Skincare & Aesthetics 101: What Actually Works for Your Skin with Stanford-Trained Plastic Surgeon Dr. Sarmela Sunder

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What is your high maintenance to be low maintenance routine? Okay, she's already dropping facts. This is already so helpful. Yeah. I had no idea. Okay, you just saved us $2,000. I'm Shari. I'm Jean. I'm Sharma Le. And where are the tiger sisters? We are your Wall Street and Silicon Valley big sisters. And we're a top 10 business podcast bringing late-night sister talk meets boardroom strategy. Hi, tiger fam, welcome to skincare and aesthetics 101. Every time I open Instagram, I feel like there's a new hot take on skincare, aesthetic procedures, and aging. It can be super overwhelming because it feels like for every single decision, there are hundreds of opinions out there online. Luckily, we are joined today by Dr. Sharma LeSunder, who is a double-board certified plastic surgeon based in Beverly Hills, who studied at John Hopkins, Cornell, and Stanford. And she is here with us today to separate beauty myths from science. Today, we're demystifying it all, skincare, Botox, micro-needling, lasers, and more. We're going to find out today what actually works, what is marketing, and what is right for you. We are so excited for this episode because Dr. Sunder's philosophy is all about helping people feel more informed and feel like the best version of themselves, not like a different person. So, quick note, before we get into it, this episode is educational. We are not saying and would never say that anyone needs Botox, surgery, or any sort of aesthetic treatment to look beautiful or age well. We are here to help you understand the options, ask better questions, and make informed decisions for yourself. All right, let's get into it. Sharma Le, welcome to the Tiger Sisters podcast. I'm so excited to be here, thank you. Yay! Yay! Dr. Sunder, we have some icebreakers and we want to get into some hot juicy topics. What's the beauty treatment you think people are overdoing right now? I think one of the treatments that people are just overdoing is filler, and nicely, I think we're trying to come off of that trend a little bit, but there's still a lot of overdone filler out there. Okay, we're going to get into that later. We have a ton of follow-up questions, but I'm glad we're starting there. All right, she's setting the scene, setting the scene, okay, filler. The other thing that I'm seeing a lot of is on the opposite end. There are people that are doing surgery too prematurely, so I think that's the flip side of the coin, and I think a lot of that has to do with messaging on social media. So on one end, you hear a lot of fillers are bad, fillers are bad, so people are swinging completely the other direction, going to surgery prematurely, and then you're seeing the flip side of it as well. I'm totally getting all of that content on social media, like everything about many face lips and how that's the best way to stay looking like yourself and people are saying you should do it as early as in your 40s, I'm like, what, okay, so we'll get into that too. And so we also want to ask, since you brought up social media, we can be quite interested and influenced by the things that we see as we're scrolling. Like what are some, I guess, guardrails or things that we can tell ourselves as we're scrolling and we're seeing people talking about these topics? Yeah, I think it's really easy to get stuck in this like echo chamber of information because once you engage with one video, even if you don't necessarily agree with the information in there, you're going to be fed similar information. And then you hear it over and over again, and then your mind kind of starts playing tricks on itself and you think, well, maybe I do need this surgery or this procedure. And I think it's really important to level set every once in a while and say, okay, this is just information for me to process and perhaps research and think about whether it's a good fit for me and really break it apart in that way rather than just taking it at face value. Yeah. I need to stop the doing scroll at like 11 p.m. before bed and I'm like seeing all these cosmetics procedures and I'm like, oh no, I'm spiraling so I'm good to get out of that. What is one beauty trend on TikTok that makes you want to scream? I would say overusing LED masks. Oh. What? I was not expecting it. Wait. This is a hot tape. Yes. So LED masks, I mean, there's so much I could say about that, but LED technology, a lot of the masks are just a waste of money. They're not effective. And for it to be effective, usually you need a certain number of lights. You need them space certain way and they need to pulse and there's all this, all the metrics that goes into it. So a lot of the ad home devices really aren't effective. Secondarily, even if you had one that's effective, it's not safe on all skin types. So most of these devices aren't tested on skin types 5 and 6, so I'm 5 and 6 or I'm 5. So I don't think a lot of people who are skin of color should be using these devices because not only are they helpful, but sometimes they can be harmful if you're not the target population. Then people that have, are that are prone to hyperpigmentation, people with malasme should not be, should not be using LED masks. So I see a lot of, yeah, I see a lot of patients who have malasme and they come in and they're like, oh, my malasme's just gotten worse this year. I'm doing the sunscreen. I'm trying to stay away from heat and then we'll kind of go down the list of things that they're using and the LED mask will pop up. So that is, you know, I think a lot of people use it thinking it's going to help them. And in a lot of scenarios, it's not only not helping, it's actually hurting you. Oh my gosh. So my journey, what the LED mask is that a few years ago, I bought one from the Nordstrom anniversary sale and I tried it on one time, but it was too heavy and it was like pulling my face down so that I returned it. Yeah. So I never ended up using it. Yeah. But what about the panels? So the panels, so for example, in our office and a lot of medical offices, medical offices, they have these panels that are appropriately calibrated. And those are what a lot of the FDA trials were performed on. And so those are effective. But the ad home