Healthy Skin Advice with Dr. Azadeh Shirazi

DR. MIKE MORENO: All right, guys, hi, it’s Dr. Mike Moreno. Welcome to Wellness, Inc. The idea of this podcast is clearly this. There are so many things going on in the world, in the medical industry. We’re talking trillions of dollars. We want to separate fact from fiction. We want to figure out what is snake oil and what’s actually real. I mean, we have so many sources of getting things. We just want to know that we’re reading the right stuff. So that’s what we do.

We are fortunate to have an amazing guest and a fellow San Diegan and I’m very happy to say, Dr. Azadeh Shirazi is our guest today. She’s a board-certified dermatologist in La Jolla, California.

DR. AZADEH SHIRAZI: Yes, thank you.

DR. MIKE MORENO: Yeah, it’s nice to have you, Dr. Azadeh Shirazi. Is it Okay if I call you Dr Azi?

DR. AZADEH SHIRAZI: That’s what everybody calls me, Dr. Azi,

DR. MIKE MORENO: Beautiful.

DR. AZADEH SHIRAZI: Nice.

DR. MIKE MORENO: So, let me just get into it a little. You do some amazing stuff and I looked at your resume, you came from some big names, Harvard, the Mayo Clinic, and UT Southwestern. You know, what I love about it is you’re all about the natural look, but still flawless but natural look. I think we see a lot of things nowadays where that doesn’t quite look natural and it’s I think for a lot of people it’s a little concerning. I love your passion for skin cancer.

DR. AZADEH SHIRAZI: Yes, yes, I still do a lot of skin cancer reconstruction, which really helps me with the cosmetic aspect of my practice, and I love the natural look. I think that’s what most people are wanting now because the unnatural just looks unusual.

DR. MIKE MORENO: Yeah. Exactly.

DR. AZADEH SHIRAZI: But I am very passionate about skin.

DR. MIKE MORENO: That dermatology, I love it. Well, let’s get into this. No one wants to hear this, we’re all Covid out, but let’s just start with what we know is coming. People are stuck at home and this whole thing about the mask, and we’re not going to get into that controversy because that’s a whole other chapter, but I have to ask you, when did the term Maskne get created?

DR. AZADEH SHIRAZI: Well, pretty much when Covid started happening and people had to wear masks and realizing all the things that could happen with wearing masks for long periods of time, nobody’s skin was used to it. And we started seeing lots of different issues in the skin with masks, including breakouts, irritation, and for the health care workers that have to wear that heavy duty mask with the strong seal.

DR. MIKE MORENO: The N95.

DR. AZADEH SHIRAZI: That’s right, the N95. Then we started seeing some areas where we see skin breakdown and so the term Maskne came about and there’s been lots of information on it and the different tips for the breakouts versus the irritation. I see it a lot and my patients and I have to wear a mask, so I’ve seen it myself too. So, it’s kind of our new way of treating our skin these days with Covid.

DR. MIKE MORENO: Right, and you and I, having gone through med school and training and I mean we’ve been accustomed to at times in our lives to wear masks all the time.

DR. AZADEH SHIRAZI: That’s right.

DR. MIKE MORENO: So, you know, but for the general public, that’s not typically something they do. Let’s start with prevention, as always. What do we do? How can we prevent some of this Maskne from occurring?

DR. AZADEH SHIRAZI: I think understanding what happens to your skin in that environment under the mask is important. You’ve got a lot of moisture buildup under the mask and you’ve got no air flow and you’ve got the pressure issues. So, I always say stay away from oils, because when moisture and oil get together underneath that mask, it almost creates this waxy substance that can get into your pores and that can cause a lot of breakouts clog cause. So, stay away from the oils.

You do want to put your mask on with clean skin. So, if you can try to avoid makeup because it’s not like anybody’s going to see you with makeup on under the mask. So, avoid the makeup. Use a gentle cleanser that’s not going to irritate your skin, but maybe has some exfoliation there, like some glycolic or salicylic acid. If you cleanse with that right before you put your mask on and use a kind of a light cream-based moisturizer, so not an oil base and something light that’s going to help protect the skin because creams actually form a coating over the skin layer that offers some protection against the mask lining.

