10. Get the Best Skin Of Your Life After 40
The following is a transcript of this episode. It has been edited for clarity.
Intro: Let’s face it, our skin isn’t the same as it was when we were in our 20s. Yeah, it’s great that our life experience is reflected in those fine lines and crow’s feet, but sometimes we just want how we feel on the inside to reflect on the outside as well. If you love talking about skincare as much as I do, this episode is for you. Joie Beck, a San Francisco based nurse practitioner with 15 years of experience in medical aesthetics, drops by the more beautiful studio to talk about how our skin changes as we get older, and what products, procedures and beauty rituals can actually give you the best skin of your life. Welcome to More Beautiful, the podcast for women rewriting the midlife playbook. I’m Maryann LoRusso, and I invite you to join me and a guest each week as we strive for a life that’s more adventurous, more fulfilling, and more beautiful than ever before.
Maryann: Thank you so much for being here, Joie. I’m going to just jump right in and start with a question that has us all thinking. Aging is a very complicated thing, and many women have very complicated feelings as they start to see themselves changing in front of the mirror. Even if you’re not like a superficial person, it’s weird when that starts to happen, right? Why do you think that is?
Joie: Yeah, it’s a really good question. Aging, you know, it’s a complex process. And I think that, you know, for a lot of women that are entering their 40s and 50s, you start to see visible change, you know, of aging, but you may not necessarily feel that way inside, and it’s just kind of like a time of transition. And, you know, for a lot of us, it’s like, there’s career changes, and, you know, kids might be going to college, or you’re sort of like embarking on some new endeavor in your life, and, you know, your marriage or relationships…There’s just kind of constant change throughout the lifespan, but I think, you know, to enter the 40s and 50s, things really start to turn. And, you know, I think our generation in particular, you know, we have access to so many, you know, kind of like health oriented activities, and ways to feel really good inside, and we want to, you know, have that be reflected on an external appearance as well. And so I think when we start to see those little signs, you know, of aging, they may not necessarily correlate with how we feel.
Maryann: So there’s a little disconnect there. We’re not looking exactly the way we’re feeling. So tell us about some of the first signs that we might see in terms of aging skin,
Joie: Yeah, it’s mostly textural and, you know, tone. So I think you start to kind of see, you know, the manifestations of some of that sun damage that you incurred during your younger years. You know, and even if you were brought up to wear SPF, and you know, protect your skin, I mean, there’s still going to be some natural sunspots or, you know, little capillaries and things like that. Kind of the fine lines and wrinkles and some of the elasticity changes, you know. We start to see those deeper anatomical structures start to shift, our fat pads, you know, kind of shift a little bit. Our bones thin, and a lot of time we start to see that, you know, in our faces where things are a little, you know, saggy or droopy or wrinkly.
Maryann :I hadn’t thought about thinning bones, does that really happen?
Joie: Yeah. It’s just like the rest of the bones in our body, you know, from osteoporosis they can thin or become a little bit more fragile. And the same goes for, you know, our facial bones.
Maryann: Wow. I have to say kudos to those moms who did encourage their daughters to wear sunscreen from a young age. Mine never did.
Joie: Neither did mine.
Maryann: I don’t know if they even knew that sunscreen was important.
Joie: I don’t think it was a thing. I mean, maybe, you know, first couple of days on vacation if you were really prone to sunburning, but it definitely wasn’t like a habitual everyday you put this on before you leave the house.
Maryann: Right, in fact I remember my grandmother saying, go get a little color. You’re so pale.
Joie: Oh, yeah. It’s healthy, looks good on you. A little glow.
Maryann: I tell my daughter. She’s, you know, she’s 19. I’m like, wear that sunscreen starting now. And you know, youth does not listen, they don’t care. You know, when you’re young. You just don’t think about that or care.
Joie: Yeah, well, you know, you compensate for it. It’s easy to be like, well, it’s just, you know, that’s just my mom. Nobody listens to that.
Maryann: So since we’re talking about skincare in midlife, a lot of hormonal changes happen, unfortunately, during this time. How does that tie in to skin, what’s happening to us?
Joie: Yeah, so aging is mostly, I mean, there’s extrinsic and intrinsic factors, and you know, the extrinsic is what we kind of just covered and that’s, you know, sun damage, lifestyle, you know, diet, alcohol, smoking, all of those variables. Intrinsic are more related to our hormones, you know, progesterone and estrogen, and those decline, you know, as we age, particularly going into our 40s and 50s. And that’s when a lot of us start to notice, you know, those little subtle changes, not just in our skin, but you know, systemically as well. So there’s, you know, there’s hormone replacement therapy, there’s things that you can do, but it’s really kind of an inevitable process. And you know, that decline is tied to our collagen stores, which by the time we’re in our 20s start to decline by about seven to 10%. So, by the time you hit 50, you may have lost, you know, somewhere between 20 and 25% of your college.
Maryann: That’s a big number.
Joie: Yeah, it is. And so you know, that process is accelerated as we sort of hit perimenopause. And then menopause in particular, you know, those stores dramatically decline.
