Episode 272: Taking Care of Your Skin with Dr. Whitney Bowe
“My favorite thing is to stretch and breathe. And I feel like that's about as close as I come to meditation.”
- Dr. Whitney Bowe
Kate starts using a prod of the past and Doree begins her tooth whitening journey. Then, dermatologist and TikTok sensation Dr. Whitney Bowe joins them to discuss skin cycling, her sun protection tips and tricks, what happens to the gunk in your zit if you don’t pop it, and how to find a legit Botox practitioner.
Mentioned in this Episode
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Transcript
Kate: Hello and welcome to Forever35, a podcast about the things we do to take care of ourselves. I'm Kate Spencer.
Doree: And I am Doree Shafrir.
Kate: And you know what? We're not experts.
Doree: No, we're not. Alas. We're two friends who like to talk a lot about serums,
Kate: And this week I have been rubbing cam four on my leg. Doree. Doree. I would love to tell our listeners about today's guest,
Doree: Please.
Kate: We had the pleasure of talking to Dr. Whitney Bowe. Now, You might be like, Hmm, that name sounds familiar. I follow her on TikTok where she's amassed over 1.1 million followers.
Doree: Yes. Yes, she is.
Kate: Dr. Whitney is a New York-based dermatologist. She has appeared on programs like Good Morning America and the Rachel Ray show. She has been featured in publications like the Wall Street Journal, New York Times, allure, InStyle. She has a massive social media following. She is extremely accessible and engaging on TikTok, and she recently even launched her own skincare line. She's also got the goods to back it up, baby. She attended Yale where she graduated. Summa CU Loudy would listen to this, a Bachelor of Science and Molecular, cellular and Developmental Biology. She went to Penn where she studied medicine. She is the medical director of Integrative Dermatology, aesthetics and Wellness at Advanced Dermatology. She has done the research and she is now here to share her thoughts.
Doree: She's the real deal.
Kate: She is. She's just on it. I was energized after talking to her. I was like, wow. I'm also going to be getting up at five in the morning with you starting my day.
Doree: Totally, Totally.
Kate: But we asked a lot of your questions, listeners that were submitted to us ahead of the interview, so we were able to get her thoughts on everything from sunscreen to vitamin C. We tried to dig in as much as we could.
Doree: We did. All right. We will be right back with Dr. Whitney.
Kate: Dr. Whitney, welcome to Forever35. We are thrilled to have you.
Dr. Whitney: I'm absolutely thrilled to be here. So thanks so much for having me, you guys. I love this pod. I'm a listener. I'm a fan, so it, it's such an honor to be here.
Kate: Well, you appeared on my for you page a while back, and I have been a follower of yours for a while, and we talked about skin cycling on a previous episode like this. Just, yeah, it all feels like it was meant to be.
Dr. Whitney: It's meant to be. That's why I'm here today. Amazing.
Kate: So we start every episode of Forever35, asking our guests to share a self-care practice that is resonating with them in their own life. So I know you're a very busy person, but what do you do to, what is a self-care practice that you incorporate on the regular that feels good for you?
Dr. Whitney: So every morning I like to start my day with something physical, and I actually like to cycle through my physical activities the same way I cycle through my skincare. I find that it's a way that, first of all, it's more for my mental health, quite honestly than anything else. It has obviously physical benefits as well, but it's really helpful for me to start my day doing something where I'm moving my body. So whether that be doing, and sometimes it's intuitive, sometimes it's like, what does my body need today? Of course, there are the days that I love to get out there and play tennis or go for a run, but there are days that my body just feels like it needs to do something more like yoga or stretching or just going for a light walk. So I'll do Pilates, I'll do bar. I'm learning how to play golf. I'm terrible, but I love it. So I love doing something physical as the first start to my day. And then at the conclusion of that activity for about 10, 15 minutes, my favorite thing is to stretch and breathe. And I feel like that's about as close as I come to meditation. It's hard for me to completely sit still and to just be in the zone and just focus on breathing. But if I'm in a deep stretch and I know I, my hips needs and hip openers, or I'm doing, whether it's a lizard, a triangle, a pigeon, some kind of a stretch that feels like I am stretching out my lower back or my IT bands or something that I know my body needs and I'm sitting in that deep stretch and I'm just focusing on my breathing and trying to be completely mindful, trying to, I can think about things that I'm grateful for or I just try to just literally focus on my breath. But I try not to fast forward to the day. I try not to so hard start punching through my checklist, start listening to my voicemails or start checking my phone, my emails. I really make a conscious effort to carve out that time, and I feel like that just sets me up to be so much more productive during the day and also have such greater patience, whether it's with my daughter, with the ability to deal with obstacles and challenges as they arrive, arise, whether it's in my practice with my patients, if it's managing my business, my skincare line that I launched about a year ago, whatever it is that I'm dealing with that day, if I start off my day and do something that gets my heart rate up or my blood flowing, really focus on that stretching and that breathing. Think about even just one thing that I'm grateful for. One thing that I want to say, I feel really blessed to have this in my life and then just try to focus on breathing. I feel like it just sets me up for the rest of the day.
Doree: Can I ask, what time does this all occur?
Kate: Oh my gosh. I was also wondering.