So, put on your cream after you wash your face and that helps kind of seal in the hydration. As soon as you get home again, you want to remove the mask and wash and get your skin clean again and hydrate it.

Now, if you do have acne prone skin, then you may want to see your dermatologist to put you perhaps on some prescriptions and things that help with turning your skin cells over more rapidly, like a Retin-A or Differin that you can buy over the counter, something that enhances your cell turnover to prevent those clogged pores.

DR. MIKE MORENO: Would you ever go so far as maybe doing like, you know, we use a lot of minocycline or doxycycline for, you know, oral antibiotics more as a preventative? Is that something potentially?

DR. AZADEH SHIRAZI: So, I wouldn’t use it as a preventative, but let’s say if you are getting those deep cystic.

DR. MIKE MORENO: Yeah. Like what if what if you get it, then what?

DR. AZADEH SHIRAZI: Yeah, you get if you get it, if it goes deep, cystic acne, pimples or the ones that don’t really come to a head, you know what I’m talking about, those ones. The oral antibiotics were great for those, because no matter what topical you’re putting on, it could be the best hospital in the world, but it’s not going to get deep enough to treat that cystic acne. Absolutely. I think prevention of acne scarring and treating those that kind of acne is really important with things like minocycline or doxycycline that’s available.

DR. MIKE MORENO: Great. So, you’re treating from the inside out rather than outside in.

DR. AZADEH SHIRAZI: Right, so if you have superficial acne, the topics were great, but once you get those deep cystic pimples, then you really need to have maybe some oral antibiotics or an oral agent to help treat those more effectively.

DR. MIKE MORENO: My favorite word in medical school was comedones

DR. AZADEH SHIRAZI: I love comedones.

DR. MIKE MORENO: What about beyond that? Like, let’s talk about some home treatments like laser hair removal and micro needling, which I can’t wait to get to. I mean, what’s safe that you can do at home and what should we be like, Hey, that’s maybe going a little far as far as being at home.

DR. AZADEH SHIRAZI: That’s a great question, because with everybody on quarantine or trying to stay inside the house and not really getting out too much and doing too many treatments outside the home, the home treatments have become very popular. The laser hair removal, they’re usually an IPL device, the intense pulse light. So, they’re great for maintenance. They’re not great at starting laser hair removal and having it be super effective.

The in-office laser hair removal is still much more effective, but let’s say you’re at home and you can’t get to your Derms office, then the IPL devices are actually pretty safe. I would say do some test sports before you treat a whole area, make sure you’re not going to get, you know, some of them some strange reaction, but I find them to be safe. There is one caveat, though, to them in certain patient population, so if you are Middle Eastern, South American, we do see this paradoxical hair stimulation with them because they’re a low light energy, they can actually stimulate hair, which is the opposite.

DR. MIKE MORENO: Ouch.

DR. AZADEH SHIRAZI: So that’s one thing to be aware of. We see this mostly on the face. We don’t really see it like on the legs or underarms or the bikini area, but the face is where you might notice something like that. So, if you do, you probably want to stop doing that at home devices. But they’re great for maintenance.

DR. MIKE MORENO: So, let me ask you a question like, Ok, so for maintenance, maybe start with your dermatologist and then go home and do more of a sort of a maintenance thing, like how much would somebody expect to spend on something like this, like on a decent product? What would you say is I mean, that may be a tough question? Like what’s an average price for the audience to say, okay, well, that’s reasonable.

DR. AZADEH SHIRAZI: Right. So, I think between two hundred to five hundred, you can get some pretty fancy ones up in the five-hundred-dollar range, but there’s lots of them on Amazon. If you go to my Instagram page, I do have an Amazon link of some recommended products and you can find some of the examples there.

DR. MIKE MORENO: All right, here we go, micro needling. I love this.

DR. AZADEH SHIRAZI: Yes, and I love micro needling.

DR. MIKE MORENO: Let’s explain what it is, first of all, because I think it’s fascinating. And then let’s talk about is this something you do at home or let’s just hear your take on this.

DR. AZADEH SHIRAZI: So micro needling is using tiny little needles that go in and out of the skin at various depths, and what that does is it induces new collagen formulation. It also induces your skin to release all these growth factors. You probably remember from med school.