Maryann: Wow, and then tie that into, you know, the hormonal fluctuations cause acne for some women, too, right? Why does that happen?
Joie: With acne, oil production, kind of, you know, fluctuates a little bit. Again, there’s those hormonal sort of hiccups where you, you know, get little spikes in your estrogen and progesterone, or progesterone drops and estrogen, you know, you might be estrogen dominant. And so yes, you can start to see that in your skin where you really, you know, have little outbreaks but then you have wrinkles and dry skin sometimes, and there’s just a lot of ups and downs with that inconsistency.
Maryann: Yeah. And when you’re getting your period regularly, back in your youth, it’s like you know, those days leading up to your period, you’re gonna get a breakout when those hormone spikes happen. And then when you’re in perimenopause, it can happen anytime.
Joie: Yes, very unexpectedly. And obviously, always unwelcome. Like right before you have an event or something important to do.
Maryann: Of course, yeah, always. There’s a product that I like, Mario Badescu makes it, it’s buffering lotion or something. It’s great for cystic acne.
Joie: Oh, really? OK, good to know.
Maryann: It’s my go to when you get that like once in a blue moon, gigantic lump under your skin.
Joie: Good tip. Yeah, because there’s not a lot of topicals that really work, you know, with cystic acne. When you’re older, you’re also not regenerating your skin cells as quickly as you would be, you know, in your youth. And so when you get a really bad, you know, cystic pimple or some other, you know, blemish, you’re more likely to, you know, have pigmentation or that, you know, process of healing just takes forever and ever. So, yeah, having something on board that can expedite that process is really helpful.
Maryann: Wow, so much we’re going through. OK, so if we can accept the fact that our skin is changing, we have to probably think about changing up our skincare routine, right? It’s not going to be the same routine we had when we were 30.
Joie: Definitely, yeah. Definitely.
Maryann: So take us through kind of maybe a sample routine of what we should be thinking about and doing.
Joie: Yeah. I think going even beyond skincare is just, you know, at all ages no matter where you’re at, the basics is diet, it’s exercise and it’s you know, your antioxidants and et cetera, et cetera. I think those are like the foundation, but you know, aside from that, skincare through your early 20s and 30s…You know, a lot of times we’re using exfoliants or we’re using things to you know, minimize our oil production, and then as we age we lose some of that oil production and that elasticity. So really the best things, and everybody’s a little bit different, but the three that I kind of always rely on are your, you know, like your vitamin C’s, vitamin E’s, any of the antioxidant family is really important, especially during daytime because that helps minimize some of the UV damage that you’re just exposed to on a daily basis. And so you know, you pair that with your SPF, SPF is still kind of the gold standard for all ages. And then at nighttime, you really want to have a good retinol on board because you are regenerating. We’re trying to, you know, again, kind of expedite our regeneration of our skin cells since things have slowed down, and also the retinol family, you know, helps with collagen production, it helps with elasticity fine lines, and just you know, kind of like minimizing some of those hormonal breakouts that we might be having,
Maryann: I have a question about layering, because it’s so confusing layering products. Like if you’re using a retinol, can you use an oil or moisturizer with it and if so, what goes first?
Joie: Yeah, absolutely. If you’re using a retinol, particularly one if you’re getting a little bit of irritation, you know, which can unhappen as you introduce that into your skincare regimen, typically after about four to six weeks, you’re going to start regulating and you’re not going to be, you know, having that dryness or redness. But if you’re kind of having some dryness, you know, to start with, and you add that retinol in there, you can definitely layer that with moisturizer. And so it’s kind of like a sandwich as you put a very thin layer of moisturizer on you. But if you’re using a good medical grade retinol, then those molecules are going to be small enough to penetrate the skin cells through the moisturizer and reach their little target. And then on top of that, you can put another layer of moisturizer on.
Maryann: Can that be an oil?
Joie: Yeah, I don’t see why not. I mean, as long as it’s something that’s really absorbent and, you know, dries relatively quickly or you’re not leaving like a sticky film on your face.
Maryann: Right. And is it true that retinae is light sensitive? Do you put it on, like, right before you turn off the lights at night?
Joie: Yes. Yeah. So it is light sensitive. It’s because of the photosensitivity, and then also because a lot of our skin cells rejuvenate and regenerate at nighttime. And that’s kind of like the best time to have something on board that’s going to facilitate that process.
Maryann: Yeah, and the next day you have to really be diligent about your sunscreen. I once put the Retinae on, forgot I did that, the next day forgot the sunscreen. It was crazy.
Joie: You will burn it’s a bad, yeah, it’s a bad combo. So yeah, you definitely want to be mindful and try to be somewhat vigilant about, you know, using your SPF with or without your retinol family. But it’s definitely very important because you know, you are going to be photosensitive, and then you can burn.
Maryann: Yeah, and what about hyaluronic—am I saying that right—hyaluronic acid? That’s all the rage for moisture, right?
