a sun lamp my sistersSun lamp.
Yeah, now my sisters are intheir late 60s, but they would
use a sun lamp and I remembersome pretty hellacious burns
from those.
But, yeah, I mean, I'm lookingat this woman and I'm thinking,
oh my God, even as confident asI can be about stuff like that,
(53:13):
I am not leaving the house forweeks.
Yeah, because it was that bad.
But I'm sure, I mean, herresults will be spectacular.
I'm sure, right, I'm just notthere yet.
Mary Alice Mina, MD (53:27):
And that's okay.
Michele Folan (53:27):
Yeah, we'll get there.
We'll get there.
All right, you are also thehost of the Skin Real podcast.
What inspired you to start apodcast?
What were you thinking?
Mary Alice Mina, MD (53:43):
A midlife crisis.
I suppose you know what I'lltell you.
It was 2020.
Okay, you remember 2020?
And I was stuck at home, like somany people and my patients a
lot of them were older, theywere scared to come in.
My partner and I were splittingup so we were on different days
.
So I had a lot of free time andI started listening to podcasts
(54:05):
and I had really never been apodcast listener until then and
I also was turning 40.
And I was noticing changes anda lot of my friends were turning
40.
And it was kind of like whoa,what's going on?
We had a lot of time to look atourselves, right Like I don't
think we ever stared atourselves like we did starting
in 2020 on Zoom cameras,different angles oh my gosh, my
(54:27):
neck.
I didn't think I looked likethat.
Where are my filters, Exactly?
So I started getting a lot ofquestions.
I was having questions and Ithought you know what, when I
went to see what was out thereand also I sort of felt like,
well, don't people know this?
But I realized there's so muchjust nonsense out there and so
(54:48):
much noise, a lot of stuff.
Just buy this, buy that, dothis product, do this crazy
12-step routine, and so I justwanted to be like a voice of
reason for someone who is justgiving people good skin
information.
I know it's hard to see adermatologist.
I know our visits are rushedand short and you don't always
get your questions answered, andso I wanted to provide a
(55:11):
resource for people where theycan get this information.
And I also feel like skin health.
We think of it as what we puton our skin.
What products do I need?
What procedures do I need?
But I think a huge part of yourskin health is how you take
care of your body, how you takecare of your mind, your physical
health, how you think aboutaging right and how you take
care of your body, how you takecare of your mind, your physical
health, how you think aboutaging right and how you speak to
(55:34):
yourself.
So all of these things impactyour skin, not just am I using
the right retinol or vitamin Cor peptide right?
So I'm hopefully giving people,you know, just good information
, science back.
You know I'm like we're notdoing gimmicks, we're not doing
hype and just give people likemy age, older, perimenopause,
(55:57):
menopause who are like what do Ireally need to do?
This is it, this is what.
Listen to this and you'll getsome good hopefully some good
information.
Michele Folan (56:06):
Yeah, it's beauty from the inside out, right.
Start with what you're puttingin your body.
You know it's funny.
You talk about 2020, that'swhen I devised this idea of
doing a podcast too, but I'vehad so many guests on the show
who have written books or donethings because of that downtime
during the pandemic, so Igiggled when you said, oh, you
(56:28):
know 2020, like oh Right, A lot.
Mary Alice Mina, MD (56:31):
Yeah, shocking.
Exactly, I think 2020 made alot of people sort of think wait
a minute, like what am I doing?
Let me think about my life, andI think also that's midlife
right Like you've maybe beendoing something for 20, some
years, but you're like where doI see my life in the next 20
years?
And and I think midlife is agreat time to kind of reinvent
(56:54):
yourself.
Michele Folan (56:55):
So we talk about that all the time on this show.
There's a lot of women, youknow, like post menopause,
they're starting to look attheir husbands and they're going
yeah, what am I doing?
I mean, it's it's careers, it'slife's life.
It's everything that we startto kind of reassess.
So, all right, dr Mary AliceMina, where can the listeners
(57:18):
find you online and on socialmedia?
Mary Alice Mina, MD (57:21):
Yeah, so you can listen to the podcast
called the Skin Real.
I have to spell it out topeople.
Nowadays R-E-A-L and I'm at DrMina Skin and if people are
wondering, I get this question alot like where do I start?
What do I really need to do?
I have a little PDF you can getfor free at theskinrealcom
(57:41):
forward slash habits where Ibreak down how you can create
healthy skincare habits withoutspinning on the hot girl hamster
wheel, as I call it.
Michele Folan (57:50):
Perfect, I'll put that in the show notes.
Thank you for that, and it wasgreat.
Speaking to you, I'm so happyyou got to be here today with us
.
Mary Alice Mina, MD (57:59):
Yeah, this was a lot of fun.
I could talk about this forever.
It's just something I love Icould, too.
Thanks for being here.
Michele Folan (58:08):
Thanks so much, hey.
Thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
.
And did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
Thank you.
Let's be real for a second.
If you're over 50 and stilltrying to eat less and move more
, that strategy expired withyour 30s.
The weight won't budge, theenergy is gone and your doctor's
side-eye at your annual checkupyeah, that's not going away on
its own either.
Enter the Faster Way, theprogram that actually works with
(00:22):
your midlife metabolism, notagainst it.
We're talking strategicworkouts, real food, and, no,
you don't have to give up yourwine or your social life.
This is not a quick fix, though.
It's a grown woman reset.
So if you're tired of startingover every Monday, do something
different.
Check the show notes for thelink or reach out with your
(00:43):
questions.
I'm here to help you make thisyour last start over Health,
wellness, fitness and everythingin between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
(01:04):
Wrinkles, dryness, thinningbrows, sun damage, sagging skin
Sound familiar.
If you're a woman in midlife,chances are you've stood in
front of the mirror wondering isthis normal or which product is
actually worth it?
This week, on Asking for aFriend, I'm joined by Mary Alice
(01:26):
Mina.
She is a board-certifieddermatologist, dermatologic
surgeon and the host of the SkinReal podcast.
She's here to help us cutthrough the noise and finally
get clarity on what our skinreally needs after 50.
We're going to cover thebiggest skin concerns for
midlife women how to tackle themhead on.
The common regrets Dr Minahears from mature patients the
(01:51):
truth about sunscreen debatesand how to use it smartly.
Because this is a definitequestion I have why your
skincare order matters, whatingredients and treatments are
worth the money and what's not.
And yes, we even talk about thetrending use of vaginal
estrogen on our face.
If you've been overwhelmed byconflicting advice on wasting
(02:12):
money on miracle creams, thisepisode is your no-nonsense
guide to smarter skincare inmidlife.
Welcome to the show, Dr MaryAlice Mina.
Mary Alice Mina, MD (02:22):
Thank you so much, Michele.