ones, especially the really small ones, there just aren't enough LED lights on there to affect the change. So I see. Yeah. I have a really, really tiny one. It's like a handheld and it's like about this small. Yeah. And if you're figuring out that probably is in that category, we're so tiny that it's not really doing anything except for maybe guashong my face. Yeah, exactly. Exactly. But I want to get one of those like larger panels that, okay, this is me also influenced my social media, but I should wake up and sit in front of my large LED light panel for like 10 minutes when I get up in the morning. But it sounds like that might be closer to the effectiveness that we're looking for rather than the face one. Yeah. But then you have to know your own skin. If you're likely to get melasma or hyperpigmentation, it could do more harm than good. Okay. Yeah. Well, I think you just saved me $500. Or however many. Yeah. No, those are the pounds, the pounds are expensive. Yeah. Yeah. Well, the face masks are a little bit more affordable, but if they're not working, yeah. And you know, all the studies on these master or all the studies on LED light really has to do with inflammation and healing. So if you're trying to heal from something, sure, or if there's inflammation, sure, it'll help. Every day life, we're not walking around inflamed, right? Or at least our skin isn't walking around inflamed. And so I don't really know if there's really that much value in it for that amount of money you're spending on it. Yeah. Okay. She's already dropping back. Yeah. Yeah. I had no idea. Okay. You just saved us $2,000. Here we go. Let's back up a little bit and start from the foundations. We want to talk about Botox. So the first question is, what is preventative Botox? Should people in their 20s be considering it or is it just marketing? So preventative Botox in its purest form, what it means is if you are intended to get a line in a certain area, doing Botox to that muscle could prevent that line from developing sooner than it would have originally developed. And so that has more to do with your anatomy than age. So for some people, that line can form in their 20s and for other people, it's not going to form until they're 50s. So if you were supposed to get that line in your 20s and you start the preventative Botox, maybe you're going to push it to that. your 30s. If you were supposed to get in your 50s starting Botox in your 20s really isn't going to do anything, right? You know whenever people ask me when should I start Botox a good example is I tell people you know if it's if you're worried about your forehead go ahead and raise your forehead keep it there for about a minute and then relax. If you have a line in your forehead after you relax it even for you know for five seconds that means you're eventually going to develop a permanent crease there and so now is this time to start doing Botox to prevent that line from becoming permanent but if you do that and there's no line you know even for a few seconds and you don't have to treat it just yet and try again six months later or a year later and at some point there will be a line that shows up so then you can do it to start preventing that line from setting it. So for some people I mean I've definitely seen patients where they're in their mid-twenties and they have creases in their skin and that could be age-related it could be lifestyle related it could be history of smoking vaping whatever it is and so for those patients starting in their 20s makes sense but for the vast majority of people I think you want to start probably in your 30s and then I've had patients who I mean I saw someone last month who had never done Botox she was in her late 40s and I was like yeah I don't think you really need to start it now give it another year or so so it just really depends on the patient yeah. I feel like the other thing that I've been hearing a lot is the term baby Botox and that gets conflated with preventative Botox all right but baby Botox is kind of just I'm thinking it's kind of just a marketing term for people to be like I just got baby Botox exactly so baby Botox baby Botox is one amount exactly it's just a smaller joke and I think for a lot of people it makes them feel better that they don't have to do large amounts of Botox or it seems like it's an entry dose as opposed to a full on dose but I think you should do the dose that that's going to work the best for you you know there there are people who need 4850 units to the upper face and then there are people that need 50 units for their entire like neck and face and if you under treat you're actually not helping things because you're not really treating the muscle to its fullest extent so long term you might actually be hurting things so I would say don't don't get fixated on the number too much just allow your as long as you trust your injector allow your injector to dose you appropriately okay so you just touched upon the other topic that I wanted to bring up which is that I feel like historically Botox used to be really focused on sort of spot treatment and everyone was like oh getting Botox in your forehead to prevent the forehead lines or like the elevenths but now there's a whole new kind of philosophy of treating the whole face right and getting Botox is not just for one area it's to kind of there's the term facial balancing I guess and then there's also the wrinkles either right exactly a holistic application so can you tell us a little bit more about that yeah so exactly when Botox first came out it was actually came out for medical indication not cosmetic indications but for when it first came out for cosmetic indications it was just targeting lines right cross-feet lines and globular lines which are the angry elevenths and now we use it much more artistically I would say so you can actually shape the face using Botox so people get it in their masseter to slim the face or to make it look a little bit softer you can also use Botox to impact other muscles that aren't being injected for example you can inject this area and this area so you can inject in between the brows and around the eyes to allow the forehead muscle to relax or you can treat the DAO to keep your lower face from turning into like a more of a pulled look or like pre-jowling things like that so you can actually weaken a muscle