Rethinking Aging in Aesthetic Medicine: Integrating Longevity Science into Aesthetic Practice - with Dr. Suzan Obagi, MD

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Wrinkles, sagging, and pigment are easy targets because we can see them, measure them, and sell treatments for them. But I keep coming back to a more uncomfortable question: are we actually treating aging, or are we only managing the appearance of aging? In this conversation, I sit down with Dr. Suzan Obagi, a leader in cosmetic dermatology and cosmetic surgery and Associate Professor in Dermatology and Plastic Surgery from the University of Pittsburgh Medical Center and former President of the American Academy of Cosmetic Surgery, to follow the smoke back to the fire and talk about what really drives skin aging and recovery.

We break down intrinsic aging versus extrinsic aging and why epigenetics, inflammation, and oxidative stress matter as much as lasers and injectables. Dr. Obagi explains what collagen, elastin, and glycosaminoglycans do, why their production peaks early, and why menopause can accelerate collagen decline. We also get honest about hormone replacement therapy: how estrogen affects skin, mood, joints, vessels, brain health, and wound healing, where risks truly live, and why many women are still mismanaged with symptom-only fixes. If you care about healthspan, longevity, menopause skin changes, and better surgical outcomes, this part will shift your perspective.

Then we turn practical. You’ll hear the simplest high-yield skincare routine we both rely on: cleansing, well-formulated antioxidants morning and night, moisturizers that support barrier function, mineral sunscreen, and retinoids with realistic timelines for results. We also unpack why some medspa “annual” treatment advice keeps people on a treadmill, and we look ahead at where anti-aging medicine may go next, from rapamycin analogs to NMN to the promise and complexity of Yamanaka factors.

If this made you rethink your approach to anti-aging skin care, hormone health, or aesthetic medicine, subscribe, share the episode with a friend, and leave a review so more people can find it.

Dr. Suzan Obagi links:

Instagram: @suzanobagimd

Website:http://dermatology.pitt.edu/people/suzan-obagi-md

Tweet me @realdrhamrah
IG @drhamrah

Episode Transcript

SPEAKER_02 (00:02):
Alright, everybody, welcome to another great episode
of the Darry Hammer Podcast.
Let me start with something thatmight sound a little
uncomfortable.
Especially if you're inaesthetic medicine.
What if everything we've beendoing to treat aging is mostly
focused on the wrong target?
So not completely wrong, butincomplete.

(00:25):
Let me explain.
For years, um actually decades,we've been trained to treat what

we see (00:31):
wrinkles, volume loss, skin laxity, pigmentations, you
know it.
And we've gotten really good atit.
There's many devices, manyproducts that help us in doing
so.
Lasers have evolved, injectableshave evolved, skincare has
become a multi-billion dollarindustry promising

(00:55):
transformation, and in manycases it has.
But there's the question I'vebeen asking more and more,
especially over the last fewyears.
Are we actually treating aging,or are we just managing the
appearance of aging?
I always use this analogy.

(01:15):
We're treating the smoke, butwe're not always addressing the
fire underneath.
Because the real drivers ofaging, what's happening at the
cellular level, things likeinflammation, hormone changes,
metabolic health, mitochondrialfunctions, those are often not
even part of our conversation.

(01:36):
And yet, they determineeverything.
How your skin heals, how yourcollagen behaves, how long your
results last.
So today's conversation is oneI've been really looking forward
to because it brings togetherboth sides of this equation.
I'm joined today by someone whohas been at the forefront of

(01:58):
cosmetic dermatology andcosmetic surgery for decades.
Someone who understands skin atthe highest level, but also
appreciates the deeper biologybehind it.
Dr.
Susan Abaji, board certified bythe American Board of
Dermatology and American Boardof Cosmetic Surgery, who is also

(02:19):
associate professor ofdermatology and plastic surgery
at the University of PittsburghMedical Center, and is the
director of University ofPittsburgh Medical Center
Cosmetic Surgery and Skin HealthCenter, and former president of
the American Academy of CosmeticSurgery.
Susan and I were recently on apanel together at the American
Academy of Cosmetic Surgeryannual scientific meeting, where

(02:41):
she spoke about the role ofhormones in specific when it
comes to skin health and aging.
For me, that was the bridge,that was the missing link.
That's where the conversationneeds to go.
So today, we're going to talkabout skin, but not just from
the outside in.
We're going to talk about what'sreally driving aging, why some

(03:03):
treatments work and othersdon't.
And whether we as a field needto rethink the entire way we
approach anti-aging.
So this is going to be a goodone.
Thanks for coming back on mypodcast.
So good to have you.
And I want to start with thefirst question, diving into the

(03:25):
deep end.
And ask you maybe anuncomfortable question in
aesthetic medicine.
Are we treating aging or are wejust managing the appearance of
aging truthfully?

SPEAKER_00 (03:39):
Yeah.
I think that's a very importantquestion.
And I you and I have had so manyside conversations over the past
few years about this topicbecause we're coming into it
ourselves.
And we're realizing that we areall going to live hopefully a

(03:59):
longer life.
The question is, do we want tolive just a longer life or do we
want to live a longer, healthierlife?
And with that being said, Ithink our population definitely
is getting older.
And we're going to see by Ithink 2030 more people over the
age of 65.

(04:20):
By 2050, a vast amount of thepopulation will be over the age
of 65 and fewer youngerpatients.
So we do need to evolve how weapproach our aging patients.
Because up until this point, Ithink you're correct.
We look at them, we cancompletely describe the
hallmarks of aging in theirappearance, whether it's the

(04:40):
changes in the bone structure ofthe face, the loss of the fat
pads, the change in skintexture.
And up until this point, we fixwhat we see.
And I think those of us who areat our our age, and of course,
granted, I'm much older than youare, are coming into the point

(05:01):
where we're starting to reflecton our lives and say, you know,
I, for my own self, want to livea longer health span.
And so we start educatingourselves about the field of
longevity.
And we are realizing more andmore that that's also applicable
to many of our patients.
So those of us who are reallytaking that interest in

(05:22):
educating ourselves are thentranslating that to our patients
and bringing them along for thatjourney.
And that's what's going to bethe true change.
Because as you and I talked inour lecture and our session at
the American Academy of CosmeticSurgery, even when we're doing
surgery, there is a role forreally managing the patient's

(05:44):
systemic health prior tostarting to do the surgery so
that they actually heal better,so that the results last longer.
And so it's it's very exciting.
I think there will be a shift,and hopefully you and I can
nudge that along.

SPEAKER_02 (05:59):
You know, you obviously when someone listens
to you and listens hopefully tothe end of the podcast, they
might think, well, this isobvious.
This is we all know that ahealthier lifestyle or you know,

(06:19):
maybe uh optimizing your healthbefore any procedure will help
that.
But why do you think as aprofession that is not something
forget about being practiced buteven taught currently?
Because people think if there issomething at the forefront, it

(06:42):
starts with the educationalinstitutions, curriculums.
And so how long do you thinkit's gonna take for things to
change, to evolve?
Because you and I just discusseduh before the podcast when we
were talking that I think thisuh shift in thinking has to

(07:03):
start with uh the young surgeonswith education because there's
gonna they're gonna be thefuture.
But we have to set the examplesas the educators.
So there is a responsibilitythat comes with it.
But prior to thisresponsibility, there has to be
a self-awareness and aself-education.
So where do you see how how longdo you think this shift is gonna

(07:26):
take, which we're gonna talkabout?

SPEAKER_00 (07:28):
It's going to take some time because I know for a
fact my daughter is currently inmedical school.
They do not teach aboutlongevity, they teach about
addressing disease.
What we need is What is thedifference for the for the
listener?