I'm super excited to be hereand have this discussion.
Michele Folan (02:27):
Well, this is right up my alley.
I love this and I know myaudience also loves this topic,
because anytime we talk aboutdermatology or skin treatments
anything in that realm thoseshows always do very well, and
you have a podcast of your ownand I want to talk about that
too.
But I'd love to know a littlebit more about your background,
(02:50):
where you're from, where youwent to school, to give us a
sense of your roots.
Mary Alice Mina, MD (02:54):
Yeah, Well, it's great to be here and yeah,
I feel like people women, right, Especially really all ages it
seems like we like to talk aboutskin right, it's right there,
it's fun, but it also can bechallenging.
So I'm glad we're here havingthis discussion.
Let's see my background.
I am from a family of doctors,but I did not decide to go into
(03:15):
medicine until I was about 21.
I actually was a ballet dancerup until then.
I realized I wasn't going to bethe prima ballerina at an
amazing company and that maybe Ishould look to do something a
little more stable and secure,and so I guess medicine
dermatology was my plan B.
(03:37):
But it worked out, and itworked out great.
Let's see, I went.
Were you asking where mytraining?
Michele Folan (03:43):
was yeah, like yeah, undergrad, and then yeah,
where were your training?
Mary Alice Mina, MD (03:47):
Yeah, so I went to Vanderbilt for medical
school and then I traveled up toNew York Memorial Sloan
Kettering Cancer Center for myinternship and then I was at
Harvard for my dermatologytraining and then I moved south
to Atlanta at Emory to do myMohs surgery fellowship and
(04:07):
that's where I met my fabulousbusiness partner, Dr Baucom, and
I've been working.
First I joined him, worked withhim, and now we're business
partners and I can't believeit's already been like 13 years.
It's crazy.
Michele Folan (04:21):
Oh wow, so you got a little later.
Start with everything too,which you know.
You're the second doctor in amonth I've interviewed who was a
dancer and then kind of veeredoff the path and it's just
fascinating that.
But you know what, when youthink about that, there's
artistry involved in what you do.
(04:42):
That's that aesthetic, and so Ican see that?
Mary Alice Mina, MD (04:46):
Yeah, I definitely think so, and I
didn't realize that I would getto pair the artistic side so
well.
But I think a lot of peoplethink, oh, medicine, it's so
data, analytical and all this.
But we can do amazing things inmedicine, but there is still an
art to it.
It's not cookie cutter.
Not everyone responds andbehaves the same way.
Michele Folan (05:09):
There's still so much we need to learn and know,
and so yeah, there really is anart to practicing medicine as
well, yeah, and then there's theoff-label uses for things that
we know work for certain things,so it's fascinating.
A lot of it is intuition andexperience.
And then I'd also love to knowwhat the path was to becoming a
(05:35):
double board certifieddermatologist and dermatologic
surgeon, because that had to beextra time as well, right.
Mary Alice Mina, MD (05:43):
Yeah, the nice thing about medicine for
people who might be listening,who are younger, have children,
right, like sometimes I'll thinklike how do people become these
jobs that are beyond, liketeacher, doctor, nurse?
You know these like jobs inbusiness, but at least in
medicine it's like once youdecide you want to be a doctor,
it's very laid out for you whatyou have to do.
(06:05):
You've got to do first twoyears and you've got to take
step one, board exams, and youdo your clinicals and you take
step two.
It's very sequential and youknow what's kind of expected of
you.
And pretty early on I knew thatI liked dermatology and probably
a couple of things, probably mybackground in dance and the
(06:26):
arts.
I'm very visual, I love to well,I don't do it so much now, but
I used to love to draw andvisual arts.
And then probably also becauseI'd really only been to a
pediatrician and a dermatologistin my 20 some years and I just
I had acne when I was growing upand it wasn't as bad as some
(06:48):
people.
I didn't really have scarringfrom it, but it was really
embarrassing and I'm normally anoutgoing person and I wanted to
fade into the background.
I wanted no one to look at me.
I did not want to put myselfout there, so I knew what it
felt like to have a skin issuethat made you just want to
(07:09):
disappear.
And what I enjoy aboutdermatology is not everything is
life or death right, but it isvery impactful when you can help
someone with their skin,because it's so visible and I
think that's why a lot of womenin this midlife phase can be
struggling, because we noticethe skin changes before a lot of
(07:29):
the other changes.
And it's not just we notice.
The outside world notices,right, and we might start being
treated differently.
We show up differently, right.
Michele Folan (07:39):
So that's why and I'm in my midlife now yeah, it
interests me more and more, youknow and here's the thing it's
not about looking like someoneelse, it's not about making
yourself look like not thatperson that you are, but it's
just having that baselineconfidence.
(08:00):
You know, to feel good aboutyourself.
I get Botox in my forehead.
I know that I am not going tolook like I'm 24, nor do I care
to look like I'm 24, but I lookmore awake and that is what
helps me feel better.
So everybody's different and onthis show we are open-minded
(08:26):
and we don't judge anybody foranything that they wish to do to
their bodies.
We're all open about that.
But most of my audience is 50plus and it'd be good to know
what are the most commonmisconceptions that you hear
from women in that age groupabout their skin.
Mary Alice Mina, MD (08:48):
I think there's a lot of insecurity and
a lot of self-hate in thisperiod, a lot of negativity we
speak really unkindly toourselves, a lot of maybe shame
and feeling like you're unworthy.
And it's just.
I do think, and I'm hopefulthat this is improving, as we're
(09:09):
actually talking aboutmenopause and perimenopause and
it seems like there's finallythis movement where women are
like wait a minute, just becauseI'm 45, 50, 55 doesn't mean my
life is over, I'm going to beput out to pasture, I'm no
longer worthy or beautiful.
So I do think things arechanging and I am hopeful about
that.
We're finally talking about it.
(09:30):
I think that's really the firststep, right, because for so
long I think people just feltthis sort of shame inside,
dreaded every birthday coming up, and I think you sort of have a
great perspective right, likeyou're not trying to look like
you did at 24, but you just wantto feel good, because when you
look good, you feel good, right,and vice versa, when you feel
(09:52):
good on the inside, it also isreflected on the outside.
So I think helping kind ofreshape the stage of life that
this is not.
You know, menopause is not adirty word.
It doesn't mean you're, youknow, worthless and no longer of
value and no longer beautiful.
We have to kind of reframe it.
(10:12):
It's different, yes, right, butit doesn't have to be bad, it
doesn't have to be negative, andI think, just embracing this
stage of life, studies haveactually shown if you have a
positive view about aging,you're healthier and you live
longer and you have fewerchronic diseases.