Joie: Yeah, it’s a great moisturizer. Basically, it kind of locks in moisture. So it tends to be more absorbent as well, it’s less of a…You know, some of the moisturizers that are really thick and heavy can kind of, you know, be like a film, or they can just feel really, really heavy on the skin. You know, they’re kind of meant to be a barrier to some degree and so they’re not really absorbed, like a hyaluronic acid would. So that’s something that your skin produces naturally anyway, so it recognizes that as something that’s, you know, basically, you know, an endogenous molecule and you know, absorbed really easily.
Maryann: And should that be treated like it’s a serum? Put on first?
Joie: Yeah, I think it’s best as a serum. The best formulations are generally the lighter kind of, you know, more serum or absorbent…You know, I think I’ve seen some other ones that are maybe blended formulas that are fine, but yeah.
Maryann: And could you double up on serums, like could you use a hyaluronic acid with a retaine? I’m reading that that’s like a new double whammy kind of recipe.
Joie: Yeah, you can. I mean, you want to obviously, you know, proceed with caution when you’re introducing anything into your skincare regimen because you don’t want to have irritation. Everybody has different, you know, sensitivities. And so I think it’s good to just go low and slow. But you know, there’s really no reason that you can’t blend those two.
Maryann: OK, shopping for a moisturizer I think has got to be the most confusing experience because there are so many out there. There are lotions, there are creams, there are people talking about peptides, talking about ceramides—is that how you say it? If you’re going to buy a moisturizer, what should you look for? Like how do you just distinguish between all those?
Joie: Yeah, the peptides are actually more of a newer, sort of, you know, approach to delivering a specific compound into the skin, I think they’re great, they’re typically present in a lot of our creams and serums that have growth factors and they have other compounds that are meant to, you know, again contribute to that regeneration of our skin cells and our collagen and elasticity, and support the texture. That being said, the ceremides have been around a little bit longer. Those are also really great, especially in terms of hydration. And so sometimes during the winter I’ll use more of a ceramide rich formula because I need that moisture barrier and I need a little extra hydration, and then I might transition to something a little lighter in the spring and summer, so that’s…I use my hyaluronic acid. But you know, I tend to mix and match and blend a lot and you know, obviously experiment quite a bit to just, you know, see what works and what I can recommend. But I do think fundamentally the ceramides are, you know, a pretty good thing to be using for your skin.
Maryann: Right, and we’re so lucky here in the Bay Area because we do have a lot of moisture in the air. If you go back east, you know, I was in Vermont last year and my skin was parched. It just wasn’t used to…
Joie: Yeah, anywhere. You know, the high desert or just, you know, higher elevations. You can go to Tahoe and all of a sudden that nice moist, hydrated skin is, you know, crepey and cracked and every little line is accentuated out there so, yeah.
Maryann: All right. So hopefully we’ll all be able to find a moisturizer this winter.
Joie: You know what, sometimes it’s just, you know, it’s the basics. You know, like CeraVe, I’m a huge fan. Any of my patients that come to see me, you know, I’m big on medical grade skincare in terms of, you know, your retinaes and your serums. You know, your vitamin C, and your vitamin D, and things that are, you know, really kind of evidence based and have the scientific backing. But I think for, you know, your basic cleansers and your basic moisturizers, you don’t need to spend a million bucks on those.
Maryann: So if you’re gonna spend the money anywhere, would it be with the serums?
Joie: Like, yeah, I think the serums and the, you know, the retinal or the, you know, the retinae, depending on what your skin needs. But those are worthwhile, you know, things to actually…
Maryann: Let’s talk about eye cream for a second. Should there be a separate eye cream and or neck cream? There’s like a product for every part of your body.
Joie: Yeah, so I never used to subscribe to that. But you know, the more that I learn obviously is that, yes, the skin around our eyes is really thin. It’s really prone to elasticity loss, and, you know, you really actually do want something that’s specifically designated for that area, because, for one, it’s not gonna absorb, or it isn’t going to behave maybe like our chin or cheeks. You know, even though it’s all congruent, it’s one skin layer. But I do think, you know, especially with some of the newer products that have come out that have those peptides, that have those growth factors, you know, some of them have, you know, like a retinal very, you know, mild percentage that’s included in those eye products. You know, and it also depends on, you know, what is your need? Do you do you have fine lines, is it more like shadowing, dark circles, hollowing, you know, there’s kind of a different thing for everything, but it’s kind of, you know, finding something that’s most appropriate for your skin, for your eyes. And then yeah, neck creams are kind of the same. That tissue is different than the skin on our face, our face has, you know, lots of, you know, adnexal structures and fatty structures, and the absorption is a little bit different. Our neck and our chest are a little bit thinner, and a little bit more delicate. And so I think, again, having something that’s actually designed to be able to penetrate those, you know, specific skin cells, and get through the layers and hit their target and actually do something that, you know, they’re they’re purported to do are really important.
Maryann: Good to know. I usually just take my moisturizer, you know, put it on my face, and whatever’s left on my hands, I smear it on my neck.