DR. MIKE MORENO: Right.

DR. AZADEH SHIRAZI: With wound healing, we have all these new components and growth factors that get initiated when there is a wound that happens in the skin. So micro needling is really based on those theories where you get release of growth factors that gives you smoother, tighter skin. We use it for many different conditions. I use it a lot for my melisma patients because I feel like that’s one of the safest treatments they could do, but I also use it on scarring. I use it for little lines like smokers’ lines or just texture on the skin.

So, it has a lot of benefits. It is it is a procedure, I think, that should be done in the office. I know there’s a lot of that dermal roller or you may have heard, micro needling devices that are out there, you can pretty much buy online anything these days. So, you have to be really careful.

DR. MIKE MORENO: What about, and I know a lot of people probably been told this by their doctor, Keloids. I mean, keloids are a nightmare. Maybe we can just spend a second or two talking about what keloids are, why they come. I tell my patients, look, you don’t know if you’re keloid former or not until it shows up. But would this be effective for a keloid?

DR. AZADEH SHIRAZI: So, keloids are almost like tumors in the skin, and they form generally like in the chest, the shoulders, the upper back, and it’s when you have some sort of trauma. I’ve seen keloids from a cat scratch. Some people’s skin is so prone to keloids, it doesn’t have to be much trauma to get it. Then the skin starts forming scar tissue, but it doesn’t know when to stop. So, it over grows. This big mound of scar tissue that’s super thick.

Now micro needling, once you have a keloid, micro needling is not going to be very effective unless we flatten the keloid first because the needles only go in a couple of millimeters now at the most, but could these at home devices cause keloids? Possibly if they’re done at certain depths or if there’s a lot of trauma to the skin and that patient or that person has a predisposition to form keloids.

The other thing that I want to warn people about is that the dermal roller’s you see the people use at home, the needles actually go out after the first session and if you have any type of organism that grows on these dermal roller’s and you’re rolling it on your skin, you can really inoculate the skin with some pathogens like bacteria or funguses. I’ve seen some pretty crazy long-term problems with chronic infections from dermal rollers, so I’m not a fan of those. I think they’re dangerous and I feel like they’re not very effective. Maybe the first time you use it, the needles are sharp, and you get maybe some good results, but subsequently I would be very, very cautious in using them.

DR. MIKE MORENO: Great so leave the micro needling to the professionals in the office, not in the kitchen of your home, is the takeaway.

DR. AZADEH SHIRAZI: That’s right, especially not the kitchen.

DR. MIKE MORENO: All right. So, let’s switch gears and get into something more uplifting, no pun intended, but the foxy eye lift. Let’s hear about it. Not that I’m a housewives junkie and I watch them all and I am not ashamed to admit. Bella Hadid, her mom, was on the Beverly Hills housewife and I heard her career has just exploded. I’m not going to go off on a tangent. Like I said, I’m not a huge fan, but I watch every episode multiple times. So, she brought in the upturned eye look. That became the quote unquote, foxy eye lifts sort of birth. So, can you get this look, can I walk in and walk out with Bella Hadid’s? Look.

DR. AZADEH SHIRAZI: It’s so popular, I have so many people that come into my office wanting that foxy eyes. So yes, to a certain degree, but I also want to say that a lot of these photos you see online, these people have professional makeup artists doing all sorts of contouring and shaping the eyes with liner and shadow.

What we can do in the office is a simple treatment of Botox. Now, Botox, everyone thinks Botox are for wrinkles, while the way I see Botox, I can shape the eyebrows with Botox depending on what the person wants. If we relax certain muscles and allow other muscles to lift. We can get the ends of the brows to really go up and elevate nicely. And we can use other treatments like threads. Have you heard of these dissolvable threads?

DR. MIKE MORENO: Right. I’ve heard of them.

DR. AZADEH SHIRAZI: So, the threads can actually be used underneath the surface of the skin and this is a non-surgical procedure and I do a lot of this and I’ve been actually pleasantly surprised at the results, now in the right patient. So, we can go in with dissolvable threads. We can catch the end of the brow and lift the end of the brow with these sutures. It lasts about a year or two, a year and a half.

DR. MIKE MORENO: Oh, that’s a good amount of time.