Dr. Whitney: It usually happens before my house is up. So I'm a very early riser. I tend to get up before the sun. I get a lot of it done before my daughter is up. She is adorable with, it's really cute. I feel, when we think about parenting, the one thing that we're always taught is you want to parent by example. For me, when I'm teaching my other parents, my kids never put on sunscreen. I'm like, well, the best thing is to model the behavior because if they see you putting on your sunscreen and they see you putting on your hat, then they know that that's just part of their routine. So it's so funny, my daughter's 11 and just recently she started setting her alarm for six 30 in the morning. She's plenty of time and she starts meditating and stretching.
Doree: Wow.
Dr. Whitney: And breathing. And she does an entire skincare routine all before breakfast. It's like the cutest thing ever. And my husband's like, what is going on in my house?
Doree: Wow.
Kate: Buckle up buddy.
Dr. Whitney: Right? It's really cute, but it's really, it's like, it's very sweet. So, so I try to get all of my rituals done before she's even up so that when she wakes up, I can give her breakfast and we can talk about the day, make sure her backpack is packed and I can send her off to school. But it's just funny that now she's literally started to mimic my morning routine. She just does it about an hour later than I do.
Kate: So wait, I want to just circle back here to sunscreen and a hat because we are sun care obsessives, especially Doree is really conscientious about sun protection.
Dr. Whitney: Doree, I love you that much more. We were talking before how my sister's name is Doree, and so we immediately had this kinship and now you're a sunscreen worshiper, like, okay, girl. I gotcha.
Doree: Yes.
Kate: What is like, do you have a go-to sunscreen or a go-to hat even? What are your best sunscreen, sun protection tools that you keep in your own arsenal?
Dr. Whitney: Absolutely. So the first thing is you want to always use a vitamin C serum in the morning because that's the perfect pair for your sunscreen. So sunscreen is so important, but it only blocks about 50, 55% of the free radicals that are generated from sun exposure. So when the sun hits our face, we've got all that UV light and infrared heat, et cetera, and only about it, only about 55% of those free radicals are prevented from forming when you have sunscreen on. So you want something else to mop up the rest of that free radical damage, oxidative stress, because that's what's going to really help prevent slow down signs of aging and of course skin cancer as well. So I start with a powerful antioxidant serum, ideally containing vitamin C. Then I put on my sunscreen some of my favorite sunscreens right now, I swear by one called the Beauty of Joe Sean, j o s e o n. It's a Korean sunscreen in Korea. We have different filters that are approved that are not yet FDA approved. The FDA is much, much slower when it comes to approving sunscreen filters. And so Korea, the formulations are very advanced, and this one I tend to apply and reapply. I'm really good about my sunscreen, Doree. You and I could reapply our sunscreen all day long together, but I also have acne pro skin, so when I keep reapplying certain formulations, I'll find that I'm breaking out. Or if it's a tinted sunscreen that's not made well, I'll find that it's dripping down and streaking down my face and getting on my clothes. And I feel like that formulation is beautiful and very lightweight, and so I'm able to reapply it throughout the day very easily without really breaking out. Some other excellent sunscreen brands that I love are La Roche Posay, which is sounds very French and fancy, but you can get it really at any drug store and it's a very affordable price point. And then also, Supergoop is a great brand. They have one called Glow screen that has these light reflecting particles in it. So it's a little too disco ball for me in terms of if I put it all over my face, but I do love to, I layer my sunscreen. So say that I'm using my beauty of Johan all over my face, and then I'll put my supergoop on the cheekbones. ELTA MD also makes some really nice sunscreens. There's this perception that they're mineral only and people are like, oh, I'm only use minerals. I only use zinc oxide and titanium dioxide. So I use Elta md, but it's actually considered a hybrid sunscreen, which means that it's a combination of both a mineral sunscreen as well as a chemical sunscreen. I think that there's a lot of fear mongering going around about chemical sunscreens, and quite honestly, I don't like to feed into that. So I think a lot of people are just worried that it's going to be toxic and it's going to kill them. And meanwhile we know that the sun can cause melanoma. We know that tanning beds can cause melanoma. We know that UV rays is a known carcinogen. The way that cigarette smoke is, we know that it can cause, but we don't know exactly what some of these sunscreen ingredients are doing to our skin, our body, some of them are absorbed more than others. In general, I'm not super concerned about the safety hazards. There are a couple of ingredients that I personally tend to avoid. I don't like to use oxybenzone. That one's a little bit more controversial in terms of both our health as well as marine health and the health of our coral reefs and our environments. Even that's still controversial. One of those topics that's like hotly, hotly debated right now, even among environmental experts and scientists, how much of it is because of the sunscreen ingredients, how much of it is because of global warming? There's so many different factors involved that can be leading to the bleaching of the coral reefs and what is considered reef safe. But in general, I do feel comfortable using the chemical filters, except with the exception of something like oxybenzone on my face, on my daughter's face. For the rest of our bodies, I tend to prefer sun protective fabrics. So Kate, you were saying before, what kind of hat do I recommend? So when it comes to fabrics, so when we think about sunscreen and a skin, we think about spf. That's something that people are familiar with. S SPF is a measure of how much something protects against UV B rays. UV B for burn, what S SPF doesn't cover is UV A raises, and you can think A for aging, which is a whole other category of ultraviolet rays. So for that, I like to look for the words broad spectrum, that there are some countries that actually even do UUV testing. So they'll look for, they do something called a grading system with certain number of plus signs. So I'm looking for the spf, which represents UVB protection. And I'm also looking for the UVA protection when I'm recommending sunscreens and when I'm at those. But it comes fabrics we don't uses pf, we use something called U pf. So UPF is basically like s pf, but for fabric. So I recommend a UPF 50 plus when it comes to looking for a rash guard or looking for a hat or a visor. So just recently on my Instagram stories, I was, I'm always gifted a bunch of different things that are related to the sun and skincare. And I got this great visor that was really broad rimmed and it had UPF 50 plus. And so I talked about it on my channel, but I do always look for that UPF 50, and I'm always hunting for something that's going to protect me, especially my body, so I don't have to reapply sunscreen from head to toe all day long. Yeah, it is just completely inconvenient. My daughter doesn't want to do it.