SPEAKER_02 (07:43):
What is the difference?
Uh because longevity is justsuch it seems like a buzzword,
but there's a lot into in inthis word.
So for the audience, quicklydescribe what's the difference
between treating disease andlongevity.

SPEAKER_00 (07:59):
Longevity truly is the fact that we are all, if we
take relatively good care ofourselves, are going to live
longer and longer as we havecompared to generations past.
And I want to throw another wordin there.
Aside from a longer lifespan, wereally need to change that focus
now to a longer health span,which means that we want to

(08:22):
spend the vast majority of ouryears healthy as opposed to just
living to 90 and having a lot ofsystemic diseases.
And what needs to change is thatwe need to recognize that aging
itself is an inflammatorydisease process.
When you label aging as adisease, in a way, and this is

(08:46):
not to take away from just theknowledge and maturity we gained
through the years, we're solelytalking about how the body ages
right now.
We need to look at it as most ofwhat we see as aging is uh is
impacted by our environment.
So we have intrinsic aging,which is just our biologic

(09:06):
clock.
And that biologic clock is goingto slow down over the course of
years.
But none of us live in a bubble.
We are breathing the air that'spolluted, we are drinking water
that may be contaminated, we areingesting foods that have a
gazillion chemicals in them.
So we are now accelerating theaging process by these extrinsic

(09:29):
factors, which now is calledextrinsic aging.
And that's the disease process.
So, yes, we're all going to age,but how can we modify those
extrinsic factors so that we agewell?
Once we change that thoughtprocess and treat that truly as
a disease, then we'll see themedical schools come on board

(09:51):
and educate about that.
Unfortunately, there's nopharmacologic reason for
companies to invest in thisright now, although there are
some interesting medications outthere for increasing longevity.
But right now, since mostpharmacologic companies want to
treat diseases, that's where thefocus and the money and all of

(10:14):
that's going to be.
So they're going to treatdiabetes, they're going to treat
hypertension, they're going totreat obesity, they're going to
treat cancer, but no one'slooking at the preventative side
of it because there's no moneyto be made there.
And that's sad because a lot ofwhat we teach in medical school
now is driven by things that wecan treat pharmacologically.
And we really need to improvewhat we can do just behaviorally

(10:39):
with modifications and so forth.

SPEAKER_02 (10:42):
It's one thing you said we are experts in defining
skin aging, the hallmarks ofaging, describing everything.
Every textbook you open up as astudent, resident, fellow, and
even for us, every articlethat's still published so
focuses on the symptoms ofaging, right?

(11:03):
And then the next step is okay,how could we fix it?
And at no point there is evenforget about a paragraph, there
is not a mention or a sentence,a word about why that occurs.
And you you you talked about alittle bit about what what I

(11:24):
call the or what is called theepigenetic factors, meaning the
influencers of the agingprocess, the influencers of
lifestyle.
You know, today you talked aboutall these extrinsic factors, you
know, back in the days, whichtoday still in most countries in

(11:44):
the world, factors like simplysmoking and drinking, which at
this point everybody knows howbad it is, not only for your
health, but for the agingprocess.
I mean, there is so many twinstudies out of uh Finland, even
here out in the United States,that really show the effect of
the extrinsic factors, of theepigenetic factors like smoking,

(12:08):
drinking, uh lifestyle, lack ofsleep, stress, all of those
things on your aging process.
And but that's never mentioned.
Is it because it's notinteresting?
People accept it, they're like,well, you know, it is what it
is.
You know, people live theirlives the way they want.
Our job is not to educate themon that.

(12:30):
Our job is just to fix it.
We are fixers.
We are skin fixers, we aretissue fixers, like mechanics in
the mechanic shop.
No one asks, how did the carcrash?
Why did the car crash?
Maybe we should build in somesafety features into the car so
we don't crash it.
But if you're a body shop,you're not interested in that,

(12:51):
are you?
So do you think there is anethical obligation or an ethical
dilemma within what we do and aresponsibility that we carry to
educate patients on that?
I know I'm taking us a littlefarther now, way into the
future, but I'm asking thesequestions to maybe evoke some

(13:13):
curiosity and rethinking,perhaps, from our profession.

SPEAKER_00 (13:17):
Well, I think right now depends on the kind of
surgeon that you're going to.
If you're going to somebodywho's only going to be doing
body lifts and body work orfacelifts and rhinoplasties, and
then send that patient home andwait till they need another
procedure and not see themagain.
That's a different type ofpractice.
That's not somebody who's goingto be easily convinced that they

(13:40):
need to take into considerationthe patient's longevity and how
to set them up for aging welland how to set them up to delay
the need for surgeries in thefuture.
Because their job or theirpractice is set up to just do
procedures.
I think my practice is a littlebit different.
I get a sense that your practiceis a little different.

(14:02):
I build long-term relationships.
My patients are my patients forlife.
I've had I've been veryfortunate in that I even have
many patients that are stillwith me from residency and
fellowship years.
Wow.
And I take care of theirchildren now.

SPEAKER_01 (14:15):
Wow.

SPEAKER_00 (14:16):
So I think that's an honor.
And I love that.
So I do want to make sure I taketime that to educate my patients
about behavioral modifications,lifestyle changes, hormone
changes that they can make tohelp them age better.
And then when they needprocedures, I'll do the
procedures.
But my focus is not solely onthe procedures.

SPEAKER_02 (14:39):
And and so let's talk about skin aging for a
second, because you know, wetalk a lot about the hallmarks,
and we assuming the audienceknows these things, knows what
happens to the skin.
You know, all they see is maybewrinkles, wrinkles in the skin
and color changes.
But I think when we try toaddress aging of the skin and

(15:03):
help in prevention thereof, andalso treating the already
occurred aging, it's importantto understand first what happens
for the audience.
And as most listeners arenecessarily not have not
necessarily studied biology oranatomy.
So let's talk about uh skinaging very briefly for the

(15:26):
layman.
What happens during the skinaging and is there a stage or a
decade where that part of theaging accelerates and what are
the causes of it?
And then we can talk aboutobviously the extrinsic factors,
which are obvious hopefully tomost people, but mainly focus

(15:46):
also on the intrinsic factors.

SPEAKER_00 (15:48):
Sure.
So if we look at just skin agingin general, what's going to
happen as you intrinsically aregoing to have your biologic
clock slow down?
The skin is comprised of theepidermis, which is the top
layer of the skin.
That's the part that you feelwhen you touch your skin.
Then you have the dermis, whichis the part that you pinch.

(16:10):
And that dermis has collagen,elastin, glycosaminoglycans in
there.
And those each have a role.
The collagen gives you skinfirmness, the elastin gives you
bounce back.
When you pull the skin away, itsnaps back.
And the glycosaminoglycans giveyou hydration.
Now, patients are shocked.
I always pose the question tothem when they come in.

(16:31):
At what age have we peaked inour collagen, glycosaminoglycan
production, elastin production?
And it's 18.
Somewhere around 18 to 25,that's our peak, bone density as
well.
But we don't talk about bonedensity until we start to see
osteopenia and osteoporosis.

(16:51):
We could talk about skin health.
Our peak skin health is aroundthat time, 18 to 25, and then it
starts to decline.
From 18 onwards, you start tohave a 1% decrease each year in
that production of those threeproteins.
So from 20 to 30 to 40 to 50,that's a 30% drop in what your

(17:13):
body is normally making.
By the time women hit menopause,that decline doubles.
It goes from 1% decline a yearto over 2% decline a year.
So it shows you that you'retaking away something, whether
it's estrogen, progesterone,testosterone, that is a driving
force for skin turnover and skincollagen production.

(17:37):
And by entering menopause, thatyou're having that 2% decline in
those production of thoseproteins.
So that that's what's happeningas we are intrinsically aging.