(10:34):
So this isn't just like thinkhappy thoughts, right, like this
actually does work, and so whyI started my podcast and what I
really love to do is just helpwomen feel confident, right, get
your confidence back.
Yes, you look different than youdid at 24, but it doesn't mean
bad.
And I'll just say I had abeautiful woman as a patient the
(10:57):
other day.
She was 94 years old and thiswoman she did not look 24.
She didn't look 50, right, youcould tell she was 80 plus, but
she had this elegance to her andshe had wrinkles, right, she
didn't have no skin laxity andno blemishes and all that.
(11:20):
But it reminded me that you canstill be beautiful and elegant
and graceful and still look ageappropriate and not look like an
alien, right?
So there's just lots of ways tothink about beauty and aging
and we need to sort of shift ourmindset that we want to totally
prevent aging at all costs andactually learn to embrace it and
(11:43):
try to do more likepreventative stuff.
Really I think is like so keywith so much.
Michele Folan (11:51):
You know, and, like I said, I don't judge, but
I did see a woman today at thegym who had had a lot of work
done and I'm thinking, wow, Icould tell underneath all of
that that she was a very prettywoman.
But I don't know if you everhave patients that come in and
they say, oh, I regret this, orwhatever.
(12:13):
But do you have a particularregret that you continually hear
from your more mature patients?
Yeah, Well.
Mary Alice Mina, MD (12:21):
So I think the number one regret that I
hear is that they wish they hadworn sunscreen and that is it.
Now I do treat a lot of skincancer, but it always comes up.
They'll tell me we didn't know,this was back in the 70s and we
had baby oil and iodine in thefoil and they'll say I wish I
(12:46):
had known.
I wish we had known to sunprotect.
That's the number one thing Ihear.
I don't hear too many peoplecoming in regretting,
necessarily, cosmetic proceduresand stuff like that.
But I also think patientsgravitate towards me based on
kind of, I think, what I looklike where I do cosmetic
(13:09):
procedures.
But my goal is always a verynatural approach and for some
they don't want that, like somepeople actively want a more
exaggerated full look, and so Idon't tend to see those kinds of
patients because that is justnot.
I'm not really the best personfor them.
Okay, yeah, so I think there issome self-selection with that?
Michele Folan (13:32):
Oh, absolutely, I definitely do, and we're going
to take a quick break and whenwe get back, since we started
talking about sunscreen, I wantto dig into that topic.
How many drugstore products areyou going to try before you
finally decide?
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(13:53):
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(14:15):
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They're sending me selfiesbecause they can't believe the
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If you're ready for skincarethat actually works and feels
good to use, rimon might be yourglow up in a bottle.
Want the details?
Shoot me a message or check thelink in the show notes.
Okay, we are back.
(14:38):
Before we went on the break, Imentioned sunscreen, and If you
are on social media right now,you are hearing a lot of
conflicting advice about sunexposure, and we all know that
getting light in the morning isgreat for resetting our
(14:58):
circadian rhythm.
But there seems to be someinformation out there, dr Mina,
about the fact that eliminatingsun exposure is actually
detrimental to our health.
Can you talk about that alittle bit and what you're
actually hearing and what youropinion is Right?
So?
Mary Alice Mina, MD (15:18):
I feel like there are people who you know.
I remember when I was aresident, like I do feel like
there were days I probably neversaw the sun.
But depending on where you liveat least here in Atlanta, like
I'm sitting by a sunny windowthe sun is coming in.
So my view is you should wearsunscreen every day, because it
(15:40):
might be cloudy, it might beraining, you might forget, but
it's like brushing your teeth,it's just a habit, and to me my
sunscreen is like my moisturizer, so it kind of like kills two
birds with one stone.
I'm also very pale, so my skincannot tolerate any sun.
Versus someone who has moremelanin, they can handle a
little more without burning andI've been burned before plenty
(16:03):
of times.
I've tried to tan and it didn'twork out well.
I think the I'm not saying don'tever like expose any part of
your body to the sun and likelive in a basement, right, but
we get sun through car windows,we, you know.
So if you have a commute 30minutes a day, you're getting
sunlight.
If you know most people, theymight do a quick walk with their
(16:25):
pet outside or water theirplants.
They're outside.
So I think most people aregetting more sun than they
realize.
And if you don't think you are,you can look at your stomach or
look at the inside part of yourarms.
And look at the outside part ofyour arms, and if you see a
difference, that's the sun doingthat to you.
So I think a safe bet is towear sunscreen.
(16:49):
You're still going to getexposed to sunlight.
No one, including myself, wearsas much as we should.
I have to say I'm notreapplying before I get in my
car to drive home, you know sowe're not, as we're not as
diligent and good as we say wedon't wear it, we don't apply it
enough.
So what we do know, though Imean I see this thousands of
(17:10):
patients with skin cancer, and Isee how some are very easily
treated and then others aresometimes life-threatening.
So I just think it's not worththe risk, and if you just get in
the habit of wearing sunscreen,great.
Other options are to like Idon't love to slather sunscreen
on, you know, multiple times aday either, but what I'll do is
(17:33):
if I'm going to be outside withmy kids or taking a walk, I wear
a hat, and that's a great way,and I just try to never feel
like I'm like a rotisseriechicken roasting in the sun,
right, yeah.
And if you're not worried aboutskin cancer, then premature
aging right.
Like, one of the biggest thingsthat causes premature aging and
(17:55):
accelerates aging in us is UVradiation.
So if you are like I'm aminimalist, I don't want to do
anything then if you just sunprotect and don't lay out, go to
tanning beds and get tan,you're going to look way younger
when you're older than someonewho doesn't.
So, yeah, I mean, if you want tolook at the UV index and go
(18:20):
outside when it's lower thanthree or not, I mean I think
there are some people who takeit too far.
Right, you see their outfits,they wear in the car and all
this and that, but it's justhard for people to know what's
this.
We don't really know what is asafe amount of sun, Okay and
yeah.
So that's kind of it.
Michele Folan (18:37):
Do you have a preference on sunscreen?
I mean, you've got kids, yeah,so do you pick a particular
brand based on safety and that?
So mineral versus, I guess,physical sunscreen?
Mary Alice Mina, MD (18:51):
Yeah, yeah, so chemical versus physical.
So there's a lot of.
There've been studies in ratsnot in humans where the rats ate
it.
They licked it, they ate.
You know, you'd have to wearsunscreen for 200 years to get
anywhere close to the amountsthat they were exposed to.
But there have been no studiesin humans showing harm from
(19:13):
sunscreen and there are copiousamounts of studies showing the
harm of sun damage.
For my children they're 10 and11 now.
I really try to get them towear hats and we wear rash
guards at the beach and I'm finewith mineral or chemical
sunscreens.