Doree: Totally, totally.
Dr. Whitney: I'd rather just wear a lightweight, breathable fabric that has that sun protection built in.
Doree: What do you wear to the beach slash Do you even go to the beach?
Dr. Whitney: So I'm always on the beach. I'm like, I'm probably one of the most outdoor dermatologists that you're ever going to meet. So I mean, first of all, we have a beach house about an hour 15 minutes away from our primary house, and it's literally right on the water. So we'll paddle boarding, we're kayaking, we're on the water constantly. And my daughter loves swimming. We have a pool here in the backyard. She's swimming throughout the summer and I love playing tennis every morning. And I'm totally into golf now, and that's literally hours in the summer. We dabbled in sailing for a while, didn't stick, but we're just an outdoor family. We literally love being outside as often as we can. So yes, so I'm definitely that person who's outside, but just practicing sun safe behavior. So I'm wearing my sunscreen on my face, neck and chest tops of my hands. I'm reapplying that throughout the day, but the rest of my body is covered with a fabric just because it's so much easier. It's just realistically speaking, it's really annoying to have to keep reapplying that sunscreen. So if you find the right fabric and it's a breathable fabric and it doesn't make you feel like you're just suffocating and sweating underneath it. And some of the brands now are super cute. You used to be not so flattering. I'd be the mom at the pool who was like, oh God, at least I'm being good to my skin, but nobody really wants to look like me right now. But now I feel like there's a lot of surfer inspired kind of fabrics. A lot of the bigger brands are getting into this. And so we're seeing some really cute options out there now.
Doree: So we're just going to take a short break and we will be right back.
Kate: As a research scientist, which is part of your background, you have a fascinating background. Do you find that that influences your approach both as a dermatologist but also just as a person standing in their bathroom doing their skincare routine?
Dr. Whitney: Absolutely. So I'm such a nerd. So I have published over 40 peer-reviewed scientific publications, book chapters. I have a patent. I'm one of those people who is obsessed with something being evidence-based. So I'm very critical and I just approach everything with skepticism, but also just being inquisitive. I'm open minded, I want to be open to new things, but I'm always approaching it with that sort of scientific skepticism where it's like, okay, prove it to me that it actually works.
Kate: Yeah, I love that. Good. Yeah, that seems like the right way to do it.
Dr. Whitney: It definitely helps in terms of being able to find things that really work and make recommendations. I'm that person. Of course, my patients all come to me for recommendations because they know that I'm really doing my homework. And I think that's one of the reasons that I built such a strong following on social media so quickly is because I'm not just sort of spitting out information that everybody else is saying. I'm actually going back to the primary source and I'm saying, okay, wait a second. I get that everybody's been saying X, Y, and Z, but what's the evidence? What does the science actually say? And so I'll go back and it takes a little extra digging, but that's my background. I'm trained in clinical epidemiology and biostatistics logistic regression. I took those courses at Wharton. I know how to look at the studies with a very skeptical eye. Not only have I published these studies and the top journals, but I know I used to be a reviewer to basically determine if the articles get accepted or not for publications. So there's a very different threshold when something gets accepted for a really rigorous peer-reviewed scientific publication. And that's the lens that I look at when I'm looking at all these different products to see is this actually living up to its claims? And quite honestly, guys, it's taken on a whole new light now that I'm a brand founder because as I'm formulating products and determining what claims I make for my skincare products, I am now realizing just how much marketing hype there is out there.
Kate: Yeah.
Dr. Whitney: Cause it's like it's so easy to make these claims and say that something is science backed, and then you look at the actual science that's backing that product and it's just given my background. I'm like, oh my gosh, how have these brands been getting away with this for so long? So it's definitely been a huge learning curve in terms of just learning the difference between what a brand is able to do from a marketing perspective, and then ethically what a brand in my mind should be doing in terms of backing the claims with actual science.
Kate: How does a layperson cut through that bs like me going to the drug store and wandering the aisles? So I personally am so influenced by marketing. So it seems like so much of beauty products, skincare products, it's all marketing.