to allow the lifting muscles to get stronger so you can use it a lot more artistically than we were 20 30 years ago I don't know if you've seen this but recently a podcast host comedian Hannah Berner from Giggly Squad was injected I think in her jawline somewhere and it like froze her face and she couldn't smile all the way so there's been like a ton of clips of her like kind of like this where she's like trying to smile or when she's like laughing she's like and like it's become this whole thing yes so that that's been sent to me a few times and I think I'm I might not have the facts completely right but I think she got masseter Botox and what sounds like happened is there's a muscle called the Rasorious Muscle which pulls your lip corners to the side when we smile and that sits right in front of the masseter sometimes it could be a little bit of overlap but it sits right adjacent to the masseter so Botox that's injected into the masseter could drift into the Rasorious and then that could impact that muscle from moving so it can limit how much you smile or how wide your smile is so it sounds like that's what happened to her yeah and she's waiting for it to fade now I think yeah unfortunately you know for fillers we have a way to reverse it Botox there's just no way to reverse it yet and so you just kind of have to wait it out there's things you can do to hasten the process but for the most part you just have to wait it out yeah can you sweat out Botox I've heard maybe it's like their size a little old white tail sauna so there is some evidence and it's not very strong evidence but heat to the muscle can make the Botox effects go away sooner and sometimes vibration or friction so I've had patients where I've advised them to use like like a mechanical like a buzzer or a like an electric toothbrush use the opposite side of it and hold it on to the muscle and sometimes I can speed up the the effects of the Botox I never knew that yeah if there's you know if there's ever a time when you feel like the Botox is too strong or you want it to come out sooner those are things you can try like heat to the area or friction vibration cool and so going off the topic of like injectors and people who maybe are injecting the Botox are there things that we should look out for like for example if we go to a med spa like should there be questions that we have ready to ask them to suss out whether the injector is qualified or someone that we would trust with our face yeah so now in the US and depending on the state there are different types of professionals that can inject so in California yeah in California a physician MDDO and that could be you know a dermatologist a plastic surgeon it doesn't even have to be someone that's trained in aesthetics so it can be a gynecologist it could be a medical doctor a dentist a dentist yes so and then nurses physician associates really anyone can inject as long as you have one of those degrees and so that means that if someone got their degree on Friday like they're nursing degree on Friday they can theoretically start injecting Monday without having any proper training or instruction on the muscles and how they're what their interplay is like for example the resorius masseter thing I bet if you asked a lot of injectors they wouldn't know that relationship they wouldn't be able to tell you where the resorius is relative to the masseter and so I don't think and that goes for MDs there might be nurses that know that relationship and there might be MDs that don't know that relationship right and so I think it has more to do with experience and their level of training within the field more than their degree so there are a lot of great nurse injectors there are a lot of great PA injectors and I think what's more important than anything is who the PA's and nurses are working which company they're working as part of so I think the ones that are affiliated with a plastic surgeon I'm bias right so I'm facial plastic surgeon so the nurses in our practice really really know their anatomy they know the limits and I think that's really important because knowing when to say no is so important in our field and I think that's why you see so many crazy looking faces out there because there are a lot of providers that don't know how to say no are uncomfortable saying no and so knowing your limits is really important and I think when you work within a plastic surgery practice or you're working within a dermatology practice I think those standards are established and there are a lot of good medspas but I would say a lot of the medspas are not as critical in the thinking as some of these physician-led practices but that's that's the generalization right and so there are like I said there some great medspas where they have routine training and continued medical education. And so they're great. So it's just really hard to tell, you know, as a patient who to go with, but I think the experience is really important and seeing who they're affiliated with. That's a good starting point. And also like maybe if there's like a consultation or some sort of conversation you can have ahead of time. So I think the point that I'm really latching on to is like, do they know their limits? Yeah. Or like went to stop to? Exactly. Or like if someone comes in like wanting to do a lot of things like at what point is it the provider's responsibility to say no? Yeah. I see patients all the time where they come in and they say, oh, you know, I wasn't happy with this injector because they wouldn't do this. And I know you guys do that. And I always tell them that's wonderful that your provider knew their limits and wouldn't do it because they didn't feel comfortable doing it. On the flip side, I've seen so many patients whose faces have ruined by someone that didn't know that this was inappropriate to do and went ahead and did it anyways because they were asked to do that. So I think it's always better to have a provider say, I don't know how to do this. Or this is not a good idea. Go see someone else. Yeah. And here's a referral to someone that's comfortable doing this. Yeah. And when you see those patients, have they had procedures done to them that are irreversible or what, like what are some examples? Yes. So because our practice is both surgical and non-surgical, we see the gamut. So we've definitely seen irreversible