So the main issue with thephysical sunscreens the zinc and
(19:34):
titanium is that it's uh, has athicker feel a lot of the times
, a chalkier like residue.
So people with darker skin, um,can look almost like gray or
purpley you know, the worst lookever.
Michele Folan (19:49):
Let's just admit that white ghosty look.
Mary Alice Mina, MD (19:52):
Yeah, again , we don't apply it enough.
There've been zero studies inhumans showing any harm, even
the studies about reef issuesand all that.
It seems it's more globalwarming than anything else.
But if you are worried, thenjust stick with zinc and
titanium.
You may have to shop around alittle more to find one that you
(20:14):
really like.
I actually.
I just got this from my office.
It's the Elta MD spray and Ibelieve, yeah, this is 100% zinc
and I do really like this onebecause I can spray it, it's
really light and it rubs onreally well.
So it is possible to find thephysical blockers that are nice.
It just takes a little moretrial and error and I would just
(20:35):
tell the audience, like, don'tgo crazy, you are okay if you
use chemical sunscreens.
The only people I wouldn't useit on is maybe a teeny, tiny
little baby.
Then we recommend just usingreally we use truly physical
blockers.
Like put the awning up, put ahat on stuff like that.
Michele Folan (20:52):
Yeah, so what is the cutoff age for using
sunscreen on babies?
Mary Alice Mina, MD (20:56):
So really six months and older is when we
recommend it.
But I actually was just doing apodcast with a pediatric
dermatologist and he was sayingwe put a lot of diaper rash
creams or zinc oxide, which issunscreen, right, and we do that
at one day old.
So really we say six months andolder, but really the most
(21:20):
important thing is that you'reprotecting their skin.
Michele Folan (21:23):
Okay, I'm asking because my listeners have
grandkids and I figure theyoften have to chime in on those
things, so all right.
So we did touch on menopause alittle bit and that estrogen
loss does show up on our skin aswe age.
Huge trend right now of usingvaginal estrogen on our faces,
(21:48):
and there's even some brands outthere now that are including
estriol in their formulation.
What's been your experience andhow are you feeling about the
science behind it?
Mary Alice Mina, MD (21:59):
I am loving it.
So I have, and I've beentalking to some of my older
patients and they'll say, ohhoney, we've been using this for
decades.
Right, like they've been using.
This is nothing new for a lotof ladies.
They've been using theirvaginal estrogen cream on their
face, on their chest, on theirhands, so they've been doing it
(22:20):
for a long time.
We know it's very, very safeand actually super protective,
decreases risk of UTIs in womenand helps hydrate the skin, the
perineum, the vulva, and so itmakes sense.
Our skin has estrogen receptorsto put it on skin of your face,
your hands, your neck, and nowcompanies are making it,
(22:41):
formulating it specifically forthe skin.
I haven't tried vaginal estrogento know the difference between
the facial one and the other one, but I do know the facial
creams that I've tried arewonderful.
I think of them as like amoisturizer, so I have been
getting a lot of requests for itto use and I think it's great.
I would say the only people Imaybe would use a little caution
(23:04):
with is someone who has really,really bad melasma.
Where they flare, they getthose brown discoloration on the
face.
The data is sort of like hit ormiss on that, whether it truly
does exacerbate it, but we doknow estrogen can make melasma
flare, along with sunscreen orsun.
(23:25):
So if someone had really severemelasma I would definitely just
talk with them about that.
But otherwise super safe.
I think it's wonderful.
I think if you're inperimenopause or menopause you
should be putting it on yourface.
Whether you get one that's justfor your face or you use your
vaginal one, it doesn't matterto me one.
Michele Folan (23:52):
It doesn't matter to me.
Okay and this is my plug kindof off the topic but for women
that are not on vaginal estrogen, I don't care how old you are
and if you haven't had a sexualrelationship in 20 years, the
data really shows that probablyevery single woman should be on
vaginal estrogen after menopauseand it's preventative for so
(24:13):
many things.
And I've had this discussionwith my friends and they're like
, nah, I'm fine, I'm like no, no, you say you're fine, but
things get shriveled up downthere and it causes all kinds of
issues.
So, anyway, that's okay, I'llget all kinds of issues.
So, anyway, that's okay, I'llget off my soapbox, but anyway
all right, yeah, and it's sosafe.
Mary Alice Mina, MD (24:33):
It's so safe.
So I think, yeah, use it onyour face, use it in the vaginal
area.
It's wonderful.
Michele Folan (24:43):
So for women that are experiencing skin changes
in midlife okay, we're talkingdryness, dullness, loss of
elasticity, because I thinkthose are the main concerns I
always hear.
Where should they focus theirattention first?
Mary Alice Mina, MD (24:58):
Gosh, I would say your best bet if you
want to save time, frustrationand money is see a dermatologist
.
I think a lot of times peoplesort of piecemeal well, I'm
going to go here for this, I'mgoing to go here for that.
I got a group on for this.
So I would say see yourdermatologist.
Like this is a skin, your skinexpert.
If you've never had a skincheck, you should get a skin
(25:19):
check, because this is when westart to see skin cancers pop up
and you may have things thatare more medical.
You may be struggling with acnebelieve it or not, it happens.
You may be having rosaceaflares.
Again, get the skin checks.
So I would start with yourdermatologist and then they can
help you come up with a plan onwhat really should be the first
(25:40):
thing I do, if anything right,Like maybe it's just getting on
a skincare regimen, Maybe it'sadding estrogen cream, estriol
cream, Maybe it's addingtretinoin.
So I just feel like, ratherthan kind of shopping it out to
lots of different people whoyour friend went to and all that
, I would say start with theskin experts, like a
(26:01):
dermatologist.
And a lot of times if a patientasks me like well, what should I
do, what should I do?
I started off with saying, well, what bothers you?
Right, Because what I see mightnot be what bothers you, and
this happens all the time.
So I like to hear what bothersthem.
And if it's that, they justfeel like their skin's not
bright or they've got some looseskin here or there, you know.
(26:23):
So it's helpful to know well,what bothers you, Because if it
doesn't bother you, you don'tneed to fix it.
Michele Folan (26:28):
You brought up tretinoin and I know I've tried
it in the past and my skin gotsuper dry and they say, oh, just
use it every three or four days, whatever, give us your
strategy for using tretinoin andhow people can be more
successful with it.
Mary Alice Mina, MD (26:45):
Right, and I hear this a lot too.
In fact, I had thisconversation a couple hours ago,
so I'm a big fan.
I mean, I think it's probably,other than sunscreen, the most
powerful potent topical creamthat we have, especially for
anti-aging.
I mean, the data is abundant.
It increases your collagen 300%versus know, versus collagen
(27:08):
powder we're debating does itwork, does it not?
