Slow Aging with Holistic Plastic Surgeon, Dr. Anthony Youn

Trevor:             Welcome to the Spa Dr. Podcast. I’m Dr. Trevor Cates, your host. Today we’re talking about seven top tips to slow down aging from a holistic plastic surgeon’s perspective. My guest is Dr. Anthony Youn. He is a board certified plastic surgeon, award-winning author and anti-aging expert. He is known as America’s holistic plastic surgeon and is considered one of the nation’s best known experts in looking younger with or without surgery. You may have seen him on TV shows such as the Rachel Ray Show, The Doctors, The Dr. Ox Show, Fox and Friends, PBS, and many others. Or you may have read one of his articles, such as in The Huffington Post, Cnn.com, MindBodyGreen.com, USA Today, or one of the many others.

Trevor:             You may be wondering right now why is Dr. Cates having a plastic surgeon on her podcast when she always talks about a natural approach to skin, beauty, and aging. Well, I do recommend a natural approach; I do think that’s important. And I also believe that using the least invasive treatments possible. But I also realized some people are still going to choose plastic surgery, and if you’re considering it, you should know what you’re signing up for. And I know that Dr. Youn recommends actually using surgery as a last resort for patients who want to look and feel their best. He has plenty of less invasive tips to share without having to resort to surgery. Plus, after all he is one of the top plastic surgeons in the United States according to Harper’s Bazaar, US news, and world report, and many others. And in his bestselling book, The Age Fix, a leading plastic surgeon reveals how to really look 10 years younger, he shares advice on how to look 10 years younger without going under the knife, how about that for a plastic surgeon.

Trevor:             I wanted him to come on the Podcast to share his top seven tips. Dr. Youn just had me on his podcast, and you can find that at dryoun.com/audio, where I shared my top seven tips to slow down aging from a naturopathic physicians perspective. I think you’ll really enjoy hearing both of our perspectives, and right now you’re about to hear Dr. Youn’s top tips. Some of these actually might surprise you and you’ll see how we look at the science behind this, and consider the risks with the benefits and remembering, I think you’re beautiful just the way you are. This is just information to help you make educated decisions, so please enjoy this interview.

Trevor:             Tony, it’s so great to have you on my podcast.

Anthony:          Thank you so much for having me, it’s my pleasure.

Trevor:             I was on your podcast, now you’re on mine. This is fantastic that we’re able to both share our seven top tips to slow down aging. And we do have a different perspective, you are a holistic plastic surgeon, I’m a naturopathic physician, so we do definitely do have some different tips here so I’m excited to share yours today though.

Anthony:          Yeah, for me it’s like I’m a very practical person, I like doing stuff and so some of my tips are very different than yours. Now, you were on my podcast obviously that we just put up a day between yours and mine. And you gave such awesome tips and stuff I’m sure that your followers have been hearing that have really helped them out. I’m excited to share mine, which I think just like I said are going to be very different than yours.

Trevor:             Yeah, absolutely. Well, great. Well, let’s go ahead and get started Tony. I know the first of your seven top tips is an antioxidant every morning. Now, that’s definitely something I agree with, but tell everybody why you think that’s so important?

Anthony:          Okay. This is one of the few areas where our tips do overlap. And antioxidant basically the idea is antioxidants are meant to or used to attack or to neutralize free radicals. And free radicals are one of the substances that really age us both on the inside and on the outside. And you can get free radicals from anything from pollution in the air to people smoking around you to even eating horribly processed bad foods. And these free radicals will attack our bodies, both our inner organs as well as our skin. Antioxidants are basically our friends; they’re the ones that fight those free radicals, they neutralize them, the ideas that they donate an electron because the free radicals are looking for electrons scavenging them. But by neutralizing these free radicals, you can prevent aging and slow that aging process down, which is so important. And the most common antioxidant that you find let’s say in skincare products is vitamin C.

Anthony:          You can either get the antioxidant from a great skincare line like yours, or if let’s say that’s something that you can’t afford and you’re going really … Trying to go as fast as possible then any type of a vitamin C is typically an antioxidant.

Trevor:             Okay. And do you recommend people that they do the antioxidants in their skincare products or internally?

Anthony:          Well, it’s both. And that’s what I love about your book is that you recommend both as well because we do get obviously going internal and you ingest vitamin C rich foods or antioxidants rich foods and you’re going to fight those free radicals on the inside. But also by applying it to your skin, you can neutralize all those free radicals that are actually attacking you from your skin. Now our skin is as you know is the largest organ in our body and it’s made to protect our insides from damage-like from free radicals. So, Both on the inside and the outside. The one tip I would give you though is I do know a lot of people who say, “Oh yeah, I’ve been applying vitamin C every night to my skin.” No, you want to apply it in the morning because at night your skin rejuvenates itself, you don’t have to apply it at night, really in the morning is when it’s most important.

Trevor:             That’s a great tip, I like that. And also free radical damage happens, those changes happen even just with aging. And aging itself speeds up the free radical damage. That’s why it becomes even more important for anti-aging or to slow down the aging process as we get older.

Anthony:          Yeah, we all have free radicals. Our internal body processes, create free radical, it’s just that the environment that you’re exposed to as well as the foods that you eat and the activities that you do can cause those free radicals, more and more of those free radicals to be attacking you and more than your body can actually neutralize.

