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Welcome to Inside-Out Dermatology, the podcast that goes beyond the surface to connect your skin health with your overall emotional and physical well-being. Hosted by Dr. Julie Kenner, a board-certified dermatologist and PhD scientist, this podcast honors the fact that what shows on the outside often reflects what's happening internally. Dr. Kenner merges her decades of clinical experience and research expertise to provide a holistic approach to skin conditions, recognizing the profound impact they can have on your self-esteem and life choices. Join us as we explore the newest therapies, unpack complex skin conditions, and empower you with the knowledge to manage your skin for a life filled with confidence and complete wellness.
People who look older than their stated age die earlier. So skin being the largest regenerative organ in our body has a profound impact on the rest of our organs and our longevity. Sun produces 90% of our skin aging. Really 90% of aging of the skin is due to sun. Healing is not, you know, sort of a binary where it doesn't heal or it heals.
Julie Kenner:There is this whole gradation and you want to be at this right extreme part where you get perfect rejuvenation quickly. This is Inside Out Dermatology with Doctor. Julie Kenner, where we explore science, skin, and well-being. Hi, welcome to Inside Out Dermatology. I'm Doctor.
Julie Kenner:Julie Kenner, board certified dermatologist, scientist, and skincare formulator. Today's episode is called the biology of recovery. And we're going to talk about how to enhance healing with aesthetic procedures. We have a special guest with us today, Melanie Shearer. I'm going to give a little preamble first and then we're going be asking about an experience that she had recently with an aesthetic procedure.
Julie Kenner:And we're going to talk about some elements of this whole skin biology in the healing post aesthetic procedure. So I want to start everything off here today by mentioning or reminding listeners that skin is a living organism. Certainly it has aesthetic appeal, or that's the ideal is to get to the aesthetic appeal, but it is a living adaptive biological surface. And it is responsive to both our internal environment and our external environment. And as much as people like to blame genes for things, it's important to recognize the importance of epigenetics.
Julie Kenner:And this is a newer understanding of biology. And even though we have the genes, what turns these genes on, the signals, the communication the cells get from all sorts of things, whether it be ultraviolet light or hormonal influences from our own internal body, etcetera. These influences or the epigenetics of the cell's environment is what actually will contribute to the expression of the proteins and the activation of those genes themselves. And that is 84% of what happens. So the genes themselves are only responsible for about 16% of what goes on in a cell and therefore the expression of, in this case, skin.
Julie Kenner:And so 84% of what the cell is exposed to is what actually makes it do its things. So what that translates into is a very big empowering for a person because that means we have a lot of control over modifying how our cells behave. Does that make sense? And so one of the areas that I like to remind my patients about all the time when we talk about aesthetic procedures is the fact that our chronological age and our biological age are vastly different. And so the chronological age is actually the age that our skin has been on planet earth.
Julie Kenner:So it's a number of years that we have been on the planet. What the biological age of the skin is, is how much of an influence these external or internal environmental influences have had on the cell's behavior. And cells behaving good regenerate themselves, they look healthy, they look pretty from an aesthetic perspective. Cells that do not get good environmental influences start to undergo senescence or death and or start to behave poorly and look, as a consequence, not so attractive. Now, one of the things that is going on in our society is the fact that we all have phones in our pocket.
Julie Kenner:And we have been influenced by social media for a very long time now. And so our sense of self esteem comes often from our appearance. And this has a great impact on our life but it also has a biofeedback on the behavior of the cells because one of the influences in addition to ultraviolet light, nutrition, in addition to our sleep status, in addition to our hormonal status is our emotional status. So actually looking at yourself and feeling bad about your appearance actually can lead to a cascade of further negativity. And I think all of us have known people who either look older or younger than their stated age.
Julie Kenner:And we also, I think most of us know people who have gone through difficult times, whether it was a divorce, a bad illness, a stressful time in their financial life. All of these issues can impact us. And I have patients coming on all the time saying, Gosh, I seem to have aged ten years overnight. And there really is some truth to that in that their whole meal you or the whole environment that they're allowing their cells to have has undergone an aging process because they haven't fed it the good things. So we'll talk a little bit more about these good things at the end.