We don't know, we do know.
Tretinoin does it and retinoids.
So the main issue is it isirritating, especially if you
have real sensitive skin.
It's wintertime all thesethings can make it harder.
So my trick is you can startwith over-the-counter like
that's going to be weaker.
(27:28):
You can start withover-the-counter that's going to
be weaker.
You can start withover-the-counter adapalene or
Differin that's a little bitstronger if you want.
So those are ones you can startwith.
I recommend using it on cleanskin at night.
I like the skin to be reallydry, because the more moisture
it has, it's going to absorbmore deeply and cause more
irritation.
So this is a time where weactually don't want you to put
(27:49):
it on your skin wet, so let itdry.
Sometimes what I'll do is afterI shower, I will wait even like
30 minutes or so, because Itend to have oily skin.
So within 30 minutes my skinalready has a little oil to it
and then I put it on.
But you could also put amoisturizer on and then wait a
(28:10):
little bit and then it's justone little P on your finger, not
big at all.
Dab it across your whole face.
I do my neck, tops of my hands,you could do your chest too, if
you want, and then you can puta moisturizer on afterwards.
So the sandwich technique ismoisturizer, tretinoin
moisturizer, and sometimes Iwill do for that second
(28:32):
moisturizer.
Like my eyelids tend to getreally dry, I will just put on
Vaseline or Aquaphor in thoseareas, or like around the
corners of my mouth.
I'll add what the kids callslugging and I will put the
Vaseline or Aquaphor there, andthen I still get dry.
I mean, I'll tell people I'vebeen using tretinoin, except for
(28:52):
when I was pregnant, since Iwas in my 20s and you know,
because I had acne and then Ikind of stopped it for a few
years but then got back on it assoon as I became a dermatology
resident.
So I still get dry.
So I don't use it every night.
I used to use really strongstrengths, but now we realize,
(29:13):
even the lowest strength is good.
It's not like you have to getto the top layers or at the top
highest percentage.
But if you really really can'tyou know, if you really can't
tolerate it doing all thosethings, then try
over-the-counter or try.
My patient today was telling meshe uses Bacushiol, which is a
(29:34):
plant version that acts similarto retinoids and we don't have
as much data on it but it'scertainly gentler to the skin,
gentler to the skin.
So those are just some tips andtricks to try, and usually by
(29:55):
using less and really bulking upthe moisturizer I can get most
patients, most of my patients,to tolerate it?
Michele Folan (29:59):
Do you use it at night or in the morning?
Mary Alice Mina, MD (30:02):
So tretinoin or retinoids you want
to use at night, got it Allright?
Yeah, so you want to use thoseat night and then you want to
use your sunscreen and maybevitamin C in the morning.
Michele Folan (30:12):
Okay, and then in the evening you use your
Tretinoin, and then what elsewould you use at night
Moisturizer?
Okay, all right, so you keep itpretty simple.
Mary Alice Mina, MD (30:21):
I keep it very simple.
Now I know there's a lot oftalk and I have to say I've been
doing that for like decades,but in the last like six months
I have gotten really excitedabout exosomes and so I am using
a product called Plated, whichI really do love.
So I do, I wash my face, I usemy Plated, then I use my
(30:42):
Tretinoin and moisturize.
So I would say, at night, tryto be on a retinol, retinoid of
some sort.
You can use your Estriol creamas your moisturizer if you like.
I think that's a great idea.
And if you are someone whoreally enjoys skincare and you
want the latest, greatest andall that and you want to play
around with stuff, then try somepeptides or exosomes or growth
(31:07):
factors.
So that's something you canthrow in in the evening.
But it can be as simple.
I mean, my mom just usesmoisturizer okay, so it can, and
she has beautiful skin, so itcan be simple.
Michele Folan (31:19):
All right, where are exosomes derived?
Mary Alice Mina, MD (31:22):
Yeah.
So exosomes are little, thinkof like a little envelope.
So the exosomes get littlemessages from stem cells and
deliver it to other cells of thebody.
So an exosome can be good orbad.
Just saying this is an exosomedoesn't really tell us much.
What you care about is what'sthe little message in that
(31:44):
envelope?
So you don't want the messageto be cell death or, you know,
cancer growth, right, right, orlike pro-inflammation.
So what I so you, you know withwhat people are looking at with
skincare is little messages inthe exosomes that tell the cells
to get rid of these thingscalled zombie cells, to
(32:06):
eliminate those that are sendingout bad signals to our other
healthy cells.
You wanna stimulate things todecrease inflammation, to
increase collagen fibroblastactivity.
So I think we're gonna hear.
Your audience should know we'regonna be hearing a lot about
exosomes in the near future ifyou haven't already heard about
them.
And I would say, take it with agrain of salt, because there's
(32:29):
going to be a lot of snake oilout there, a lot of people
pushing exosomes as injectionsor IVs and, first of all, that's
not FDA approved, so I wouldn'tgo see anyone for that.
But I do think there is somegood science and data behind it.
You just need to make sureyou're not spending a lot of
money for a moisturizer.
Michele Folan (32:50):
All right.
And then my other question iswhen we do microneedling, do you
ever do?
Mary Alice Mina, MD (32:58):
PRP, yeah yeah.
So it's a great option.
That's called the vampirefacial and so PRP is kind of
like one step after exosomes, soyou could think of like stem
cells as being like the mostpotent, and then exosomes carry
the messages from the stem cellsand then PRP are some of those
(33:22):
stimulate growth factors too.
So it's like kind of the nextlevel.
So PRP is wonderful.
It can help with healing.
You can do it after lasers.
You can do like kind of thenext level.
So PRP is wonderful, it canhelp with healing.
You can do it after lasers, youcan do it after microneedling,
you can do it to help with hairgrowth on the scalp.
The only thing where PRP can geta little tricky is there's a
lot of variability.
(33:43):
It's not like you pick up thisjar and you're like okay, I know
what's in there, I know howmany platelets are in there.
I know Our bodies are veryvariable.
So even within month to monthwhen you get your treatments,
you may have more platelets oneday, fewer another.
The older you get, there'sthought are the platelets not as
(34:03):
effective.
Is it better to get platelets,platelets from younger people?
So I do think we're going tosee that evolve.
But certainly, especially ifyou are someone who likes the
idea of a very natural approach,using your own blood and
platelets, is, I think, a greatoption for you.
Michele Folan (34:21):
So for anyone that hasn't heard of this before
and they're kind of grossed outby this conversation because
it's a little different, right?
Yeah, they draw your blood andthey spin out the platelets,
correct?
Yeah?
Mary Alice Mina, MD (34:35):
Okay, yeah, exactly, because the platelets
are the key signals.
