The Holistic Plastic Surgeon: Devices, Ozempic Face, and What Your Habits Do to Aging Skin

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Tony Youn, board certified plastic surgeon, bestselling author of Younger for Life, and the most followed plastic surgeon on social media. In part two of this conversation, Dr. Youn moves from skincare into devices, lifestyle, and the bigger picture of how women can think about aging and anti-aging without getting swept up in the extremes. Dr. Youn walks through the most commonly asked about in-office treatments, explaining what each one actually does and where the limitations are. He covers IPL for hyperpigmentation and sun damage, fractional CO2 lasers and how they differ from older more aggressive approaches, chemical peels and how depth determines results, and radiofrequency microneedling including what it can realistically achieve and where it falls short. He also addresses at-home devices, covering red light therapy and what the studies actually show about collagen and elastin, and what to look for in a dermal stamper. Guest links: Anthony Youn, MD https://www.dryoun.com/plastic-surgery/dr-youn/ Tony Youn, MD https://www.instagram.com/tonyyounmd/?hl=en (Instagram) Doctor Youn https://www.tiktok.com/@doctoryoun (TikTok) Dr. Anthony Youn https://www.facebook.com/dryoun (Facebook) Doctor Youn https://www.youtube.com/tonyyounmd (YouTube) The Doctor Youn Show https://podcasts.apple.com/us/podcast/the-doctor-youn-show/id1202449205 (Apple Podcasts) Books “The New Perimenopause,” https://thepauselife.com/pages/the-new-perimenopause-book?srsltid=AfmBOoqkbc2_wmfEQSfuf1fMT3s-ImuwNhUak8wC4KsEiYhHyNtQgSy5 by Dr. Mary Claire Haver “The New Menopause"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z/ref=sr_1_3?crid=10GNBSGVPDFJZ&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QIefDxRPHA-WKVyCC9DQ7X71Ad734j96bPWX-yewnsv9Pqm7WCali5P5-h2eixUH_yHkbz1DHy2rQFoQSh7O92HNwttIL_ZBgXVor81D-Z3sbsfBh7JOJXDQwUuhWNnA5LHbsuI1CyhIyjtRm6_DXYJFaWrkYTjJeqJyFBnBZfgTprhlgJe_RZoWH9pOY6S9XzRapnMjnZgOq7PBA7Wy2KM. ZfI9WXwN58225D-i3qDhw4ZlXZO4pt8rPX1nAKiBNHM&dib_tag=se&keywords=perimenopause+book+mary+claire&qid=1775810714&sprefix=perimenopause+book+mary+claire%2Caps%2C511&sr=8-3 by Dr. Mary Claire Haver “Younger for Life: Unlocking the Secrets of Longevity, Nutrition and Self-Care for a Youthful Life,” https://www.amazon.com/Younger-Life-Great-Science-Autojuvenation/dp/1335007873 by Anthony Youn ⁠"Playing God"⁠ https://www.dryoun.com/books/playing-god/ by Anthony Youn ⁠"The Age Fix" ⁠ https://www.dryoun.com/books/the-age-fix/by Anthony Youn ⁠"In Stitches"⁠ https://www.dryoun.com/books/in-stitches/ by Anthony Youn For full show notes, please click here https://thepauselife.com/blogs/the-unpaused-podcast/the-holistic-plastic-surgeon-devices-ozempic-face-and-what-your-habits-do-to-aging-skin.

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

• 0:00Dr. Mary Claire Haver?

  What about a woman who has spent thousands on non-surgical procedures? I mean, and you're like, no, it's time, you know, chasing a result. When does she know? When is it time?

• 0:10Speaker 01

  Okay, so one thing that we cannot treat non-surgically is really just excess loose skin. Okay? Skin is a little bit loose, a little bit loose. And yes, Morpheus, like radiofrequency microneedling, yes, lasers can help and stuff like that. But when there's truly a lot of excess skin, unfortunately, there's nothing you can do about it other than cut it out. And the problem with cutting it out is it creates lengthy scars.

• 0:44Dr. 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. In part one of our conversation with board-certified plastic surgeon Dr. Tony Youn, we reframe the way we think about skin in midlife. It isn't just about aging well or finding the right products. It's about biology. Estrogen loss changes collagen, healing, hydration, and structure at the cellular level. Once you understand that, the entire conversation around skincare, procedures, and expectation

• 1:29Dr. Mary Claire Haver?

  starts to look very different. This episode is part two of that conversation. Dr. Youn walks us through what works and what doesn't when it comes to devices, lasers, and treatments. From IPL and CO2 lasers to microneedling and red light therapy, what's worth your money and what isn't? He also draws a clear line between non-invasive treatments and the point where surgery may be the only real option, breaking down the trade-offs in a way most patients never hear. And then we zoom out because you can't out-procedure your lifestyle. We talk about the daily habits that shape how your skin ages: sleep, stress, sugar, and inflammation.

• 2:15Dr. Mary Claire Haver?

  And cut through the overwhelming noise of modern skincare. If you've ever wondered where to start, what to skip, or how to think about all of this without getting swept up in the extremes, this conversation is for you. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 2:56Dr. Mary Claire Haver?

  Buy smart, drive for less, and trade for more. That's Toyota affordability, and it all starts with a great deal from your local Toyota dealer. Make a smart buy on an all-wheel-drive Camry, Corolla Cross, or get a Corolla sedan packed with the latest features, advanced tech, and head-turning style. Take a test drive in two of Toyota's most popular SUVs, the spacious, family-friendly Grand Highlander and adventure-ready RAV4. And with so many hybrid and plug-in hybrid models available across the lineup, plus efficient all-electrics like the BZ, BZ Woodland, and all-wheel-drive CHR, you can drive your way and skip the pump.

