Menopause Skin Treatments: Botox, Lasers and Lifestyle

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Erica Kelly, board-certified dermatologist, Clinical Professor at the University of Texas Medical Branch, and founder and director of UTMB's Cosmetic Dermatology Division and this time it's the practical half: sunscreen, routines, treatments, and hair. Dr. Kelly settles the questions filling everyone's feed — chemical vs. mineral sunscreen, whether the endocrine-disruption fears are backed by evidence, why some filters are banned in the US but not Europe — and explains why the best sunscreen is simply the one you'll actually wear, every day, including the spots everyone forgets: scalp, ears, and lower lip. Mary Claire also shares her own recent diagnosis: a squamous cell carcinoma on her nose — which Dr. Kelly removed. Guest links: - Dr. Erica Kelly at UTMB Health Aesthetics https://utmbhealth.com/aesthetics/about/erica-kelly - Dr. Erica Kelly (UTMB Health) https://doctors.utmbhealth.com/profile/005428 Recommended Books: - "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book - "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z 00:00:00 – Mineral vs chemical sunscreen 00:02:16 – Are sunscreens endocrine disrupting? 00:04:56 – Do you need sunscreen every day? 00:06:28 – The ideal morning and evening skincare routine 00:07:19 – What a dermatologist actually uses on her skin 00:10:17 – Supplements and the evidence for collagen 00:12:43 – When professional skin treatments make sense 00:13:22 – The four approaches to cosmetic treatment 00:15:02 – How menopause changes lasers and Botox 00:17:01 – How to choose a safe cosmetic provider 00:19:18 – When to start Botox 00:22:22 – Menopause changes across the whole body 00:24:49 – Diet, sleep and skin aging 00:27:02 – Does red light therapy work? 00:28:25 – What actually helps menopausal hair loss 00:32:16 – The number one thing to do for your skin 00:32:46 – Drugstore skincare Dr. Kelly recommends Never miss an episode—sign up for The 'Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The 'Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

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• 1:12Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. So we'll get into skincare routine, but let's start with sunscreen.

• 1:32Speaker 01

  Okay.

• 1:33Dr. Mary Claire Haver?

  Is, you know, that's my true number one.

• 1:35Speaker 01

  Chemical, mineral, is it endocrine-disrupting? Why are things banned in the US and not in Europe? This is what fills my feed.

• 1:41Dr. Mary Claire Haver?

  Yes, okay.

• 1:42Speaker 01

  So, um, yes, this is truly my number one sunscreen, skincare ingredient. But sunscreen in general, there are chemical and physical sunscreens, or you could call that organic and inorganic. And sometimes people call the, the physical one mineral, because they're titanium or zinc. But the way they work is chemical sunscreens absorb into the skin, and then they, you know, take ultraviolet radiation and convert it to heat. So that's the sunscreens that you need to apply 30 minutes before you go out, because it has to penetrate and get into the skin to work. The physical sunscreens or mineral sunscreens, like zinc oxide, titanium dioxide, they basically lay on the surface.

• 2:24Speaker 01

  They lay on top, and they scatter and reflect the ultraviolet light. The, the problem is, chemical sunscreens are much more elegant. You know, they, they absorb, they feel better, they're not, you know, so white and sticky. Um, but I think the physical sunscreens are getting a lot better. They're more micronized, they're tinted now, so they don't have such a white cast. And, you know, in general, the physical are just, they're better, probably for sensitive skin. They're better for the environment. They have negligible percutaneous absorption, so they, absorption from the skin into the bloodstream. So those are probably, you know, we recommend those more. But the bottom line is, I recommend the one you will use.

• 3:06Speaker 01

  So if I recommend some sticky sunscreen that you hate and you're not going to apply it, I'd much rather you apply one that you like and not burn, you know? So that's the main thing is, that's my number one skin, sunscreen tip is just, you know, use, wear the one that you will, you will wear.

• 3:23Dr. Mary Claire Haver?

  And then what about the endocrine disruption worry? Is that real?

• 3:27Speaker 01

  So, I don't know that that, I don't think that there's been studies that really elucidate that. There are studies that show we absorb the chemicals in our sunscreen, but there's studies that show we absorb the chemicals from everything, you know? We're just like, I mean, it's funny, because it's hard to get some things through the skin that you want to get through, but those things seem to make it in. Things in your shampoo and things in the environment. So I don't know that it's been, that there is enough evidence to prove endocrine disruption. But what I always say is, just cover what you can and apply the smallest amount of sunscreen. And I usually use a physical on face, hands, and then I just cover everything else. Also, don't forget scalp.

• 4:10Dr. Mary Claire Haver?

  Scalp.