Julie Kenner:But I wanted to mention and embrace the fact that because of all of this, aesthetic procedures are not only here to stay, but they are dramatically on the rise. And these are things that are surgical, so facelifts, neck lifts, etc. These are things that are energy based, so lasers, radio frequency. These are things that are mechanical, things like micro needling And things like chemical peels. And all of these have become more frequent.
Julie Kenner:They're here to stay. They're powerful. And we want them. Because our Yes, population
Melanie Scherer:we do.
Julie Kenner:Yes. Our population is growing. We're living longer and we want to look better longer. So let's just talk briefly about what the stages of healing are very briefly. And then we're going to talk to Melanie and ask her some questions and we'll have an interactive conversation about her experience.
Julie Kenner:So I just wanted to point out that any of these procedures are producing what's called a controlled injury. And the injury itself is a signal. It is a signal to our cells. Now, what is happening post the signal is really, really important because if those cells are not given the right molecules or haven't been replenished enough in the beginning, they're not going to be able to heal in the same beneficial way that we want than if we pretreat the cells and then give a really impactful post treatment set of signals. So cells go through, all cells, when they have this injury signal, go through an inflammatory stage, go through a stage where it wakes up the keratinocytes and things turn over and you get extra blood vessels activated, etcetera, etcetera.
Julie Kenner:And so when you go down this inflammatory and it produces an activation of the fibrosis, when you go down this pathway, you want it to be done expeditiously, efficiently, and with healthy cells functioning well at the end. If the cells don't have a right environment, they will produce scarring, fibrosis, prolonged inflammation. And I think Melanie was talking to me a little bit before the show that one of the dreaded consequences of undergoing an aesthetic procedure is the downtime. And so what happens is the downtime can be modified by having proper environment provided to the cells and so you can get a quicker downtime and a good outcome, a regenerative outcome, but you can also have the opposite. And so sometimes it's a tendency to get wowed by the technology or the treatment itself.
Julie Kenner:And we want to remind people that in this biology of recovery that the most important thing after you get a procedure is to make sure that you're feeding those cells very well. So Melanie, tell us a little bit about what you had done and what your experience was.
Melanie Scherer:How much time do you have today, doc? It's a lot.
Julie Kenner:Well, why don't we start with why did you get the procedure? Obviously you're a very beautiful woman.
Melanie Scherer:Oh thank you. But well, you're supposed to say that.
Julie Kenner:No I'm not, you really are.
Melanie Scherer:No. Well first of all, I mean that was a lot of technology for me. But in everyday layman's terms for someone like myself, I. E. Melanie, I am admittedly a vain person.
Melanie Scherer:I don't want to I want to get I want to mature. I want to remain in it, you know, I want to get as old as I possibly can. But I don't want to look fake. I really don't. I love to take really good care of myself.
Melanie Scherer:I eat well, I exercise, and I want my skin to look as pretty as possible. I am 55 years old. I just turned 55 December 30. I'm proud to be 55. I am grateful to still be here at 55.
Melanie Scherer:But I want to do as much as I can to look as good as I can for my age. You
Julie Kenner:had a procedure recently right after
Melanie Scherer:your birthday? Yes, yes. Okay. And the other thing to back up on what I was saying earlier too is I want to look good but I don't want to look fake. And I've been down that road too in my late 30s and 40s chose some real interesting paths and really reverted back to okay how do I still look as youthful as possible but not crazy.
Melanie Scherer:Know when you walk into a room and you're like woah someone went way overboard. I just didn't want to do that anymore. So I'm sorry, what was your question again?
Julie Kenner:No, it's okay. So you had a procedure. And I just kind of putting a little comment on what you're saying is, first of all, I never like people to say, oh, I'm vain. It's not vanity to want to look nice. I think you just embrace that.