Trevor:             Okay, great. Besides vitamin C, are there any other favorite antioxidants that you have?

Anthony:          That’s my favorite one. Obviously, there are a lot of other ones that do act like antioxidants, Zinc is a great nutritional supplement, it’s a nice mineral that can also help with decreasing inflammation. But I try to keep it simple with most of my patients and if I say just remember vitamin C, citrus fruits, oranges, and people say, “Okay, that I can remember that.”

Trevor:             Great, perfect. The second tip you have, and I imagine you have a lot of experience with this is retinol, that’s something that you recommend to help slow down the aging process. Let’s talk about that, why do you think retinol is so great to help with slowing down aging?

Anthony:          Retinol basically is a form of vitamin A. And vitamin A is an essential nutrient, very important for our bodies. And when you look at actually those creams in those ingredients that are studied scientifically in peer reviewed scientific journals, nothing has quite the power and the strength as retinyl or tretinoin. Now, this is prescription strength. The strongest version is 0.1% tretinoin, and that’s what most of studies look at. And these studies are typically and the dermatology literature will show that by applying the strong, the 0.1% tretinoin prescription strength retinyl, you can actually reduce wrinkles, you can tighten up the skin, you can thicken the dermis, which is a deeper layer of the skin, you can exfoliate the skin. And one of the interesting things a lot of people don’t know is that you can actually reverse early pre-skin cancers. So, people who have skin cancer developing, they don’t even know maybe that they have it, by applying retinyl you may be able to reverse that and just never see it pop up.

Anthony:          And so that’s the strongest. You can only get it via a prescription or at a doctor’s office. But the problem with tretinoin or retinyl is that it’s very strong. And I’m sure you’ve seen people who apply it and go, “Oh, this is the best cream, I’m going to apply it twice a day every day.” And two weeks later their face is … It looks like a pizza because it is just so red and inflamed. And so retinol is a weaker form of retinyl, and there is a lot of skincare products that carry that, it’s relatively inexpensive, it’s much better tolerated. So for those people who have more sensitive skin, people who don’t have access to a doctor to purchase it, then I do recommend retinol based creams because even though they’re not as strong as retinyl, you’re not going to get all that reaction yet you can still get a lot of that anti-aging and skin health benefit.

Trevor:             Okay. There are some concerns with retinol though, let’s talk about those?

Anthony:          Yeah, so if you do look there is a website … Or actually it’s an app that I like, it’s Think Dirty, I think. Have you heard of that app? There are some people who are concerned about the safety of that and there are definitely different products that people have concerns about. With retinyl, I myself have never seen a lot of issues with it other than what I have spoken about, and I’d love to hear if you have any concerns because I don’t think that your products contain retinol, do they?

Trevor:             No, my products don’t contain retinol but they contain oils that are rich in vitamin A, so people are getting some vitamin A through that. One of the things too sometimes I’ll do is have my local compounding pharmacist make a natural form of it for people or added into a cream that we are using. And so sometimes I’ll do that too. One of the concerns is that the photosensitizing effect, so people that use it become more sensitive to sun. And here we’re trying to protect our skin and sun damage can speed up the aging process. I noticed that when you shared this tip me you said you recommend it at night, so there is a reason for this.

Anthony:          Yeah. I mean, it actually just like you said, no question, it will sensitize your skin to the sun. I’m here in Michigan and people would put people on tretinoin or on retinol and we always tell them, “Hey, if you’re going to go down south to Florida in the winter time, then stop it about a week or two but one to two weeks before you go out because your skin will get more sensitive and you will at a higher risk of sunburns.” There are definite drawbacks to it and not everybody can tolerate tretinoin, I’ll tell, I can’t tolerate prescription strength retinyl, my skin is too sensitive for it. It’s not for everybody and that’s why I think forms like retinol that are weaker, that are more easily tolerated can be better for some people. As far as using it at night, just like you said, the issues with sensitivity, the sun is one thing. But also my understanding is that sunlight can actually deactivate it and render it not effective, so that’s why we usually recommend putting it on at night as well.

Trevor:             Okay, great. And then people will still need to use sun block? I mean, they will do that anyway.

Anthony:          Oh yeah. Yeah, yeah. So follow all of your suggestions as well, you got to protect your skin, no question. These are just two of the things, if you’re looking at anti-aging, what I recommend is two definites from my standpoint is an antioxidant every morning and anti-aging cream at night whether that’s retinol, which is usually my top choice, growth factor based creams, peptides, you name it. What you tolerate, those are all great to help reverse aging.

Trevor:             Okay, great. And then the third tip that you’ve shared with me is to exfoliate your skin two to three times a week. I definitely think that exfoliation is great. Now, let’s talk about what that means though because there are lots of different types of exfoliating products, so what do you mean by that?

Anthony:          Yes, you can pick however you like to exfoliate, whether it’s chemical exfoliation by doing at home mild chemical peels, be very careful don’t go online and buy one on Ebay or on Amazon, you really want to get it from a manufacturer that you know, is made here in the United States that you know has a very low percentage because you don’t want to burn yourself. But you can do it chemically by doing that, you can do with washes, you can do it physically either with like a Clarisonic type device. For me I prefer little scrubs, so I have one that we have that’s like an exfoliating scrub that’s very nice, you just put a tiny bit on your skin and you rub it in and it really helps to exfoliate your skin.