• 3:37Dr. Mary Claire Haver?

  And long after you leave the lot, your Toyota keeps delivering with legendary resale value built on a reputation for quality and reliability. So when it's time for your next Toyota, you could trade in for more. From a great deal today to a great value tomorrow, a Toyota is right for you. Shop toyota.com for deals and details, or stop by your local Toyota dealer today. Toyota, let's go places.

• 4:09Dr. Mary Claire Haver?

  All right, let's move on to devices. Love devices or like talking about them. Let's talk about IPL. That's an old one. That's been around. That technology's been around for a long time.

• 4:19Speaker 01

  Good bang for your buck.

• 4:20Dr. Mary Claire Haver?

  Okay.

• 4:21Speaker 01

  So IPL stands for Intense Pulse Light. And essentially, it is a great treatment if you've got spots. So hyperpigmentation, sunspots, age spots, liver spots. Those are all names for essentially the same thing. And it's melanin clumping in your skin due to excess UV radiation. Now, for some reason, and I don't know exactly why, women after menopause seem to develop that more. I do think that what we do see when we're in our 40s and 50s and older is we are seeing in the creation of spots, we're seeing the aging and the sun damage that we had when we were much younger.

• 4:53Dr. Mary Claire Haver?

  Yeah.

• 4:53Speaker 01

  Because I get patients that come to see me all the time. They say, look, I've got all these spots. Dr. You know, I wear sunblock every day. I wear a hat.

• 4:58Dr. Mary Claire Haver?

  It just accumulated.

• 4:59Speaker 01

  Where are these coming from? And I firmly believe that this is sun damage from when you were younger. And so IPL, great way to treat it using light energy. So what it does is it will actually turn those spots darker. And within one to two weeks, those spots, a lot of them will actually slough off.

• 5:14Dr. Mary Claire Haver?

  Okay.

• 5:14Speaker 01

  Most people will need a few treatments. This is something you do typically in an office setting. Because these IPL devices are not super, super expensive. They're usually a bit less expensive than a true laser treatment.

• 5:25Dr. Mary Claire Haver?

  Okay.

• 5:25Speaker 01

  And that's why I think it's great bang for the buck.

• 5:27Dr. Mary Claire Haver?

  Are there any at-home IPLs available?

• 5:29Speaker 01

  There are some at-home IPLs. A question about how effective they are. So for at-home, like light-based devices, I would stick more with the hair removal. There are at-home hair removal devices, I think, that can be moderately beneficial. But the at-home IPL, I'm still on the fence with it.

• 5:46Dr. Mary Claire Haver?

  Okay.

• 5:46Speaker 01

  I think they can be helpful if you're trying it. I just don't know how truly effective they are. Because even in the office, you do need at least three to four IPL treatments to truly get rid of that pigment as nicely as you'd like to. Combine IPL, though, with a good brightening cream. Because that way, you're going to get an inside-outside combination.

• 6:02Dr. Mary Claire Haver?

  Magic. All right, what about CO2 laser? Everybody's talking about it right now.

• 6:07Speaker 01

  So CO2 laser basically is kind of like the original ablative laser. And the way you want to describe it is that

• 6:13Dr. Mary Claire Haver?

  The CO2 is carbon dioxide.

• 6:15Speaker 01

  Carbon dioxide, yep. And it's ablative, meaning that it burns the skin. All of these skin tightening treatments, essentially, the ones that use energy typically are creating heat in the deeper skin. And when you heat the collagen of the skin to a certain temperature, it causes the collagen to actually heal in a tighter fashion. So it's kind of like that log cabin we talked about at the beginning of the podcast. And those logs start to fray, they start to fall apart. When you laser it and you heat that cabinet essentially to a certain temperature, the collagen will tighten afterwards. So lasers will do that by using light energy. They target essentially a chromophore or a color, and then they heat that color up. IPL also, you know, to an extent does that. There is radio frequency that will do that, ultrasound-based devices that will do that.

• 6:59Speaker 01

  So really, they all kind of do the same thing, creating heat in the deeper skin. The original lasers did that by literally burning the skin from the top all the way down. And it'll be like literally leveling everything. And those are very effective for certain really tough skin conditions. Like if you've got really bad pitted acne, acne scarring, then that could be very helpful. People with really advanced sun damage. But the problem is, is those CO2 lasers are really aggressive. You feel like a burn patient, you're oozing for a week or two, a lot of redness, and even potential risk of pigmentation problems. There are people who get that, and then they come out and they literally look like a ghost because the melanin has actually been destroyed for some of them. So those are not being used all that much anymore. Now they're using them in a fractional pattern, in which case what you're doing is instead

• 7:44Speaker 01

  of just burning all the skin all the way down, you're burning a fraction of the skin. Or a pixelated version. So it's tiny little columns of skin that you're burning all the way down. You're getting that heat there that's causing the skin tightening. But you're also seeing some exfoliation of the skin because you're burning, you know, some of that skin at the surface. But because you're leaving all the skin, you know, that's not being actually burned around it, then you can actually heal much faster.

• 8:08Dr. Mary Claire Haver?

  Okay. And still get the benefit.

• 8:09Speaker 01

  So that's a CO2 laser. And so those are still being used. I think if you're looking for the most aggressive rejuvenation treatment, then that's a fractional laser laser. Like a CO2 is probably the way to go.

• 8:18Dr. Mary Claire Haver?

  And then in that same vein, and we'll come back to other, other topical, other devices. I don't want to forget about this is I'm seeing a lot of chemical peels.

• 8:28Speaker 01

  Yeah.

• 8:28Dr. Mary Claire Haver?

  So getting rid of the top layer of skin.