• 4:11Speaker 01

  I think we see a lot of skin cancers on the scalp, a lot of skin cancers on the ears, the lower lip, don't forget about these things. And I, one of the things, if you're in a place where it's too windy, like here in Calviston, to keep on a hat, um, you know, you can use a spray, or I actually have a translucent powder that I use on my part. Um, so just don't forget those areas.

• 4:32Dr. Mary Claire Haver?

  How can we convince our children to wear sunscreen?

• 4:36Speaker 01

  It's a good question. Mine were oh-so-good until they became teenagers, but they're pretty good, again, I have to say. I, the, the thing is, we don't want you to be a hermit. We want you to go out and be active and be in nature.

• 4:51Dr. Mary Claire Haver?

  I mean, you hike more than any human I've ever met in my life.

• 4:53Speaker 01

  Yeah, you know, with my big hat, my long sleeves, my, yeah, but yes, I know.

• 4:56Dr. Mary Claire Haver?

  Your beekeeper outfit.

• 4:57Speaker 01

  Yes, but I feel like, you know, it's the evidence that ultraviolet light causes skin cancer is definitive. There's no arguing it. And it is, ultraviolet light is officially classified as a carcinogen, so cancer-causing. And, you know, it causes, it basically causes mutations in the DNA in our cells. There's a signature mutation, you see these permitting dimers, and it causes reactive oxygen species. And I sometimes explain it this way. There is a genetic condition that these patients have one mutation in one enzyme, and this is called zerodermopigmentosin. This one enzyme is the enzyme that repairs ultraviolet damage in our DNA.

• 5:41Speaker 01

  And they have a 10,000-fold increase in non-melanoma skin cancers, and a 2,000-fold increase in melanoma with the one mutation. And so, just to drive home the point that we know it causes skin cancer and premature aging, but we don't want you to stay inside. We, you know, just don't get burned, just go outside, you know, be active, but just don't get burned.

• 6:04Dr. Mary Claire Haver?

  Do we need sunscreen every day?

• 6:07Speaker 01

  I mean, I wear sunscreen every, that's one of my tips is always, don't look at the weather, just make it a habit, put it on. I mean, I just put it on my face and neck every day. I really don't put it on my arms. I, you know, I get it, it's sticky, it's gross, I don't like it either. But I keep a sun shirt in my car, and when I get in the car, I just slip on my shirt backwards and cover my hands and up to my neck. So I'm probably a little more cautious than most, just because all day, every day, I'm finding skin cancer and, you know, looking at.

• 6:36Dr. Mary Claire Haver?

  On me? So, yeah, hello, here's my confession. I was recently diagnosed with squamous cell carcinoma on my nose, and you took it off for me, and it's, it's going to be fine.

• 6:47Speaker 01

  Yeah.

• 6:48Dr. Mary Claire Haver?

  But yeah, I.

• 6:49Speaker 01

  So, I mean, it's just, I think I'm probably a little more, um, you know, conservative with sun exposure than, than most.

• 6:56Dr. Mary Claire Haver?

  Is it, okay, the skin cancer that I had was cumulative and mostly probably related to sun exposure I had years ago.

• 7:03Speaker 01

  Yes, that's true. It is.

• 7:06Dr. Mary Claire Haver?

  And the skin cancer I have at 80 is what I'm doing right now.

• 7:08Speaker 01

  Yes, are probably also still what you did, in fact, because you're probably good now, you know? It still kind of catches up with you. I'm just hoping, you know, we've had more years where we're aware than not. I mean, my, my poor patients in their 80s and 90s, they didn't even have sunscreen when they were kids, you know? And, I mean, you know, we just see so many skin cancers, and, you know, here in the South, and I have all these fishermen and golfers, and so it's just a big part of my practice.

• 7:36Dr. Mary Claire Haver?

  Well, let's go through a skincare routine. Let's do morning and let's do night. So what are the non-negotiables? I wake up in the morning, what's my morning skincare routine?

• 7:44Speaker 01

  So I think a basic skincare routine that everyone could be doing is, in the morning, you cleanse, then you apply your antioxidant serum, then you apply your moisturizer and your sunscreen. And honestly, you could combine those. There's some great sunscreens that are, and moisturizer. Um, and I kind of think of morning as more your protect. You know, you're protecting with your antioxidant and your sunscreen. So in the evening, I think of it more as your treat. So you start with cleanser, you apply your retinoid or retinol, or whichever active you're using, and then you put your moisturizer on top of that. So I think that's kind of a basic skincare regimen that just about anybody can be doing.

• 8:25Dr. Mary Claire Haver?

  So what do you do?

• 8:27Speaker 01

  So, this is embarrassing.

• 8:30Dr. Mary Claire Haver?