SPEAKER_01 (17:51):
Now add to it, I was going to say add to it.

SPEAKER_00 (17:54):
Any external factors.
If you tanned your skin a lot,spent time in a tanning bed, if
you smoked, you're literallyadding fuel to the fire now.
If you eat a high sugar diet, ifyou don't have an
antioxidant-rich diet, all ofthis plays a role in how fast
the skin is going to age, andyou're going to accelerate that.
So I'm telling you what thebaseline is, and then everything

(18:16):
else that's extrinsic is goingto accelerate that.

SPEAKER_02 (18:20):
So you talked about glycosamine, glycan proteins,
and elastin and collagen.
Just briefly describe what thoseare and what their function is
just for the layman, so theyunderstand the relationship
between those and skin aging.

SPEAKER_00 (18:37):
Yes.
So collagen is what gives youyour dermal thickness.
So, you know, we as we age, weknow skin gets thinner and it's
more fragile.
So that's because of the loss ofcollagen.
As we get older, skin getsdrier.
That's because of the loss ofthe glycosaminoglycans, which
act like sponges and suck upwater and keep that dermis

(18:58):
hydrated.
And then also as we get older,skin gets lax and wrinkled.
And that's the loss of theelasticity or the elastin fibers
that give you that bounce backand keep that skin firm rather
than lax.

SPEAKER_02 (19:14):
So when you knowing this now, understanding that it
sounds like this from what yourdescription, this aging process,
one to two percent aging overtime, is inevitable.
How much of it can we slow down?
And what are some strategiesthat you recommend to slow

(19:35):
slowing this process down?

SPEAKER_00 (19:37):
Well, definitely taking care of the external
factors as much as possible.
Patients really think that allthey have to do is throw on some
sunscreen and that's enough.
And there is no sunscreen that's100% protective.
Otherwise, you'd be walkingaround covered in zinc oxide,
white paste, the really thickstuff to try to prevent some of

(19:59):
that damage.
So I always say you've got touse sunscreen and the hat as
much as you can to try tominimize the impact.
And I said minimize, you can'tcompletely avoid the impact of
those environmental rays on theskin.
That's one thing.
Don't smoke, eat a healthy diet,because some of those damaging
rays are going to get throughand they're going to cause free

(20:22):
oxygen radicals in the skin thatthen go into the skin cells and
damage the nucleus of the skin,so they're damaging the DNA.
That's what causes thatepigenetic shift.
So that means that I was goingto say that means that our and
for your listeners who don'tknow what epigenetic shift is,

(20:43):
we are born with a set of DNAand genes.
But if you check our genestoday, yours and mine, we are
different than what we were bornwith.
And that's because of thisepigenetic shift.
The environment has causedchanges in our DNA from the
damage that's accumulated overtime.

(21:04):
So our genes have changed now.
And so we need to try tominimize that.
We need to try to minimizeantioxidants with antioxidants
to the free oxygen radicaldamage that's happening.
So that comes from applyingantioxidants to the skin.
It also means eating anantioxidant-rich diet.
We need to make sure we'retaking in enough protein because

(21:26):
as we age, our ability to buildmuscle mass diminishes.
So we have to exercise, try tokeep our muscle tone strong and
feed those muscles with theright protein so they can build
muscle mass.
But the most important thing tounderstand, whether it's
menopause or andropause, whichis the male equivalent of

(21:47):
menopause, as we live longer,we're going to spend many more
years in andropause andmenopause.
So female patients right now,given how long we live, can
expect to spend four.
Of their life lifetime inmenopause.
We need to address that becausewe had a faulty study, the

(22:08):
Women's Health Initiative, thatincorrectly said that the
bioidentical hormonereplacements caused breast
cancer.
And so for 20 years, women gotshortchanged and were not given
the proper hormone replacementtherapy.
A lot of doctors now are awareof this and are having these
conversations with theirpatients to try to make sure

(22:32):
that they capture those patientsduring the perimenopause phase,
but at least try to get themeven early into menopause to
start them back on estrogen,progesterone, maybe even low
dose testosterone, if they don'thave any risk factors for that,
so that they spend a healthieramount of time during that 40%

(22:53):
of their life.

SPEAKER_02 (22:57):
And the way you said it, which is the reality which
dates almost half of a woman'slife is spent in peri and
postmenopause.
And those happen to be thepatients that we see that we
treat.

(23:22):
Almost like a frenzy ofdesperate attempts and methods
to correct or what weerroneously call reverse the
aging process, which we're not.
I believe actually we'recontributing to it in some ways,
especially when it comes toinjectables.
But that's maybe we'll get intothat topic.

(23:43):
I know that's a verycontroversial topic.

(24:17):
So I want to know from you,maybe you can guide us in the
audience on how you are tryingto address this issue and
address it at the cellularlevel, meaning adjusting hormone
levels in an attempt to improveor even avoid skin or slow down

(24:37):
the aging process that youdescribed.
We we already know who isaffected by this.
I mean, perimenopause starts tenyears prior to menopause, which
I think the average age ofmenopause is 49 to 50.
Which means perimenopause startsat 39 to 40.

(24:59):
And then you have menopause 10years later, and then another 10
years you have menopause.
So there is about 20 yearsperimenopause, and then there's
postmenopause.
So it's a huge patientpopulation.
And I know in my practice it's80% of my patient population
last time I checked.
Describe first the effects ofhormone decline and skin aging,

(25:24):
specifically the thickness andthe quality, as well as what how
improvements of hormone levelscan mitigate that to a degree,
and how you if or if you'retrying to integrate that
treatment in your skincareregimens and treatments like
lasers, IPLs, skincare products,etc.

SPEAKER_00 (25:50):
Yes, I think you said it before.
We are fixing the car after itbroke down.
And what we really need to do ismake sure people are taking care
of that engine before it breaksdown.
And so I'm constantly now tryingto bring this up as a discussion
point.
Even when patients are coming infor something as simple as Botox

(26:12):
or neuromodulators or fillers,which I you and I might disagree
a little bit on some fillers.
I do use uh fillers in mypractice judiciously.
But I that gives me a chance tohave a conversation because I'm
seeing my patients every threeto four months, which is really
fantastic from that standpoint.
And I can bring them up to dateon the latest knowledge I've

(26:34):
gained during the interim sinceI saw them last.
And I think what I try toeducate them on is if they're
starting to see dryness in theskin, fine lines and wrinkles,
skin changes in the neck, all ofthat, those are signs of hormone
decline.
And I do have, I'm lucky to havemidlife GYN in our neighborhood

(26:59):
that I can refer to to make surethat she's checking their
estrogen and testosterone levelsand trying to get them on the
bioidentical hormones so that itdoesn't uh let them go into
full-blown menopause wherethey're starting to really
suffer from the estrogenwithdrawal.
Estrogen is basically theantioxidant effect in the body.

(27:24):
It actually helps to increasethe production of certain
antioxidants in this in thebody, not just the skin.
It has anti-inflammatory effectson joints, on the vessels, on
the brain.
It has really good effects onwound healing, which is why
younger patients heal betterthan older patients.

(27:47):
And it has tremendous effect onwound and scar remodeling as
well.
So basically, every cell in yourbody has estrogen receptors,
your keratinocytes, thefibroblasts that are in the
dermis making all those goodproteins, your vascular cells,
your immune cells, they all haveestrogen receptors, which is why

(28:08):
the minute you take away thatestrogen, all of a sudden women
have more autoimmune diseases,women have more joint issues,
women start to have cognitivedecline, women start to have
increased risk for cardiacdisease, stroke, all of that.
Now, I don't want to downplaythe risk of estrogen and

(28:29):
progesterone in terms of breastcancer and uterine cancer, but
that risk is always there.
And you have to tailor theapproach to the patient's family
history and to how often arethey going for their mammograms
and doing their pelvic exams andall of that.
So I'm not out here sayingeveryone should just be on it

(28:51):
and it's a panacea.