Joie: Yeah, which is absolutely fine, too. And it’s the same goes for, like, you know, your retinol or your serum or anything like that. Anything that’s benefiting your face is going to benefit your neck and chest too. But there has been sort of, you know, like, I would say, you know, last probably five or 10 years, there’s definitely been more products out that have been a little more sophisticated than just your typical moisturizer that are designed for those areas.
Maryann: And do masks work, or are they just like a pampering thing?
Joie: I think masks are great. There’s all kinds of, I mean, there’s a million different masks out there. But, you know, again, you can go for something that’s really hydrating, when you’re dry, there’s masks that have hyaluronic acid, and basically it’s kind of like a little mini infusion, and I think if you’re using something that has, you know, some active ingredients, then you’re gonna get the benefit of that.
Maryann: But do masks deliver the active ingredients in a way that’s more effective than just putting on you know, just a topical?
Joie: Some of them do, they’re more sort of like a short…I consider them kind of like a short term, you know, quick fix. So if I’m feeling just a little congested or I’m, you know, a little just oily, I might use something that has some clay or that has some some other kind of like more detoxing ingredients in them and then likewise, if I’m really dry and you know, crepey, then I might have something that’s a little bit more moisturizing and kind of goes back to those peptides. So, I do think, yeah, there’s definitely some things that can, like, infuse to a certain depth in the skin. It’s not going to get down deep into those structures that you know, where those elasticity and volume issues lie, so you’re not going to solve that with a mask.
Maryann: Too bad. We want that fix, right?
Joie: Also for exfoliation. Exfoliation is the other thing that I think it’s really important not to overlook, because we have quite an impressive buildup of things on the top of our skin. There’s like dead skin cells and just, you know, things environmentally that we pick up and so I think to have something that you know, can brighten and tone and you know, tighten the skin as well as just exfoliate is really important. And you can get those with a really good facial also, but you can also, you know, do a good amount of correcting at home.
Maryann: Right, I’m glad you brought up exfoliation because if you’re using retinae, that is a form of exfoliation, right?
Joie: It is, yeah.
Maryann: Can you use other types of exfoliation, if you’re using retinae?
Joie: You can, you can definitely. It’s always meant to be used judiciously, so it’s not something that I would recommend using every day, particularly if you’re using something that has, you know, alpha hydroxy or glycolic acid, because those are a little bit more potent, and we don’t want to strip the skin of its moisture barrier and have issues with dryness or rebound acne or other things. Definitely a couple of times a week, I think it’s fine, you know, in conjunction with your retinae.
Maryann: OK, and for those of us who can’t use retainae, because their skin is too sensitive, or they get too dry and peely, what’s like the next best type of exfoliation? Would you say the alpha hydroxy?
Joie: Yeah, alpha hydroxy, glycolic acids, you know, there’s different formulations. There’s pads, there’s serums, there’s all kinds of formulas out there that you can use, so there’s definitely something for everybody.
Maryann: So many products. All right, so moving away from topicals, we have the topicals down now, what are some other things that we could do to help our skin at this stage in life? That are, you know, within our control?
Joie: Yeah, there’s things like collagen, which, you know, up until recently, I don’t think really had a good amount of evidence that supported, you know, the efficacy. I think if you find a product that actually has…the ingredients are formulated in a way that you can actually absorb and, you know, benefit from those, I think they’re great.
Maryann: Are you talking about drinks?
Joie: Yeah, yeah.
Maryann: There’s no topical collagen?
Joie: No, yeah. You need something, you know, because the acid in your stomach, a lot of times will break down, you know, the proteins and amino acid chains, and so you’re not always absorbing what you think you might be absorbing. So, you know, I think with some of the newer collagen powders, those actually are formulated to be absorbed, at least some, you know, some degree. So, you know, some people find those really helpful. I was a little bit of a skeptic up until about a year ago, and then I started using one that I really like, and I do think I see, you know, a difference.
Maryann: It definitely softens, and I feel like some people say they swear by it for their joints. Right?
Joie: That’s what I was going to say is, yeah, I think for you know, for joint health, as well as just, you know, skin integrity. And, you know, I definitely think there’s something there. I think that there’s enough evidence that supports those claims, whereas before, I did not really subscribe to that.
Maryann: Yeah, Jennifer Aniston is doing ads for one of those big companies, knowledge and power, she is the name of it. So what about good old fashioned rest, you know, sleep, water?
Joie: Yes, those are always, you know, number one. That’s always, you know, the foundation. So aside from any products or procedures that you can do, I mean, that is really the most important. Because if you’re not, you know, if your diet isn’t balanced, if you’re not hydrated and sleeping—you know, sleep is just the number one restorative and regenerative thing that we can do for our bodies, none of the other things really matter that much, or they’re not going to be as impactful, you know, they’re all kind of like, meant to go together. And I think with skincare and procedures, it’s like, you know, rest and diet and exercise, and being outside and being mindful, you know, whatever that looks like for you. I think, you know, it’s kind of the foundation of the house and anything else is like trim, or it’s, you know, a little paint here. I mean, it definitely contributes, they all can go together for the big picture, but yeah, it’s really, you know…Particularly I think, as we enter our 40s and 50s, and sometimes we don’t sleep as well, or sometimes you’re busy and, you know, going through your day, and you’re not always doing self care and making sure that you’re hydrated and you’re well nourished, and you really start to see the effects of that much more.