Dr. Whitney: It's so true, and it's actually really, really hard to decipher. And even dermatologists it, a lot of dermatologists aren't trained as research scientists. So even dermatologists, your typical dermatology residency, maybe once a week you'll meet in something called a journal club and you'll sort of learn a little bit about how to interpret the literature. But that's completely different from, I actually took years out of my training to just focus on research and how to do research and how to critically analyze research, et cetera. So I think it's asking a lot of the consumer to pick up a bottle and to be able to determine just how efficacious something is. So a couple things to keep in mind. One is that a lot of brands will base their marketing claims on an individual ingredient. And so that individual ingredient, it's called relying on ingredient supplier data. So say that you have a product that has one ingredient in it, and that ingredient by itself has been proven to repair the skin barrier. There are brands that will use that information from that single ingredient, and they'll say, proven to repair the skin barrier. And then there's a little asterisk and you scroll down on the website and you see the little asterisk because based on an individual ingredient in this formulation, that's very different from doing a clinical study on the final formulation, the product that you're holding in your hand that you bought from the store, because that one ingredient at a hundred percent concentration in a laboratory study may do X, Y, and Z. But when it's put in that final formulation, it may be completely different. I try to explain it to my patients by saying, for example, if you ate two hard-boiled eggs for breakfast every single day, that's very different. And it is going to have very different impacts on your health and on your body than if you ate a huge slice of cake every morning that was made with two eggs. So the cake is the final recipe. It's got the sugar, it's got the cream, it's got the milk, it's got the eggs, but it's got the eggs, But if you have the cake and you're like, and you start making claims based on just what the eggs can do for your health, that's that's an extrapolation of that data. That one is an ingredient, and one is a final recipe or a final formulation. So what you're looking for is you're looking for brands that are investing in clinical studies by a third party testing facility, an independent unbiased testing facility that's actually testing the final formulation in humans on real skin and not just measuring what's called subjective results. So it's one thing to do a consumer perception study where you basically, it's like a survey and that's where you see things like 97% of people noticed an improvement in their fine lines and wrinkles.
Kate: Got it.
Dr. Whitney: So that's basically giving out the product and saying to the people, did you notice an improvement in your fine lines and wrinkles? And people are like, yeah, I did notice. It's ok. Then there's something called objective measurements, which is what, as a scientist, that's how I approach those types of claims. I want to use instruments, I want to use tools that measure changes in the skin. And if there is this statistically significant improvement in that parameter, whether it's dark spots, brightening up, fine lines becoming smoother, firmer texture, improving, if we're objectively measuring quantifying, it's a mathematical change that you can detect in the skin using an instrument or using an expert greater or standardized photography, and you can actually measure that change to me, then I'm okay making that claim. So it's a little tricky. I think looking at brands, you can even ask the brands. You can DM the brands on social media. A lot of them have customer service people who will be responsive to you, or you can directly email the brands and you know can ask them, have you done clinical testing on the final formulation? And can you tell me about your testing protocols? And if they say like, oh yeah, we have these special ingredients that have science behind them, that they're basing their claims on individual ingredients that have nothing to do with the final formulation, which is the vast majority of skincare brands out there blew the claim design fact.
Kate: This just blew my mind.
Dr. Whitney: Crazy.
Kate: Wow, I never thought about it this.
Doree: Love it. So Dr. Whitney, I think a lot of our listeners probably know you as I think we became aware of you through social media and skin, your skin cycling
Dr. Whitney: Method.
Doree: Method. Yes, thank you. I was going to say program, I was like, that's not exactly right, either one. Yeah. So first of all, could you just explain what that is for the benefit of our listeners who might not be aware of it, and then also talk a little bit about your new skincare line and how skin cycling informed the development of your products.
Dr. Whitney: So skin cycling is a very sort of less is approach to skincare. It's a deliberate, streamlined approach to skincare. It takes a less is more approach where we're really thinking about maximizing driving results, but minimizing irritation. And in the past we used to educate our patients myself, my colleagues, we used to educate our patients in a very linear way. We would say things, try to exfoliate the skin, but only do it two to three times a week. Retinoids are wonderful. You should try to include a retinoid in your skincare routine, but you want to start off slow and gradually increase. Oh, try not to use your retinoid on the same night as you're exfoliating because that can irritate the skin. So we were delivering this information that we thought was very meaningful and helpful, but it turns out that our patients and just people in general, when it came to skincare, they were very overwhelmed. They really felt like it was very complicated and a lot of people were taking a kitchen sink approach to skincare. They were just mixing, matching, layering, different products, ingredients that didn't necessarily work well together. And it was leading to a lot of irritation. It wasn't really leading to results. So I started coaching my patients years ago in the office before I even introduced it on social media. I started talking to them about skin cycling. It was based on my knowledge of skin biology, skin histology, how these ingredients work, their mechanism of action, which ones work well together, which ones complement one another. And so I started coaching my patients through this and they would come back month after month and their skin was literally transformed. It was game changing. And they would come back and say, this is amazing. Not only am I seeing these incredible results in the skin, but for the first time skincare makes sense. I have this template in my mind that it just takes the stress out of skincare. So when I introduced it on social media, I started talking about it on social media in April, 2021 a while back, and it developed initially this cult following. And the initial way that I started talking about it was there's this skin cycling is the classic skin cycling program is the one that sort of went mega viral over almost 4 billion views on TikTok. And the classic skin cycling program is a four night cycle. So you start with exfoliation night on night one, and then you have retinoid night on night two, and then you have two recovery nights, recovery night, recovery night, and then you cycle back to exfoliation night. So it's this four night cycle, it's this cyclical way of approaching skincare that builds in these push nights, these nights when you're deliberately pushing your skin outside of its comfort zone. And then you're also building in these recovery nights where your skin barrier can recover your skin, microbiome can recover. You're just thinking about hydration, repairing the skin. And by cycling through, that's where people were seeing these beautiful results. And in my office, I started then sort of having some nuances where I could flex up or flex down their skin cycling program based on their skin needs and their skin goals. So for example, somebody who had acne prone skin, I would start to drop recovery nights and build in more retinoid nights. So for my patients who had more oily acne prone skin, or my patients who were more accustomed to were able to tolerate more stronger actives, their skin had sort of gotten used to it, they were better able to tolerate it. They were able to do something like this night, one would be exfoliation night, and then they would have retinoid night, retinoid night, retinoid night, recovery night, and then exfoliation night, retinoid night, retinoid night, retinoid night, recovery night. And so that would be their cycle. And then I have patients with eczema and rosacea who would have more recovery nights built in. So they would do exfoliation night, retinoid night recovery night recovery night recovery night exfoliation night retinoid night recovery night recovery night, recovery night. So there's ways of, it's skin cycling is meant to be a flexible framework. And really the goal with skin cycling and the way that I've been educating about it is that it teaches you this basic framework, but then it also teaches you to listen to your skin. So if you feel like your skin is thriving and doing well, you may be ready to level up and go to an advanced skin cycling program, build in more of those retinoid nights. If you feel like you're just super stressed, you're not sleeping well, or it's the dead of winter and your skin's just dry and you're just having or say that you know, overdid your exfoliating serum or something and you just need to regroup and rebalance everything, you may just build in more recovery nights. So it's been a wild ride. I feel like it almost broke the internet and it was literally in the Wall Street Journal, the New York Times. The Washington Post. Page six.