• 8:31Speaker 01

  Exactly. So chemical peels will do it in a different way, but essentially what you're doing then is you're applying an acid to the surface of the skin. And it will essentially just burn the surface of the skin and it will go to a certain depth. Same thing like with the laser. Now deeper peels can go into the dermis and that can do more of a change. Other peels are more superficial and really it's the length that you peel that is going to determine your result. So there are chemical peels, there are lunchtime peels that are a mild exfoliation. It really can do much, feel a little softer afterwards, no big deal. There are peels that have like a one to three day downtime where that's a little more of an aggressive exfoliation. To peels that are seven to 10 days, that's kind of the deepest that we go in my office. It's more of a moderate depth chemical peel. Now you're in that superficial dermis, so you're past the epidermis or the upper layer of skin.

• 9:16Speaker 01

  You're into that little slightly into that deeper layer of skin. And then there are peels like the phenol peel that go even deeper and those can get kind of scary. I'm not a fan of those. The problem with that is phenol, it's a poison. And what happens is if you put too much phenol on the skin, you can get cardiac arrhythmias and people can actually die from it. And so you have to actually peel a quadrant of the face at a time and give it time because you have to give your body time to actually clear the phenol from the system. You need the liver and the kidneys to eventually excrete it. For a facial treatment, that's a lot when you're thinking, yeah, so it's not being done much. I see videos from people overseas using it. The thing with peels that are good is that they're, you don't have the overhead of a laser that may cost $200,000.

• 9:57Speaker 01

  And so the doctor or the physician performing it is not going to charge as much because, you know, it may, it may be a hundred bucks for the supplies of a peel. So bang for your buck with chemical peels can be very, very good. But the negative with peels is that it may take a little longer for you to heal from it, you know, to get a similar result. And then like I said, when you go really deep with a phenol, that, that is when it gets potentially dangerous.

• 10:17Dr. Mary Claire Haver?

  Okay. So walk me through the classes of lasers. So we talked about CO2. I mean, they have different depths. It's also confusing. It's like an alphabet soup.

• 10:25Speaker 01

  It is. And then there's different. And brand names and

• 10:28Dr. Mary Claire Haver?

  Yeah.

• 10:28Speaker 01

  So I think with lasers, you have to keep in mind that lasers all have different purposes. So there are certain lasers that are primarily made for like tattoo pigment. So those are Pico lasers.

• 10:38Dr. Mary Claire Haver?

  Okay.

• 10:38Speaker 01

  They can also be used for anti aging too, though. So a lot of lasers can be good for one thing and so so for other stuff. And then people, because they have it and they paid two or $300,000 for it, they kind of recommend it to everybody. And so what you have to consider with the laser is what it's truly good for. So there are certain lasers, like an Alexandrite laser is great for hair removal. Okay, so that's what you want to do. But if you're a person of color, then Alexandria is not going to be good for you. You want to use an ND YAG laser. And then there are other lasers, like a pulse dye laser, that's great for vascularity. You know, so if you've got, let's say, a lot of redness to your skin, if you've got port wine stains, it's used for that. It's used better for scarring. And so it's, there's so many out there that I think the first thing you have to keep in mind is that

• 11:24Speaker 01

  some doctors will buy one laser and use it for everything.

• 11:26Dr. Mary Claire Haver?

  Yeah.

• 11:27Speaker 01

  And so ideally, if you're going to get a laser treatment, you want to go to a place that has a number of different options. So that you know that they're not just recommending the same thing for everybody. And that may not be the best option for you.

• 11:37Dr. Mary Claire Haver?

  What about the Morpheus type? I know there's a few on the market now where you get needles in the skin plus heat.

• 11:45Speaker 01

  So as I mentioned earlier, with lasers, the idea is you heat the collagen, the deeper collagen to a certain temperature, and it causes collagen to tighten. Microneedling originally originated as the dermal rollers, where they're like little rolling pins with tiny pins on it. And it would create tiny little pokes in the skin. The trauma from those pokes essentially causes the collagen to get damaged. And then, like I said before, it heals in a tighter fashion. So the idea behind radio frequency microneedling is that you get the little pokes in the skin. And those needles go to a certain depth, but they are insulated up until the tip of the needle. And the tip of the needle emits radio frequency energy or heat to heat up the deep skin. So the needles will go in, release the heat, and then come out. So you get a twofer with that treatment. You get the needle poke and you get the deep heating.

• 12:30Speaker 01

  And if somebody is being proactive with it, you can apply Growth factors, you can apply exosomes to the surface of the skin. There are different things you can apply. You can apply PD-RN, the salmon DNA on the surface. That will then seep into those tiny holes and help to rejuvenate the skin as well that way. So RF micronealing, I think is great for non-invasive skin tightening. Right now, it's the gold standard. I'll explain the where it can work really well, but where the concern is.

• 12:54Dr. Mary Claire Haver?

  Okay.

• 12:54Speaker 01

  So if you've got an area like, say, hey, I don't want a facelift, but I got a little bit of loose skin here on my neck. Can I do RF micronealing for it? Typically, yes. Like, I actually get it done myself every four to six months to try to prevent this from drooping. But if the needles go too deep and the energy is too high, there is a belief that it can actually cause the underlying fat to potentially be damaged.

• 13:16Dr. Mary Claire Haver?

  Okay.

• 13:16Speaker 01

  And so the knock on it is if it's done overly aggressively, you could potentially get fat loss from it. And we don't want fat loss in, let's say, in our cheeks, especially because we lose fat there. If you get a little fat loss in the neck, a lot of people won't mind that so much.

• 13:29Dr. Mary Claire Haver?

  What about at-home devices? What would you recommend? What works? Is any of them really worth the money?