SPEAKER_01 (28:53):
Of course.

SPEAKER_00 (28:53):
It is a true medication.
There are the risks that goalong with it.
But I think if you can make aneducated decision as a patient,
many will choose to go for theirannual screenings and take that
chance of a small increase inthe risk of any breast cancer or
endometrial cancer for thetremendous benefit in all the

(29:16):
other aspects of health.
More women die of excuse me,more women die from dementia,
osteoporosis-related disease,cardiac disease, all of that
than they do of breast cancer.
So it's not to say it's notimportant, but you have to
educate your patients so thatthey can make that decision for

(29:37):
themselves.

SPEAKER_02 (29:38):
100%.
I mean, you we already see theshift that's happening in the
awakening and the education thathas occurred in the past two
years.
Now, the estrogen patches,there's a shortage of estrogen
patches of many patients thatare freaking out.
They're they're like, I'm on mylast patch and I don't know what
to do.

(29:58):
And what that says is two thingsis first the need that there is
and how far backed up theindustry, the pharmaceutical
industry is with supplying thedemand.
I don't know why they've beenwaiting for this.
I mean, the cast was out of thebag a couple of years ago.

(30:20):
I don't know how maybe theymiscalculated it.
But that tells another story onhow desperate the this peri- and
post-menopausal population wasthat as soon as they learned
about it and educatedthemselves, they went all in
because a lot of these women,you know, they are my patients,

(30:44):
they are suffering when theytalk about their pain, they say
it with tears in their eyes.
And and I didn't understand fora long time.
I didn't know, I always, andthat was my fault and my
ignorance.
I never understood why they'reso emotional, why and and

(31:04):
because I was never taught intraining.
I was just taught that there'ssome people that are very
emotional, some people they'renot emotional, others are crazy,
and then there's a normalpeople, stay away from the crazy
people.
You don't want to deal with theemotional ones.
Well, after 20 years ofpractice, I'm like, then I can't
treat anyone if if that was thecase.

(31:27):
But how how can we help thesepeople?
Now understanding the root causeof a lot of these issues was the
hormonal imbalance is was veryeye-opening for me.
So several years ago, I reallytried to invite a lot of experts
in this field, like Mary ClaireHaver, etc.

(31:50):
And I learned so much about it,and it was so humbling for me.
So I approached my patients witha complete different empathy and
understanding, and alwaysaddressed that before I even
make suggestions about whattreatments we're gonna do, or
even before we schedule theirsurgery, because you yourself

(32:12):
alluded on the effects ofhormones and wound healing.
You know, talk talk to us alittle bit, both for men and
women, right?
You know, in a negative andpositive way.
I mean, we are treating scarswith steroid and Kenlock
injections and or woundnecrosis.
We're so worried about woundnecrosis, flap necrosis.

(32:35):
Well, a lot of this can bemitigated and prevented through
addressing at a cellular leveland optimizing these patients
before we take them to theoperating room.
So talk to us a little bit abouthormones and wound healing as
well as scar formations ormitigation.

SPEAKER_00 (32:55):
Absolutely.
But let me backjack one secondto something you said, which is
you're talking about hormoneabsence now in menopause and the
fact that women come in withanxiety and depression, and it's
not anxiety and depression abouttheir appearance.
That estrogen deprivationincreases anxiety and

(33:17):
depression.

SPEAKER_01 (33:18):
In general.

SPEAKER_00 (33:19):
In general.
And so what's happening is womenare being prescribed anxiolytics
or antidepressants when theyshould be given estrogen.

SPEAKER_01 (33:27):
Yes.

SPEAKER_00 (33:27):
For any patient that doesn't understand this, think
back to when you were a teenagerand you were having premenstrual
symptoms.
You know, the those women whohave premenstrual symptoms,
right, leading up to theirmenses, with whether it's
depression, hot flashes whenthey're sleeping, change in
appetite, that's your hormonewithdrawal.

(33:49):
That's almost like a miniversion of menopause, right
there that you're experiencingas a teenager and young adult
every time you're pre-menstrual.
And we used to always say, Oh,that person's pre-menstrual,
they're they're tearful.
We would just chalk it up tosomething in their head.
And it's truly the hormonedeprivation that's happening at
that time of a cycle.

(34:11):
Take that forward.
As you said, we start to enterperimenopause 10 years before we
actually are in menopause.
When do we see the highestnumber of women being given
antidepressants and anxiolyticsthat age group?
And it's because they're havingthat hormone deprivation at a
low level.

(34:32):
Address it.
We need to address the rootcause, not the symptom.
We're not, we should be able todo that.

SPEAKER_02 (34:38):
You know, Susan, this this really makes me this
makes me upset.
This makes me so upset at adifferent level.
Because this makes me upsetbecause I feel like we're making
it way worse by prescribingantidepressants.
I can't tell you how many of mypatients are on antidepressants.

(34:59):
And I wonder, I I just wonderhow many of those could have
been simply treated differently.

SPEAKER_00 (35:06):
Well, you know what?
It's not too late.
Here's my advice to my patients,even those that are already
through menopause.
And I think what I try toeducate them, they tell me, Oh,
I'm already done, I don't haveany more hot flashes, I don't
need to go on hormonereplacement.
And I tell them, it's not forthe hot flashes.
You need to be on this so thatyou reduce your bone loss risk,

(35:31):
so you don't want to developosteopenia overseas and
osteoporosis.
You need to be on this to reduceyour risk of dementia, to
improve your cardiac health andyour skin health.
So there are more reasons to goon it than just getting through
hot flashes.
That's not the only reason to beon it.
But there's this thinking thatif you're over the age of 65,

(35:54):
for example, and you've been inmenopause for 10 years, if
you're if you've been inmenopause 10 years or longer,
that there's no reason to putyou on hormones.
And I beg to differ.
No one has studied that.
No one has looked at this oldergeneration and tried to give
them hormone replacement to seeif they benefit.

(36:17):
So we do know maybe it doesn'tbenefit their heart, for
example, as much at that pointbecause maybe they already have
calcifications.
But no one's looked at does itbenefit their dementia risk?
Does it benefit their overallbone health?
And so I tell my patients, okay,you've been in menopause over 10

(36:38):
years.
You need to have a frankdiscussion with the midlife GYN
and say, I understand I'm inthat group that they don't know
if it's going to help me, but weknow it's it no one's looked at
whether it's going to hurt.
So if someone's going to be.

SPEAKER_02 (36:54):
You know, you humbled me at the meeting
because that was a question fromthe audience afterwards.
And the question was whether ithelped we should take it beyond
10 years post-menopause.
And and I was wrong because Ithought from what I had learned
that there is no added benefit.

(37:17):
But then you really humbled me,but and and and I completely
changed my thought process onthis by what you just said,
because that was exactly yourresponse.
And you said, well, the studiesare about cardiovascular risk.
They are not, they didn't lookfor other benefits like bone
health, dementia Alzheimer's,for skin health, for a lot of

(37:38):
other uh factors, and because wejust don't have any studies.

SPEAKER_00 (37:44):
Yes.

SPEAKER_02 (37:45):
So I that's a huge potential.

SPEAKER_00 (37:48):
Yep.
I tell my patients, you may haveto be your own guinea pig.
You may just have to read up onthe risks.
And if you're willing to takeit, find a doctor that will
listen, that will start you onthe estrogen and progesterone.

SPEAKER_02 (38:02):
Good luck with that.