If you injure yourself, thoseplatelets are activating that
wound healing cascade, and sowhat we're doing is we're taking
those platelets and activatingthe growth factors, the
messengers stimulating healing.
And yeah, it is.
(34:56):
So I've never done it myself,but when I've done it to my
staff and patients it does feela little bit weird, and you do
have to leave it on for about anhour before you wash it off.
So it's kind of a differentsensation, but in the long run
it does help you heal faster.
Michele Folan (35:11):
All right, I might have to do that I haven't
done microneedling in like twoyears, but I always look like
I'm drugged behind a bumper.
After I have it done, I thinkshe goes kind of hard on me.
But I'm curious what PRP woulddo in my healing process because
yeah, yeah, it should help itheal faster.
(35:31):
It scares the hell out of myhusband when he would come home
and he sees me after I've haddone it, he's like oh my God,
what happened to you?
Mary Alice Mina, MD (35:39):
Like, don't worry about it, I know, but you
know, it seems like do you feelyou heal pretty quickly, like
the next day you're lookingsignificantly better, or do you
have more downtime?
Michele Folan (35:50):
I mean downtime.
Define downtime because I neverhave any downtime and I'm the
one that goes to girls night outafter I have microneedling and
they make fun of me but I don'tcare.
Mary Alice Mina, MD (36:06):
You know that it always makes me laugh
because, just to your point,patients will say well, how much
downtime I'm like.
You know everyone's different.
Yeah, because our staff come towork the next day.
But you may be like oh no, Idon't want anyone to know, I'm
going to hide out at home.
Michele Folan (36:20):
So, yeah, everyone's different, yeah, okay
.
Well, yeah, I'm like whatever,I really don't care.
I want to talk a little bitabout things that are just a
total waste of money, and I'mgoing to ask you first about
beef tallow.
Mary Alice Mina, MD (36:37):
Yeah, so I mean, I've never used it but I'm
like I don't need to use it.
I think this concept of foodfor skincare don't use it on
your skin if you wouldn't eat itis kind of ridiculous, I mean.
I guess I kind of see it doessound appealing like nature and
natural and all that, but wehave amazing products formulated
(37:02):
just for what your skin needs.
So I don't know, you know, whywe're going back and using
something that's never beenmeant to be used on the skin.
It can clog pores, you can haveirritation.
It's just unnecessary, so Idon't recommend it at all.
Michele Folan (37:18):
All right, that was my first one.
What about red light masks thatyou see all over?
Mary Alice Mina, MD (37:24):
Yeah, so we do know.
In dermatology we use a lot oflight therapy.
Lasers are a form of lightamplification, so red light
therapy is helpful.
It does help reduceinflammation and you know, I
think it's cool People like it.
It's relaxing.
The issue with the face maskit's kind of like exosomes it's
(37:46):
hit or miss.
Some can be really good andsome can be really bad.
So you want to find a mask thattruly is red light.
You want to make sure there areenough dots in the mask so that
your skin is adequately covered.
You don't want a mask with likefour dots that you're putting
on, so you want lots of dots tocover your skin.
You want it to form to yourface.
(38:07):
You know I've seen those likelittle wands and I think those
are like ridiculous.
So if you're going to do it,get like the scalp one, get the
one for the face or the neckthat your skin is covered.
They do work.
You just have to do itconsistently and for me I'm like
I could get better results byusing my tretinoin and my
(38:30):
sunscreen and maybe a laser oncea year, once every couple of
years.
So I don't personally do it,but if you want to do it you can
get good results, but you justhave to be consistent, you have
to do it and you have to stickwith it, and I think that's
where people you know they sortof fall off using it after a
certain amount of time.
(38:54):
So this is back to my I don'tcare what people think bucket,
you go to the grocery with it.
Michele Folan (38:56):
No, I would not go to the grocery, but I've
filmed myself on social mediawith it on my husband I'll wear
it when I'm watching TV at nightand he just he doesn't even
blink anymore because he's like,oh Jesus, what next?
Mary Alice Mina, MD (39:12):
Yeah, here she goes again.
Yeah, yeah, like, do it whileyou're journaling or meditating.
Yeah, yeah.
Michele Folan (39:19):
I don't know.
It feels like self-care to me,so whether it works or not, I
don't care.
Yeah, this phase of life isfrustrating because not only do
we lose elasticity in our face,but we're also our eyebrows and
eyelashes and our hair arethinning, and this has come up
(39:40):
on my show before I interviewedDr Bauman, who does a ton in the
hair rejuvenation space.
When patients come to see you,what are their options now in
terms of, you know, rejuvenatinghair, particularly?
I mean, let's talk about thehair on our scalps, because that
(40:01):
is such a source ofconsternation because of our you
know our confidence.
Mary Alice Mina, MD (40:09):
Oh, for sure, For sure.
Yeah, like hair, I think thisone, like women who have breast
cancer, right Like they alreadyare hit with that and then it's
like, oh, you're going to loseyour hair, right Like our hair.
For so many, it's ourfemininity and it can be really
distressing to lose it.
And the thing is, whether youhave thick hair or thin hair to
(40:29):
begin with, if you notice hairthinning, like I noticed, I mean
people would look at me and sayyou have thick hair, but I
noticed I felt like my foreheadwas going farther back and I was
seeing more of my scalp thanI'd ever seen before and I was
like this is different.
I'm like I don't like this.
So the good news is I do feellike we actually have treatments
(40:50):
now that can help.
So if you're noticing hairthinning again, see your
dermatologist because first ofall, it could be a medical
condition, so it could beseveral things.
So vitamin D could be low.
We're reading, learning a lotabout vitamin D and our immune
system and just our overallhealth.
So most people are vitamin Ddeficient, especially people
(41:13):
with darker skin, and if youlive in like climates where the
sun sets really early, you don'tsee the sun.
So get your vitamin D levelschecked, get your thyroid
checked and again, if you havesymptoms, right for thyroid Iron
, you could have low ferritin.
So these are all like commonthings that can be.
Just a quick blood test canlook at it, so your
(41:35):
dermatologist can also assess.
There's something calledtelogen effluvium, where your
hair just falls out in clumpsand you see it.
So that's different from likefemale pattern balding or
androgenetic alopecia.
So telogen effluvium, where thehair is truly shedding and
falling out.
The good news is that isreversible, so it will come back
(41:57):
, but it can really freak youout when you see that, yeah.
So see your dermatologist,perhaps get some blood work,
perhaps supplement as neededwith, maybe iron a multivitamin
work, perhaps supplement asneeded with maybe iron, a
multivitamin vitamin D that canbe super helpful.
Look at your diet.
So if you are vegan or reallycalorie restricting, then you
(42:20):
are probably going to have morehair loss.