DR. AZADEH SHIRAZI: Yeah, it’s a great amount of time and there’s no cuts, there’s no stitches because know the traditional brow lift you may remember from your medical school rotations back in the day. The brow lift is where we make an incision in the hairline or in the in the scalp and we actually go in and pull on the BATIA and there are stitches. And it could be a long recovery. Some people may require this, but now if you’re the right candidate, then you just use thread’s. There’s no stitches, there’s no scar. And it’s a 30-minute procedure. I do it in my office. It’s under a local anesthesia and it’s incredible. I’ve been really pleasantly surprised with the results of the threads for foxy eyes.

DR. MIKE MORENO: That’s a 30-minute procedure, that’s it.

DR. AZADEH SHIRAZI: Yeah, for most people, it’s, pretty easy, I would say. Now you have to be the right candidate. Now, if you don’t want foxy and you want more of an arched brow, then we can do that, too. You can use the threads depending on where you place them and how you lift them. You can actually create different shapes to the eyebrows and get a little lift the lid as well.

DR. MIKE MORENO: Very interesting. Let me ask you this, you know, I see in my practice, I see a lot of Bell’s palsy and I’m sure a lot of listeners are out there saying, oh, my gosh, I’ve had that. I mean, Bell’s palsy is so common. You know, for the most part. 85, 90 percent of people over the course of weeks or months will, you know, clear that up and not have that facial droop.

In your experience, have you had in some of these more chronic type conditions where people continue to have that that we do physical therapy, we do a lot of different, you know, speech therapy? So, you’re working with the muscles of the face and so on and so forth. Is there any sort of stuff that you could do or recommend that may help with that that droop?

DR. AZADEH SHIRAZI: Well, you know, the threats is a possible option.

DR. MIKE MORENO: Yeah, that’s of the way you’re describing it, I was like, I wonder if this is possible.

DR. AZADEH SHIRAZI: Yeah, it could be, because what it does is it catches the tissue underneath the skin and then repositions it. But Bell’s palsy, as you know, is quite complicated. It really depends on where and the degree and the patient’s skin type. Do they have thin skin? Because if you’ve got thin skin, sometimes these threads are not a good option for you. So really need somebody with good subcutaneous tissue that the threads can hook onto to adjust the position. But yeah, I’ve never had anybody, I’ve never treated anybody with for that, but that’s a great point you bring up

DR. MIKE MORENO: No, I was thinking about it because, like I said, most people recover and they’re fine, and it’s quite a traumatic experience for so many people. But, you know, it’s really scary, but I’m thinking, as you were talking, I was thinking, I have to look into that. All right. Let’s move from eyes to lips, and Lisa Rinna comes to mind. Lisa Rinna has got to have the most famous lips on TV.

DR. AZADEH SHIRAZI: Oh, my gosh. Famous or infamous?

DR. MIKE MORENO: I mean, it’s made her what she is. She is one of my favorites. I love her. She’s such a go getter.

DR. AZADEH SHIRAZI: I love her, too. She cracks me up, she’s fabulous.

DR. MIKE MORENO: So why would we fill the outline, like give us the story. Give us the whole rundown.

DR. AZADEH SHIRAZI: So, you’re probably talking about those the Russian lips.

DR. MIKE MORENO: Right.

DR. AZADEH SHIRAZI: You know, where they get the elevated border of the lips and that’s, you know, all about the hot trends. I’m impressed.

DR. MIKE MORENO: Well, you know, let’s just call it research and Bravo TV. Listen, I’m not ashamed to admit it.

DR. AZADEH SHIRAZI: Yes, so Russian lips, where we get this exaggerated, dramatic definition of the border of the lips, and that is a great treatment for somebody who has fuller lips. Now, if you’ve got thin lips and you’re trying to go for that Russian lip, look, it’s not going to be the same. You might end up more like the duck lips because putting too much filler in the border of the lips is great if you’ve got the tissue for it. But if somebody like Lisa Rinna but somebody who’s got very thin lips, it’s not going to it’s not going to work. But I love doing lips. Lips are always very, very popular. There is a new filler out that I’m just really enjoying using. It’s called Restylane Kysse. It’s a great name.