SPEAKER_00 (38:03):
And eventually testosterone.
I find that they're starting to,though.
I have found, I have found, atleast in my community, I have
someone I can work with that isdoing it.
But even that person, thatdoctor, is giving them the
lowest level estrogen and notincluding testosterone at some
point.
We have to catch up.
Testosterone is not just forlibido.

(38:26):
That most doctors areprescribing it just to improve
libido.
They have to understandtestosterone is working in
conjunction with the estrogen tohelp us build muscle when we
can't build muscle as muchanymore.
And when you build muscle, youmake your bones stronger.
So it's about strengthening ourpatients.
If they get benefits in theirlibido, fabulous.

(38:49):
But that's not the main reasonto just do it or not to do it.

SPEAKER_02 (38:53):
You know, we just need more education, like you
said.

SPEAKER_00 (38:58):
Yes.
But coming back now, this was along winded answer to get back
to surgery.
Yeah, we do know that within 12hours of surgery, your body has
produced massive amounts ofmatrix metalloproteinases, which
are these enzymes that arebreaking down collagen and
elastin and remodeling thatdermis in response to the injury

(39:20):
or the surgery.
And unchecked, that response canbe deleterious and cause delayed
wound healing.
Estrogen protects against thatby inhibiting too much matrix
metal protonases from beingmade.
So it's a vital component ofproper wound healing.
And you need that so that youdon't get the wound dehiscence

(39:43):
or the wound breakdown.
And at the same time, when youhave estrogen-rich skin, that
skin is thicker, more resilient.
It has the ability to heal muchbetter.
And estrogen has, like I said,beneficial effects on the blood
vessels that you need to come inand heal that wound as well.
Even male patients, when theywere given topical estrogen to

(40:06):
apply to wounds that were nothealing, their wounds healed
better.
So it's really important formale patients and female
patients for wound healing.
And it's going to be extremelyimportant for patients that are
transgender, that aretransitioning from one sex to
another, because you you mayhave to manipulate those

(40:29):
hormones even a little bit moreand optimize them a little bit
more during the healing processso that they heal from these
major surgeries that they'regoing to have.

SPEAKER_02 (40:39):
And this is something that I've anecdotally
observed within my patients.
I have now two groups ofpatients.
I have the ones that, when theycome to me, they are on a
longevity journey, they have hadtheir hormones regulated,
optimized.
I mean, they look amazing, theyare happy, they feel amazing.

(41:03):
I mean, if I could ask for apatient, I would ask for that
type of patient.
And then post-operatively,everything is so smooth.
I mean, there is no forget aboutwound distance and breakdowns.
I mean, their wounds healamazingly.
I mean, the wound edges, there'slack of inflammation, there is
the whole process is soaccelerated.

(41:24):
And I know it's not a blindedstudy.
I mean, I obviously know thatthey're optimized, but this has
been just my observation and Icompare it to the past.
It could be also my techniqueshave improved.
I don't know.
But the thing is, the sciencebacks it up, like you said, and
it's not difficult to do tooptimize these patients, because

(41:48):
if we don't, the downside is allthe other potential
complications and wound issuesthat we have to then deal with,
not to mention with the unhappypatient.
You know, they have highexpectations.
So today, because of thoseexpectations, because not only
from a healing standpoint, likehow they heal, but how quickly

(42:09):
they heal, the expectations aregoing up.
You know, more and more of ourpatients are out of town, so
they don't want to want to flyback after their surgery, they
want to look presentable whenthey go to the airport, etc.
And they most of them want to goback to work.
They have those expectationsthat after like a week, they're
like, why am I still bruised?
What's the swelling?
It's like, well, it's been onlya week.

(42:30):
So they have these expectations,which some are unrealistic.
And but when we look atoptimizing these patients, not
just from a lifestylestandpoint, which is what I do
also, but also from a hormonalstandpoint, we can meet a lot of
their expectations at alllevels.

(42:50):
And and so that's something thathas been a different approach in
my practice, I know in yourpractice.
And the other aspect I want totalk to you about when it comes
to simple things, like let's noteven talk about lasers, let's
talk about simple skincare,which you're an expert on.

(43:11):
From all these skincare creams,now obviously you're carrying a
huge legacy with the Obajiskincare, and I think just for
the audience, many might knowthat you're the daughter of the
the father of modern skincare,Dr.
Zayn Obaji.

(43:33):
And we I think the Obajiskincare started the
sophisticated and modern versionof skincare, which was beyond.
I remember back then, all mymother had in her bathroom was
the Nivea box, the blue Niveabox that uh of cream.

(43:53):
It was terrible.
Now thinking of it, it wasterrible, right?
But that's all people put on.
And so with all these modernskincare now, we expect, of
course, the patients expectmiracles.
They even ask uh at a tea partyor they're on a vacation, they

(44:14):
meet someone, hey, what's yourskincare?
Meaning they expect miraclesfrom just a skincare.
How do you couple the educationon uh the epigenetic extrinsic
factors and intrinsic factorswith the hormones and lifestyle?
How do you tie that into yourskincare regimen and

(44:34):
recommendations?

SPEAKER_00 (44:37):
So I think I'll build on what we've already said
so that I don't repeat that.
Yeah.
But you have to optimizeeverything from diet to
hormones.
That's a given.
I do tell them there are somebasic rules that you have to
follow for good skincare.
I follow them myself.
I preach, yeah, I practice whatI preach for the most part.

SPEAKER_02 (45:00):
Obviously.

SPEAKER_00 (45:01):
Thank you.
I'm actually a hundred years oldand you just wouldn't know it.
I know.

SPEAKER_02 (45:07):
I was gonna ask you half an hour ago when you talked
about the extrinsic andintrinsic factor.
I mean, by the way, nothingapplies to you.
So people are sitting there, ifthe if for the ones that are
watching, they're gonna want toknow okay, just cut to the
chase.
What's your secret, Susan?

SPEAKER_00 (45:24):
Oh, thank you.
So I say the most importantthing morning and evening is
cleanse your skin well.
Because you need to removemakeup, oil, environmental
pollution, all of that.
And it has to be a relativelygood cleanser that's going to
remove all of that buildup.
So that you have now a cleancanvas on which to apply your

(45:46):
skincare.
Everybody needs an antioxidant.
It could be al ascorbic acid, itcould be an antioxidant serum,
but it has to be wellformulated.
I know you also have yourskincare line.
It's difficult to formulatewell-made products, especially
antioxidants, because the firstthing they want to do is

(46:09):
oxidize.

SPEAKER_02 (46:10):
Especially vitamin C, the LScorbic acid.

SPEAKER_00 (46:13):
Absolutely.
So there are special techniquesthat you have to undergo so that
when you give a patient aproduct, you know it's
delivering the results.
I stand behind that.
I will never recommend somethingthat's not going to give a
patient a results.
Every step I give them, I tellthem has a function in the skin.
So they after they wash, theyput on an antioxidant.

(46:35):
Morning and night.
Most people are telling theirpatients, just put it on in the
morning because you're goingoutside.
But you deplete it during theday.
That antioxidant gets depletedas it's combating all those
high-energy visible light, bluelight, UVA, UVB, all those rays
hitting the skin use up thoseantioxidants.

(46:57):
So you have to reapply it againat night.
Antioxidants are key.
Those are to help your skincombat the rays that get through
your sunscreens and so on.
The second step is to have agood functioning moisturizer.
For some patients, thatmoisturizer has to have a
glycolic acid, phytic acid, orpolyhydroxy acids in it.