Kate: Yeah. Were you like, what the F is happening?
Dr. Whitney: It was literally wild. I told you guys before that I have an 11 year old and for all of my accomplishments in my life, it wasn't until skin cycling that people were stopping us at airports and they were like, oh my gosh, Dr. Whitney Bow, oh my gosh, your skin cycling method has changed my entire life. I used to be, I was wearing layers of makeup and they would've tears in their eyes and be like, you literally gave me back my confidence and my self-esteem and you changed my life. And my daughter seeing that. It was all of a sudden I had street cred. I was like, yeah, mom's cool now.
Kate: All it took took was going viral all to prove yourself.
Dr. Whitney: All those years of schooling and graduating, taught my class at Yale and University of Pennsylvania and literally the patents and all the publications, those were not important.
Doree: Nope. Don't matter.
Dr. Whitney: You're verified on TikTok, man, you got over a million followers on TikTok, all of a sudden you're cool. It's a whole other level.
Kate: We have some other questions from listeners that we would love to ask you and
Dr. Whitney: Sure.
Kate: This one really stood out to me because honestly, it's something I've wondered and I feel like this is a safe space. So a listener wanted to know, if I don't pop a pimple, how does the funk get out of my pores? Where does it go?
Dr. Whitney: Oh my gosh, I love it. So your body actually does resorb or take in, all of the gunk. So sometimes a pimple will naturally come to a head and if it does come to a head, that's awesome. What I would love you to do is instead of pop it, put a pimple patch on, which actually the hydrocolloid material will actually absorb all that gunk for you and you'll wake up and in the morning it looks like it's turned a little bit white right in the center, and that's actually the gunk that's absorbing into the hydrocolloid patch. So that's a very clean, beautiful way of getting rid of that excess gunk. But if you're one of those people who the pimple never quite comes to a head and it's just sort of sitting underneath the surface, ideally you're not rupturing it, ideally you're not manipulating it, picking on it or anything like that because if you do, you can burst that material into the deeper layers of your skin and that can trigger hyperpigmentation like dark marks and also scars. So you really want to try not to do that. But if you do leave it alone, the body actually naturally has a way of getting in there with enzymes and it does a little mop up. It actually breaks down that material and it flushes it out on its own.
Kate: Wow.
Doree: Oh, I was, I was one of those things where someone asked this and I was like, wow, I've never thought about this. But now I'm really curious.
Kate: Where does it go?
Dr. Whitney: Yeah, we have a whole lmphatic system and vascular system that sort of bring, we have certain vessels that bring oxygen and nutrients to the area, and then we have other vessels that bring away the debris and the stuff that you don't want to be there. And so we have this beautiful system that will take care of a lot of that inflammation for us. Oof.
Doree: Okay.
Kate: Thank you body.
Doree: This is another question that was sort of after my own heart. How much sun protection should you wear while driving?
Dr. Whitney: So when you think about window glass, any kind of windows, uv, A rays can penetrate through the window glass. And so we talked before that uuv B stands for burn and UV A rays are the ones that are primarily responsible for aging. They actually dive deeper into the skin into what are called, what's called the dermal layer. And so they break down our collagen, our elastic fiber as it leads to fine lines, wrinkling, laxity, loss of elasticity. So if you are driving over the years and you're not using any sun protection, even if you never get a sunburn, because the UVB rays aren't penetrating through those UV A rays will. And so I always recommend using some kind of a sun sunscreen on a daily basis if you have some kind of a commute. And those same UV rays can penetrate through clouds, which is why even on cloudy days, if you're outside, you're going for a walk, you know, still want to be careful about sun protection.
Kate: Ok, sounds good. Doree, it sounds like we're doing it right. Yeah, especially you. You, here's one. What is your least favorite skincare trend? Is there anything that you kind of roll your eyes, not rolling your eyes at, but are like y'all, this really doesn't work, this is a bit of a gimmick.
Dr. Whitney: Well, I think that probably facial exercises, I think sometimes that one can be a little bit of an extreme, especially if the exercises have to do with contracting muscles that we as cosmetic dermatologists are deliberately relaxing in the office. So there are some facial exercises that are more yoga that sort of relax the tension in the muscles and those are fine. But sometimes I'll see people on social media doing these repetitive movements that I know are going to actually create etched in lines. And that's actually what we're trying to train people not to do with muscle memory by giving them some Botox or DYS for it to relax those muscles. So it's just ironic that we have some people who are actually creating those problems.