  They want to know, they want to know. And don't be afraid, look, Erica is purely academic. She does not support any brands, she has no affiliates, so like, and she has access to the best in the world. What do you use?

• 8:42Speaker 01

  And she tries everything.

• 8:43Dr. Mary Claire Haver?

  Yeah.

• 8:44Speaker 01

  So I'm, I always am generally a very low-maintenance person, except for when it comes to skincare. I mean, I could pack for a two-week trip and a carry-on, but I have to decant all my lotions and potions into little jars. So currently, what I'm doing, in the morning, cleanse. So I have a variety of, I don't know, you know, I'm CeraVe, La Roche Posay.

• 9:04Dr. Mary Claire Haver?

  You don't have to spend a, that's what you taught me. You don't have to spend a lot of money on a cleanser.

• 9:08Speaker 01

  On a cleanser, for sure. Sometimes I just use the micellar or micellar water. Then, right now, currently, I am using an exosome product in the morning called Plated. So exosomes are little nano-sized vesicles that basically all cells secrete, and they're used for intracellular communication. And so there's been, there's not, there's small studies on this. I think the ones that have the most robust-ish are the platelet-derived ones, and, and they've been shown to upregulate, you know, gene expression for collagen and elastin. So I'm currently using an exosome in the morning, let that dry. Then I, it's, it's supposed to go first.

• 9:50Speaker 01

  So then I apply my antioxidant serum, then I apply my estriol.

• 9:57Speaker 01

  Then I use an anti-glycation eye cream, um, age interrupter by SkinCeuticals. And then my, um, my lotion, right, it depends. Moisturizers are often used CeraVe PM. Sometimes I use the, uh, TNS ceramide lotion by SkinMatica. I really like that one, too. And then my sunscreen, which is, uh, my favorite is the Instant Tinted. So I skip one step because it's tinted, so it dubs as my makeup. So that's my morning right now. Um, then my evening, I currently am using a product very first thing after I cleanse called Re-Q. This is a brand new thing. I, I don't even have much evidence.

• 10:40Speaker 01

  I don't, I don't have any of the white papers yet, but the way they market themselves is as a, a skin longevity topical. And it works somehow on the mTOR pathway, kinda like rapamycin. Um, and it's supposed to like wake up your tired fibroblasts. I don't even know if my fibroblasts are tired yet. I just went through menopause last year, but I'm currently trying the Re-Q. Um, and then I use my taziratin, which is my retinoid every other night. So on the other night, I use the TNS Advanced Growth Factor Serum. And then I cut then my eye cream and then my moisturizer. And sometimes I use a thicker moisturizer at night and some, something really thick on my lips.

• 11:22Dr. Mary Claire Haver?

  Do you take any supplements specifically for skin?

• 11:25Speaker 01

  I take a ton of supplements and not really taking any of them specifically for my skin, I guess. But, you know, there, there's, you know, definitely evidence that, um, well, we need vitamin C, you know? Um, that is a co-factor in the production of collagen. So we do need vitamin C. Those studies have shown you actually get higher concentrations of it topically. Um, also omega threes have been shown to help with, you know, inflammatory skin conditions, inflammation in the skin, and also help with hydration. Um, so yes, I

• 11:57Dr. Mary Claire Haver?

  What about collagen?

• 11:58Speaker 01

  So collagen, I, this is one thing that I think I have changed my mind on over the past couple of years. So I used to be like, I mean, it's a huge molecule. It's not gonna make it across the stomach and get to your skin. And, or it's gonna be broken into just all of its amino acids. So you might as well just eat protein. But it turns out that there are, there are studies that show benefit, like significant improvement. And it turns out that there are dye and tripeptides that do make it across the gut. Um, and that have been found in the skin. So, you know, there was a large meta-analysis in

• 12:32Dr. Mary Claire Haver?

  Came out this week.

• 12:33Speaker 01

  Oh, really? I didn't see that one.

• 12:34Dr. Mary Claire Haver?

  Yeah.

• 12:35Speaker 01

  I didn't see that.

• 12:35Dr. Mary Claire Haver?

  I'll send it to you.

• 12:36Speaker 01

  Okay. But one in 2023, kinda when I, you know, first really started to say, hmm, I should probably be doing this. But, um, that was a meta-analysis of like 26 different randomized controlled trials, like over 700 women. And no, there was more than that. It was like 1,700. That, you know, basically showed significant, statistically significant improvements in all, all parameters. Mostly hydration and collagen.

• 13:03Dr. Mary Claire Haver?

  This, this study showed the same exact thing and it was like 16, but they had like 7,000 patients.

• 13:09Speaker 01

  Yes.

• 13:09Dr. Mary Claire Haver?

  So.