• 13:36Speaker 01

  So the first one I would definitely recommend for pretty much anybody is red light therapy. Red light therapy has been shown in studies after typically the studies I've seen. The idea is red light therapy is energy. And, you know, we talked about mitochondria and stuff. And as we get older, you know, our skin cells produce less mitochondria, less ATP. The belief is that red light therapy will basically energize the mitochondria to create more ATP. But even more than that, there are studies have actually looked at collagen and elastin in the skin after undergoing red light therapy. And studies that I've seen, two months of regular red light therapy will increase the collagen elastin in the skin. Now, it's not super, super dramatic. Okay? It's just like taking a collagen supplement. You know, I fully believe in collagen supplements. I know you do too, but it's not the same as applying retinol to your skin.

• 14:20Dr. Mary Claire Haver?

  Right.

• 14:20Speaker 01

  You can't expect the same benefits, but it does seem to definitely help. And for me, the way I look at red light therapy is there's so many people out there. You know, who they can't spend $1,000 for a treatment every couple of months at a doctor's office, but what they can potentially afford is, you know, $400 or $500 for a laser mask or a tabletop device that they can use for years to help with stimulating collagen production. Keeping in mind that the benefits still are modest, but there are definite benefits there.

• 14:49Dr. Mary Claire Haver?

  So I see some influencers sitting in front of a giant red light panel like every morning while they're vibrating and doing all these things. Would you recommend that for all skin?

• 14:58Speaker 01

  I think it's good. You know, I so what I do is I actually have an infrared sauna and we ours has red light with it. Honestly, like the best thing I ever bought for myself is a treadmill, my wife and I, because I would probably be 30 pounds heavier right now if I didn't have one.

• 15:12Dr. Mary Claire Haver?

  I turned mine into a walking desk. I mean, I work on it.

• 15:14Speaker 01

  There you go.

• 15:15Dr. Mary Claire Haver?

  Every day I'm at home.

• 15:16Speaker 01

  The second best thing I think I've ever gotten is our sunlight and sauna. It's beneficial in more ways than one. So that I'm a full believer in that.

• 15:23Dr. Mary Claire Haver?

  Okay. Any other at home devices?

• 15:25Speaker 01

  Okay. So number one is red light therapy. I think the number two, if you want to do something, but you have to be careful with it, is at home microneedling.

• 15:31Dr. Mary Claire Haver?

  Okay.

• 15:32Speaker 01

  So I'm not talking about dermal rollers, but actual dermal stampers. Okay.

• 15:36Dr. Mary Claire Haver?

  What's the difference? Because I did buy a roller one day off of TikTok.

• 15:39Speaker 01

  Yeah. So the idea with rollers, if you ask any dermatologists, they'll tell you that it tends to tear at the skin because it's on a roller and the pins don't go just directly. They kind of roll over it that you can get tearing. There are dermal stampers. Actually, there are devices that have removable heads that have the pins in it that are sterile, where you can go ahead and stamp the areas.

• 16:00Dr. Mary Claire Haver?

  Tried those before and it came with some serum that you put on top.

• 16:04Speaker 01

  Exactly. And those I think can be pretty effective. You just have to be careful because you have to follow the instructions. You don't want to keep reusing the head because you can get an infection. You want to make sure that you're not going at angles. So you don't, you know, cause something to break in it. You just want to be careful with it and follow those instructions. And if that's the case, and it's not some black market one that you, you know, buy on eBay or something, then I think it could be very beneficial. Just be careful. You don't want to microneedle your face and then put just anything on your skin. Because if you've got, let's say, a real pungent moisturizer that's not made to, let's say, go a little bit deep in your skin, then you don't want to apply it right away. Okay. Because you do have the tiny little holes afterwards. So that's why they come with those special serums. Those are in general safe, but you don't want to just apply anything over top.

• 16:48Dr. Mary Claire Haver?

  Okay.

• 16:57Dr. Mary Claire Haver?

  What about a woman who has spent thousands on non-surgical procedures? I mean, and you're like, no, it's time, you know, chasing a result. When does she know? When is it time?

• 17:08Speaker 01

  Okay, so one thing that we cannot treat non-surgically is really just excess loose skin. Okay, skin is a little bit loose, a little bit loose. And yes, Morpheus, like radiofrequency microneedling, yes, lasers can help and stuff like that. But when there's truly a lot of excess skin, unfortunately, there's nothing you can do about it other than cut it out. And the problem with cutting it out is it creates lengthy scars. And that's the big trade off.

• 17:33Dr. Mary Claire Haver?

  And you do do facelifts, correct?

• 17:35Speaker 01

  Yes.

• 17:36Dr. Mary Claire Haver?

  Use yours?

• 17:37Speaker 01

  Yeah, so I do facelifts.

• 17:38Dr. Mary Claire Haver?

  What is a facelift?

• 17:39Speaker 01

  A facelift, basically, in general, it's an operation, I do it under general anesthetic, some doctors don't, where you make incisions around the ears, you elevate the skin to a certain extent, you tighten up the muscle layer, remove or reshape the fat, and then you cut the extra skin out.

• 17:54Dr. Mary Claire Haver?

  I didn't realize the fat part.

• 17:55Speaker 01

  Yeah, so some people will re-drape the fat, some people will remove it, just depends on the anatomy of the patient. But essentially, it's dealing with removing skin, tightening up of the muscle layer, and repositioning the fat and or removing some of the fat. And in everybody who has a facelift, they will get scars typically in front of and behind the ears, oftentimes a scar underneath the chin as well. And the thing to keep in mind with a facelift is that's the big trade off. You cannot predict how those scars are going to heal. No matter what somebody tells you of like, I'm great at scars, your scars will heal based off of how your body heals those scars, not what a surgeon does. And, you know, a surgeon can operate on you for three or four hours, they can remove the sutures to prevent track marks, but what they can't do is, is cause your scars to heal

• 18:38Speaker 01

  in a certain way, because your scars will heal 24 hours a day, seven days a week, for literally two years. And what a surgeon can do in the three or four hour operation pales in comparison to what your body does during that time. And you and I both know, you know, we're both surgeons, and, you know, you operate on somebody, and I've seen patients where they get a thick scar from their appendectomy, but their C-section scar looks fine.