Kate: Okay. Well let's take a quick break and we'll be right back. Can you just give us the rundown on Botox versus fillers versus lasers versus microneedling? There's all these cosmetic dermatology options and there's a feeling, at least for me of what the hell is all this? Where do I begin if I want to begin?
Dr. Whitney: Absolutely.
Kate: But obviously not for everybody. But if it is
Dr. Whitney: Yes, yes, yes. And this is not necessary abs, it's not necessary. But if it's something that you're interested in, it's good to be informed. And I always think that information is power. And so if is not your jam, you can fast forward to the next section. So when it comes to Botox, Dysport actually a new one that was recently FDA approved, dfi, which it supposedly lasts a lot longer. I'm not a cowboy, I don't like to integrate new things and I don't like my patients to be Guinea pigs, in other words. So I like to see how things pan out first and if there's going to be certain side effects that are going to be reported, I'd like to know that before I implement it. In my practice, I have a very unique practice. My practice has been capped for over six years. And so I treat a lot of celebrities, a-listers, get them ready for red carpet events, met gala, et cetera. So for me, if there's a new technology that's exciting and sexy, I'm not the first to use it because I want to make sure that it is tried and true and that we have learned everything that we really want to know before I start injecting it or doing it to my patients. And I will actually always do it to myself first before I introduce it to my patients. Cause I want to live through it. So when it comes to Botox, those are botulinum toxins and the way that they work is by interrupting the message between your nerves and your muscle fibers. So they basically stop your nerves from telling your muscles to contract. And so they relax your muscles when used the right way, they can be game-changing in terms of relaxing the muscles between the eyebrows. So for people prone to getting those angry elevens or some people get an angry one, just one line right here, it can relax that. But I also use it very frequently in my patients who their eyelids are getting a little bit heavy. As we mature, our eyelids do tend to get a little droopier, a little bit heavier, and we can actually rebalance the muscles in the upper face and can give a little bit of a nice lateral lift to the brow in a very subtle way. You don't want to overdo it or it leads to something called a Spock or a peak, which can look a little evil, a little strange, a little Jack Nicholson. So you don't want to overdo that. But having a nice lateral lift to the brow can give you sort of a natural arch to the brow and it can also just open up the eyes. It just makes you look well, well rested, refreshed, and it also can slow down the changes in the face that can lead to the need for surgery. So we're trying to postpone surgery as long as we can. In my office, when people need to have an upper blepharoplasty, when I say to them, look, Botox Dysport it, it's just not cutting it anymore for you. I think you need to have a consultation. If you're unhappy with how this looks and you really want to do something about it, you're at that point where you would benefit from having a conversation with a plastic surgeon and oculoplastic surgeon to talk about potentially getting eyelid surgery. But Botox Dysport can do a beautiful job of really opening up the eyes and even delaying the need for that kind of surgery for as long as possible. And I love it for those reasons. Botox disper is also great for what we call the crow's feet. Those creases that form around the outside of the eye, the lateral part of the eye. It can also help with forehead creases, but I'm very light in my forehead injections because if you overdo the forehead injections, it can lead to a frozen sort of shiny looking forehead. And for me that it takes away that natural, beautiful aesthetic, that ability to relate to people. And I treat a lot of people who are on television and have to, either they're news reporters or they're interviewing people and showing empathy. And if you get rid of the ability to really raise and lower the eyebrows, it can lead to a very frozen appearance. I just don't like that appearance. And if you over inject the part, it can also drop the lids and drop the brows. It can lead to a heaviness of the eyes, which is the opposite of what most people actually want to achieve. Ultimately, when it comes to balancing the face, I do use lower face Botox and I can inject it in the chin area. You can actually get dimpling of the chin. I can inject it in certain areas along the jawline to prevent the corners of the mouth from turning down into a muscle called the D A o, which actually pulls down the corners of the mouth face and injected around the lips too. I can do something called a lip flip, which for you who are not interested in lip filler, you can get a little bit of aversion of the lips and you can also help with the fine lines around the lips. I have a lot of patients who are aging and they feel like the lines around the lips, their lipstick is sort of bleeding into the surrounding skin. And we can actually inject just a couple little drops of Botox or Dysport and really smooth out those lines very nicely. And I also inject it into the neck to help with the lines on the neck as well. And the platysmal bands thing that things that age the neck and there's something called an RTD lift, lots of different things you can do with Botox and disparate. I would say the upper face is a little bit more straightforward if somebody's going to be injecting your lower face with Botox or that can be very complicated and can have more side effects. Be really careful with that. One of the procedures that I'm doing all the time now in my office with lower face Botox is to inject the master muscle for tmj. So people who clench and they grind and they get headaches, sometimes they'll use a retainer, they'll use a night guard, they'll go to the dentist or the orthodontist and they'll still have pain, they'll still get headaches, they'll get tension headaches in the back of their neck and they get that discomfort. They'll wake up in the middle of the night and be like, I am grinding my teeth. And sometimes they even wear down the enamel of their teeth, so I'll inject just that muscle right there or the masseter muscle and that can just be so helpful in terms of relieving those symptoms. So that was a long answer just for Botox or Dysport. So I'll dive into fillers.
Kate: Fascinating.