treatments. For example, with a lot of these devices, these heat devices, these radio frequency devices, ultrasound devices, we've seen fat loss. And so that's irreversible in the sense that your body's not going to produce the fat. There are ways to, you know, with fat transfer or sculptor. There are treatments to try to fix it. It won't be back to 100%, but there are ways to fix it. And then there's reversible treatments. For example, filler scenarios where someone looks crazy or it was placed inappropriately and then we can reverse it and address it. Well, I don't know if you remember this, but I used to write for the school newspaper. And I actually had an interview column in The Dartmouth, which was our daily newspaper. And I would interview students where every time I interviewed them, I would audio record the whole interview and then play it back and manually transcribe the whole interview out for myself. Oh, my God. I feel like that must have taken so much time. So much time. Honestly, think about all the hours I could have gotten back in my life if I had had granola back then. Well, thankfully, 2026, Jean has granola because granola is an AI-powered notepad built for the way that people really meet. So here's how it works. You can take rough notes in the meeting like you normally would. And then granola runs in the background and it securely transcribes the meeting. And at the ends of the meeting, granola gives you these really clean and structured notes. And granola works through your device's audio, which means it integrates seamlessly into the video conferencing tools you already use. And as someone who has literally done the manual version of this dozens, if not hundreds of times, let me tell you, I am so happy that we have granola today. So if meetings are eating up your day, granola is a no-brainer. You can try it totally free. Just head to granola.ai/tiger-sisters. So before we get even deeper into aesthetic treatments, we were thinking let's take it back to even more basics. So we start with skin care. Yeah, so we wanted to ask you a little bit more about sunscreen because everyone says you have to wear sunscreen, but what does that actually mean? Like, SPF 30 versus 50, mineral versus chemical, how much should we be putting it on our face and reapplying? That's a great question. So the most important thing with sunscreen is consistency and secondarily, more important than the number is the amount. So the number is important, but if you're doing SPF 30 and just doing a small smear of it, you might as well just not be using anything. So the appropriate amount is, I think it's two grams per centimeter squared. So what that works out to is about half a teaspoon for your face and extend down to your neck. So what this is really fascinating when I learn this is that the protection goes down exponentially if it's less than that. So if you're doing SPF 50, which is what I usually recommend, and you're doing half a teaspoon, then you're getting SPF 50. But if you're using a quarter of a teaspoon of SPF 50, you go down to like SPF 7. Oh, okay. So the amount really matters, and I think a lot of people just put a little bit on it, and they are like, okay, I'm good for the day, and that's just not cutting it. So I prefer SPF 50 because I feel like most people are under treating any ways you need, you need at least SPF 30. And SPF 30 gives you 97% protection, SPF 50 gives you 98% protection, so it's just 1%. But if you're not using the amount that you really need to of the 30, then you're just putting water on your face at that point, right? So I feel like if you can bump it up to SPF 50, then you're giving yourself a little bit more protection. But then you really want to make sure you're doing that half a teaspoon on your face and neck. Is SPF 100 100% protection? No. So that's like 99. Okay. Yeah, so you're still not a, you don't ever really get to 100%. You're never protected. And then the other thing, I just thought people knew, but I've been understanding that people don't really know, is tinted to sunscreen is really important for skin of color. For malasma, because it offers indoor light protection, which can trigger malasma and can trigger hyperpigmentation or worse than hyperpigmentation on skin of color. So anyone that's not northern European, of northern European descent or European descent is technically skin of color. So we're all skin of color, right? And so tinted sunscreen is really important for us. I've actually heard, so correct me if this is right or wrong or just, you know, in the ether. But I've heard that tinted sunscreen can actually start to help reverse skin damage or it can actually improve your skin as opposed to just preventing further damage. What's the level of truth? I don't know if it can improve the skin, but if you, in the sense that if you are preventing further damage, you're protecting your skin so that it has the chance to heal from the previous damage. So, you know, through that mechanism, it couldn't be doing that. And there are certain sunscreens that have antioxidants built into them. So, Isden is a brand that I really like and it has what are called DNA repair zones. And so there are certain factors in it that can help reverse some of the sun damage and it comes in a tinted form. Yeah. And when you say indoor light, like if we're staying indoors all day and I'm like, I have no plans to go outside, I'm just working from home. Yeah. Why? Tinted sunscreens. Tinted sunscreens. Tinted skin of color. Yeah. If you're prone to hyperpigmentation and then if you have malasma, yes. Are you kidding? Yeah. The fluorescence of the lights? Yeah. That's horrible. Obviously, it's not as strong or as impactful as solar UV, but it still has some sort of effects to it. So my patients who have malasma or the ones that are really trying to work on reversing malasma, that you could be doing all the things. But if you're not wearing that tinted sunscreen, you're just throwing away thousands of dollars, you know. So for people that have pigment concerns, it's really important to wear sunscreen indoors. How do you know if you're prone to malasma? How can you tell? Well, I mean, you don't really know until it shows up and it shows up, it shows up more commonly in skin of color. Okay. It usually shows up on your cheeks. On the sides of your cheeks, it can show