• 13:10Speaker 01

  You know, then there was another meta-analysis in 2025 that sort of questioned some of the studies that were included.

• 13:18Dr. Mary Claire Haver?

  Okay.

• 13:18Speaker 01

  So were the, you know, they considered some lower quality or industry funded. And so they, they said when they remove those, that the improvement was removed. I think overall, I mean, I can't say definitively with the evidence we have now, but I think that the body of evidence we have does trend towards benefits.

• 13:38Dr. Mary Claire Haver?

  Okay.

• 13:38Speaker 01

  Um, you know, my thing is that I only drink water. Like anything in it, no flavorings whatsoever. So I'm like, somebody please put it in a capsule. It'd probably be 15 capsules, but I'm okay with that.

• 13:51Dr. Mary Claire Haver?

  I've seen your supplement stack.

• 13:53Speaker 01

  Yes.

• 13:54Dr. Mary Claire Haver?

  We travel together, but yeah, you have thyroid and other stuff. Um, okay, let's talk about treatments. Lots of questions coming in from my followers wanting to know about professional treatments versus using just skincare.

• 14:07Speaker 01

  So I think it depends on your concerns. You know, if you, it depends on your concerns. It depends on your, um, appetite for downtime or your tolerance of downtime.

• 14:17Dr. Mary Claire Haver?

  Costs.

• 14:18Speaker 01

  And finances, because I mean, a lot of this stuff is expensive. So I think everyone could be using at least a good skincare regimen. And then we just kinda take it on a case by case basis, you know, from there. So say someone comes in for an aesthetic consultation. One of the first things I do is just to hand her a mirror and say, what's bothering you? What do you notice? So we start there and then we talk about the, I would say the four Rs. So that's relax, like you would do with a neuromodulator like Botox for, you know, muscle, you know, overactive contractions of muscles. Um, refill, so that's when you have volume loss and we're using fillers. Then there's resurface. So that's kinda more superficial on the skin surface.

• 15:02Speaker 01

  Like that could be anywhere from skincare to maybe peels, lasers, microneedling. Um, and then there's redrape and that's surgical. So that's when I refer to my plastic surgery colleagues.

• 15:15Dr. Mary Claire Haver?

  Where do lasers fit into all this?

• 15:17Speaker 01

  So say someone comes in and their, their main complaint is superficial discoloration, unevenness. They're getting brown spots or getting dilated blood vessels. That's sort of a, a perfect, um, scenario for maybe a package of IPLs or BBLs. And we can talk about laser types or someone comes in more with etched in lines on the surface. You might wanna use a resurfacing laser or you may come in with volume loss. And then we talk about fillers or some of my, you know, darker skin types that may, um, hyperpigment from energy-based devices and we can offer microneedling. Or, you know, if you're, it's muscles of facial expression that are causing the dynamic lines, then we talk about neuromodulators, Botox.

• 16:00Speaker 01

  Um, so you can think about lasers in kind of maybe simplistically like three broad categories.

• 16:07Dr. Mary Claire Haver?

  How aggressive can you be in menopause with these things?

• 16:10Speaker 01

  So a couple of things I, I adjust in menopause. One would be if, since we're talking about lasers, one would be the depth of penetration of the laser. So for instance, if you're using a non-ablative laser like Fraxel, um, the fluence, basically the joules per centimeter squared is what dictates the depth of penetration. So I may just dial that down a bit because the skin is thinner and I wanna target like the upper and mid dermis. Um, that's one thing I adjust. One of the important things to adjust in post-menopause is the delivery of toxins or neuromodulators.

• 16:47Dr. Mary Claire Haver?

  Oh, really?

• 16:48Speaker 01

  Yes. So you, you only have one, this is the main thing, I think. You only have one muscle, the frontalis muscle here in your forehead, that elevates your brows. So as we age, we get a little laxity, you know, there's a little, the brows get a little lower, the upper lids get a little lower. You only have that one muscle that raises your brows. So this is also a time period where people will start to notice more of these horizontal, horizontal lines on the forehead. And it's for a reason. It's so you can see better. So you're trying to open up your eyes more and you're activating that frontalis muscle. If you walk into the van that's doing Botox, they'll, they'll botox it for you, but then you won't be able to see for a while. So you have to be very careful with the forehead.

• 17:32Speaker 01

  Um, it can be done by very advanced injectors, but you have to be very conservative. What I do like to make sure I include are all the brow depressors. So the proceerus and the corrugators and the depressor supercilii. And then over here, um, I guess people can't really, some people can see, but over here, the crow's feet area, that's the orbicularis, oculi, all of those muscles pull the brows down. So I do like to weaken those, so they basically kinda float up a little bit. I, I, I use the analogy of like a helium balloon and I just let out a couple millimeters and it, you know, they float up. So I, I think you have to adjust your botox with time.