Dr. Whitney: So feel free to edit me out after this. So fillers, fillers, I love, for me, it almost, I get into this meditative state when I'm doing fillers. It's really my area of expertise. I feel like I initially wanted to be a surgeon when I was in training. I love using my hands. And when I'm doing fillers in a very natural way on the face, it literally is sculpting. I'm looking at ratios, proportions, and really making, I'm just enhancing someone's natural beauty. I don't want to change the way that anyone looks. And that really takes skill. You have to really understand anatomy. You have to be able to point that needle and know exactly what your target is, what are the blood vessels in that area, what are the nerves in that area, how to avoid danger zones, and then how to achieve that beautiful, natural, subtle aesthetic so that people just say, wow, you look great, but they can't put their finger on it. They dunno why you look great. So I do a lot of fillers into the tear trough area, which is that under Eye Hollow, the people just say that they just look tired no matter how much sleep they're getting. I do fillers into the cheekbone area just to sort of lift. I do it into the temple areas. We tend to get very trophic in the temple area as we age. I do fillers in the marionette around the mouth area. I do, I love doing lip fillers. Again, I feel like there's some really bad lip filler out there that gives lip filler a bad name. But when done beautifully, it can give you back that beautiful cupid's bow that contours. It really is a big part of a woman's identity to have a very pretty defined lip that doesn't feel overfilled, doesn't feel like a platypus or a duck. So you have to really be careful with the technique there. I do fillers into the chin to really define that beautiful jawline and help lift and prevent that sagging, the jowl effect that people get. I love doing S Sculptra, which is one of my favorite fillers. It works completely differently from the other fillers. The other fillers are primarily made of something called hyaluronic acid, meaning they act like sponges. They just bind a thousand times their weight in water, and so they sort of plump the area, whereas s Sculptra stimulates your own collagen. So it's a very slow, steady tightening effect. It's really very similar to a facelift effect and a very natural way that just tightens everything and it almost builds the scaffold of the skin. And so my patients who start doing sculptor are always just, they're blown away because it's such a slow, it takes three months to even see the result of your first sculptor injection. So it's something that you know can do without anybody really noticing that you've done anything. But when you look back at the pictures beforehand, people can't even remember looking like that. It was this transformation takes place in such a slow and steady way. And my patients just love that. I do tons of lasers as well. Lasers, microneedling, those are more for texture. So if you're dealing with dilated pores, acne scars, if you want to help with brown spots, I think about fillers. I say think about plumping up the pillow. And then if you're thinking about lasers, microneedling, radio frequency, microneedling, that's like taking a thousand thread count, rete pillowcase and pulling it on top of your pillow, the canvas, it's the texture on top. So it just makes the skin look like it's got that beautiful, healthy, even glow.
Doree: So someone who is just sort of dipping their toe into this whole world of Botox and fillers and whatever they want to do. There's so many practitioners out there, and as you said, your practice has been capped for six years, so they're not going to go to you. But how can people evaluate all the options out there? Should they go to always go to a dermatologist? Can they go to an aesthetician? Can they go to a nurse practitioner? How do we evaluate who is good and who's going to make us look like ourselves, I guess?
Dr. Whitney: Yeah, I think it can be really scary. And it's your face. So I think some of the red flags are, you know, don't want to go somewhere has a Groupon, or if the price is too good to be true, it's too good to be true. Another really big red flag is if you call and you can get in very quickly and very easily, that's not a good sign. People who are in demand and are really good at what they do, they will book out way in advance. So you may have to go on a wait list. And quite honestly, this shouldn't be an impulse purchase. It shouldn't be like you're sitting in your dentist or gynecologist chair and it just happens to be convenient. And they're like, Hey, by the way, should I do your Botox before you leave? It should be a really well-researched. Not to say that all dentists and gynecologists are not capable of doing really great Botox, but you want to go to somebody who really specializes in that and really has been up to date and gone to all the cadaver courses and dissections and completely understands the anatomy. Because it's one thing to do the injections, it's another thing to manage the complications. People don't talk about the complications as often, but there really are complications. Fillers can make you go blind. They can lead to necrosis tissue death. You can have major issues. And even if it's rare, you want to have that person who knows exactly what to do in that moment. You don't want that person to panic and say, oh gosh, I didn't take that part of the course. So you want someone who knows how to avoid complications and then someone who knows how to manage them should they arise. And it's true, usually that's going to be a board certified dermatologist. But there have been some nurse injectors and physicians assistants who I've seen who really have gone the extra mile, done tremendous studying and really shattered me in my practice, shattered my colleagues, and spent a tremendous amount of time educating themselves on all of the nuances. So I don't think that, you can't always say it's just one specific type of practitioner, but I think a big part of it is going to be word of mouth. And if you see a friend, a colleague, a family member who looks really healthy and beautiful but doesn't look like they had work done ask, they may not volunteer the information, but you can say, what is it that are to somebody? Is anybody doing something for you? I think another thing to realize in my practice, one of the reasons I got so excited about skincare and launched my own line is because I was one of those people who said to people, my patients, I would say, you may not need to do lasers. We can actually achieve some of this using skincare or lifestyle changes at home. Let's talk about your diet. Let's talk about your stress levels, let's talk about your sleep habits. Let's bring in a bag of the skincare products that you're using at home. And if there were things that we could accomplish without having them do in-office procedures, I was the first person to tell them that and help them and coach them and spend the time with them to do that. And I think that a practitioner who's in it for the right reasons, who's really in it because they want to achieve the best result for you, and they're really thinking about the long-term health of your skin and not sort of the quick bandaid fix. That's a sign. That's somebody who I think you can be more ready to trust. So somebody who's constantly looking to upsell you, and if it feels like a sales experience, that's not a good feeling and it shouldn't feel that way. It should feel like somebody you can trust. And if you go in and say, what do you think about all therapy? And that practitioner's like, you know what? I have the all therapy device. I've been trained in all therapy. I know exactly how to do it. I've treated thousands of patients over the years looking at you and doing the consultation with your skin and your skin goals. I don't think that's the most cost effective way to meet your expectations. Let's start with this instead. And if you've got somebody who's having that kind of honest conversation with you and really looking at your skin, those are really good signs.