up as like a darkening of your upper lip so it can look like a shadow almost or like a little mustache, if you will. And then it can show up along the periphery of your forehead also. Is it kind of like freckles for people of color? It can look like freckles, but usually freckles are sun damage, but it can look like freckles in some people. But it's more it's more coalesced than. Yeah, more swatching exactly. Wow. Exactly. And it's it can correlate with your period. So it's hormonally mediated. So oftentimes it used to be called like the mask of pregnancy because when your hormones are elevated during pregnancy, it really shows up. Wow, skin of color and pregnant women can't catch a break ever, ever. Watch out for those. - Doorlights! - Hey TigerFam, take five seconds to subscribe to the Tiger Sisters podcast. When you subscribe, you are notified every single time a new episode drops. And if you're listening on Spotify or Apple Podcast, please rate us five stars and leave a comment about this podcast because it really helps people discover our content and it helps us to continue to make the show for you. If you're listening to this on Spotify right now, take this opportunity to turn on the video. Thanks, now back to the show. So the next thing I want to talk to you about is skincare routine. And I'm going to kind of talk about mine. So I'm really into skincare, but I am not overly specific about my products. So usually I will use some sort of serum, a moisturizer, tinted SPF, and what else. Oh, and then some sort of Korean skin wipes with active ingredients. And my philosophy in general is that I think that Korean skincare and Japanese skincare is generally better than the skincare you can get in the US because, and this is just my theory, but I think that the competition is higher in those countries. So you have to have better product for cheaper prices to stay in the market. And I also think they have higher FDA equivalent regulations. So for me, I'll just kind of buy whatever Korean skincare and not be super discriminating. And is that true? OK, fine, let's stop there. Is that true? What do you think? I think the logic makes sense because Korean skincare is like 10 years ahead. Yeah. Yeah. So I do think a lot of the skincare there is better than a lot of the skincare here. However, we have some really great products here. So it might be 5%, 10% of our products are comparable to 90% of Korean products, maybe. The other thing is what is highlighted in Korean skincare products is different than what's highlighted here. So pigmentation is number one priority in Korean skincare. And that and skin texture, which is not necessary-- until recently was not necessarily a priority for Americans or American skincare. And I think for-- you have Asian skin. So it will play well with your skin type. Whereas someone, which Asian skin tends to be a little bit more sebaceous, not as dry in general, whereas Caucasian skin is not that. It's not as sebaceous usually. So I think you do need to be a little individual in picking skincare. And so I can see how it would work well for you. And I think that logic completely makes sense, but it doesn't apply to everyone. But it would apply to Asians. Yeah, I think. And I think-- Well, also my Asians out there. But also for Caucasians that have pigment concerns and textural concerns. And they're incorporating a lot of ingredients that we haven't really started thinking about. So for example, PDRN or even snail mucin was-- or Alan Toine-- was I remember like 20 years ago when I was in Asia picking up this product, like snail mucin, and being like, it was so popular there. And no one had heard of it in the US. And then like 10 years later, it worked its way over here. And so there's a lot of like TXA in Asian products, which TXA is trans-examic acid, which is a good component for pigmentation. That is just starting to show up in American skin care. Interesting. And I feel like also nice synamide, right? It affects the pigment pathway. Yeah, yeah, yeah. Jean is definitely way more advanced than I am in her skin care routine. I'm really into skin care. I love it. Well, when you were asking about what's a TikTok beauty trend that drives you nuts, that is actually my number one issue is kids who do not need to be using anti-aging products who are using a ton of skin care. That, I think that is my number one issue. Because it's just too young. It's too young, and there's no need for it. And a lot of kids are damaging their skin care barrier by using these products that are way too strong. So I hear that term a lot. What does it actually mean to damage your skin barrier? So people are always trying to repair their skin barrier. Yeah. So when we-- I think we're going to talk about retinols or retinoids, right? And so that is something that happens commonly with retinoids when you use too much of it. You're actually breaking down the-- so the barrier is basically the fabric of the skin, and you're breaking down the surface layers of it, and creating little cracks in the initial layer of the skin. And that's what causes redness. That's what causes that stinging sensation. And so your body needs to go through a process of healing all that before you can introduce retinoids again. And so a lot of-- it's really funny. I'll see these influencers with super shiny skin. And it's meant to be perceived as healthy skin, but oftentimes it's really them like really aggressively weakening their barrier. And so the skin is just trying to heal itself, and it looks really shiny, and it's not healthy skin. So it's a different type of shine on healthy skin versus damaged skin. How can you tell visually? I mean, I think it's just gotten-- because I've gotten used to seeing what that looks like, but it's just different. It's not like you've got this glowy skin, and it looks plump and glowy, which is different than the irritated shiny. Yeah, I was an expert eye. I was at Sephora a few months ago, and I was buying some makeup there. I was online. And these two young girls were next to me online. And in my head, I was like, where are your parents? Number one. Number two, I engaged with them. I was like, hi, girls. They're like one of them's like 10 or 12. And I asked them, how old are you guys? She's like, I'm 12. I'm nine. Wait, no, I'm 10. And I'm like, what are you buying? They're like