Julie Kenner:And the other thing is that there is some very interesting data to show that obviously the whole field of longevity has just ballooned in the last several years. And this is a multi organ system event, right? And so making sure you sleep properly, making sure you exercise properly, making sure you have good nutrition, making sure you have mental wellness is really important. And so of course our aesthetics ties into our mental wellness and so it gives a positive feedback to everything else. And there's a very interesting study that has been ongoing in Baltimore for many years, the Baltimore Longitudinal Study.
Julie Kenner:And they have actually shown that people who look older than their stated age die earlier. And so skin being the largest regenerative organ in our body has a profound impact on the rest of our organs and our longevity. And so taking care of your skin is very important. Now inherent to the taking care of it, you're not just getting procedures done, you are probably using skincare products and things like that too.
Melanie Scherer:Absolutely, one
Julie Kenner:And hundred so those molecules are regenerating these cells and these more youthful cells that you have created in your skin not only give you a better appearance, but they actually are impacting the rest of your health. So let's talk about your specific procedure that you had done. So you had a CO2 laser resurfacing.
Melanie Scherer:I did. Think it was at the November.
Julie Kenner:Oh, was it at the November? Okay. Yes. So that is a fairly big procedure. There aren't very many places that are still doing that now.
Melanie Scherer:It is it's a commitment. I have tried a lot of other lasers and different peels. Everything's everyone's great. But I still always go back to the co2. I just I love the results.
Melanie Scherer:It is a commitment for time for downtime. There are different levels of the co2 that you can get so that there isn't as much downtime. But I always look at it like this, if you're going to go for the downtime, go for the downtime. And I do schedule it accordingly. But it's it's a lot of downtime.
Julie Kenner:Well, that's part of why we're here today. We're talking about what we might be able to do to enhance the speed with which you heal because that's I think the dreaded complication for every not complication, but it's the dread for everybody jumping into something like we talked
Melanie Scherer:about. And also everyone's skin is different. I'm more fair, So I'm more red longer than a lot of other people are. And that's, you know, I mean, I can do that with makeup. But it's still, you know, if you're not used to it, it can be a scary feeling like, oh my gosh, how long am I going be red for?
Melanie Scherer:Is this going to heal, etc, etc? So it's good that, you know, I ask a lot of questions before the procedure, which is the second time I've had the CO2. So it's difficult in the sense that some people are like, oh, you know, think this is what the downtime is going to be. It's like, no, no, no. Ask really good questions about your skin type.
Melanie Scherer:How much downtime it's going to be? Are you going to be able to psychologically deal with that? There's a lot involved. Go to someone who's very credited. It's a very serious laser.
Melanie Scherer:It's a very, very serious procedure. And you need to go to someone who is very credited and utilizing that particular And
Julie Kenner:I know which provider you went to, and she's excellent. So I fully endorse that. I also want to say that it's very difficult for the provider to just give a point blank, this is how long the downtime will be, because of the issues that we described just a couple of minutes ago. So what were the products that you were using pre treatment, and then what did you use post treatment?
Melanie Scherer:What lines do I use?
Julie Kenner:Well, not the lines, the ingredients kind of in general.
Melanie Scherer:That's a great question. So I did not do any retinols for the first two weeks before. Just anything that was going to be making my skin extra sensitive or maybe extra exfoliating, I stayed clear of. And I was told to do that for sure.
Julie Kenner:Okay, so those were things like alpha hydroxy acid, retinol,
Melanie Scherer:trinoxines, things like that. So
Julie Kenner:I'm going talk a little bit about sort of tailoring pre and then post care so we can really get the highest regenerative speed. And so some of them are older and some of them are newer crafted and then others are newer molecules in general and are very exciting. So this is a really important thing for the person undergoing a procedure is to recognize that once you get that procedure, that's not the end. That's the signal that starts and it's your job to kind of continue to shepherd those cells into a happier growth and regenerative state. So I like to pre treat patients prior to any kind of procedure, particularly an energy based system like a laser.
Julie Kenner:Thermal injury is very hard on skin, so you to prep it a little bit. I agree without, that retinoids are sort of our gold standard for skin rejuvenation for the last fifty, sixty years. There's a lot of data to show that it not only rejuvenates skin, but it has anti cancer and other benefits. You're a fair skinned woman, we want to keep you from having any cancer. So that is always a little side, Benny, that dermatologists try to do.