Anthony:          Now, the benefits for exfoliation are pretty simple, when we’re young our skin turns over fairly rapidly, every six to eight weeks or so you get a new layer of skin cells that comes up to the surface and slips off. And that’s one reason why when we’re young our skin is vibrant, it’s youthful, it’s smooth and wrinkle free, and as we get older our skin tends to feel rougher, it feels thinner, it feels more uneven, it feels more wrinkly, drier. And one of the reasons why is because our skin the exfoliation process slows down, and instead of taking every six to eight weeks for the skin to turn over, it takes 10 weeks, 12 weeks, 14 weeks, it takes so much longer and we get this build up of dead skin cells on the surface that causes it to look aged.

Anthony:          The idea behind exfoliation is that you can get rid of that upper layer skin cells and the great thing about it is by getting rid of it there is actually a cellular signal that is sent to the deeper layer skin cells to cause the skin to turn over again more quickly. So the idea is that if you exfoliate regularly, not only are you going to get kind of that initial benefit of, whoo, my skin feels smother, but you can also get your skin turning over more quickly to get a back to that metabolic rate, that turnover rate that you had when you were younger. So it does more than one thing. And you pick whatever works for you for exfoliating. For me, it’s anything from like I said, taking your fingers and gently rubbing your skin to using an expensive Clarisonic device as long as you exfoliate a couple of times a week if you have normal skin, if you have sensitive skin maybe once a week is all you need.

Trevor:             Right, okay. And so why two to three times a week for most people, is there any particular reason why there is that amount of time?

Anthony:          Yes, and it’s very scientifically based. Basically, if you do it more than that and you get red skin then your skin gets irritated and that’s not good for it. If you do it any less than that then you can probably do more and get a better result.

Trevor:             Right. Okay. And like you said, if somebody has really sensitive skin once a week is probably sufficient.

Anthony:          Yeah, you don’t want to exfoliate so much that your skin is red and irritated afterwards, then you know you’re doing too much.

Trevor:             And why is that?

Anthony:          I’m sorry?

Trevor:             Because there is a reason why we don’t want our skin to be red and irritated, obviously it doesn’t look good but why else is that?

Anthony:          Well, just because you are exposing it to more of the elements, I mean, you’re causing irritation and in general, inflammation is not good. The idea behind a lot of let’s say our treatments and stuff is that controlled inflammation and an acute inflammation can actually be good for our skin. And that’s why if you do laser treatments or chemical peels, you get the skin really inflamed and people look younger afterwards because controlled acute inflammation can actually help to tighten up the collagen in your skin. However, just like we’ve always talked about, long-term chronic inflammation is bad for us and if you’re exfoliating your skin so aggressively that your skin is always inflamed chronically, then that’s not necessarily a good situation to be in.

Trevor:             That’s a great point, and I’m really glad that you brought that up because yeah, a lot of times people are like if I just do more of that, if I got a little bit of improvement once and it was short term, then if I keep doing that then I’m just going to get more benefit, that’s not [crosstalk 00:15:50]

Anthony:          And this is a little bit different from that but in plastic surgery, that is the absolute truth in plastic surgery as people do that all the time where wow, a little bit of this, that looks really good, let’s do a lot of that. This is an aside, but years ago I did a fellowship out in Beverly Hills and I wrote this seminar article about how the face ages in three dimensions, and our face gets thinner, we lose volume. And so we wrote this paper on how by adding volume by taking fat from your tummy or your thighs and injecting it into your cheeks, we can add subtly some of the volume back and people look younger.

Anthony:          Well, of course what happens, people take this great idea and they go, a little bit of volume is a good thing, so a lot of volume must be awesome. And so now you go and you watch the Oscars or you watch the Real Housewives, and there are these people with these big pillow faces. And so what you said is no more truer than there is no greater truth in plastic surgery is that more of something does not necessarily mean better.

Trevor:             Yeah, let’s all be smart about that. And I’m so glad that you brought up exfoliation because we do have at Spa Dr. we have a pearl and rose petal exfoliant. I wanted to keep my skincare line really simple, but I kept realizing that exfoliation was so important and I know people wanted a really high quality one that wasn’t too abrasive and that had natural ingredients, so that why I added that to the line.

Anthony:          And everybody I hear is raving about it. We have some similar friends and everybody I hear loves it. My only thing is I hear every so often it sells out, so people are really liking it.

Trevor:             Yeah, we have sold out but we’re working on keeping it in stock.

Anthony:          Good, good, good.

Trevor:             All right. Let’s move to your fourth top tip to slow down aging, and that is IPL treatments, so let’s talk about that.

Anthony:          IPL basically stands for Intense Pulse Light. The best way I describe this is it’s like a razor. For all intents and purposes, it’s like a razor treatment. And the idea is that one of the things that we see as we get older and one of the most common complaints that I have with patients as they get older are age spots. Now, first question people ask, I have patients say, “Well, I don’t have age spots, I have sun spots.” Or, “What about liver spots, I can’t have a liver spot.” Well, the idea is that they are all the same, an age spot and a sun spot and a liver spot, it all means the same thing. The only reason why they call it the liver spot is because it’s brown and people a long time ago, “Oh, look it’s brown, it looks like the color of liver, let’s call it the liver spot.” So it doesn’t have anything to do with the health of your liver.