DR. MIKE MORENO: Well, Restylane Kysse has been around for a while, right?

DR. AZADEH SHIRAZI: For a while, yes, so this is a new line on the Restylane products, and what I like about it is that it integrates really nicely with the tissue and it’s stretchy. So, there’s different fillers on the market and they all have different properties. We use them in different areas of the face. I particularly like the stretchy, these new stretchy fillers because they integrate very nicely with the skin and so forth around the mouth or in the lips. When you move and talk, it looks more natural because of that stretchy property of the filler.

DR. MIKE MORENO: That’s great.

DR. AZADEH SHIRAZI: So, doing a lot of that and a lot of people do ask for that more defined lip line. Now, women in particular, as we age, you may notice when you put on your lip liner that that border of the lip gets less and less defined with age, so that Russian lip look it’s nice to get a little bit of the border back. I also use threads to accentuate the lip border as well. So that’s another play on the threads there that we were talking about earlier, putting some in the border. The lips stimulates collagen and gives it a little structure, a little more definition there.

DR. MIKE MORENO: Got it, Restylane Kysse out there. Remember that one. I love it. Okay, so now let’s move to something that I’ve been dealing with for 20 years. Not me personally, but with patients, melasma. The dreaded dark spots. I can’t tell you, listen, there are so many reasons I’m happy I’m a guy and not a woman and this is one of them amongst so many. I tell my patients all the time, like, I am so glad I’m a guy and not a woman, because women have to go through so much more stuff than us. We’re like big babies.

So, this is my only thing I can’t wait to talk to you about this because I know there’s it’s a lot of it is hormonally based. I was like a Silicon Forte baby back in the day. Right. Silicon Forte like it in the nineties is what that was my thing and in fact, I still use Silicon. Let’s talk. Maybe tell the audience a little bit about melasma, the dark spots in the causes. Let’s get into this is a big topic.

DR. AZADEH SHIRAZI: Melasma is a chronic condition, the way I explain it to people, it’s kind of like if you have diabetes, once you get it, it needs chronic management because it’s so difficult to cure. You always have it. And if you don’t take care of your skin, then it will come back. It’s so responsive to the sun. As soon as you get any sun, boom, you get these brown patches and we call it the mask of pregnancy because you have brown patches on the nose, the upper lip, the cheeks, the forehead. It almost looks like you’ve got kind of a brown mask on because the pigmentation is different than like freckles or some damage. It’s a solid sheet of brown.

So, it’s such a distressing condition for women. I wake up and I look like I have a mustache on, but I have to say it’s one of my favorite treatments. Now, if you were to ask me this five years ago, I wouldn’t say that. But now I love treating Melasma.

DR. MIKE MORENO: Tell me, give me your tricks.

DR. AZADEH SHIRAZI: I love it so much that my practice actually just formed a program specifically designed for melasma patients called Skin Bright. Skin Bright just does exactly what I said. Has people on a regimen of skin care regimen 12 months of the year because that’s what it really takes. Just like you have somebody with diabetes on a certain regimen and you check in with them periodically, I do the same thing with melasma.

So, there’s been some really good, great advancements in terms of topical therapy, and we’ve learned so much about it. One thing that is a misconception a lot of people automatically want to do laser, they say, I’m going to laser it, it’s going to come off, that’s what’s going to cure me. You always feel like you have to do something in the office, but that’s not true. Actually, a lot of lasers actually make melasma worse.

DR. MIKE MORENO: Really?

DR. AZADEH SHIRAZI: So, yes. And people don’t realize this until they go in for a laser treatment. Initially, they’re great for a week and then, boom, the patches are back and they’re actually worse than they were before. Because if you think about it, Dr Mike, melasma, as soon as you get any UV rays, it comes off. Right. And lasers are light based. So, the light from the lasers can actually make them a lot worse long term.

DR. MIKE MORENO: So, UVA, UVB, that sort of thing.

DR. AZADEH SHIRAZI: UVA, UVB, different wavelengths of light.

DR. MIKE MORENO: Makes perfect sense.

DR. AZADEH SHIRAZI: The other thing with melasma patients, if their skin gets red, it turns brown. They go from red to brown so heat can exacerbate and make melasma worse. Even now, there’s pretty good data on blue waves from the screen with everybody at home.