Julie Kenner:But I myself can't tolerate tretinoin or retinol.
Melanie Scherer:You can either.
Julie Kenner:Yes. Just can't stand it. It breaks me out. Yes. I get broken out.
Julie Kenner:I have a red face. I had a red face through residency.
Melanie Scherer:So funny. Yeah, I can't at all. And never ever break out. And that breaks out.
Julie Kenner:Yeah. Just those are the active molecules in the retinoid family. But they are too strong for certain people. And it has to do, they bind to DNA, the retinoids, the family of molecules, it binds to DNA. And that's why it's so powerful.
Julie Kenner:It can turn on the genes that have been turned off. And it will repair genes that have been broken, etcetera. It's wonderful. It is sort of the anti sun, which sun produces 90% of our skin aging. So what did we do here at Skin Happy?
Julie Kenner:I spent ten years developing our own formula for a retinoid and it is a gentle but powerful retinoid. It's a precursor form and we encased it in special emollients to push it through skin and get it so your skin can tolerate it. So I've tried this on kids as young as three years old. I've tried it on my sensitive rosacea patients and I have all of these patients can pretty much tolerate it. And so we have a step up system for that.
Julie Kenner:So I do like patients to use retinoids but not retinol or tretinoin. I also like them to use B3. B3, niacinamide, is a molecule, it's a vitamin that helps encourage energy to cells. So retinoids work on DNA, you know, kind of reversing all the things the sun did. Sun also depletes energy from ourselves.
Julie Kenner:Undergoing these procedures are high energy intensive activities for cells. They have to really turn back on. So if you can preempt that and give niacinamide to your skin, that is a benefit. Both of these molecules also will grow collagen and so we're tickling the fibroblast by doing this procedure and we might as well get them in high gear on making the collagen. So those are my two go tos.
Julie Kenner:The other thing is vitamin C. I have patients use a lipidized form of vitamin C. We like to do that because vitamin C is a required co factor. As a dermatologist, we can see if somebody's got scurvy or vitamin C deficiency by looking at their skin. And so we want that skin that has been depleted by sun to have lots of vitamin C available.
Melanie Scherer:I love vitamin C.
Julie Kenner:It is wonderful. And
Melanie Scherer:I take it every day as well internally.
Julie Kenner:Yes. But when you take something internally it does not know you want more to be here versus more to be on the bottom. It will just give a little bit everywhere. So that's why it's great to supplement systemically but you want to supplement topically as
Melanie Scherer:And I love it. I do. I have a really good vitamin C ically that I But I love vitamin C. Yes. And you know, I also want to say this too.
Melanie Scherer:You know, don't sit before everyone here and like, oh, know, hey, I, know, do the best that I can. I am really careful with the sun. I made some really bad decisions when I was a younger girl. I was a big horseback rider, a swimmer, a snow skier, a water skier. So everything was sun, sun, sun reflection.
Melanie Scherer:And I think it was like at the very end of my 20s, I really started seeing some dark spots. I was like, what is this? This is crazy. Had a dermatologist at that time really said to me this is all sun damage and I was like what do you mean sun damage? Don't what do you mean?
Melanie Scherer:So even playing golf the years that I did, I learned golf in a huge hat. And I just I haven't even I don't even know the last time I laid out in the sun or anytime I'm on a walk or a hike. It's always a big cap and really, really, really good sunblock.
Julie Kenner:Okay, So you are singing the choir. I mean that is basically I tell that to patients all the time. And really ninety percent of aging of the skin is due to sun. It is a highly depleting phenomenon or impact on cells function. I did a study when I was practicing Hawaii on, it was called the cheek study and I took five different women from five different decades starting at 25 and going to 65.
Julie Kenner:I took a picture of these cheeks and I took a picture of their bottom cheeks. And then I shuffled up the pictures and I had the next 50 patients coming into the clinic and I said, put these pictures of the faces in order of decade. There's five different decades represented here. And do the same at the bottoms. Everybody could do the faces.