Anthony:          So, how do you get rid of sun spots or age spots or liver spots? The simplest way that you can do that is to use IPL, and Intense Pulse Light treatment is a laser treatment that will target the pigment in that spot cause it to get dark, it basically destroys the pigment, the pigment gets darker and a lot of that pigment even within a week could slip off. We’re talking about a very simple procedure, it’s typically done in dermatologists or plastic surgeons offices, takes maybe a half an hour, and I think in my office we charge $300 for it. Usually you do need multiple treatments for maximal effect, and you can see a pretty impressive clearing of those dark spots. So that’s IPL I think is one of my top seven tips for anti-aging is because so many of us get these spots and this is a very effective way to treat them.

Trevor:             Okay, great. And I’m glad you brought up this treatment. And I know that the practitioners ability to do this is important and the equipment. When you said there is a reason why this is done in plastic surgeon and dermatologists offices because you need the right equipment, you need the right person doing it. What are the things that people need to think about when it comes to this?

Anthony:          The big thing is that anybody with any type of medical degree can purchase these devices and hire people to perform these treatments. Now, every state is a little bit different, so here in Michigan where I’m at, the laws are pretty lax so you can have anybody who is a licensed professional can do it, whether it’s an aesthetician or a physician or anybody in between. The problem that we see is that there are offices that will buy it and the doctor won’t even … Basically would be like a family doctor that just signs off on charts once a week, and they may have no idea anything about aesthetics or the care of skin or the health of skin, and if you get a burn the question is who’s going to help treat you. And so just be very careful, make sure that if you’re having these types of treatments done that you know who the doctor is, that the doctor is available, and that you trust whose providing it.

Trevor:             How often does it happen, people get the burns, is that a common thing, is it?

Anthony:          What the companies actually do when you purchase this type of a device, they will actually give you very specific guidelines of what settings to use. I think for me what I find when it becomes an issue, and we don’t see burns much at all, so to answer your question, very, very rarely. But for me, when I hire people to do either laser procedures or injections, I’m very careful to hire somebody who really understands and has a healthy fear of these complications because there are people out there who have … The idea of a little knowledge is a very dangerous thing and people who think, Oh, I know how to do this and I’m just going to turn up and they’re going to do fine, they’re going to get a great result, and now they get burned and then who’s going to take care of you. So, really a lot of it is interpersonal and finding the right people who have a healthy appreciation for how powerful these devices are.

Trevor:             Right, so the key here is to find a good doctor who’s doing this who’s going to be around to help if something goes wrong, yeah absolutely.

Anthony:          Exactly, and make sure that you know who the doctor is who’s in charge of the treatment.

Trevor:             Right, and like you said, most of the time with a good practitioner, you’re going to be fine, but it does sometimes happen. This is a slightly more invasive treatment, it does come with a risk, but it also has some great potential benefits for getting rid of those dark spots like you said.

Anthony:          Exactly. And that’s not for everybody. And now we’re going the get into one here very shortly that is a bit more controversial and I’d love to get your take on it. But with IPL, worst case scenario, yes you can get a burn, but it’s a very mild treatment. There are a lot more aggressive lasers out like fractional lasers and things like that to definitely be more weary of.

Trevor:             Okay. And so with those laser treatments, what are some things that you want to remind people about to be careful with?

Anthony:          Well, the first thing is if you’re going to consider any type of a laser treatment, number the color of your skin really does matter. Most of the laser treatments are not color blind, and you have darker skin, my color skin and darker, then you’re going to be in general at a higher risk of a complication. So make sure that if you do have darker skin that the person who’s doing the treatment with you is taking that into account because you can’t treat different color skin the same way.

Anthony:          The second thing is you want to make sure if you’re going to have an invasive treatment, if you have a history of cold sores, even if your last cold sore was 10 or 20 years ago, you got to let that practitioner know because in general if you’re going have more aggressive treatment, you want to get on medications to help prevent literally what could be an eruption of cold sores over your entire face, all the areas that they treat. And if they’re going to do a treatment like that and nobody asked you about cold sore history and they’re about to turn the machine on, get up and run out of that office because they may not know what they are doing.

Trevor:             And that’s why I love having you on Tony because … I mean, my first treatment recommendation for people isn’t to go get laser treatment but I love that you’re talking to people about this because I know people are going to do it anyway. People are going to go and they’re going to search for these things, and so having your experience and expertise in this area is so valuable for people to know what to look for, what to ask, and then you can make an educated decision as to whether or not you want to go and do these things, which leads me into the next one.

Anthony:          Okay, here we go.

Trevor:             So your fifth top tip for slowing down the aging process, it makes sense that you would put this on here. Now you know because we’ve talked about this, this is not something that I’m a huge fan off, and that’s Botox. But I know a lot of people are going to go out and they’re going to get Botox, so it’s important for us to talk about it, and I’m glad you have it on your tip so we can talk about if you’re going to do it, how to do it safely, and how it works.

Anthony:          Okay. All right, so this is how it works. Years ago there was a husband and wife team from Canada who thought, hey if we can inject Botox into the tiny muscles around the eyeball that can help the eye move better, what happens if we inject a little bit of this Botulinum toxin, which is basically one of the most powerful toxins in the world, what if we inject the tiniest amount of that into some of the muscles that create wrinkles of the face, what happens? And as you know, Botox was born after that.