(47:20):
So that it helps to gently keepthe skin from building up that
thick dead layer and allows yourother products to penetrate
better, but it gives hydration.
Some patients, though, as theyget more mature, might not
tolerate even the polyhydroxyacids as well.
So it starts in the younger agesas glycolic or phytic acid,

(47:43):
midlife more polyhydroxy acids.
Later in life, it may just be avery well-compounded moisturizer
that keeps moisture onto theskin.
It gives the skin hydrate.
And then you seal it all in withyour sunscreen.
And for me, hands down, until weget a new ingredient approved by
the FDA, it has to be a mineralsunscreen.

SPEAKER_01 (48:04):
100%.

SPEAKER_00 (48:04):
Zinc oxide or titanium dioxide blend.
Tinted is even better becausethat iron oxide gives you even
an added protection beyond justthe zinc and titanium.

SPEAKER_02 (48:15):
Yeah, it's an extraordinary.

SPEAKER_00 (48:16):
That's your morning routine.
Yeah, that's your morningroutine.
In the evening, you wash,reapply your antioxidant serum,
and then you need to apply yourretinoids.
And that retinoid can be retinolif you're very, very young.
Retinaldehyde for 30-year-oldson up.

(48:37):
And then as you start to needmore, you add in a prescription
tretinoin a couple nights aweek.
Eventually the goal would be touse that even more.
And then as we get more matureagain, if we're not on hormone
replacement, we might find thatour skin doesn't tolerate that
prescription retinoid as much.
So we revert back to two nightsa week, the prescription

(48:58):
retinoid, five nights a week,the retinaldehyde, that
combination.
Now, if patients have pigmentaryissues in there, we add in a
skin brightening agent.
But again, it's aboutconsistency and it's about
making sure that you're not justusing your skincare and then
thinking you can go outside andexpose your skin to sun.

(49:19):
It's about always having a haton, always having your sunscreen
on every day, because evensitting in front of this light
that I'm in front of here,that's emitting high-energy
visible light and blue light.
So we have to make sure that wehave our sunscreen on all the
time.

SPEAKER_02 (49:35):
Yeah, I think the blue light is something that
most people uh underestimate,especially the ones that uh work
in front of computers all day.
And even regular people that Imean, if you look at from a
social media usage standpoint,the average American spends over
four hours a day on theirdevices.

(49:59):
I mean, that's a long time.

SPEAKER_00 (50:02):
That's a whole other conversation.

SPEAKER_02 (50:04):
That's that's that's a long time.
I mean, it blew my mind, and I'mguilty too, but I do a lot of
work for an education on that.
So, but the antioxidant advice,which is, you know, I use the
alascorbic acid, which isvitamin C.
Many years ago when we did thepodcast, I took your advice and
I used it both in the morningand evening.

(50:25):
And I give that advice to that'ssomething that I learned from
you that I said makes totalsense.
Like, why how come I didn'tthink of it?
It's like, what was I thinking,not putting it on twice a day?
It's like, what's what's theharm?
And if I look today and and Ithink uh the the judicious
application and the disciplineand the consistency with all of

(50:46):
what you said is really key,otherwise it won't work.
And how do you educate a patientthat is not consistent with it
with with this?
Because they have theseexpectations, they think they
put it on and within a week theyexpect miracles.
How do you how do you get thosepatients to become disciplined,
uh, especially those with highexpectations and the ones that I

(51:09):
guess the best example are themen.

SPEAKER_00 (51:12):
They are tough.
Although sometimes they willstart to use their wives'
products, and then they'll comein and say, okay, my wife said I
have to come in and get aconsult because I can't keep
using hers.

SPEAKER_01 (51:24):
Yes.

SPEAKER_00 (51:25):
But you know, skin is constantly turning over.
And when you have healthy skin,you literally go one full cycle
of turnover from the base of theepidermis to the seratum corneum
and then off in six weeks.

SPEAKER_02 (51:41):
And that changes with age too.
Can you slow down?

SPEAKER_00 (51:45):
That does it slow down as we get older.
But as we incorporate retinoidsonto the skin, you're turning
those genes on again that willstart to normalize that cycle.
That's why retinoids are soimportant.
And they do the same in thedermis with collagen, elastin,
glycosaminoglycan production.
They stimulate those fibroblaststo make that.

(52:06):
But that's six weeks.
So truly, if you want to seeimprovement, you have to give it
a full skin cell cycle.
I tell patients you'll see ifyou follow things consistently,
you should see improvementwithin six weeks.
If you wait full three cycles,which is 18 weeks at this point,
that's when you really see verynice improvement of the results

(52:29):
of a good consistent skin careregimen.
The second thing I tellpatients, there is no quick fix.
You want lasers, you want peels,for example, you want a
procedure.
The minute you have it done, theresults are going to start to
reverse again.
The only way to get the biggestbang for your buck is to prepare
your skin well in advance sothat when you have a procedure

(52:52):
done, your results are evenbetter.
And then to go back on yourskincare regimen so that the
results are maintained.
There is no other way.
There's no shortcut.
Otherwise, you have to come backevery month and have a procedure
done in the office.
I tell them your best investmentis your skincare, and then you
have to do less in the office.

(53:12):
And that's antithetical, Ithink, to a lot of ways that
physicians and medispas arethinking because they think if
they put a patient on a goodskincare regimen, they're not
gonna come in and do procedures,so they're not gonna make as
much money off procedures.
I'm looking at it, I'm trying tobuild trust, I'm trying to build
a long-term relationship.
I'm not there to capitalize onprocedures nonstop.

(53:36):
I want my patients to reallylook good.
So I'm gonna give them that, andthen when we do a procedure,
they're going to be happier,which builds even more trust in
what I'm telling them, whichmakes them want to stay as my
patient for a longer period oftime.
I think so.
I approach it a little bitdifferently.
I would encourage every cosmeticprovider to think about it that

(53:59):
way.
Don't think short-term gain,because the more you improve
your patient's health, the morethey're going to trust you and
want to stay with you.

SPEAKER_02 (54:08):
Yeah, you mentioned something about the business
model that is, I guess, for lackof a better term miseducating
our patients that a lot of thesepop-up med spas have, you know,

(54:28):
without calling anyone out, it'sjust any business has to be
profitable.
And the profitable business isthe recurring business.
And a lot of these are set upthat way, like you alluded to.
And if you count the numbers ofthose pop-up spas compared to

(54:49):
institution like ours, I mean,we're outmanned by the
thousands.
And I feel a lot of and I'vefelt this trend in the past ten
years, the majority of thepopulation, their first entry in
anti-aging and rejuvenation isgoing to a Met Spa and trying to

(55:12):
get a treatment, and that'swhere their journey starts.
And there are the ones, thereare great Met spas, and I know
them, I'm friends with them.
They're phenomenal.
They're they're ethical, theyeducate themselves, they're just
they're just a student of thefield.
They really want to do good,they want to do great work, they
want to help their patients.

(55:32):
But a lot of these corporate runspas and they're part of these
MSOs and they're part of thesebasically profit business
machine that are educating thepatients erroneously the way I
know it, because uh the patientstell me.
They come and I had just lastweek a patient came and said,

(55:54):
I'm here for uh CO2 laser.
I said, It's always weird whensomeone walks into your office
and requests a certainprocedure, isn't it?
Without having discussed theirproblem, their goals, and
everything.
So And so I said, I'm curious toknow what makes you think you
need CO2 laser and how much doyou know about this?

(56:15):
Why do you believe that's goodfor you?
She said, Oh, I get it everyyear.
And I heard, uh, you're thebest, so I'm here now.
And I said, Why who told youthat you need CO2 laser every
year?
She said, Well, that's everybodyknows that, you know, where
where I had my laser and I saidI have to come back every year

(56:36):
because that's how long theeffect would last.
Only a year.
So this education is going onand educating our public whereas
I have patients and I learned itactually through my patients
many years ago when someone camewith immaculate skin in her 70s.
Like skin like yours,immaculate, like flawless.