• 18:59Dr. Mary Claire Haver?

  Right, and my scars are not all the same.

• 19:01Speaker 01

  Yeah, it's just, and I think hormones have something to do with it. Two, I think that I have seen patients where I've operated on them more than once. And for some reason, the first time they heal great, the second time their scars got thick. And I do think that hormones may have something to do with it. I just don't know exactly what.

• 19:14Dr. Mary Claire Haver?

  Yeah.

• 19:15Speaker 01

  And how. But the thing is, we cannot predict how good a scar will heal. So you are trading removing that skin for those scars. And you have to be okay with that because if you're not, you don't want to regret the operation.

• 19:25Dr. Mary Claire Haver?

  So let's talk a little bit about, you know, aging as a woman. Eighty percent of your patients are female, correct?

• 19:31Speaker 01

  Yes, yep.

• 19:32Dr. Mary Claire Haver?

  And I do feel much more pressure than my husband does. Aging, he doesn't think about it the same way that I do. The way that my skin looks, the way that my face looks, you know, or the parts of my body look. And I absolutely love being 57. Like, I feel like I'm living the best time of my life. But like, watching certain parts of my face change is, can be distressing. And so, you know, if you do too little, you're letting yourself go. If you do too much, you're vain.

• 20:00Speaker 01

  Yeah.

• 20:00Dr. Mary Claire Haver?

  Like, how do you counsel your patients about that?

• 20:02Speaker 01

  Or? I mean, I think it's first thing we have to realize, society is not kind to women who age. I can't tell you how many patients told me that I feel invisible after I get to a certain age because I'm not 20 years old anymore. And then, just like you said, then they get some stuff done and, you know, people judge them for it and say that they're vain. And it really is, it's a, it's a difficult place to be. And I sympathize with my patients and my followers who tell me these stories all the time. I think there's, you know, a couple of things to keep in mind. The first thing I think is that we all have a desire to feel good about how we look. And that desire, I think, is, is really universal. And it's in men as well. And, and it can be something as simple as how you feel when you go to the store and you buy a new outfit and you wear that outfit out and you just feel good.

• 20:47Speaker 01

  Like, there's this part of you that feels good because you're wearing a new outfit. And other people may not even notice it, but you feel that. It's a great thing, you know, it's, it's a good thing. There's no, nothing wrong with it. Obviously, getting a cosmetic procedure is a similar type of a feeling, but obviously you're doing something different with that. And I think the way I would recommend people to think about it is, number one, don't feel guilty if you want to get that feeling, because I think we all want that, even men do too. And number two, we're all on a certain continuum of what we are willing to do for that. And wherever you are on that continuum, it's okay. I have patients of mine who'll do Botox, but they don't want to do filler and other people who will have surgery. And wherever you are on that whole continuum, it's okay, you know, as long as you're happy

• 21:31Speaker 01

  with that. If you are considering a cosmetic procedure, the thing that I would recommend that you really, really take into account is kind of this principle that I have in holistic plastic surgery, but it's do the least amount of procedures necessary to make you happy. Okay. Cause you never regret not getting something done, especially when you're talking about surgery. You only regret when you did something that maybe you shouldn't have. Okay. So if you're not ready and if you're not a hundred percent gung ho. So it's like if somebody says, Hey, I'm thinking about a facelift, you know, I've gone through menopause, I'm 55, I've had some changes and stuff. Do you think it's the right time for me? I'll tell them, look, you'll know it's the right time when you really, really dislike the appearance of the lower face and the neck so much that the thought of

• 22:13Speaker 01

  spending tens of thousands of dollars, going under the knife for three or four hours, getting permanent scars in front of and behind the ears, that we cannot guarantee how they're going to heal in the end, with the potential risk of complications, the thinking about all that, you are still excited to do it because man, you can't stand looking at this turkey gobbler neck or the jowls, whatever, then maybe that's the right time for you. But if the fear is more or the concern is more of these complications than the excitement, then maybe it's best to wait, you know, because at some point, maybe you'll get there.

• 22:44Dr. Mary Claire Haver?

  If you could rewrite the standard of care for aesthetic medicine, the way that we're kind of rewriting the standard of care for menopause, what would that look like? You just briefly mentioned, and we're going to get into this, you are the world's holistic plastic surgeon. And so, you know, we're going to talk about lifestyle here.

• 23:02Speaker 01

  Yeah.

• 23:03Dr. Mary Claire Haver?

  But how would you rewrite that?

• 23:05Speaker 01

  So I would look at it, the whole kind of anti-aging is like you're building a house. And when you build a house, the foundation of the house is what you always start with. And what's the foundation of anti-aging? It's really what you eat.

• 23:16Dr. Mary Claire Haver?

  Yeah.

• 23:16Speaker 01

  So that's going to be the foundation. That's the first thing I recommend. If you're thinking, hey, I'm not liking what I'm seeing, or I want to prevent the aging, what do I do? The first thing to think about is your diet. Second thing after that is going to be skincare. Okay. Because it can be very, very effective, along with supplements. Actually, probably number two would be supplements and then skincare, going in order of how much they are technically as a foundation. So let's say the first floor is going to be supplements. Second floor of the house is going to be skincare. And then the attic of the house is going to be the non-invasive or minimally invasive treatments. And then the spire way at the top or the chimney, that's actual surgery.

• 23:51Dr. Mary Claire Haver?

  Okay.