• 18:09Dr. Mary Claire Haver?

  So you mentioned that the botox in a van, you know, if someone is listening to this and interested in these procedures or the lasers, what should they look for? Like, you know, do you wanna go to the, the guy on the corner who has one laser? You know, do you wanna go to a big multi-specialty practice that has 10 lasers? Like, like, how do you ensure that you're gonna have the best results possible as safely as possible?

• 18:32Speaker 01

  Right. I think that's really hard to figure out. I, I feel like it ends up being word of mouth more than anything. Like people that have had, you know, successful treatments.

• 18:40Dr. Mary Claire Haver?

  What are red flags to look for?

• 18:42Speaker 01

  Well, I think it, it's, you know, most of these are best done in the hands of dermatologists and plastic surgeons, you know? Um, I know that some plastic surgeons, maybe even some derms delegate, but as long as they're, you know, supervised by a physician, I think a lot of, you know, med spas, there's no one, there's no one on site. And even if, if they have a, a physician supervisor, it might not even be a specialty that is trained in these things, you know? Yeah, I think it's tough. It's really tough for the consumer because it's kind of the Wild West out there. Like, anybody can do a weekend course and then buy a device, and it's hard to know, you know?

• 19:21Dr. Mary Claire Haver?

  So, what are big red flags, though?

• 19:23Speaker 01

  Um, I mean, I think a red flag is if you have no physician involved. Um, you know, I would want to know credentials, I would want to know numbers, and, you know, do they know what to do if there is an adverse effect, you know, because we get all of those.

• 19:38Dr. Mary Claire Haver?

  Yeah, so how often do you see complications from other people's procedures?

• 19:42Speaker 01

  We do a bit. I mean, you know, Galveston's a small area, probably not as many, you know, places around here, but, um, within our dermatology groups, you know, we all see a lot of these adverse effects. I mean, the worst thing that can happen with Botox, you know, you might make someone look funny for a bit, you know, they'll have the spock brows, or, you know, heavy lids, or something that looks unnatural. But what I really worry about are fillers, because fillers, I mean, there are deleterious effects if you don't know anatomy and what you're doing. I mean, the worst possible outcome with a filler is you, you get an arterial occlusion. So, that I worry much more about. I'm like, definitely do fillers with, you know, in a qualified practice with board-certified dermatologists or plastic surgeons.

• 20:26Dr. Mary Claire Haver?

  Let's talk about Botox. When is the right time to start? So, what is baby Botox?

• 20:32Speaker 01

  If you're gonna start at all, I think the right time is probably before you have the etched in lines. I think you can have some depressions, like, sometimes in between the brows, you know, people will start to develop a little bit of a little gully. Um, that can go away, you know, when you start to do Botox on a regular basis, because that's more, you know, muscle hypertrophy, and as it atrophies, that can smooth out. But it's much harder to get those little etched in on the surface lines, once they're etched. Um, so I would say before that is probably a good time. Baby Botox, I don't like to call it that, because it sounds like we're doing Botox on babies, um, but I call it micro Botox. Um, but it's honestly how I do mine. I, this is a couple of different

• 21:14Speaker 01

  things. It's either just lower doses, or it, some people call micro Botox when you're just doing really diffuse, like, intradermal injections for skin, you know, texture and oil production. And that's not a very common way to do it. I think usually what people are talking about is lower doses. So where you still have movement in your face, and you have facial expressions, but, you know, you're not, I think when we very first started doing Botox, like, back in the, you know, 2000, it was higher doses, and, you know, people looked more frozen. And I think we've really, you know, our technique has really come a long way in the past, you know, 26 years.

• 21:54Dr. Mary Claire Haver?

  Is it ever too late to start Botox?

• 22:00Speaker 01

  Um, hmm. There probably is a time that's too late. I'm picturing, I'm picturing, um, some consultations. I mean, if you have a lot of laxity, you know, sometimes there's just so much laxity that the skin just sort of bunches up here, you know, in the crow's feet area, and in the globella area, that area between your brows, and you're not going to get enough lift from the Botox to make that much of a difference. So I do think there is a time period that sometimes it just doesn't really do very much for you anymore. Um, but you kind of have to take it on a case-by-case basis. I mean, I have some patients that, you know, they're in their 80s, and they look like they're 60, or, you know, so it

• 22:42Speaker 01

  just depends on each individual patient. That's actually saying, that reminded me. One thing that I notice in my practice, and this is just anecdotally what I notice in my practice, if I have a woman that comes in to see me, who is in their 70s, 80s, 90s, that looks, her skin looks really good for her age, and there's like, not a lot of sagging, I always ask, and usually discover that she was placed on hormones at menopause, and I can notice a difference. And they're, and then maintained them, or at least was on them for years. And, you know, you notice a difference in, in clinical practice between, because I see a lot of patients that went through menopause before 2002, when, you know, prescriptions were really dropped.