lotions and stuff, and they had like drunk elephant. And I was like, how are you affording this? Right. And also, I'm like, in my mind, I was just like, wow. They're really young. I'm like 20 years older than them. And we're like in the same line at Sephora. So I thought that was pretty insane. And I wasn't going to be like, where's your parent? But I was just like, she was about to, though. I was engaging with them. I was like, hey, girls, dang. It was so crazy. Yeah, I mean, at that age, you really just need SPF, and then maybe a moisturizer, but that's, you don't really need much more than that at 10 and, you know, 10, 11, 12. And in our practice, we've definitely seen young patients where they've-- I had a patient who basically burned her skin with using a retinoid and a salicylic acid cleanser, which she-- and usually that would be our recommendation for someone that has acne. She never had acne. She just saw someone doing it. And so really traumatized her skin and basically gave herself a chemical peel, doing that combination, yeah. Because there are definitely some things you should never-- you shouldn't combine. Yeah. I know if you're doing a retinal like at night, like you probably shouldn't do vitamin C in the morning. Or no, you can do vitamin C in the morning. But you don't want to do too many acids altogether. OK, back to me. OK, my other question is that I-- well, so both Shereen and I recently started doing facials. So we started getting facials monthly. And I really think it makes a difference. And I love it. But I guess what is the science behind it? Is it just that it's helping to cleanse your skin? And then it just seems funny in my mind, because you're putting on just lots of layers of things to treat the skin. So is it scientifically helpful? So facial is like a very broad term. It's an umbrella term. So it depends on the type of facial that you're getting. So if it's just a basic facial, I think the only way that it's helping is it's probably just cleansing your skin to a deeper level. But as part of the facial, you can also incorporate certain ingredients. If someone's not using vitamin C routinely incorporating the vitamin C as part of the facial may help, or a lot of facials have certain enzymes that exfoliate your skin. And a lot of people don't exfoliate regularly. And so this is an opportunity to have that exfoliation. But then there are more advanced facials also. There's hydrophacial. There are facials where you're using different types of AHA, BHA acids that are really improving or increasing cell turnover. So that's more of a true treatment. And so it depends on what kind of facials you're getting. And so I can definitely see it being impactful if it's one of the ones that are incorporating these acids in the higher active ingredients. OK, Dr. Sundar, let's talk lasers. I feel like lasers are such a broad category. And I'm not sure if they include all of these things. So radio frequently. ultra sound, all therapy, morphia, surf, softwave, their mod, CO2, picolaser, they're all, I think they're all totally different modalities, but they all get bucketed under the same bucket. So can you tell us a little bit more about that and how do you figure out what is right for you? Yeah, so those are all what we consider devices. Lasers are actually very specific. So IPL is a laser, CO2 technically is an laser radio frequency ultrasound. Those aren't really lasers. They're all devices and they all tackle different problems. So usually ultrasound is for tightening and toning. So all therapy, softwave, those are ultrasound devices. Then there are radio frequency devices. They can also tighten and tone, but they can be combined with microneedling like morphias, viva, potenza, vivaci, all those are microneedling radio frequency treatment. So those can help with texture and tone as well as a little bit of tightening. The issue with the radio frequency and some of the ultrasound devices is that depending on the energy level and depth of penetration, it can lead to fat loss in some cases. And so when we were talking about experience level of the provider, and choosing a medspot versus choosing a physician's practice, I think that's where some of that is really important because when these device companies give you, you know, when you buy the device, they tell you standard settings. And you know, just between the three of us, your skin depth is different than your skin depth is different than mine. And so it really needs to be a provider that can tell based off of what we look like and based off of examination, how to adjust that setting. Because if you just did standard settings on everyone, or you cranked up the settings trying to achieve tightening, then you could run into trouble with fat loss. And we've seen that a lot with patients that have referred into us who've had fat loss or other complications. So in our practice, we really understand how the technology works and we know how to adjust it so that you can achieve great results without really cranking the energy. So rather than doing one treatment at the highest setting, you do three treatments at one third the setting maybe and ultimately get to the same result. So there's risk even for radio frequency? Yes. Oh wow. Yeah. Yeah. Now, it's not a very high percentage. I think this is another scenario where social media is really blown it out of proportion where I have patients come in. And if I'm recommending a radio frequency treatment, they're like, oh, no, no, I can't. I don't want to have fat loss. So it's not that anytime you get radio frequency, you're going to have fat loss. But if you, if it's used inappropriately or if it's used to lift, there's a chance that you can have fat loss with it because the settings required for lifting heat up the tissues so much that you could inadvertently get fat loss. Okay. So radio frequency is not really intended for lifting. It is. Oh, it is. So there are some radio frequency devices that you use for lifting. And what are they called? I mean, all of them. So Morpheus, you can use it for lifting. Okay. But if you use it at that setting, you're usually going to get fat loss. So when I have a patient come in and say, I want to have a certain, you know, a certain result, we have that discussion. And I say, well, if we do it at this setting to give you the level of lifting that