Anthony:          The way Botox works is it is a toxin, it’s a protein made by Clostridium Botulinum. And this is an extremely powerful toxin that basically causes paralysis of muscles. And if you have a large amount or even a small amount injected into you, it could kill you. But if it’s injected in the tiniest, most minuscule amounts into the muscles that create wrinkles of the face, it can temporary paralyze those muscles causing those wrinkles to smooth out for about three to four months. Now the injection now is the most popular treatment honestly probably in the cosmetic treatment history of the world according to the American society for aesthetic plastic surgery. Last year, upwards of five million people underwent Botox injections. As long as you’re having it done with Botox cosmetic that is made by the company called Allergan, you’re having it done in a responsible fashion, people can get some very dramatic improvements in the smoothness of their skin.

Anthony:          Now, you typically treat up to three areas, the crows feet, the glabella, which are the frown lines here, and then the forehead. Those are kind of three classic areas to treat, but we’re also using it for other parts of the face as well, for people who have TMJ, people that have migraines and all that type of stuff. It’s very easy to have injected, it’s easier than going to the dentist, it’s not all that painful, it’s the tiniest needle, takes about a week, and I’ll tell you, it’s the most popular treatment in my practice. But I’ll tell you as well that it’s not for everybody and I’d love to hear what your concerns are about that and see kind of where we have some common ground here.

Trevor:             Well, one of the things that I’ve heard is that if you’re freezing the muscles, will the muscles atrophy over time because I’ve heard people say they were getting regular Botox and then they stopped doing it and they were aged more rapidly. Now, I’m just wondering is there really a change in muscle atrophy and that causes the skin to sag more afterwards, or are they just so used to how their skin looks like with Botox that all over sudden they look different?

Anthony:          There is definitely atrophy. What we do I have a lot of patients who come in and one of the things that I do, and a lot of Asians especially Koreans and that’s part of the ethnicity, they get overgrowth of the master muscle, which is the muscle here at the corner of the jaw and it causes the jaw to look wide. And I do see it also in people who chew a lot of gum, people who grind their teeth while they sleep at night to have more kind of spastic disorders as well. And so what we can do is if we inject a good amount of Botox into that muscle, within about a month the muscle paralyzes within a week, it weakens, and then within a month that muscle actually gets smaller. And so we can actually do, and people have kind of these wide jaws out here we can actually help to contour their jawline in and get it looking thinner by injecting Botox.

Anthony:          And the way I describe is like if somebody breaks their leg and they have a cast on their leg for a month, they take that cast off a month later and that leg is much smaller than the other leg, which has compensated, which is a lot bigger and so you don’t use muscles in those muscles atrophy. Now as far as a rebound effect or looking older if you stop using Botox, I’d never actually heard that from any of our patients, and we probably treat 10 patients with Botox a day in my office, if not more, and I’ve never actually had a patient come back and say, “Wow, I stopped using Botox for six months or a year or whatever and I look older.” I’m not sure about why that would be the case, and I don’t think it’s from droopiness because it’s not like … The muscle doesn’t take up that much volume that you’re going to have a lot of droopy skin afterwards.

Trevor:             Okay. And I know that you hear these horror stories of people getting Botox and it being done poorly, that’s the other concern it can really mess up your facial expressions or not have any facial expressions.

Anthony:          Yes. And we’ve all seen celebrities where they show up and they’ve got this eyebrow that’s like way up here. So, if you’re thinking about Botox, if you say well I’m going try it … Sorry, if you’re thinking maybe I’ll try it but I’m afraid that I’m going to look weird, stay away from the forehead, that’s my big thing because when we inject it in the forehead if you do too much Botox you can freeze the forehead and your forehead can actually drop because what you do is you weaken the muscles that lift your eyebrows up. And especially in those people who have very dynamic eyebrows, typically people who are older and they got extra skin in their eyelids and they’re always doing this all the time, if you inject Botox in their forehead because they go, “Oh, I do all this all the time, I got all these wrinkles here, inject Botox.” Then everything drops so much that you go, Oh my gosh, you can’t even recognize him anymore.

Anthony:          On the opposite way, if you have somebody already who has a very arched eyebrow, you can create that Cruella De Vil type of look by really overarching it if you inject Botox too much centrally and not out in the forehead. Botox in the forehead you have to be very careful, you got to really look at the anatomy as a practitioner, you can’t just do it the same way on everybody, if you’re going to try it, just do a small amount, start either here or in the the Crows feet, deep your toe in the water first, don’t just go in and say, “Hey, just do it all on me and lets see what happens.”

Trevor:             Right, right. Yes because also people that get it around their mouth and they have a crooked smile?

Anthony:          Yeah, I never inject Botox around the mouth that’s because the whole idea of these wrinkles around the lips here, and if you inject the perfect amount of Botox you can smooth those wrinkles and not affect the mouth movements, but if you do a little much then all over sudden you can’t suck on a straw and you look funny, so I don’t recommend injecting around the mouth.

Trevor:             Okay. That being said, we’re talking about this and how to do it safely and make sure you get a good practitioner that has lots of experience and go right on if you decide to do this. Still it is a toxic substance and you mentioned to me a while back when we talked before about a rodent study or something on Botox?