So you just need to make sureyou're getting enough calories
and you're getting enoughprotein Protein, I know right,
our hair is protein.
So that is, you know, keratinis protein.
So those are things you can do.
And then there are medicaltreatments and I was just
(42:40):
talking to a patient today aboutit.
So it ranges from topicals.
So minoxidil is super powerful.
Rogaine is the brand name.
I think most people have heardof that, but we can compound
even stronger versions of that.
So your dermatologist can get astrong, compounded formulation
if you don't like the minoxidilor you feel like it's not
(43:02):
working enough for you.
I'm a big fan of oral minoxidiland at really, really tiny doses
just 1.25 milligrams it canmake a huge difference and I
don't know if your audience likeI, have all this little baby
growth from my minoxidil, so ittruly does work.
I know some people are like Idon't want to take a pill, but
(43:24):
it's a half tablet.
It's tiny, very safe, even ifyou're on blood pressure
medicine.
I mean, of course you want totalk with your doctor, but I've
never had someone's PCP orcardiologist say they didn't
feel comfortable with someonebeing on it.
So that's a great option.
Is it prescription?
It is a prescription, yeah.
And then for menopausal women,there are even more choices.
(43:46):
So let's see I'm trying to notuse the trade names, but
dutasteride is an option,finasteride, which is propesia
these are options as well forwomen who are postmenopausal
that they could be on.
So we've got medications.
We've got topicals.
(44:07):
People are looking at exosomesfor hair growth.
So the company I was talkingabout before, plated, does have
a hair product, so that works.
And then PRP we were talkingabout before.
There have been some goodstudies showing that that
increases hair regrowth.
And lastly, hair transplants.
I had a hair transplant surgeonon my podcast and I didn't
(44:30):
really realize women did hairtransplants.
I had a hair transplant surgeonon my podcast and I didn't
really realize women did hairtransplants.
I thought it was just for men,but he was telling me women make
up half his patients and theyeven do hair transplants on your
eyebrows, so I thought that wasreally interesting.
Michele Folan (44:46):
So fascinating.
And Dr Bauman did talk aboutthat a little bit and I was like
, oh wow.
He said it's amazing He'll doeyelash transplants as well.
Mary Alice Mina, MD (44:57):
Yeah, yeah, I'm a bit so Latisse, or what
is the?
Yeah Latisse, it's theprostaglandin.
Yeah, Latisse is great foreyelashes.
I know there are a lot of likeRodin and Fields and other
companies making serums, butyeah, I always had very, very
short eyelashes and I useLatisse a couple times a week.
(45:19):
I was really nervous aboutusing Latisse because I have
green eyes and there have been,when people use it as drops in
the eye, that it can change thecolor of your iris.
But knock on wood, so far sogood.
Michele Folan (45:32):
You know, I think , if you're only using it a
couple times a week.
I know my eye doctor, because Ihave dry eye and all sorts of
things she's so I have to findanother option, A different one.
But you know, I saw someone theother day, of course on social
media.
Yeah, they were using Rogaineor Minoxidil on their eyebrows.
Mary Alice Mina, MD (45:54):
Yes, yeah, you can totally.
Okay, which I like that idea.
Yeah, you can use that.
And I've been amazed too, howyou can get really good eyebrow
tattooing.
You can even get some tattooing, like on your scalp or hairline
, or if you have a scar, theycan tattoo some pigment in, and
(46:15):
there's some phenomenal artistsout there who can do that too in
a very natural way ormicroblading for your eyebrows.
So it seems like there are tonsof stuff we can do nowadays,
and a lot of it.
It's not just one thing, and Ididn't mention supplements, and
your audience probably isthinking about supplements like
Nutrafol, and there's anotherone called Interglow Vitamins,
(46:39):
and I think there's certainly noharm in doing a hair supplement
.
I think if you just do a hairsupplement, you're going to be
disappointed.
But again, a lot of these theyall kind of work together and
it's not like there's one magiccure for it.
Michele Folan (46:56):
Okay Now, thank you for that, because it does
come up and I, you know, in mycircle of friends and stuff
talking about hair thinning andit's really frustrating for some
people and I wanted to makesure we covered off on that.
In terms of professionaltreatments that you offer in
(47:18):
your office or procedures, whatare you most often recommending
and I guess it depends on whatthe patient's concerns are yeah,
but what are you probably doingmost often?
Mary Alice Mina, MD (47:36):
So I think for a lot of people, especially
if they're new to getting thingsdone, evening out the
complexion I think is number islike so key.
I think it makes such a bigdifference and I think why that
patient I told you about earlier, who was in her 90s and she
looked just so beautiful andelegant.
It wasn't that she didn't haveloose skin and wrinkles, but her
just overall complexion wasvery even and uniform.
(48:00):
She didn't have a lot ofdiscoloration.
So to me a beautiful canvasmakes everything look better.
So I usually like to start withthat, whether it's with
skincare products, whether it'swith a chemical peel or laser
treatments.
But I think evening out thecomplexion makes the skin
(48:21):
brighter.
You're gonna look in the mirrorand feel better about yourself.
It's gonna reflect light better.
So that's a great option Forsome people who aren't maybe
quite ready, because there canbe a little bit of downtime.
Microneedling is a great way tokind of have a little pick me up
.
But again, if you have a lot oflike discoloration on the skin,
(48:42):
you really do need like a laseror chemical peel.
But I think a great gatewaydrug, if you will, is Botox,
because it's not reversible butit wears off right, it's not
permanent.
The results, especially if youdo it in the correct way, at low
(49:02):
doses, it can be very natural,very subtle.
You can still emote, but itjust brightens your skin.
Right, like you said you'd havedone Botox.
So it just the light reflectsoff of it, it just gives a
brightness and if you know,every now and then I'll meet
someone who's like no, it's notfor me, you know.
(49:23):
And it's like, okay, you triedit, it wears off.
No harm, no foul, you don'thave to do it.
So I think that's a great onefor, like, dipping your toe if
you want to see.
Michele Folan (49:33):
You know, and back to the Botox thing, and
I've been doing it for 14 yearsprobably and just in my forehead
, but I'm telling you, thatalone is such a pick-me-up in
terms of just looking a littlemore brighter and refreshed.
Mary Alice Mina, MD (49:49):
So, yeah, well, and here's something cool
They've actually done studies toshow that it helps with
depression.
Yes, so you know, we don'tfully know 100% why, but it kind
of makes sense, Like if you'reconstantly scowling and people
think you're angry, they mighttreat you differently.
You look in the mirror.
(50:10):
You feel you look angry, youfeel angry, but when that
softens that, people feel betterabout themselves and they're
happier and they're lessdepressed.
So there's real science behindit.
Michele Folan (50:24):
I think we generally feel less depressed
when we feel confident about ourskin.