Julie Kenner:No surprise there. You can tell the difference between a 25 year old and 35 year old, etc. But only 4% could do the bottoms. Interesting. And the person themselves of course has the same diet, has the same sleep, has the same sense of purpose, has the same nutrition.
Julie Kenner:Everything else is the same with the exception of sun. So that is a fundamental thing that everybody needs to do. Whether it's cloudy, whether it's anything So perfect.
Melanie Scherer:In fact I have a really good friend of mine who is still a big avid rider and she loves her horses and that's her deal. But this last time I had this procedure she said, I need to do that. I said, you can't do this, Jill. You ride every day and you're in the sun every day. Wall wear hat.
Melanie Scherer:I'm like, no, I've seen your hats. This is not a hat.
Julie Kenner:There's the rest of this
Melanie Scherer:that it's constantly exposed. Yeah. And that's what people have to understand too. If you do this, you have to be a person who is very careful with the Yes, just within those ninety days. It's for years, you have to be very, very, very careful.
Melanie Scherer:You're very exposed. Yes. So
Julie Kenner:excellent. And on top of that skin cancer is, if you remove a layer of skin, it's a little bit thinner and more susceptible. If you're not, you're more at risk of skin cancer. And never, never, never go to tanning booths.
Melanie Scherer:No, I've been there too. We won't tell anybody. Oh my gosh, I cannot when I look back, was like, was I crazy? I was crazy. Tan, tan, tan.
Melanie Scherer:Sun, sun, sun.
Julie Kenner:I know. But it was part of our culture. Anyway, Okay. So the injury happens. You had your CO2.
Julie Kenner:Somebody might have a chemical peel. Somebody might have a facelift, whatever it is. So then what happens is that the healing process starts. So this is where the patient themselves, you need to be really spectacular about being committed to what you're feeding those cells because now they've been woken up and they're dividing. And so I just want to emphasize that healing is not sort of a binary where it doesn't heal or it heals.
Julie Kenner:There is this whole gradation and you want to be at this right extreme part where you get perfect rejuvenation quickly. Okay? And so that's where the skin care program for that is really important. And so for post procedure, I like to use those same ABCs, the retinoid, the B3 and the vitamin C, but I add in a couple of other things. So I like a glut athione cream that gives more, it's an antioxidant, it really helps give support to cells.
Julie Kenner:I like to give people some specific instructions about cleansing, not to over cleanse. Your skin is not dirty. It's in this need for a barrier repair. And so just kind of getting involved in that. There are other new treatments that we're using that are also stem cell growth factors and things like that that we will sometimes include.
Julie Kenner:I carry a very sophisticated Korean skincare line that I will incorporate into some of our skincare programs for people to use post procedure. And they can do things that I can't do or acquire here in The United States. And this particular line has not only plant based exosomes or growth factors coming from stem cells from the plant, but they also have in it something called spicules. And these spicuses are little bio micro needles that will help enhance the penetration of skin products into where the business ends.
Melanie Scherer:I've had one of your facials Uh-huh. And I hope to have more, and I know I will. But it was one of those. I Yes. And it's great because your girls are so amazing here.
Melanie Scherer:And she said to me, you're gonna feel a little Prickle. Prickle. Yeah. And I'm like, oh, I'm like, oh, you really do. And it's all plant based, which is really interesting.
Julie Kenner:Well, one comes from a sea sponge.
Melanie Scherer:Ah, prickles. Yes. But you can feel it,
Julie Kenner:for Yes. So the ironic part is the skin, as it gets healthier, becomes a stronger barrier and it won't let things in. So that's why this is so innovative where it's like, oh, wait a minute. We're going to allow little bits of this in because we want the cells to get these instructions. Interesting.
Julie Kenner:So, yeah. Good. So how was your recovery? How long did it take?
Melanie Scherer:Oh, I still think I am recovering. I'm not near as bad as what I was. A lot of redness with me, but that's typical with me. I'd probably say, like, let's put it this way. I was still running around with a hat.