• 23:51Speaker 01

  Okay. And you may not need that, which is totally fine. But anybody can stop at any of that point. Like you may say, hey, you know what? I built the house and I just want a one-floor ranch. And you're doing supplements and a good diet and wearing your sunscreen and that's good for you. That's fine, you know? But if you want to take it up higher, you can always add those added floors if you'd like. The big thing really that I would want to change a paradigm, there's, I think there's too many plastic surgeons who are a cut-first mentality. And for me, my goal of being a plastic surgeon is to keep my patients out of the operating room and keeping plastic surgery only as a last resort.

• 24:34Dr. Mary Claire Haver?

  Let's talk about lifestyle factors. Well, first of all, can we out-procedure a lifestyle that is not conducive to healthy?

• 24:40Speaker 01

  You cannot.

• 24:41Dr. Mary Claire Haver?

  To a healthy life.

• 24:42Speaker 01

  No, although, you know, there are interesting studies that show that the younger you look, the healthier you are and the longer that you live in general. Okay? This is a general fact. So they've actually taken twins and have done twin studies.

• 24:55Dr. Mary Claire Haver?

  Yeah.

• 24:56Speaker 01

  And the twin that actually looked younger tended to be healthier and live longer, which you think about it, it kind of makes sense.

• 25:01Dr. Mary Claire Haver?

  We're not talking cosmetics. We're talking, you know, why does this twin look younger? Probably because they eat better and they sleep more and they exercise.

• 25:08Speaker 01

  Less bad habits.

• 25:09Dr. Mary Claire Haver?

  And they, all the things. All right, let's get into habits then, sleep.

• 25:12Speaker 01

  So sleep is going to be huge. And really, I mean, you've Talked about sleep on your podcast before. It's such a hard thing after menopause, but it is so, so incredibly important, just like stress. You know, sleep and stress I put together.

• 25:24Dr. Mary Claire Haver?

  Okay.

• 25:24Speaker 01

  The good thing is there's a lot of tools that you can use. You know, I tell you, my mom, she called me, gosh, this is probably about nine months ago. She called me because she was supposed to come visit and she said, Tony, I have to cancel my trip because I cannot sleep. And she said, I'm literally sleeping one night out of every three. Two nights in a row, she would not sleep and then she would sleep the third night and then go another two nights. And so we put her on a bunch of, we've tried different supplements. I tried L-theanine. We tried magnesium. Each of those would work for like once or twice, one or two nights, and then it would go back. And you know, the thing that really made the big difference? I called a friend of mine, he's a gynecologist, and he said, well, put her on some progesterone. So I started on the progesterone and it was a game changer.

• 26:06Dr. Mary Claire Haver?

  Wow.

• 26:07Speaker 01

  Absolute game changer.

• 26:08Dr. Mary Claire Haver?

  And she's in her eighties.

• 26:09Speaker 01

  She's, she just turned eighty, just less than a year ago. And, and she had never been on any really HRT because she was part of that group where they're like, no, don't do it. Don't do it. And she's always had sleeping problems, but not to the extent where it just recently got so bad for her. And that progesterone is like saved her life.

• 26:26Dr. Mary Claire Haver?

  We need more studies, but in our patient population, you know, it's a miracle. We know it converts to allopregnanolone, which goes into the brain and binds to the GABA receptor, which causes relaxation. And I mean, for our patients, it is night and day for their sleep. I mean, it's not hot flashes waking them up. You know, this is like that 3am cortisol spike for whatever reason. And GABA just seems to kind of roll right over that. You've touched on stress. What about sugar?

• 26:52Speaker 01

  So sugar is the great ager of the skin. So sugar ages the skin in two different ways. Actually, I just put an email out today all about sugar to my followers. But really what it is, is two things. It's glycation, meaning that sugar will actually bond to the collagen of your skin, as well as the collagen of all the other parts of your body and will deform those collagen fibers. So we're getting back to that kind of that log cabin with this tight, tight logs. And sugar will actually bind to it and will cause those logs to kind of kink and, and be in an abnormal position essentially. And those hybrids, that sugar protein combination are called advanced. Glycation end products or AGEs. And so that happens in the skin, but also happens in all these other parts of the body, too. So sugar really ages the skin with that. Plus, you get these chronic insulin spikes,

• 27:35Speaker 01

  which can cause chronic inflammation on top of that. Having too much insulin can also increase issues with acne and a lot of skin disorders, too. So sugar really is a great ager of the skin.

• 27:44Dr. Mary Claire Haver?

  So how much sugar, is there a amount of sugar that's okay?

• 27:47Speaker 01

  For the way I look at it with my followers is I tell them, look, just try to reduce what you have. So I encourage people, don't worry like, oh, I've got to get rid of sugar. Just reduce, you know, start by reducing it. You know, if you're having a can of soda pop a day, maybe switch to, you know, half a can, you know, then maybe even do one every two days or something like that. Really trying to reduce it is going to be huge.

• 28:06Dr. Mary Claire Haver?

  And that's the main place that people are getting sugar in their diets.

• 28:10Speaker 01

  That's, I think, the easiest.

• 28:11Dr. Mary Claire Haver?

  Yeah, and the coffee drinks now.

• 28:13Speaker 01

  And energy drinks, too. It's like all of those that are just not, not good for you.

• 28:18Dr. Mary Claire Haver?

  Inflammation and skin aging. You mentioned that briefly. Can you talk a little bit more about that connection?

• 28:23Speaker 01

  Yeah, so inflammation is one of the main agers of the skin, you know, along with collagen degradation, along with oxidation. Inflammation is, and one of the things really is the whole sugar thing. And so that's going to create chronic inflammation by actually, you know, causing those insulin spikes. But also inflammation comes from the gut, too. And so that's where certain types of foods that you eat can really help with inflammation as well. So we can talk about products like antioxidants that can help with it. There are certain things actually in your diet that can help with overall chronic inflammation. So eating good, healthy sources of fat, so cold water fish, nuts and seeds. You know, all that's great to try to get those healthy fats, avocados, olive oil. And so really reducing inflammation. For me, the way I look at inflammation is sugar and microbiome.