• 23:27Dr. Mary Claire Haver?

  Yeah, when we dropped the prescription, percentages off. With everything we've talked about, does this apply to the body as well?

• 23:33Speaker 01

  All of these same things are happening. I think with the body, the difference is the photoprotected sites often show a more pure, like, intrinsic aging pattern, like the thinness, kind of the creepy tissue paper, the easy tearing, easy bruising, dryness, um, as opposed to the, the exposed sites that also have all the dyschromia, so the brown spots, and the deeper wrinkles, and the, the pebbly elastosis that you see, kind of on the photo-damaged skin of the face. But it's happening everywhere, and it's most pronounced, actually, in the vulva-vaginal area.

• 24:09Dr. Mary Claire Haver?

  Yeah, that was my next question. You use a lot of topical estrogen. Thank you for your service, by the way. Um, you're not scared to look at the vagina, the vulva?

• 24:18Speaker 01

  No, no.

• 24:19Dr. Mary Claire Haver?

  Um, what about hyaluronic acid moisturizers? Do you ever recommend those, prescribe those?

• 24:25Speaker 01

  So, so this, the vaginal moisturizers were new to me. I don't know if you remember, earlier this year, I listened to a podcast on female sexual health, and then I texted you, and I was like, wait, are we supposed to be moisturizing our vaginas? I'm like, no idea. I think this is not on most dermatologists' radars. I mean, I texted all the females in my department, and they were like, what? So I, I, this is not something that we learn. I don't, do you think that you should?

• 24:52Dr. Mary Claire Haver?

  So, I, you know, vaginal estrogen first and foremost, right? But I think, I think every woman should consider a lubricant in menopause, even with vaginal estrogen. You know, vaginal estrogen's not a lubricant, and like, it's just the friction coefficient just changes so much, and there's, you can never replace your 25-year-old vagina, you're still aging.

• 25:11Speaker 01

  Right.

• 25:12Dr. Mary Claire Haver?

  So I love a lubricant. Lubricants are oil or silicone-based, and just, just, or thick, um, for friction.

• 25:17Speaker 01

  Yeah.

• 25:18Dr. Mary Claire Haver?

  To decrease friction with activity.

• 25:19Speaker 01

  Yeah.

• 25:20Dr. Mary Claire Haver?

  Okay, whatever that is, for you. Um, but a moisturizer is basically hyaluronic acid for the vagina that just pulls water in. And, you know, for patients who are just chronically dry, outside of intercourse, or within, you know, but for that everyday dryness, and it lasts a long time.

• 25:36Speaker 01

  Yeah.

• 25:37Dr. Mary Claire Haver?

  So you can put a moisturizer, you know, hyaluronic acid in whatever form, and, and you will get protection, like, for 24 hours. And so they just are much more comfortable, they have less chafing, and so, you know, if that's what your patient's complaining of, I am recommending it.

• 25:51Speaker 01

  Okay, good to know. Good to know.

• 25:53Dr. Mary Claire Haver?

  So, yeah.

• 25:54Speaker 01

  I'll share that with people.

• 25:55Dr. Mary Claire Haver?

  So lubricant's different than a moisturizer?

• 25:56Speaker 01

  Yeah.

• 25:57Dr. Mary Claire Haver?

  Okay. Is it ever too late to start protecting your skin?

• 26:00Speaker 01

  No, I said it's never too late. I mean, you might not be able to reverse the damage you already have, but you can at least stop accumulating more, because that's, the problem is the accumulation. So, if you, whenever you can stop, and you may be able to reverse some, but at least stop accumulating more.

• 26:14Dr. Mary Claire Haver?

  Does what you eat impact your skin?

• 26:17Speaker 01

  Yes, and unfortunately, sugar is a big one, because you know how I love it. Um, so sugars, refined sugars can cause glycation. So, um, they will bind to the proteins in our skin and make them more stiff. That's the, the Maillard reaction. That's like when you brown a piece of meat, or when you apply yourself tanner and it turns brown. It's that same reaction, and it makes the collagen fibers more stiff, so they can't, you know, form their triple helix like they should. And so it stiffens elastin and collagen, and it kind of causes a yellowing of the skin, and just kind of where that sallowness, and, you know, diabetics are sort of the prototype of this. In fact, for years, the

• 26:59Speaker 01

  skin aging model in studies was to use diabetics. Although my mom looks fantastic, and she's not, but anyway. Um, so, yes, for sure, sugars can. Um...