Maryann: Right. And sleep, I mean, sleep itself can be an entire episode. We’re going to do one on sleep, because there are so many sleep disturbances that happen in midlife. So it’s really important to, like, figure out how you can get that good night’s sleep, right? Which for me means like, no more wine. Yeah, you know, after like one glass of wine, I cannot sleep.
Joie: Yeah, yeah, I think that’s true for a lot of people where that wasn’t, you know, maybe the case 10 years ago, and it’s very unfortunate because I love wine.
Maryann: And just one more thing we have to give up.
Joie: I know. It’s not fair.
Maryann: It’s not fair. So what if you’re doing all of this, right? Like you said, you’re exercising, you’re drinking water, you’re taking care of yourself, you’re well rested, you’re using the right products. But it’s not enough. You look in the mirror and you look tired, right? You don’t want to look tired, because you’re not tired. What’s the next step?
Joie: The next step is really the, you know…Tthe least aggressive, least invasive, you know, approach is first. So we kind of start off with what, you know, what is it that you’re seeing? What is different, what’s bothering you? Sometimes we look at pictures, sometimes we just, you know, sort of talk about the process. It’s really important to me that, you know, women, people that come into my clinic, I want them to feel really supported when they come in. And I also don’t want them to come in with like, a laundry list of things that they hate, or that bother them. And, you know, it’s really important that we kind of identify like, what is it that you feel good about? What are your best features? And, you know, what do you like about your skin and your face? And we kind of work from there, and we build on that when we’re sort of creating a treatment plan, versus just, you know, someone coming in, like, I feel like I look tired, I have bags under my eyes. Well, here’s what we can do for that, you know, it’s more of a holistic approach, and really kind of like looking at the big picture.
Maryann: I like that. I like starting from, what do you love about yourself? That’s a great start.
Joie: Yeah it’s the most important, especially because I think, you know, as women, a lot of times we’re conditioned to kind of be like critiquing ourselves and sometimes critiquing others. And, you know, a lot of it is just appearance based, and I think we need to sort of move beyond that and dig down into the big picture. And, you know, part of that is really identifying the positives, and what do we want to build on, and then we go from there.
Maryann: Because most of the time, I feel like women don’t want to change, they just want to be refreshed. They want to be the best versions of themselves.
Joie: Absolutely. Yeah, I think they want their external appearance to reflect, you know, how they’re feeling internally. Which is really, really important too. So yeah, we just kind of take it really slow. Especially if you’re new to some of these procedures, it’s always really conservative, and we kind of build, you come back, let’s talk about, you know, what are the next steps, what can we do? Sometimes we’re going to continue with our skincare regimen, and we’re going to work on some other things, you know, our sleep or things like that. So it’s not necessarily a segue into, you know, procedures.
Maryann: Right, that’s what I love about you. You don’t push anything, you’re all about being natural, natural beauty and bringing out the best in yourself. I love that. If, you know, there is a procedure that kind of fits with what a woman is looking for, like, can you take us through some of the most common ones?
Joie: Yeah, so probably the most common procedure that I do on a daily basis is something like Botox, and at this point in time, I think it’s a somewhat underwhelming procedure, just because it’s been around for a really long time as a great safety profile. It’s very, you know, effective at not just addressing lines and wrinkles, but sometimes softening or muting certain things, little fine lines. Some people really have some very, you know, deep etched in, you know, wrinkles, or there’s something where they’re just like, I feel like I look really angry, and I’m not, or…
Maryann: No one wants to look angry.
Joie: No. You know, the frown lines and things like that. And so, we start…You know, again, we don’t jump right into Botox. I usually give a little bit of an overview of what your options are. You know, I think Botox probably works the best in terms of kind of, like having more immediate effect in the wow factor, you know, as well as having some preventative benefit, also that’s a big one. And it’s not that, you know, you need to do large volumes, or you need to try and erase every wrinkle because that’s not the goal. It’s really, how can we just minimize things a little bit, you know, just so you feel like you are refreshed. So you feel like you know, you don’t see those angry lines or crow’s feet or things like that.
Maryann: You soften it up, right.
Joie: You know, smiling a lot. We don’t want to take that away, it’s really important that we preserve that range of motion and expression and that people are still able to be animating.
Maryann: What’s after Botox? Is there something else that people request a lot?