Anthony:          Yes. Botox is something once again that we do all the time, and I have family members that have it done, so I don’t have concerns about it. But there are people who are concerned. And there was a study that was performed many years ago, they did actually inject Botox Botulinum toxin, not the brand name Botox but Botulinum toxin into rats, into the muscles of their hind area or maybe around there face, and did find the tiniest amounts in their CSF, the Cerebral Spinal Fluid. Now, we don’t know if there is any significance to that, for all we know Botox seems to be removed from the body and when we inject it, it’s in the tiniest, tiniest amounts that in general we don’t think that there is any clinical significance there but there is some truth to that and so it’s a reason why if you’re going to have it done, see a board certified plastic surgeon or a board certified dermatologist to make sure that these doctors are keeping up with all the latest research.

Trevor:             Yeah. I also encourage people to realize that we’re talking about tips for slowing that aging process. But i think there is beauty in having some wrinkles and facial expressions. And so if people are going in there Botoxing their entire face, sometimes these people having conversations with them, I don’t even know if they’re happy or sad.

Anthony:          It’s like a mask. Yeah, they have a mask. And by all means, I’m all about you start by getting your health good, by eating the right food, then from there you apply the right products, you take good care of your skin, and things like Botox and the invasive treatment are really … Nobody ever needs any of that. You don’t any of it, but if you want to try it then these are your options, and I do think it does help millions of people but at the same time like anything in plastic surgery, too much can be too much.

Trevor:             Right. Well, thanks for having this conversation with me, I know it’s one thing we’ve been talking about before. Let’s move on to your number six top tip, and that’s radio frequency skin tightening treatments.

Anthony:          Okay. This is going back to technology, and radio frequency basically the idea behind it is the old style lasers, the first lasers that came out. Basically, the ideas that you get heat into the deeper skin, into the collagen of your skin and if the collagen of your skin gets to a certain temperature it denatures, and when it re-heals, it heals in tighter fashion, in a tighter packed fibrous. And so you can get tightening of the skin. And the old style lasers would get the heat to the deep skin by burning everything from the top all the way down. So you’d get these patients that look like burn patients for weeks.

Anthony:          Well luckily, technology is so much better now and radio frequency is not a laser, it’s a radio frequency wave, a different type of energy that can actually bypass the surface of the skin and create heat to that deeper skin without creating any surface damage. And so the idea is that you want to heat up that deep skin to get the tightening effect of it.

Anthony:          Now, there are some ones that we have one in our office called ReFirme, there is another one called Pelleve that can create that deep skin heating and it’s perfectly painless. There is no downtime, there is no redness, and it’s a very nice way for people to help to keep their skin tight if they’re younger or even get some mild tightening as they get older without having to go under the knife or have a very invasive or long downtime type of procedure.

Anthony:          So, if you’re in your 30, 40s, and even 50s and you’re noticing some early skin looseness and you’re trying to kind of slow that aging process down, then these non-invasive, no downtime, radio frequency treatments like ReFirme and Pelleve I think are a really good option.

Trevor:             Okay, great. It’s great to be aware of these. Now, is there something that you only do on the face because I know people talk about the backs of their arms or their legs, their skin is starting to change in different of the body, can you use it in different areas?

Anthony:          You can, but I don’t recommend you spend your money on it. There are devices right now that claim to be body tightening treatments like that, some people use the the face ones on the body but the problem is that the body when you notice loosening skin of the body, you notice that it’s a lot worse typically when notice it than when you notice loose skin of the face. And when it gets to that point where you’re really noticing, oh, the skin of my body is loose, spending all that money on these treatments is probably not going to pay off unless you won the lottery and for you plunking down all that money and hey, if I get a good result or not doesn’t matter, then if want to try it that’s up to you but in general bang for your buck is poor for body skin tightening treatments.

Anthony:          And I joke with my patients that if I can create some type of laser that’s like a CT scanner where you could just get naked, lie down on it, and just go through the whole thing, I’d make a mint but they don’t have anything like that right now.

Trevor:             Not yet.

Anthony:          Not yet, but you and I should make one, we should develop one?

Trevor:             As long as it’s safe, that’s all I care about. And then what about the neck, can you use it on the neck?

Anthony:          You can. That’s a great place to use it. Typically it’s the face and the neck, where you notice loosening is usually in the cheeks, the lower face, the neck, and even sometimes in the forehead people find as they get older they feel like their brows are dropping a little bit. And that’s a great way to just do some mild tightening of the skin there that’s very, very safe.

Trevor:             Okay. Let’s move to your seven tip, which I love. And your seven tip is to decrease the amount of sugar you eat. Now, my audience hears me talk about this a lot, but certainly let’s hear it from you?

Anthony:          I think you described it so well on my podcast when I interviewed you on the top seven tips and you described the glycation and how that works. My tip obviously is to avoid sugar and you and I are 100% in agreement with that. And the idea behind it is kind of back to that whole idea of inflammation and chronic inflammation. And once again, acute inflammation in certain very controlled situations, we may be able to use to our benefit, but chronic inflammation is almost always bad for us. And so what we do know is that by eating a lot of sugar we get these … People think, Okay, Sugar, I don’t eat dessert, so I don’t have much sugar, well, do you drink Soda pop? That’s probably one of the worst sources of sugar. Do you eat a lot of white bread, white rice, do you eat a lot of bagels, plain bagels, all of that is junk full of sugar.