• 27:09Dr. Mary Claire Haver?

  What's the best diet for your skin?

• 27:11Speaker 01

  I mean, you know, just in general, a healthy life. I don't know if there's a best diet, but I think, you know, exercise, and prioritizing sleep, and eating right, and whatever supplements you may need do show through on the surface. Um, but I don't know that there's a specific diet.

• 27:29Dr. Mary Claire Haver?

  How important is sleep?

• 27:30Speaker 01

  Sleep is very important. I mean, sleep is important for so many reasons, but even for the skin. So probably one of the most obvious reasons is, when your sleep is disrupted, your cortisol increases. And when cortisol increases, you produce less collagen, you have more inflammation in the skin, and actually can alter your barrier. So, I think that's probably the most obvious. There's also, less well-known, but we actually have a circadian rhythm in our skin.

• 27:56Dr. Mary Claire Haver?

  Really?

• 27:57Speaker 01

  Yeah, so they've recently discovered, um, opsin cells in our skin, which are like the ones in our retina that set our circadian rhythm. I don't think we know yet exactly what they do, but it's pretty fascinating.

• 28:08Dr. Mary Claire Haver?

  Well, on that topic, do you think there's any benefit of red light therapy for skin?

• 28:12Speaker 01

  There, I think so. I think that there is benefit there. The most benefit is for hair growth, actually.

• 28:19Dr. Mary Claire Haver?

  Really?

• 28:20Speaker 01

  Yeah, so there's a most, there's a lot of studies for hair growth, um, and more and more that come out all the time. So I actually do recommend that on a regular basis for people with androgenetic alopecia, um, so, which was the female pattern hair loss. Um, and I think that, you know, there's also pretty good evidence for wound healing, and a little bit less so, but still so, for, um, kind of skin rejuvenation, and somewhat for acne. It's a little more, uh... Short-lived for acne because it targets the bacteria and they just come right back. But there's science behind it. I mean, it's called photobiomodulation and what happens is light in the red wavelength and the near infrared wavelength stimulates the cytochrome

• 29:02Speaker 01

  C oxidase in the mitochondria and just basically makes you produce more ATP. So I think, I think about it like adds a little energy to your cells battery. Also causes vasodilation so brings more blood flow to the area and decreases inflammation too. So sometimes people use red light after another laser that causes a lot of inflammation that you can kind of calm it down faster with red light.

• 29:26Dr. Mary Claire Haver?

  Do you have red light at home?

• 29:28Speaker 01

  I don't, I, you know, I, I probably will get one, but I do have one. I have the hair max laser band for my hair and I've had that for years.

• 29:37Dr. Mary Claire Haver?

  What do you do for your hair? I think a lot of questions on hair loss.

• 29:40Speaker 01

  Yeah, yes, we see a lot of hair loss. Just happens, you know, can happen way before menopause, but accelerates after menopause. In fact, after menopause, so at 50, studies show that 50% of women have some degree of androgenetic alopecia. At 70, 70% and over 80, virtually everyone. So, you know, we don't die with the same amount of hair we had when we were 20. No one does. But, you know, what I do typically, you can use, so one of the reasons for that is estrogen stimulates aromatase activity in the hair follicle and that, that converts testosterone to estradiol. Well, when there's, estrogen's

• 30:22Speaker 01

  not there anymore, there's more testosterone available to be converted to DHT, which is our strong, the stronger testosterone. And that DHT causes miniaturization of the follicles. So that, there's three growth phases of hair. The antigen phase is the one you want to prolong because it's the growth phase and it, so hair grows longer and of a bigger diameter and testosterone shortens antigen phase. So that's one of the reasons this is happening. So one of the ways you can treat it is with a five alpha reductase inhibitor, which is like finasteride or dutasteride. But really what's becoming the favorite is low dose oral minoxidil.

• 31:02Dr. Mary Claire Haver?

  I'm taking it.

• 31:03Speaker 01

  I'm taking it too. So it's basically, this was an antihypertensive, a medicine for blood pressure and, you know, at higher doses and everyone who was taking it was getting really hairy. And so some smart person said, hey, why don't we put this in a liquid and apply it to the scalp? And that's how Rogaine was born, which Rogaine works if you apply it. So it's

• 31:25Dr. Mary Claire Haver?

  And the hair math is a lot.