• 29:08Speaker 01

  And so doing things for the microbiome can really help with overall chronic inflammation. And so that's going to be taking daily probiotic and or eating good fermented foods as well.

• 29:17Dr. Mary Claire Haver?

  What about fiber?

• 29:18Speaker 01

  I mean, fiber is huge, you know, so that's going to be the prebiotic. And what is it, like 90% of Americans are deficient in fiber?

• 29:25Dr. Mary Claire Haver?

  Yeah, I think the average American woman, of course, I only look at female data, so that's our audience. I know the data for men, though, for this one. Women get 10 to 12 grams per day.

• 29:34Speaker 01

  Yeah.

• 29:35Dr. Mary Claire Haver?

  Female cardio for gut health, it's 25 for minutes, 35, but for cardiovascular health, add another 10.

• 29:41Speaker 01

  Yeah.

• 29:42Dr. Mary Claire Haver?

  So it's, it's amazing. And so we're getting half to a third to a fourth of what we really should be getting. And most of your fiber, I mean, here, this is from a doctor who sells a fiber supplement, but you really should get most of it from food because those foods are packed with all the other things that we need.

• 29:58Speaker 01

  Yeah, that's why I don't understand the carnivore diet because there's so little fiber in it. And I don't understand how you can go without, but yeah. And I think people need to realize there's soluble and insoluble fiber. They work kind of differently. And I think a lot of people forget about soluble fiber. A lot of people are now, and I'm taking psyllium husk. I think it's great. And honestly, it makes bowel movement so much easier and less messy, I guess is the way to describe it. So I'm a huge fan of fiber. As far as the impacts of fiber on the skin, I think that, you know, I would look at that more as a microbiome type of a thing and reducing inflammation, just because you've got a healthy microbiome. I don't know of any studies that have ever looked at technically fiber and skin and aging necessarily. But I think you're looking at kind of the whole holistic body in the whole way.

• 30:41Dr. Mary Claire Haver?

  So just a good, basic anti-inflammatory diet.

• 30:43Speaker 01

  That's.

• 30:44Dr. Mary Claire Haver?

  High in fiber. Okay. What about, like you said, carnivore, are there, you know, is there too much protein that's bad for skin? Has anybody looked at protein?

• 30:53Speaker 01

  So, I mean, I think from the skin standpoint, collagen is a protein. And we do have to get enough protein in our body in order to support that collagen. And with the collagen loss, you know, looking at it from a purely vain and aging, you know, skin aging perspective, you definitely need enough protein in your diet. Now, how much protein that is to help to support collagen production? I don't think that's really been elucidated yet. What we have seen though, in general, is that the reduction in collagen in the body and how long it takes to kind of, you know, replenish it, that seems to follow a lot of what you see in the bones as well.

• 31:26Dr. Mary Claire Haver?

  Right. Like I tell my patients, the same thing that gives you, you know, from as far as food, nutrition, supplements and exercise.

• 31:34Dr. Mary Claire Haver?

  The same things that help your heart, help your brain, help your gut, help your, I mean,

• 31:37Speaker 01

  100%. But interestingly, it's very similar amount. So when you're looking at aging of the skin, you see a similar reduction in collagen in the same way as you see with the bones and muscles and all that as well. So it's interesting, but in general, I would say, you know, increased amount of protein in general, because we do know that it can, that it's necessary for collagen production. How much is necessary, like I said, I think is still being figured out.

• 31:59Dr. Mary Claire Haver?

  Okay. Before we jump into supplements, because I know everyone's interested, what is Ozempic face?

• 32:04Speaker 01

  So Ozempic obviously causes weight loss, and with weight loss, you would lose fat in the face too. And fat does provide structure to the skin. Okay. So if you, it helps to plump the skin out. And when the skin is not plumped out, it drops. And that's some of what we're seeing with Ozempic face. But there are other things to keep in mind. GLP-1s also have an anti-inflammatory effect. Now, we're still learning just how much of an anti-inflammatory effect, how, you know, how much that and what that does. But that can be actually beneficial for the skin. But then, at the same time, we do know that there are stem cells that are created by fat. And so there are some early studies that are showing that losing some of those stem cells from the fat reducing may cause negative impacts on the skin. I've actually talked to a few plastic surgeons, which I

• 32:45Speaker 01

  found this really interesting, because I see now in my practice, I swear 70% of my patients are on GLP-1s.

• 32:52Dr. Mary Claire Haver?

  We prescribe them in our clinic, not to everyone, you know, but we use them.

• 32:56Speaker 01

  I see a lot of patients with it. I have plastic surgeons that tell me that they, they believe that being on a GLP-1 and losing weight on GLP-1 impacts the quality of the collagen of your skin different than losing it in a different way.

• 33:10Dr. Mary Claire Haver?

  Wow.

• 33:10Speaker 01

  I have not seen that in my patients. I had one doctor tell me that when he does breast surgery now, if it's a patient who's on a GLP-1, he'll use actual mesh as a way to stabilize things because of the effects of collagen on this, on the tissues.

• 33:23Dr. Mary Claire Haver?

  Wow.

• 33:24Speaker 01

  I have not seen that in my patients personally yet, but maybe I just haven't seen enough of it yet to really say. So I think the jury is still out on that. But that's really Ozempic face. It's kind of that rapid weight loss, causing the loose skin. There are things you can do. Injecting fat into the face is a, is a surgical way to do it. Fillers, bio-stimulators, those are other ways to try to improve it.

• 33:45Dr. Mary Claire Haver?