you're hoping to achieve, the unintended side effect will be fat loss. And so I don't want you to have. And there are lots of people who say, oh, I feel like I have a full face. I'm fine with losing a little bit of fat. You don't want to lose fat because that's the, the subcutaneous fat, especially the fat that is right under your skin kind of nourishes your skin. It's what gives the skin its plump quality. So if you lose that fat, that will inadvertently age your skin faster. I think with all of these technologies and devices, for someone like me who is not as advanced in it, it can feel really intimidating. Like with all these names, like, how do you suggest that someone, a consumer, go research it? Like, what should we be looking at? Or is it just talking to a provider? It's talking to the provider because there's just so much information and it can get very confusing. And it's not very black or white, right? So like I said, radio frequency can cause fat loss. It doesn't most of the time. And in most practices where they do it in a way that's thoughtful, it's not going to happen. And so I think the information, especially on the internet, it's not fact-based, right? If you're reading it off of someone's website, there's some level of subjective anecdotes involved, right? And so I think it goes back to identifying a provider that you trust, that's ethical, that's going to be honest with you, that can help guide you. And really the other thing is I think it's really important for the patient to not push the provider either. Because I think in general most of us want to help our patients achieve whatever their goal is, right? And so if if a patient is saying, oh, I really want to do this, I really want to do this, but I, you know, I don't want to do surgery, but I really want lifting. And so the provider is going to be tempted to, okay, let me turn up the energy to give them that lift. And they're thinking about short-term benefit, which is lifting, but long-term loss is the fat loss, which over the course of five years, ten years is actually going to do the patient into service. Yeah. I think maybe a good question to ask as a follow-up to a provider is like, what are the long-term effects of treatment? What are the long-term effects? But also I think a lot of patients now are open to surgery. The question should be asked, how will this impact future surgery? If I'm thinking about having a face of two or five years, how will this impact it? Okay. And I have heard that some of these devices can impact, yeah, because it, so it can create scar tissue or, no, yeah, it creates scar tissue. So the dissection planes are not as easy to identify. It's not impossible to do, but it, you know, it makes it more challenging. So it's definitely something that you want to disclose to your surgeon. And I usually have a time frame. So if someone has had any of these heat devices within a year of surgery, I usually ask the patients to wait. And not necessarily because of the scar tissue, but because of the inflammation. So when you have a treatment, it can take a full year for your body to reset and for the full healing process, the collagen simulation process to complete. And so if you go in three months after a treatment when there's some low level of inflammation, you're actually going to aggravate the tissues and there could be potential complications from the surgery. So if it's beyond a year, it's not as problematic, but it's good for the surgeon to know there's going to be scar tissue. So the surgery may need to be a little bit longer. We may want to do certain things as part of the surgery to improve healing, whether it's PRP or hyperbaric oxygen or exosomes, different, different modalities to help improve healing. So I think it'll help formulate a game plan better for the surgeon to have that information. And is that a general I guess rule of thumb that you have for each of these. What do you call them? Like all therapy and these other all these heat based devices. Yeah. Is that your rule of thumb that you should wait a year between. Yeah. That's my personal rule. Different surgeons have different rules about it. But my personal rule is you want to wait a year because your skin is still inflamed. Yeah, over the course of that year. Yeah, and it depends on the depth. So for example, more obviously if you're doing it at a superficial setting and you're having a deep plane lift, it doesn't you don't have to wait a full year. But all therapy, which goes deeper. And it can affect healing of the skin that I would wait a year in between those even like all therapy to all therapy. No, that depends. Yeah, sometimes you can do it at six months. Yeah, depending on on the settings. I know we talked about filler very early in this episode, but I just want to ask you, do you have any words of wisdom or advice when people are thinking about fillers? So I going back to the provider and listening to the providers really important because I see it time and time again with filler patients will come in and they're the most conservative patient. I don't want to do too much. It's just so scared of I just want to do a little bit and we do it. And then they're back three to six months later wanting more in the same area because our minds play tricks on us. So the initial delta is so significant, the change in what you see is so significant that once that change starts going away, you think it's all gone. So the three months, six months later, when some of it's going away, patients want to come back in and do another full syringe to that area because they don't forget where they started off. And so that's where it's really important to have a provider that says, no, look at your photos from three months ago or six months ago, there's still some filler there, you're not ready for more. Yeah, you might be ready for more, but chances are you're probably not ready for more, especially in the lips, right? And so I think not overdoing it is important, so volume matters and frequency matters. And that's when you get a lot of these migration issues, especially with the lip is when you're doing too much in an area that can't handle that volume. And so it has to go somewhere. So it's following the path of least resistance. So if there's no way for the filler to come forward with the lip, it has to go up into the white, the the