(56:59):
And I asked her how old are you?
And she's like, I'm proudly, I'm72.
And the first question I askedin awe, what's the secret?
How is your skin so great?
She's like, Oh, I had laser 20years ago, just one time.
After that, literally, she saideverything you just said about

(57:22):
the skincare regimen, verbatimwith the retinols and
everything, judiciously said Ihaven't skipped a day.
And that's a power of skincareand maintaining it, like you
just said.
You don't need CO2 laser everyonce a year.
You can just that just to setthe clock back, and then you
maintain that and with properskincare and judicious

(57:45):
application and consistency.
So I learned that because I sawit with my own eyes.
Otherwise, I would maybe Iwouldn't believe it.
But when I saw the pattern, andthis was not just one patient,
this is like consistently overthe years.
I saw these patients and I askedthem what's your secret, they
all said the same, it's almostlike they're read from the same
script.

(58:06):
And so, to your point.

SPEAKER_00 (58:10):
Yeah, I agree.
Daria, I have those patients.
I've taken I have patients nowwho are in their 70s.
I treated them in their early50s.
And they were probably to thisday, actually, they still are my
most diligent patients when itcomes to skincare.
They travel with their skincare,they will use nothing else on
their skin without calling mefirst.

(58:31):
They follow my plan.
And okay, we have done the majorresurfacing when they were 50
and 51.
They were each that age.
Now at 75 and 76, they have hada couple medium-depth loop heels
in between all of that, but theystill get stopped all the time.

(58:53):
People are asking them all thetime about their skin.
And they see look, their skin isyounger now than at 50 and 51,
but they have kept using theirskincare regimen.
They don't skip a day.
They take it with them, Godforbid, if I've had patients go
into the hospital, they take itand line it up on their counter
in the hospital and they use theprotection.

(59:15):
So I think that's the mostimportant part.
You can't, you know what?
I don't look at the medispasdown the road, for example, and
say, oh gosh, you know, they'rejust trying to turn over
treatments and get patients inas many as they can and just do
procedure after procedure,because eventually those
patients will come to theirsenses and they'll come and look

(59:39):
for a good provider that hastheir best interests at heart.
So I just think, you know,eventually those patients will
make their way over.
And then we can educate them.
But hopefully, this podcast willreach a lot more people and make
them really think hard about howthey're spending their time,
their effort, their money, andreally refocus that attention

(01:00:00):
because everyone wants a quickfix.
I want the quick fix.
I have all the lasers in myoffice, but I'm not on that exam
table getting these treatmentsdone all the time.
Same.
I do about one treatment a yearin the practice, and that's
about as much as I have timefor.

SPEAKER_02 (01:00:18):
Yeah.
No.

SPEAKER_00 (01:00:19):
So I have to use my skincare.

SPEAKER_02 (01:00:21):
I know.
Well what are you, Susan?
Well, I'm curious, what are youexcited about for the future
when it comes to skin andanti-aging?
I mean, you you you described inthe very beginning of the
podcast, and I wholeheartedlyagree with you, it's actually
the intro question in many of mykeynote speeches when I asked

(01:00:42):
the audience or challenged theaudience to look at aging as a
chronic disease, which is atheory or concept that is has
been popularized by Dr.
David Sinclair out of Harvard.
And he describes it beautifullyin his book.

(01:01:02):
Where do you see the future ofour profession and of anti-aging
and rejuvenation in general?
Is there anything that you haveinside and are looking forward
to see what will happen andwhether or not we get to live to
apply it or at least to witnessit?

SPEAKER_00 (01:01:23):
Yeah.
I well, I'm going to say, youknow, for our audience, educate
yourself as much as you can.
And you mentioned DavidSinclair's book, Health Span or
Lifespan.
Lifespan was the name of thebook.
It's a phenomenal book.
I also like Outlive.
I also like Unbreakable by Dr.
Vonda Wright.

(01:01:44):
She's a midlife menopausal bonespecialist.
She's an orthopedic surgeon.
I love Marty McCary's book,Blind Spots.
And he's now our FDAcommissioner.
So that's where my hope is.
And I'm hoping he's listening tothis podcast.
Because first I want to saythank you for removing the black
box warning on estrogen.

SPEAKER_02 (01:02:05):
Yes.

SPEAKER_00 (01:02:06):
And thank you in for in your book, Debunking the Myth
of the Women's Health Initiativestudy.
So everybody should read thatbook because it talks about
cholesterol and how we followdogmas in medicine without
really thinking, like, how didwe make this decision?
And he goes through and methodmethodically breaks down those
dogmas and says, you know, wewere wrong to follow this.

(01:02:29):
And here's what the sciencereally shows.
So I'm hoping when you haveprogressive medical leaders,
maybe they can start toinfluence.
Like I said, he's a commissionerat the FDA.
Maybe he can start to allowpeople now to research longevity
medications and really classifyaging as a disease so that we

(01:02:51):
can develop medications for it.
We I know lots of companiesright now are looking at
RAPILOGs, which are analogues ofrapamycin, which is one of the
medications that is used totreat patients going through
transplants so they don't rejecta transplant organ, but when
there's pulsed intermittently,it may have, I'm saying may have

(01:03:13):
some improvement in longevity.
We do know David Sinclair is abig proponent of nicotinamide
mononucleotide, NMN, and howthat may impact the cellular
energy at the mitochondriallevel, because the mitochondria
are the energy power cells ofthe bigger cell itself.
And you need they're almost likethe battery pack, and you need

(01:03:34):
that energy to be replenished,and that declines as we age.
So there are things that weshould look at because I'd love
to have more than just onedoctor or one scientist out
there saying, This is what youshould take because I'm taking
it.
I'd rather see a long, along-term study, a prospective
study, placebo controlled ifpossible, looking at people who

(01:03:58):
take it, people who don't takeit.
And do we see an impact in theaging markers?
Do we see an impact in energyproduction?
All of that so we can speakscientifically about it the same
way we speak about every otherdisease process.
So I am excited that this willhappen, but we need money to go
towards that.
Whether that's money from theNIH, which right now they won't

(01:04:21):
they don't see aging as adisease.
So the NIH will not usually fundstudies related to anti-aging.
We need to change that.
And maybe some people out thereare listening to this that might
actually start to think aboutthis as a disease process and
say, you know what, for the sakeof our population, we need to

(01:04:44):
invest some of our resourcesinto how to get people to live a
longer, healthier lifespan.

SPEAKER_02 (01:04:50):
Yeah, I think that was very beautifully and
eloquently said.
And I think there is on theother side of that, is there are
private companies that arecurrently researching these very
things that are funded bybillionaires.
You know, a lot of thesebillionaires, they're loving
life, they're sitting and livinglife and thinking, man, I don't

(01:05:14):
want to go to the next life.
I want to stay in this life aslong as possible.
And I want to milk this, I wantto live as long as possible,
healthy.
And they have endless money,they're billionaires, so they're
funding a lot of these research.
So actually, you took we talkedabout David Sinclair.
I think he is working with acompany that is working on

(01:05:37):
turning back the genetic, the epgenetic clock through
epigenetics.
Have you heard of the Yamanakafactors?
Have you heard of the so so theYamanaka factors in I think He
mentioned them briefly in hisbook.

SPEAKER_00 (01:05:54):
Yeah, so so I I don't know a whole lot about
them.