I mean, I think there's that'skind of a no-brainer, but I
again.
I saw this on social media.
I hate saying that because itsounds like that's all I do.
I do way more than that.
But there was a woman who isshowing her.
(50:48):
I don't know if she had a lasertreatment or chemical peel, but
from her tip of like herhairline down to her chest here
she looked like a hot mess.
I mean to tell you looked likeshe had been in one of those old
(51:08):
we do you, we used them waylong ago A tanning light.
What did it?
You know what I mean?
Like the foil, yeah.
Like she had been bait, yeah.
So what did she have done?
Mary Alice Mina, MD (51:24):
Well, hard to say.
I would imagine if I mean itcould have been either, and both
can give some pretty.
You know it definitely takessome counseling.
That's why I say it may not bethe right first treatment for
people who have never done itbecause there is some downtime.
But oh my gosh, like theresults are phenomenal.
They can be phenomenal with theright laser at the right
(51:46):
settings, with the right laserat the right settings.
So she probably had either amedium depth chemical peel like
a TCA acid peel, or she had likean ablative laser peel.
So either CO2 or Erbium laserthat really was the chemical
peel is going to take off thewhole top layer of skin and the
(52:10):
lasers that we use nowadays makethese little channels in the
skin with normal skinintervening.
So the lasers tend to heal alittle bit faster because you do
have that intervening skinChemical peels.
I usually tell my patients it'sseven days for the face, a
little bit longer off the face,but the results are phenomenal.
So I usually tell my patientslike on day you know tonight and
(52:34):
tomorrow you're going to bequestioning your life decisions,
but by day four or five for alaser you're going to be loving
me.
And day seven on a chemicalpeel.
I get these smiling picturesand they're so happy and they're
like you know, they're so happyand they're so glad they did it
.
Michele Folan (52:51):
Yeah, why did I wait so long?
It was a sun lamp my sistersSun lamp.
Yeah, now my sisters are intheir late 60s, but they would
use a sun lamp and I remembersome pretty hellacious burns
from those.
But, yeah, I mean, I'm lookingat this woman and I'm thinking,
oh my God, even as confident asI can be about stuff like that,
(53:13):
I am not leaving the house forweeks.
Yeah, because it was that bad.
But I'm sure, I mean, herresults will be spectacular.
I'm sure, right, I'm just notthere yet.
Mary Alice Mina, MD (53:27):
And that's okay.
Michele Folan (53:27):
Yeah, we'll get there.
We'll get there.
All right, you are also thehost of the Skin Real podcast.
What inspired you to start apodcast?
What were you thinking?
Mary Alice Mina, MD (53:43):
A midlife crisis.
I suppose you know what I'lltell you.
It was 2020.
Okay, you remember 2020?
And I was stuck at home, like somany people and my patients a
lot of them were older, theywere scared to come in.
My partner and I were splittingup so we were on different days
.
So I had a lot of free time andI started listening to podcasts
(54:05):
and I had really never been apodcast listener until then and
I also was turning 40.
And I was noticing changes anda lot of my friends were turning
40.
And it was kind of like whoa,what's going on?
We had a lot of time to look atourselves, right Like I don't
think we ever stared atourselves like we did starting
in 2020 on Zoom cameras,different angles oh my gosh, my
(54:27):
neck.
I didn't think I looked likethat.
Where are my filters, Exactly?
So I started getting a lot ofquestions.
I was having questions and Ithought you know what, when I
went to see what was out thereand also I sort of felt like,
well, don't people know this?
But I realized there's so muchjust nonsense out there and so
(54:48):
much noise, a lot of stuff.
Just buy this, buy that, dothis product, do this crazy
12-step routine, and so I justwanted to be like a voice of
reason for someone who is justgiving people good skin
information.
I know it's hard to see adermatologist.
I know our visits are rushedand short and you don't always
get your questions answered, andso I wanted to provide a
(55:11):
resource for people where theycan get this information.
And I also feel like skin health.
We think of it as what we puton our skin.
What products do I need?
What procedures do I need?
But I think a huge part of yourskin health is how you take
care of your body, how you takecare of your mind, your physical
health, how you think aboutaging right and how you take
care of your body, how you takecare of your mind, your physical
health, how you think aboutaging right and how you speak to
(55:34):
yourself.
So all of these things impactyour skin, not just am I using
the right retinol or vitamin Cor peptide right?
So I'm hopefully giving people,you know, just good information
, science back.
You know I'm like we're notdoing gimmicks, we're not doing
hype and just give people likemy age, older, perimenopause,
(55:57):
menopause who are like what do Ireally need to do?
This is it, this is what.
Listen to this and you'll getsome good hopefully some good
information.
Michele Folan (56:06):
Yeah, it's beauty from the inside out, right.
Start with what you're puttingin your body.
You know it's funny.
You talk about 2020, that'swhen I devised this idea of
doing a podcast too, but I'vehad so many guests on the show
who have written books or donethings because of that downtime
during the pandemic, so Igiggled when you said, oh, you
(56:28):
know 2020, like oh Right, A lot.
Mary Alice Mina, MD (56:31):
Yeah, shocking.
Exactly, I think 2020 made alot of people sort of think wait
a minute, like what am I doing?
Let me think about my life, andI think also that's midlife
right Like you've maybe beendoing something for 20, some
years, but you're like where doI see my life in the next 20
years?
And and I think midlife is agreat time to kind of reinvent
(56:54):
yourself.
Michele Folan (56:55):
So we talk about that all the time on this show.
There's a lot of women, youknow, like post menopause,
they're starting to look attheir husbands and they're going
yeah, what am I doing?
I mean, it's it's careers, it'slife's life.
It's everything that we startto kind of reassess.
So, all right, dr Mary AliceMina, where can the listeners
(57:18):
find you online and on socialmedia?
Mary Alice Mina, MD (57:21):
Yeah, so you can listen to the podcast
called the Skin Real.
I have to spell it out topeople.
Nowadays R-E-A-L and I'm at DrMina Skin and if people are
wondering, I get this question alot like where do I start?
What do I really need to do?
I have a little PDF you can getfor free at theskinrealcom
(57:41):
forward slash habits where Ibreak down how you can create
healthy skincare habits withoutspinning on the hot girl hamster
wheel, as I call it.
Michele Folan (57:50):
Perfect, I'll put that in the show notes.
Thank you for that, and it wasgreat.
Speaking to you, I'm so happyyou got to be here today with us
.
Mary Alice Mina, MD (57:59):
Yeah, this was a lot of fun.
I could talk about this forever.
It's just something I love Icould, too.
Thanks for being here.
Michele Folan (58:08):
Thanks so much, hey.
Thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
.
And did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
Thank you.
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