Anthony:          And what we do is that by getting all the sugar in our system, we get these sugar spikes and sugar spikes create insulin spikes, and so it’s insulin spikes that can create this chronic inflammation. And so if you do one thing with your diet, if you say, “Hi, I’d love to slow down the aging process and I just want one simple tip to slow it down.” Then my tip would be to try to decrease the intake of sugar and very simply maybe drink less Soda pop because so many Americans are addicted to their Pepsi or their Coke or their Mountain Dew or Sprite or whatever the heck it is, if you just drink less of that, you don’t even have to give it up, just start by drinking less Soda Pop then you’re going to really be doing yourself a favor both on the inside and on the outside as well.

Trevor:             Great. And I’m so glad you brought up drinks and I didn’t even think about that. When I was on your podcast I didn’t mention it but a lot of times people forget … And I left that off too, people are thinking about what they’re eating and they don’t think of their drinks as adding to that sugar content. Sodas are definitely one of the big ones that people get sugar with, but also things like orange juice, people think it’s a healthy thing but unless it’s freshly squeezed, you just picked the oranges and you just squeezed it, it’s going to be pretty deplete of nutrients and mostly just sugar. And some thing with some of these smoothie drinks that have been sitting in the grocery, they’re full of sugar. So, think about what you’re drinking. Thank you for bringing that up.

Anthony:          Yeah, it’s super important because if you’re going to drink your fruits, make sure that it’s the whole fruit that you’re drinking and not just the juice because otherwise it’s sugar water, and yeah, there maybe some vitamins and stuff in it but when you take that fiber out then you get that big sugar spike. So, no question you are 100%, I agree with you.

Trevor:             But I think if people mix veggie juice in with it, so if you’re doing like greens and you have a little bit of apple juice in there, that’s okay, but we’re not talking street fruit juice here, so yeah definitely. And I know that you and I both … Sorry, go ahead.

Anthony:          And even the type that you say, “Oh I love smoothies, I love fruit smoothies.” Just add a little bit of kale to it, just a little green in it and that’s going to make so much better as well.

Trevor:             You and I both have PBS specials, and we’ve talked about the foods and the sugar and we talk about that on our PBS shows too, right?

Anthony:          Yeah. And I think it’s so important because there is not a lot of us who are out there talking about these things because even dermatologists, plastic surgeons, most of them are talking about, oh, you’ve got aging, then do this treatment, do that treatment, people aren’t talking about food yet that really forms the basis of how quickly we age and our overall health. And it’s so important I think, and I’m so happy that you and I are having this discussion and that we’ve got these podcasts that can spread this word out there with so many of our colleagues because I don’t even think doctors realize this.

Trevor:             Yeah, absolutely. So Tony, if you’re okay with it, I have a few extra questions for you that I got from some of my audience. One of them, I had one person emailing me about they just experienced a lot of weight loss, and they have a lot of excess loose skin from that weight loss, is there anything that can help with that?

Anthony:          When you ask me as a plastic surgeon, what I try to do is I always tell my patients surgery should always be the last resort because when somebody asks me, “Hey, if I have surgery, what’s the worst thing that can happen to me?” I always tell them you can die, that’s the worst thing that can happen and it does happen sometimes to people in surgery, it’s extremely rare, extremely, extremely rare, but that can happen. There are only a few instances where actual surgery is the only true option and one of those instances is when you have excess skin.

Anthony:          So, if you’ve lost a lot of weight and you’ve got skin hanging from your tummy or your breasts or your arms or your neck, unfortunately there just isn’t anything out there that can remove that skin other than surgery. But to perform that surgery, that will then create very lengthy scars. So, for a tummy tuck, you’re looking at a hip to hip scar. For a breast lift, you’re looking at scars that extend all the way round the areola, a scar that goes down and even underneath your breast. For an arm lift, the scar goes literally from your armpit all the way to your elbow. These are long scars, they’re permanent, they will disappear. But for those people who’ve lost a lot of weight and they’re kind of carrying around this excess skin kind of this sign of the body they used to have, then these surgeries can be very, very impressive and very affective but you have to know what you’re getting into if you consider that.

Trevor:             Right. So it’s definitely an educated decision, which are you better with? Are you going to be okay with living with the loose skin or do you want to have scars and go through a really invasive surgery with the risk associated with it?

Anthony:          And I’d also want to make the note that the surgery should be done when your weight is stable. You don’t necessarily have to get to your ideal weight, sometime people just don’t but they lose a ton a weight anyway and they feel healthy and good as long it’s maintainable that is usually a good time to do it. You don’t want to do it when you still have 20 or 30 pounds to lose because you may find that the surgical result then gets worse after losing more weight, and obviously you don’t want to do it and then gain a bunch of weight afterwards because once again you’re going to lose a lot of those results too.

Trevor:             Right, okay. Great, I’m glad we’re talking about surgery here because you’re a plastic surgeon, so of course you have a lot of experience with this. And I know some people are probably surprised that I even have you on my podcast considering I always talk about the least invasive approach and a natural approach, but the thing is that people are still going to go and get a plastic surgery, they’re going to look at their options. And so I want people if they’re going to do it, I want them to have very educated decisions on this and really think about it before they jump into it because I have seen people that afterwards they weren’t educated and afterwards and the doctor did not educate about all the possible downsides or complications and they were very upset in the end with their results.