Melanie Scherer:I could, you know, I could go to dinner with my husband somewhere if it was, you know, kind of off the beaten path. And plus, I obviously showed everybody on a video what it was from beginning to end. But I did tell everyone and I reminded everyone that you still within a week after that, you're going to repeal again and shed and it could be even another week after that. So with you know, if you're going to be going to a wedding or you're in a wedding or you're going to something where you are very visibly avail. I mean, you are on the red carpet so to speak, you want to plan for a good three plus weeks to really let everything just settle.
Julie Kenner:I've been in dermatology long enough to have seen patients who had the early versions of the CO2 laser resurfacing and they were still red six months out. Six months. Oh. No question. Really?
Melanie Scherer:Oh, that would not make me happy.
Julie Kenner:No. And I've seen patients who've had scarring from CO2 laser surfacing. So times have changed. And I think now we have a lot smarter ways. But tell me last thing, and then we'll tie up.
Julie Kenner:Tell me how do you feel about yourself? How has your mental health
Melanie Scherer:Love it. I was looking forward to that. I'd already booked at six months ahead of time. I had to look at my schedule. Have a very busy schedule.
Melanie Scherer:So I just see, okay, when am I gonna be able to do this realistically without stressing out. And I picked a time booked at six months ahead of time. Could not wait to get it done and I'm very, very, very happy with the results. Good. Yeah.
Julie Kenner:Well Melanie, first of all, you do look beautiful.
Melanie Scherer:Thank you.
Julie Kenner:And secondly, Melanie does a lot of really important things. She's kind of a high powered woman that is a doer and shaker and she's involved in a very successful non profit. And what's nice is that we can avail ourselves now to aesthetic procedures And we can shorten that downtime. Just like I was saying, it's dramatic, the difference between sort of But just
Melanie Scherer:you talking about it, literally I was like, well, here, I'll be scheduling before the next one to go see you and then after as well.
Julie Kenner:Yeah, well we'll see if we can even speed up the healing beyond. But what we're doing is we're allowing people to age gracefully, naturally, and continue to put their minds not on sort of feeling bad about their appearance as time is going on, and why don't I feel like myself, but doing important things for our community, for our world, because they're not worried about their appearance anymore. They are proud of their appearance. So their self esteem is
Melanie Scherer:I'm very envious of women who feel that way and literally walk in like a peacock because they are going to own their age. They've had no work. They've had they don't skin is not important to them or whatever it is. I'm just saying I've got a lot of respect for both. So and I think it is important to look beautiful and look young or feel like you said feel the best that you personally feel about yourself in the mirror because you can tell me all day long that I look beautiful or I look great or I like this I can go home look in the mirror and be like oh boy I need some of this I need a laser I need some good products.
Melanie Scherer:So but it is you know to go back to what we were talking about earlier also find your purpose in life. Yes. If you're lucky enough to do that while you are still here on this planet,
Julie Kenner:right,
Melanie Scherer:that is such the part inwardly that exudes outwardly as Exactly. So I agree with you on And that 100
Julie Kenner:I always tell people there's beauty inside and beauty outside and that's really confidence has a beauty of its own. And so people are able to pick up on confidence. And you feel more confident when you're not worried about
Melanie Scherer:And I've met some beautiful, drop dead, gorgeous people, men and women on the outside. And I've known them on the inside and it's not so pretty. And so having that equal balance to me makes you just a beautiful person all I the way
Julie Kenner:agree, 100%. So I think that the science of aging and the science of well-being and the science of longevity are all intersecting really in an exciting time now. So it's a wonderful time to be in medicine. It's a wonderful time Yeah, to be it growing
Melanie Scherer:is. It's great. My grandmother, God rest her soul, I know she would have been like, what are you doing? Let's go do that
Julie Kenner:thank you Melanie for joining us on
Melanie Scherer:our My pleasure. You. This is really special. I love your office. Your staff is so professional.
Melanie Scherer:I look forward to being a regular patient.
Julie Kenner:Well, thank you very much.
Melanie Scherer:Thanks for having me. I appreciate it.