• 31:27Speaker 01

  Yes, yes. So it's effective in studies, but the efficacy is not as good because in the real world, people aren't applying it twice a day. I'm, I applied it one day and I was like, no, that's it. So I think that it can work, but we have come full circle basically. And now we use minoxidil orally again in low doses, enough to stimulate hair production, but not so much to lower your blood pressure and make you really hairy. Now you will get some unwanted hair. That shows you it's working. You get a couple on the chin, around the hairline or eyebrows. People notice, yeah, nose, forearms. So you do get some unwanted hair growth, but you just have to be okay with that and just pluck them. And, you know, you will get a shed. This concerns people a lot of times. In the

• 32:12Speaker 01

  first couple of months, you will shed hair excessively and that's actually a good sign. So wait it out because that means it is transitioning the hair to the antigen cycle. So the telogen hairs are the resting phase. It's going to kind of purge the telogen and then transition over to antigen. So wait and, you know, don't, don't stop. It's going to stop after about two months or so. And then you'll start to notice some improvement maybe around six months or so.

• 32:40Dr. Mary Claire Haver?

  Okay. So you have to be in it for the long game?

• 32:42Speaker 01

  You do. Anything that you do for hair, you have to do forever. Like do it as long as you care. And so back to what do I do? I have the, the laser helmet. It's not a helmet. It's really a band that has teeth in it. So it kind of gets through your hair. And then I'm taking oral minoxidil and I occasionally inject dutasteride.

• 33:01Dr. Mary Claire Haver?

  Okay. Oh, I didn't know you could do that. I know they have it topically.

• 33:05Speaker 01

  Yes.

• 33:06Dr. Mary Claire Haver?

  You had actually like tried something and like gave it to me and it was minoxidil or finasteride and one other ingredient.

• 33:13Speaker 01

  Yes, because I don't like applying anything.

• 33:15Dr. Mary Claire Haver?

  No, I couldn't stand the stickiness and whatever.

• 33:18Speaker 01

  I would rather have 50 shots.

• 33:20Dr. Mary Claire Haver?

  Injections. Okay. So what is the number one thing we should all start doing for our skin?

• 33:28Speaker 01

  I mean, if I can only pick one, I have to go with sunscreen.

• 33:30Dr. Mary Claire Haver?

  Okay.

• 33:31Speaker 01

  Nothing touches that.

• 33:32Dr. Mary Claire Haver?

  What's the number one thing we really should avoid for our skin?

• 33:35Speaker 01

  I mean, keeping in the vein of sun protection, I would probably say, you know, unprotected sun. You know, we want you to get sun, but just don't burn, you know, just kind of maybe avoid the hottest times of the day or when your shadow is shorter than you are. And just throw on a hat, but it's okay to get a little bit of sun, just don't burn.

• 33:56Dr. Mary Claire Haver?

  All right. Walk me through the Walgreens here in Galveston. Like what products would you pick out? Like what would be a good cleanser, your vitamin C, like in your regimen?

• 34:09Speaker 01

  So what do I recommend the most? And I write things down all day, every day. So I oftentimes start with a cleanser. I recommend CeraVe. I love CeraVe in general, you know, the face products, the body products. I love La Roche Posay. By the way, there's even better La Roche Posay, you know, sunscreens in Europe when you're there. Pick up some of those. But so often, you know, either of those cleansers, sometimes just the micellar water. I use the CeraVe PM for my moisturizer. Neutrogena makes a lot of great sunscreens. I often recommend to my dry patients that just sort of aren't, the skin's not turning over well anymore. They're super scaly and dry. I recommend a lotion called Am lactin

• 34:52Speaker 01

  that has lactic acid in it. That is basically helps to, helps to chemically exfoliate those cells. But I usually want you to apply that and then apply another moisturizer on top as your barrier that will kind of, you know, create, reseal that brick wall. So oftentimes I'll have patients do two steps when it comes to that. Another thing I recommend a lot for the, for the body, you know, all day, every day, I have patients asking me about bruising. Everyone starts to bruise so easily. And usually, you know, there's not a ton you can do, but what I typically recommend is either a retinol body cream. So you can kind of start to try to build some collagen there. And one I typically recommend is Dermin

• 35:36Speaker 01

  Fragile Skin Formula. There's a couple of others that have, you know, retinols in or maybe Bakuchiol or something. And then another thing I recommend to those patients is there's a supplement, back on supplements, or a couple of other niche ones that I recommend. And one is citrus bioflavonoids. So specifically the rutin in citrus bioflavonoids has been shown to strengthen your capillary walls. So a combination of maybe using a retinol and, you know, the, the oral citrus bioflavonoids can help with the bruising somewhat.

• 36:09Dr. Mary Claire Haver?

  Well, Dr. Kelly, thank you so much for coming in on pause.

• 36:14Speaker 01

  Thanks for having me. I've enjoyed. I love the new studio.

• 36:16Dr. Mary Claire Haver?

  You can watch full episodes of this podcast on YouTube at Dr. Mary Claire. You can also find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. UnPaused is presented by Odyssey in conjunction with Good Roommate Media and Long Wave Digital.