mustache area of the lip. So I think volume is really important, frequency is really important. And so to prevent migration, it's just like don't overfill. Don't overfill. Yeah. Yeah. And it sounds like documentation is really important. Yeah. Having a clear idea of what you looked like before and after the first treatment, yeah, that you can refer back to together. Exactly. Exactly. Hey guys, it came to my attention that some of you don't know we have a matcha brand. What? A matcha brand? Yes. Like some of my friends were talking to me like, wait, you guys have a matcha brand and it's called Sisters Matcha. Jean and I started it in October 2024. And it's something that means a lot to us because I lived and worked on the farm where we source the matcha from. This matcha brand is our baby and we are so passionate about it. And we really love everything that has gone into it. There's just so much love and passion that goes into our company. And we want to share it with you guys. We source from a small family farm, just an hour and a half outside of Kyoto called Wazuka is the name of the town. And it's absolutely incredible. We've visited the farm. We've worked on the farm. And we're so excited to bring it to you. So you can find out more at sisters matcha dot com that's sisters matcha dot com. Alrighty, now back to the show. Okay, so one question I've been dying to ask you Dr. Sander is as someone who has unlimited access to every single treatment in the world. What do you do? Like what is your high maintenance to be low maintenance routine? Yeah, that's great. I love, we have a proprietary appeal that we customize to patients. And so I try to do that once every two years or once a year just to remove any sun damage that has accrued throughout the year. So I think that has been really helpful. The other thing that I like is fractionated radio frequency. So that helps with skin quality, skin tone. And so I do that actually once a year. And that that way I'm not the best when it comes to skin care. And so I feel like that really is a great foundation for me. Botox is the other thing. I think that's an I do it for preventative reasons. And I think it's worked really well for me. I was on board to have really, really deep 11 lines. And I've really been able to reverse that pretty well. So I think Botox and then sculpture. So yeah, so I think sculpture, especially in like the chin area for me has been helpful just because I'm postmenopausal. So postmenopausal women in general will start losing bone in their jawline. And so that's expedited in the postmenopausal phase. And so that I think has been helpful in supporting my jawline. And then one quick question about sculpture, sculpture is not a filler, right? It's not a filler. It's a collagen stimulator. So it's an injection, but it's stimulating your own collagen rather than putting a gel into the face. So it's a different category. It's a different category. Yeah. I love it. Thank you so much. Thank you for having me. This is great. We have one last section called fact or fiction, which is a rapid fire. We give you a statement and you say whether it's fact or fiction or quick clarification. Okay. Number one, filler always migrates. Meet new grippy setting mist from Mabelie, New York. Gel to mist technology locks in your look for up to 24 hours with flexible all day comfy grip. No tightness, no stickiness, no residue, just plump, dewy hydrated skin that still feels like your skin. Try new grippy setting mist from Mabelie, New York. Maybe it's Mabelie. Fiction. No, actually. That one's tough. That one's tough because it it can migrate if it's placed improperly or in a different layer or if it's in an area that moves a lot. So around the eyes, it can move, it can migrate a little. But I think the way people think of migration, that's not accurate. So I've had patients who come in where we're wanting to do chin filler and they're worried that it's going to migrate up to their cheek and that's that's not how it happens. So from that respect, it's fiction. Okay. Fact or fiction Botox prevents wrinkles. Fact. Drinking more water automatically gives you glowing hydrated skin. Fiction. I'm horrible at drinking water and I feel like my skin looks pretty good because of the other things that I do to compensate for. That makes me feel better. Okay. Factor fiction. Everyone needs retinal. Fiction. Factor fiction. Expensive skincare is always better. Fiction. Okay. Factor fiction. If a skincare product burns or tingles, that means it's working. Fiction. Factor fiction. Ozympic ages your face. That needs a clarification. So it can age the face if you lose too much fat or lose too much volume in the face. But I think for a lot of people or for most people, Ozympic is an anti-inflammatory. And so a lot of people carry inflammation in their face. And so decreasing that inflammation can actually make someone look younger or more importantly healthier. So I think. Yeah. So I think it can do both. Okay. Depend on the person. Depend on the person and everything in moderation. Okay. Fact or fiction. Collagen supplements actually work and noticeably improve your skin. Fiction. What? I take it every day. No. Are you sure? Yes. This is actually there's like evidence to. Yeah. Right now, they're all the products on the market. There's no way that it's so your body breaks down these collagen supplements, right? Yeah. To like individual amino acids. It can't target specifically the skin or the hair. So if you're seeing a benefit, it's usually the other products that are, it's usually compounded with certain vitamins and other supplements that have a benefit to skin and hair anyway. So collagen itself, the molecules are just too big right now. They're just, they're just not doing. But if it's working, I mean, if it's working for you, I wouldn't say to discontinue. I think there's protein boost for you. Yeah. Yeah. Other health. Yeah. Yeah. Exactly. Exactly. Last one. Fact or fiction. It's too late to start taking care of your skin after 50. No. Fiction. Absolute fiction. Awesome. Right. Thank you so much. Thank you very much, Dr. Sunder. This was so informative. I'm so glad. It was so fun. Where can people find you online? So I'm on Instagram and on TikTok at Dr. Charmelis Sunder. So it's DR-S-A-R-M-E-L-A-S-U-N-D-E-R. Awesome. Thanks, TigerFam. We'll see you next time. Bye.