Joie: There’s a lot. If you’re gonna go and dive a little bit deeper in terms of, you know, skin texture and tone, which you talked a little bit about earlier—if there’s some sun damage, some crepiness or elasticity, then it is kind of, you know, a segue into laser therapy. You know, there’s things that can lift or correct sun damage, as well as some fine lines and wrinkles and just kind of make things look a little bit more plump and smooth. So that’s probably, you know, one of the most common things that we do, especially in the wintertime because we’re not exposed to the sun, which is inhibitive to treatment. And then there’s things like fillers, where we’re just trying to recreate a little bit of that natural volume. Particularly things like the cheeks where, you know, again, our fat pads and our bones might thin, so we’re trying to organically replace a little bit of that volume that we’ve lost. And by doing that, a lot of times, you just see a little subtle lift or things maybe aren’t quite so heavy around the mouth, or the jowls and under the eyes. So there’s some specific techniques and approaches that we can take to that. And I really like fillers, I like the fact that they’re composed of hyaluronic acid, which, again, are something that our skin is also, you know, made up of, and so you’re introducing something into the body that’s naturally there anyway. So I feel like when it’s done correctly, it can be really integrative and kind of soften things. So a little bit more long term, or there’s more longevity than there is with Botox. Fillers are designed to last anywhere from six to nine to, you know, up to two years, at least the hyaluronic class. And then there’s other things like collagen stimulators that you can use also.
Maryann: I know the thing that I think most women are afraid of is the fillers, because we see so many examples of fillers gone wrong.
Joie: Yes, yes, there’s many.
Maryann: So if you’re gonna do that, how would you go about, like, finding the right person for that?
Joie: Well, you can look at, you know, the clinicians face, whom you are seeing. I think that is a really big indicator for what their aesthetic is. And I think if you do a little research, you know, a lot of us talk to our friends, or who did you go to and, you know, there’s all kinds of forums, there’s Yelp and things, you know, ways that we can get information. And I think you can kind of get a sense of who’s treating you and what is their aesthetic, but it’s really the conversation. That’s most important, and having that initial consultation and having you know, that trust, before you ever even embark upon the actual process, the procedure.
Maryann: It is like an art form. I mean, someone is actually sculpting your face. They have to be talented.
Joie: Yeah, definitely. It’s just not something, you know, it’s not as simple as just sticking needles in tissue. There’s a lot of technique and a lot of, you know, subtleties. And then also, you know, we really want to be prepared for complications and know how to be with somebody that can manage those, that really understands the ins and outs of being able to address them.
Maryann: That’s too scary for me at the moment.
Joie: Yeah. There’s no need to even go down that path right now.
Maryann: So going back to the lasers, there’s so many different types of lasers. I think it’s very confusing for the average person to decide, you know, which laser do I need. Obviously, their nurse practitioner or doctor will recommend specific lasers, but can you take us through just some of the most common lasers?
Joie: Yeah, so probably the most common device is the intense pulse light, which is not actually a laser, it’s a light therapy, and that basically functions on pigmentation. And so it is designed to target red and it’s designed to target brown, which are the two most common pigments in our skin. When we’ve had a little bit of damage or a little bit of aging, you know, we see some broken capillaries, we see sunspots, you know, a little freckles, or sometimes just some pigmentation after having acne or other things. So…
Maryann: Our life, basically, on our face.
Joie: Yes. That is really impactful in terms of evening out the skin tone. So that really makes a big difference in somebody’s overall appearance, more so than Botox or fillers or any of these other things just because, you know, going back again to sort of the foundation of the house, if the skin is fresh looking and things are even and toned, then there’s a more youthful appearance that just kind of naturally comes with that. As well as just, you know, being corrected, because a lot of us do have little broken capillaries or you know, some people have conditions like rosacea that are really just inhibitive to feeling self-confident or socially…
Maryann: And rosacea is tied to hormone changes too, isn’t it?
Joie: Definitely. Yeah, absolutely. The estrogen and progesterone fluctuations or diminishment can really precipitate rosacea sometimes in older women. So…
Maryann: Right. Is there an order of doing these things? Like say you want to obtain skin clarity as well as, you know, take care of wrinkles. I mean, should you tackle one first?
Joie: Yeah, that’s my philosophy, is always, you know, start with one start. Because it becomes really overwhelming when it’s just like this, this and this, you know, bothers me, and I want to erase this and I want to you know, do that. Because if you start gradually, a lot of times you don’t actually move on to that next procedure that you thought maybe that you are going to need. If you have an IPL or, you know, sometimes you just have a really good facial, maybe with a chemical peel, you feel really good about your skin and just your appearance in general. And I think, you know, that confidence often carries over into not really moving on to that next procedure.
Maryann: I can see that. Would you say that tackling skin clarity would be a good place to start? Because if your skin is clear, it just sort of opens up a whole new world for you, you know, your face just looks so much more youthful.
Joie: Yeah, it does. It’s really just sort of that refreshed appearance. Some of those little, you know, blemishes and sun damage, and, you know, redness, can really detract in a way that you probably didn’t envision prior to taking on that procedure. And when those have been clarified, then a lot of times, we do feel much, much better. And those little wrinkles maybe aren’t so bothersome, or you don’t care about certain things. So I think that’s another benefit to it. But if you’re somebody that’s coming in, and you just are blessed and have this beautiful skin, but there’s some wrinkles, or some lines, maybe there’s some laxity, there are other things that we can do to kind of, again, create that refreshed appearance.