  What about supplements? What do you recommend? What's the evidence say?

• 33:49Speaker 01

  So first one is going to be, my favorite one is collagen and the evidence is pretty strong with collagen.

• 33:55Dr. Mary Claire Haver?

  Okay, what about the naysayers who are saying, oh, you, what do they say that it all just breaks down to amino acids?

• 34:01Speaker 01

  Yeah. So first of all, just to set up, the general data is actually quite strong. There are meta-analyses, thousands of patients that have found that taking a daily hydrolyzed collagen supplement can improve the hydration of your skin, the quality of your skin, it can help improve fine lines and wrinkles, and the collagen content in the skin. There have even been biopsies done of patients who've been on collagen supplements and found an increase in the pre-collagen precursors in the skin.

• 34:25Dr. Mary Claire Haver?

  Okay.

• 34:25Speaker 01

  So I do think that it's pretty straightforward that it definitely helps. That being said, you know, how much collagen is necessary? Okay, because there are some studies that are very small amounts, like two or three grams of collagen a day is minimum for it. My recommendation would be at least 10 grams a day if you're going to do collagen. So the key really then is the hydrolyzed collagen. That's the key.

• 34:45Dr. Mary Claire Haver?

  Okay.

• 34:45Speaker 01

  Because it is true, collagen is a large protein. And if you put, let's say, a collagen cream on your skin, it's going to do nothing because it's just a big protein sitting on the surface of your skin. So then the question is, how do you know that actually gets absorbed through your gut into your bloodstream? And so the key really is hydrolyzing collagen, take that large protein and they break it down into its individual amino acids and peptides. Peptides are short chains of amino acids. Those are much smaller and those are the ideas that they are going to be absorbed. Now, when they actually, they actually have done a study looking at patients who have taken collagen, hydrolyzed collagen supplements, and they've actually drawn their blood and found an increase in the, in collagen, pre-collagen precursors in the blood in those patients.

• 35:26Dr. Mary Claire Haver?

  Okay.

• 35:26Speaker 01

  So there are actual studies that do show that it does get absorbed, but once again, it depends on the quality of the collagen. One question a lot of people ask is, what about bone broth then? Is there any, are there any studies to support bone broth that's almost pure collagen into improving the skin? There are no studies on bone broth that have ever been done that I know of. I'm still watching to see, but so far still none. But it does make, seem to make sense. And a lot of people tell you that, oh yeah, I drink bone broth and it does seem to improve my skin, my hair, my nails and all that.

• 35:51Dr. Mary Claire Haver?

  What about other supplements? Anything else?

• 35:54Speaker 01

  So I am bullish on some general supplements. Like, I'm not a biohacker, so fiber, I think, is so, so important. I do think a daily multivitamin is good because I do think our food's not as nutritious as it used to be. There's so much ultra-processed foods that we're eating. I'm a fan of taking a daily probiotic, 3 billion or more colony-forming units. I think omega-3 fatty acid supplement is good. And then ideally, if you can get like an antioxidant mixture of antioxidants, I think that's good as well. Those would be kind of the basic ones for me that I think really people really wouldn't argue. You know, right now, one of the big things that people are talking about is like NAD and NMN and NR. Not a lot of science to support those yet. I think we'll see. You know, some people are saying that that can help promote longevity.

• 36:39Speaker 01

  For your listeners that are wondering, okay, what exactly is NAD? NAD is a naturally occurring substance in our body that helps to essentially extract energy from the food that we eat. And so people are doing IVs of NAD, IV drips.

• 36:49Dr. Mary Claire Haver?

  I heard it, we don't absorb it very well. If you're gonna do it, you should do-

• 36:52Speaker 01

  You can't do oral NAD, so people are doing the drips. But the problem with the drips for me, you know, is that I spent a couple of years in the surgical ICUs, and we've been in the hospitals, and we know that sometimes people get older, getting IV access can be very difficult for some older people. And, you know, you can always get access by doing a central line where you put a big IV into their neck or into their groin. My fear with people who are doing all these IV treatments like hydration and NAD is that you are scarring up your vein every time you, you know, put an IV into it. And are you gonna get to the point where at some point you need those veins, but you can't really use them because they've been all scarred up from treatments that you didn't really benefit from? And so I'm not a fan of IV. If you want to try NAD, I do have friends of mine who say, oh, I take NR or NMN. These are precursors to NAD.

• 37:37Speaker 01

  You can do those orally. I tried NR for several months and really didn't feel anything different. But you can increase NAD levels by exercising. There's a good way to do it.

• 37:47Dr. Mary Claire Haver?

  Which we do every day.

• 37:47Speaker 01

  Exactly. So, I mean, you don't necessarily need to spend the money. If you want to try the oral, I think you want to spend the money, you can try it. But yeah, the IV, I discourage people.

• 37:57Dr. Mary Claire Haver?

  Awesome. Dr. Anthony Yu and Tony, thank you so much for coming to UnPaused. You've educated our audience. I'm sure they're gonna rush out of here and go right to their drugstore and start picking out products and calling their plastic surgeons.

• 38:12Dr. Mary Claire Haver?

  To find out more about Dr. Yun and his products, go to his website, yunbeauty.com. You can also follow him on Instagram at Tony Youn MD or on YouTube at Dr. Tony. His newest book, Younger for Life, is available wherever you buy your books. I would love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepauselife.com. My new book, The New Perimenopause, is available now everywhere you buy books and through our website. If you're loving this podcast, be sure to click Follow on your favorite podcast app so you

• 38:53Dr. Mary Claire Haver?

  never miss an episode. While you're there, leave us a review and share the show with women you love. We would be so grateful. You can also find full episodes on YouTube. UnPaused is presented by Odyssey in collaboration with Pod People. I'm your host, Dr. 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.