Anthony:          Yeah, do you your homework no question.

Trevor:             But then I know other people that are happy with their results too.

Anthony:          Yeah, do your homework, understand that your body has to heal, and make sure that you’re healthy both inside and out before you have any surgery. I just put together myself a pre-imposed supplement protocol because right now there isn’t anything for patients, when you ask the plastic surgeons, “Okay, what do you have to do before you have surgery?” They say, “Stop smoking.” And that’s it, just stop smoking and get off anything that might make you bleed, but there is so much more that you can do that can help with your healing whether it’s getting on the right supplements. And a lot of these things are the things that you recommend for your patients, whether it’s getting on Zinc, adding Vitamin D, vitamin C, there are so many things that you can do to help yourself heal and also making sure 100% that surgery is really your only option to get yourself where you want to be. Because if there is another way to get there, then by all means go with the less invasive because surgery has risks, and even the best plastic surgeon has complications.

Trevor:             Okay, great. All right. One quick last question and that is about fillers. People ask me all the time about fillers, do they work, is it something to consider?

Anthony:          The way I describe fillers, we talked about Botox and how Botox treats wrinkles kind of in the upper face, or wrinkles caused by muscles, fillers they way I describe it is like synthetic skin or liquid skin. So where you have wrinkles like the nasal labial folds, these types of wrinkles you can fill them in with a filler. And fillers typically last longer than Botox, anywhere from six months up to a year or two. Now we’re also injecting into the cheeks as you probably see in Hollywood all the time ends in these other celebrities. And so a little bit of filler I think can be really, really good but a lot of filler can make people look really, really odd. It’s a very powerful option, they are expensive. It’s very difficult to get a filler treatment for less than $500 or $600, but they do last much longer than Botox.

Trevor:             Okay. All right, something for people to consider, what is used with the filler? What is the substance that you’re using and is it toxic?

Anthony:          We’re using hyaluronic acid fillers. And hyaluronic acid, you probably have hyaluronic acid I think in your products, don’t you?

Trevor:             Yeah.

Anthony:          Yeah, I thought you did. A lot of really high-end good skin care products have hyaluronic acid because it’s a natural occurring moisturizer of our skin, and those are the ones that I use. Now there are some other fillers that I’m not a fans of that have other things in it that I don’t recommend, but if you’re going to get a filler, go with a hyaluronic acid filler whether it’s a Juvederm or Restylane, those are the most super important because number one, it is reversible. If you have a complication from it, we have an antidote that we can inject that will cause that filler to dissolve away within minutes. And number two, the good thing about hyaluronic acid fillers is that you know that you’re not going to be injecting other types of weird stuff like there is one with Calcium Hydroxylapatite, which is like bone paste that they create a gel with and you inject it, which does not make any sense to me, and god forbid, Silicone, guys stay away from that.

Anthony:          So, hyaluronic acid eventually it disappears. But the final thing I want to tell you is filler injections create scaring, and so every time you take that needle and you inject it into the skin, there is a little bit of scaring under the surface. Only do the amount of filler that you need; more isn’t necessarily better.

Trevor:             Okay, perfect. Tony, thank you so much, you’ve been just a wealth of information; I appreciate you coming on and sharing that. And also people can go to your podcast too at dryoun.com/audio to learn more about your podcast, I’ll have the link to that. And also catch my interview on your podcast.

Anthony:          Yeah, you really dropped some great information bombs in mine. I think this is great because if you take your seven tips and my seven tips, you’ve got really two completely different ends of the spectrum, but they’re all complementary, which is the beautiful thing about it.

Trevor:             Yeah, absolutely. All right, thanks again for coming on.

Anthony:          Thank you.

Trevor:             I hope you enjoyed this interview today with Dr. Anthony Youn and enjoyed his seven top tips to slow down again from a holistic plastic surgeon’s perspective. And you can also get my perspective, a naturopathic physician’s perspective by going and checking out Dr. Youn’s podcast by going to dryoun.com/audio you’ll see my interview there. You’ll see some overlap in the recommendations that we share, but you’ll see quite a bit of different because as you know I have more of a natural less invasive approach. But I wanted to share Dr. Youn’s perspective with you as well because I know people are out there looking for different answers and I want you to make the best educated and safest decision for you.

Trevor:             Thanks again for joining me today, and when you’re on the Spa Dr. Website, you go to the spadr.com, go to the podcast page you can find all the information about Dr. Youn, the transcripts, the link to his website, and while you’re there I invite you to join the Spa Dr. Community, you can also subscribe to the podcast on iTunes so you don’t miss any of our upcoming shows. And if you haven’t done so already, I highly recommend you get your customized skin report at theskinquiz.com, it’s a free online quiz that just takes a few minutes, it’s free, and you’ll find out what are the root causes behind your skin and aging concerns, and get some great information to help support you. Just go to the skinquiz.com.

Trevor: Also, I invite you to join me on social media on Facebook, Twitter, Instagram, Pinterest, YouTube and join the conversation. And I’ll see you next time on the Spa Dr. Podcast.