Doree: We've taken a lot of your time. So I just have one more question that is sort of a selfish one because I am very curious about this myself, but can we talk a little bit about hair loss and P R P? Is that something that you do? Is that something that you think works? What is it? Tell us everything.
Dr. Whitney: Okay, so first of all, hair loss is incredibly common. It used to be something that men talked about very openly. Now, I think that it's much more socially acceptable for women to admit the fact that they feel like they're seeing more of their scalp, their part looks like it's getting wider. When they're putting their hair in a ponytail, they can wrap that rubber band around way too many times and they're not happy with that, or they're seeing more hair on their pillowcase or in their drain. And it can really affect your confidence and your quality of life and your self-esteem and hair loss. Hair loss is one of those things that women often, it's like the last thing that they ask about. It's almost like as I'm walking out the door, they're like, oh, Dr. Bo, by the way, what do you think? And they're always sort of hesitant to ask. And then when I come back and I'm open to really talking to them in an evidence-based way about their options and explaining it to them, they often start to cry. It's a very emotional topic for women and I think we need to talk about it more. And so yes, so I do do P r P injections in my practice. What P R P injections are is we take about two teaspoons of your blood. So we actually draw your blood, we spin it in a centrifuge, we separate out the plasma, which is very rich in growth factors, and then I inject it into the scalp. It's an uncomfortable, painful procedure. And so what I do in the office is I use something called prox, which is like laughing gas. It's a combination of nitrous oxide and oxygen, and you suck on it while I inject your scalp and you're high. It definitely has been very helpful in terms of my cell fill and my P R P injections. So I have done this for so many patients over the years, and I always say to people like, look, hair loss is multifactorial. There's stress, there's nutrition. I always do blood work first before I start with any of these things, make sure there's no underlying issues going on. But when we do think about tackling hair loss, we have to think about it by approaching it in hitting it at multiple different ways in different pathways. And one of those can be P R P injections, especially for my patients who are a little bit reluctant to go on some of the oral medications or they've experienced some side effects from the oral medications, or maybe they're using Rogan but it's not enough. Or maybe they're using a topical minoxidil or R gain and it's causing some issues with the way that their hair looks. They just don't like the way that it makes their hair look. Or there's so many different reasons why we'll go down this path. So it's always a real conversation that I have with people about pros and cons and other things that we're doing as adjunctive therapy because when it comes to cell fill, I would say about a third of my patients will experience regrowth where we see baby hairs growing in and we actually see the hair filling out, and it's just, it's game changing and it, it's amazing and they love it and it's one of the most effective and powerful tools for them, and they're thrilled. And then I have about a third of patients where it doesn't regrow new hair, but it basically slows hair loss, it slows the progression. And they'll say to me, I'm losing my hair, my aunt, my uncle, my mother, whoever it is in my family, nobody else's hair in my family. I want to slow down and we'll do it. And they'll start to say to me, I'm seeing less hair on my pillow. I'm seeing less hair in my brush. I'm seeing less hair in my drain. My hair doesn't look like it's getting thicker, but I'm not losing it the way that I used to. So for them, that's a success. And then for about a third of my patients who are doing it, we don't see that much of a difference. It's just maybe it's subtle, but it's just not a wow. And so I very honestly have that conversation with all of my patients before we embark on this, because it's expensive. It's somewhere between $1,200, $1,400 a treatment. You need at least four treatments based one month apart to even determine if it's going to work or not. And then if it does work, you're looking at seeing me again every three to six months for the rest of your life.
Kate: Oh wow.
Dr. Whitney: For those injections, rest of your life.
Kate: Not fun, rest of your life. Okay. Wow.
Dr. Whitney: Yeah, so it's one of the, especially if you have hormone related hair loss, which is the primary reason why I'm using it for my patients. If you're dealing with or if you're recovering from a stress and there's other factors involved, you may only need to do it temporarily. But for a lot of my patients, there's an underlying hormonal component, a genetic component, and they know that they're destined to having thinning hair for the rest of their lives. And in that case, it is something that we need to keep up, we need to maintain. We don't have to do it every month, but some of my patients are there every three months. Some of them are there every six months, and we are continuing to keep that hair and to maintain the hair that we have.
Doree: Okay. Good to know. Filing that away. Dr. Whitney, it's been so fun to get to talk to you.
Kate: Oh yeah.
Doree: Truly a pleasure. Can you tell our listeners where they can find you?
Dr. Whitney: Absolutely. So my website is DrWhitneybowebeauty.com. I have lots of blogs and information there about skin cycling, how to get started, lots of great educational resources there. And then I'm also very, very active on social media. So whether you're on Instagram, TikTok, YouTube, you can find me. So my handle there is @DrWhitneyBowe
Doree: Great. Well, thank you so much.
Kate: Thank you.
Dr. Whitney: Aw, thanks for having me.