SPEAKER_02 (01:05:57):
Yeah, I hope I don't uh screw it up.
I think Was in 2006 ShinyYamanaka, Japanese scientist who
then later, I think in 2012, gotthe Nobel Prize and medicine for
that.
He discovered there's these fourfactors, proteins called
Yamanaka factors now.
So the idea is that you knowevery cell in our body has exact

(01:06:20):
genetic copy, right?
We all have the same exactgenetic copy in each cell,
whether it's in our brain cell,heart cell, skin cell, every
cell, hair cell.
What makes a hair cell look likehair and a heart cell look like
a heart and function like aheart is which part of those

(01:06:41):
genes are turned on and turnedoff.
And that's determined by throughmethylation process, through on
and off switches, throughproteins that peptides that sit
on those genetic sequences andturn them off or turn them on.
So based on what gene is turnedon, a certain protein gets

(01:07:01):
transcribed, and the function ofeach cell is determined by the
proteins.
The proteins are basicallycarriers, and so for the layman,
they are the parts of the cellthat are responsible for the
function of the cell.
And so the Yamanaka factors,they are factors that when they

(01:07:26):
get into the cell, you injectthem into the cell, they turn
the genetic clock back throughinto a turn that cell into a
stem cell, back into itsoriginal function before it had
uh been induced to becomeanother organ cell, a heart cell

(01:07:46):
or a brain cell.
So it's a mis is it's a stemcell.
And so that has been proven forthat he got the Nobel Prize in
medicine.
Now the thing is we don't wantall our cells to turn into stem
cells, so that wouldn't benecessarily good because you
know you have then also risk ofcancer and so forth and
promoting cancer.

(01:08:07):
But then what they now, whatcompanies are trying to do is
injecting tiny amounts of theseYamanaka factors, very tiny
amounts, enough to go into thecell, and instead of turning it
into a stem cell, just turninginto a younger version of that
cell, like retinal cell that isnot functioning anymore, and

(01:08:30):
let's say you're blind becauseas a result of that, you cure
then the blindness.
The retinal cell anti-ages, thegenetic clock of that retinal
cell turns back, and now it'sfunctioning again, and you have
you obtained your vision again.
And they've done that onanimals, on mice.
There are some mice that theyequivalent to human life, they

(01:08:54):
are living up to 250 years,cured blindness in blindness in
mice, turned gray hair back intodark hair.
I mean, literally that has beendone on animals, and so what I'm
excited about, I mean, we havethe mechanistical proof and
evidence, we have you knowanimal studies, phase one

(01:09:18):
studies.
The challenge now is thedelivery method, how do you
inject it effectively and howmuch?
And there are now companies.
I think one the company thatDavid Sinclair is director of
has like something like ahundred billion dollars funding
from all these billionaires.

(01:09:39):
So I'm not gonna rely on theNIH, I'm not gonna rely on the
government because for thosechanges, administrative changes
to happen, even with people likeMarty McCary, who if there was a
time, it's now because he's theguy, as you said, and that's
what I'm super excited about.
And I feel his book should beread by every medical student,

(01:10:02):
by every resident, by everyfellow, and every physician
practicing.

SPEAKER_00 (01:10:06):
And all my patients, your patients.
Everyone should read it.

SPEAKER_02 (01:10:09):
Oh, I recommend it to everyone.
I'm like, you know, read thisand then we'll talk.
And uh, so I'm as hopeful as Iam and excited as I am, I'm even
more hopeful and excited becausethere's so many private
industries that are funded withbillions of dollars by all these
billionaires that are interestedin this field.

(01:10:31):
And I think the field oflongevity has been really grown
as a result of funding frombillionaires.
And and so I hope I don't knowif we get to practice it, but I
hope we get to live long enoughto live take advantage of it,
which then begs the questionwhat are we gonna do with all
this extra time that we'realive?

(01:10:52):
You know, what's gonna happen?
Maybe choose another professionand do pick another way of life.
I don't know.
Like for you, if I told you Ican add 50 years to your life,
like you get to live 150 years,how would you spend those years?
What would you do?

SPEAKER_00 (01:11:08):
Oh gosh, I am a perpetual student.
I would just learn everything.
I love history, I'd probably goget a history major.
I love other aspects ofmedicine, maybe do another
residency.
I love photography.

SPEAKER_02 (01:11:24):
Oh, me too.
I love that too.

SPEAKER_00 (01:11:26):
I love photography.
Really specialize in home lifeskills.
I love playing piano.
I'm not good.
Maybe I should become better.

SPEAKER_02 (01:11:36):
Same.

SPEAKER_00 (01:11:37):
So yeah, I could easily feel oh, and I love to
garden and cook.

SPEAKER_02 (01:11:41):
So there's enough time.

SPEAKER_00 (01:11:44):
So it's not enough time in a day, but if you give
me another 50 years, yeah, yougot you essentially got another
life.
Yeah.

SPEAKER_02 (01:11:51):
And so that's what I'm excited about.

SPEAKER_00 (01:11:53):
Now, what we need to tell our patients though, yes,
that's exciting for the future,Daria.
But what we need to tell ourpatients about is let's say
you're in your 40s or 50s rightnow, and you love to do any of
these things we mentioned,including maybe skiing, playing
tennis, all of that.
The only way you're going toensure that you can continue to

(01:12:16):
do that in your 60s, 70s, 80s,90s, is to take care of yourself
today.

SPEAKER_02 (01:12:22):
Yes.

SPEAKER_00 (01:12:22):
Using everything we talked about in this discussion.

SPEAKER_02 (01:12:25):
Thank you, Susan.
That is, I think, the bestadvice.
And you can't live for tomorrow,you have lived for today, and
there's a lot that you can dotoday, like you just said, not
just for your skin, but yourgeneral health.
And I always tell my patients ifsomething is good for your skin,
it's also good for your brain,it's also good for your heart,

(01:12:46):
it's good for your lungs, it'sgood for your muscles, it's good
for your bones, it's good foryour entire body.
And it all starts with for me,the three the four things, which
is sleep, diet, nutrition,exercise, uh, and mindfulness.
Those four things can preventAlzheimer's dementia.

(01:13:09):
My good friend Dr.
Majit Futuhi just he was mypodcast guest, I think, two
episodes ago.
He just published his new book.
He had many books on this topic.
One of the foremost authoritiesin neurology and neuroscience.
And Vanda Wright, when it comesto bone and muscle health.

(01:13:31):
So those are the things that youcan do today, and it will also
benefit your skin and yourappearance when it comes to
aging.
And even Dr.
Sinclair said, and that'saccording to studies, if you
look young, if your externalappearance is younger than your

(01:13:53):
actual chronologic age, meaningthe younger you look, the
younger you actually arebiologically, and there is a
correlation with that.
And and that all starts and endswith your lifestyle and how you
treat your body.
And so I want to thank you, uh,Susan.
You actually are my firstpodcast guest that I invited

(01:14:16):
back on this pod after having itdone for six years now.
And I was very excited about ourconversation.
So thanks for taking time out ofyour busy life and coming on.
And I could talk to you fordays, and I'm I I really hope
that at least me and you can dosomething within the academy

(01:14:38):
like we did this year tocontinue this and not make it
like a one-time thing andencourage and inspire others to
educate themselves and join uson the panel, and hopefully,
even invite some of theseexperts to come in and educate
our community.

SPEAKER_00 (01:14:55):
That would be wonderful.
It's my pleasure to be here.
Thank you for having me.

SPEAKER_02 (01:14:59):
Thank you so much, Susan.
And I know we'll talk a lot, andI hope you have a great day.

SPEAKER_00 (01:15:05):
Thank you.
Have a great weekend.

SPEAKER_02 (01:15:07):
You too.
Episodes over.
I hope you enjoyed myconversation with the one and
only Dr.
Susan Bobaji.
Please don't forget to leave mea review on Apple Podcast if you
enjoyed this podcast, or leaveany questions or comments on
Spotify, and I will get to themas soon as possible.

(01:15:31):
Until next time.
Bye bye.