Maryann: Right. Is there anything new that’s coming on the market, like any up and coming treatments or topicals, or anything that you’re excited about?
Joie: There are new things that come out every day, just about, and I’m not excited about any of them until they’ve really, you know, been tested and withstood the test of time.
Maryann: I like that. You’re conservative about that.
Joie: There are things that, you know, seem really promising and are almost too good to be true, and they usually are. I think most of the technology that we’re using today obviously has gone through upgrades. Just like any other piece of technology, it becomes better and better with each generation, but it also has a really good, solid clinical background behind it and has been vetted and we all know it works.
Maryann: Would you put those trendy facials, like the Vampire Facial, in that category?
Joie: Well, the Vampire Facial…It’s the name, I think, that’s just…It’s somewhat ridiculous. I think the procedure that actually, you know, with using platelet rich plasma and either doing micro needling or…
Maryann: Not as sexy saying, I’m gonna get a platelet rich plasma facial.
Joie: Exactly, it’s not. Yeah, Vampire Facials sounds, you know, much more exciting. And, you know, I think it was the Kardashians or somebody that went on Instagram…
Maryann: Of course it was.
Joie: That just sparked off, you know, a lot of interest. But, yeah, I mean, that in and of itself, that procedure is I think actually somewhat helpful and has its benefits. It’s actually been around for a really long time. If you talk to any of the dermatologists here in the city that have been around for a long time, they will tell you that, you know, they were using PRP back in the 70s.
Maryann: Oh, I had no idea.
Joie: Yeah, it’s had its cyclical popularity, and I think now more than ever, because I think we are so much more advanced in terms of our anti-aging procedures and things like that. It’s enjoyed a resurgence and probably like a rebranding, obviously.
Maryann: Right. There’s so many things. I mean, we could talk for five hours, but what about microdermabrasion? Is that effective?
Joie: It’s great for, you know, exfoliation or if you have some congested pores and blackheads. I think yes, it’s a really good…I consider it more kind of, you know, like, superficial. You know, skin issues, again, going back to kind of, you know, a little little congestion. It pairs well with just, you know, your kind of like really good clinical grade facial where they’re doing some steam and exfoliation and, you know, some other things. It’s a really nice adjunct, so I really really like it. I think it brightens the skin and I think it just makes everything look much fresher.
Maryann: That’s cool. So, I’m sure you’ve heard about these Korean skincare routines, like what is it, nine step, eight step, 500 steps—I don’t know, one of those. And I’m not going to do that. I know people are adding more and more steps, I feel like, to their beauty routines, and it’s crazy. Who has time for that? If you’re gonna recommend a regimen to a busy woman, like we all are, what would you say are the top things you should do, you shouldn’t skip, maybe one or two extras if you have a little bit more time one night?
Joie: Yeah, I think it’s, you know, cleansing your skin. You know, take your makeup off at night before you go to bed, we’ve all been told that. And then just going back to our earlier conversation about the basic products, and just trying to be as consistent as you can with two or three things. If you have two or three things on board that have a good amount of active ingredients and are actually effective, you’ll see a difference within four to six weeks. You’ll know if something’s working for you. You may not see anything, you know, really profound, but you’ll start to see small changes, just pore size or brightness. You know, so I think that’s really important. It’s just to keep it as simple as possible. If you have time for a nine step regiment, great, good for you. I don’t, I don’t have the patience for that either, so I’m not going to do that. I’m not convinced that there’s, you know, a ton of benefit to be had by doing all of these extras. That may change down the road. But I think there’s a lot of great products out there. And I think, you know, if you just find something that’s going to work for you and then you keep it, you know, as minimal as possible, that’s always the best.
Maryann: The ones I’m most confused about are the toners and those hydrating sprays. You know, they keep coming and going in fashion. And you just never know, like, are they really working? Because they feel like water on your skin.
Joie: Yeah, I mean, toners, to some degree, it depends. If you’re using a toner, toners are really just kind of meant to neutralize the pH of your skin. But if you have a toner that has, you know, alpha hydroxy, or glycolic acid in it, that’s great for exfoliation. Or if you have acne, that’s a nice way to kind of clear things up. They’re not meant to have much in terms of, you know, really active compounds in them. I’m a little bit on the fence about toners. I don’t think that they’re critical to your skincare regimen. If you want to use them, if you have one that you like, they’re not hurting anything. Maybe they’re benefiting for certain people, but it’s not something that I consistently recommend by any means.
Maryann: Do you remember—I don’t know if you’re old enough for this, probably not—but do you remember 10.0.6 lotion?
Joie: Yes, yeah.
Maryann: Do you remember that? I think it was Neutrogena, or…I remember like back in the 80s, that was like the bomb. That was the thing you had to have for sure in your medicine cabinet.
Joie: For sure. Yes, I wonder what happened to that.
Maryann: And Noxzema. You know, people talk about how toxic that is. But honestly, I never had a pimple in my entire adolescence.
Joie: No, a lot of people swear by that. And the smell, I can still smell that.
Maryann: I know. Was it aloe? Or was it mint?
Joie: It was mint. Eucalyptus, almost. I can’t remember exactly what it was.
Maryann: And there was just something so satisfying about it being so thick and just covering your face.
Joie: Oh, yeah. You felt like it was doing something.
Maryann: Right? We’re going to see their stock go up tomorrow. Has anyone ever bought that in the last 10 years?
Joie: I don’t know. I don’t even know if they still sell it, I’ll have to go look.
Maryann: I’ve seen it. I saw it at 7-Eleven.
Joie: You’re kidding. Oh, that’s amazing. I might have to get some for nostalgia, so I can smell it.
Maryann: I know, I know. Oh my gosh. I know what I wanted to ask you. If a woman is having a lot of hormonal upheaval, and she just can’t get it under control with all that she’s doing in terms of, you know, skincare, should she see a doctor? Because maybe is it like a hormonal thing that requires medication, HRT? I mean, that’s a whole other story. But when do you know, like, go to your doctor? At what point?
Joie: Absolutely, yeah. I think that if you’ve kind of transitioned into a place where nothing that has worked for you before is working, then yeah, I think it is time to have that conversation. Because there’s a lot of information, there’s a lot of things that I do think are beneficial that you can do without medical intervention, but there’s a point when you really do need to have that conversation. And whether that looks like HRT, or it looks like some other medication or some other intervention, there’s definitely some merit in seeking out help.
Maryann: Yeah. And as a nurse, do you see any links between diet in perimenopause and skin?
Joie: Yeah.
Maryann: You do? What are the culprits? Dairy?
Joie: Yeah. I think it’s just the inflammatory foods, it’s dairy, it’s gluten. For some people, it’s also yeast and alcohol and, you know, things like that. So it really becomes a process of elimination, where you’re having to kind of go through your diet and go through the things that you are ingesting, and really see what’s not working for you.
Maryann: I did an elimination diet last winter. I did a three month long one.
Joie: Oh, wow. That’s a long time.
Maryann: But it was so helpful. So helpful. I didn’t know I couldn’t eat nightshades.
Joie: Yeah, that’s the other thing. It was like, the inflammatory foods, which I hate to talk about, because I love the nightshade plants so much that it makes me just, you know, causes me a lot of pain to think about not eating them.
Maryann: Emotional pain.
Joie: But, yeah, I think diet is huge. And especially with inflammatory conditions like rosacea, you know, or eczema or other other issues like that, I think a lot of that does go back to how you internally process those things. And not everybody can.
Maryann: Right. It’s such a bummer. No wine.
Joie: Bread. I know, all the good things. Yeah, it’s devastating.
Maryann: It is devastating.
Joie: But there’s always substitutes, you just kind of have to find something that resonates with you and you know, makes you happy to eat it. And it’s good for you. There’s a little bit of change that you have to implement, and that usually pays off, you feel better. You know, your body feels better, your mind feels better, you have more clarity, and then obviously, you know, everything else. And then your external appearance looks better.
Maryann: It’s so true. I remember working with a woman many years ago in New York, and whenever there was candy circulating around the office for holidays, whatever, she would say no, I don’t eat sugar. And she was 25 at the time, and we’d say, why? And she goes, it doesn’t make me feel good. And that’s stuck with me. I always say that to myself, like will this make me feel good? And if it doesn’t, it’s not really worth it.
Joie: Yeah, it’s a great question. I think it’s just really easy to sort of just default into, you know, one isn’t gonna hurt, or this is just a little bit. But, you know, it becomes habitual.
Maryann: And we want to feel good. When it comes down to it, we want to feel good.
Joie: Absolutely. It’s most important. So much more than even, you know, anything else, I think is really just feeling that energy and light.
Maryann: Yeah, well I have to say because no one can see you in the studio, but Joie’s skin is glowing. She has amazing skin, so…
Joie: Thank you. I did not always. I had a lot of acne and a lot of issues, you know, in my 20s and 30s because of hormones, and I didn’t know how to manage things and I did eat a lot of inflammatory things.
Maryann: We didn’t know. We didn’t know about that stuff.
Joie: No, we didn’t know. There’s so much information now and it’s just amazing. I feel like so fortunate to be coming into, you know, this time in my life kind of armed with a really good amount of information and things that I can do to minimize just…
Maryann: I mean, we were told sugar was OK, fat was bad.
Joie: Oh, yeah. Everything was non-fat. Like non-fat cottage cheese, disgusting.
Maryann: And margarine.
Joie: Yeah. Oh, disgusting. Terrible.
Maryann: I don’t miss that era.
Joie: Diet soda, ugh.
Maryann: Right. Oh, yuck, I can never drink diet soda. I hate it.
Joie: No, never. Awful, awful.
Maryann: Well, thank you so much for doing this, Joie. We learned so much!
Joie: Thank you for having me!