DR. MIKE MORENO: Like a cell phone?

DR. AZADEH SHIRAZI: Yeah, like cell phone or your computer screen. That’s just little tiny amounts of blue waves. They’re not that strong and they’re not so strong as UV rays, but still, they can also exacerbate melasma. So melasma is very tricky. I usually suggest you start with a skin care regimen that involves various ingredients like hydroquinone, Kojic acid, vitamin C, some natural brightness like Retin-A. So, the combination of these ingredients in a dedicated skin care regimen and a very simple skin care regimen.

DR. MIKE MORENO: Beautiful. I’ve always been taught, you know, my buddies that are dumb guys, they’re always like, listen, the key to good skin is moisturizing. Moisturizing, that’s all you’ve got to remember.

DR. AZADEH SHIRAZI: That’s true.

DR. MIKE MORENO: I’m a swimmer so I struggle a lot with dry skin. I think a lot of us deal with it. We have allergies or seasonal allergies or we’re just prone to all of these dry skin conditions and eczema. It’s really devastating for people’s lives. You know, people just say, oh, it’s just dry skin. No, it’s not. I mean, it’s a big deal. When you look at severe eczema and psoriasis in these plaques, they’re really life changing for people. So, I think, you know, we need to kind of look at this and realize these things, but, yeah, my friends are always like, listen, moisturize, moisturize. So, I’m like a fanatic.

Let me ask you, just a little bit off topic, let’s say for the average Joe, like myself, I don’t have all of the lotions and potions options, and I go to your, CVS, your grocery store, to where they have a decent sort of selection of things. What is my go-to for the average Joe? What would you recommend if I had to go in and buy two things and the skin care aisle? What are the two things that you would say? You know what, these are decent products. It’s not some multi hundred-dollar thing. Like, what would you say to the average Joe?

DR. AZADEH SHIRAZI: So is the average Joe just looking for just skin care, or…

DR. MIKE MORENO: Yeah, just general skincare.

DR. AZADEH SHIRAZI: I would say stick with a gentle cleanser because gentle cleansers can be incorporated with anybody skin. The cleansers point is just to get your skin clean without irritating it. So, something like CeraVe or La Roche Posay, which you can both find at CVS are great, or Neutrogena has a hydro boost cleansing lotion. Those are all just gentle cleansers. They do the job. You don’t need a fancy cleanser.

Then the next thing would be to get a good moisturizer with SPF. So CeraVe AM. is great because it is a mineral based SPF cream that also has ceramides in it. Ceramides are important at repairing the skin barrier. If you want something more tinted, some people love those tinted moisturizers because it kind of gives them a little coverage as well. Then La Roche Posay has a great tinted moisturizer, so cleanser and moisturizer is really can make a whole lot of difference in somebody’s skin. You see imperfections with dry skin and once you hydrate the skin, a lot of those imperfections go away, your lines get better, your pores look tighter. So, I think you’re on to something with the moisturizing and hydrating and skin.

DR. MIKE MORENO: So, my friends have not been lying to me.

DR. AZADEH SHIRAZI: No. Good friends. Good advice.

DR. MIKE MORENO: I’m a Dove guy. I love Dove Soap. You know, when I was a kid, like we always had Dove and I’ve always stuck with it.

DR. AZADEH SHIRAZI: Well, that’s because you’re a man and men’s skin is tougher. You guys would just use head and shoulders as shampoo and your face wash, which by the way I recommend. I do recommend head and shoulders for a lot of people as a face wash. You know what kind?

DR. MIKE MORENO: Well, you know, I just I use head and shoulders, and Selsun for a lot of topical fungus skin fungus.

DR. AZADEH SHIRAZI: Yes, yes, and a lot of people get fungal acne if you get little bumps on your forehead that look like acne, but it’s not fungal acne, or if you get, like, peeling, redness, dryness around your nose.

DR. MIKE MORENO: Wow, so many things can go wrong.

DR. AZADEH SHIRAZI: I know skin is complicated.

DR. MIKE MORENO: Now here’s a good one, I know everyone’s going to know about this, let’s talk about tightening of the skin. There are so many things out there and what do we do? Where do we how do we sort through this myriad of options? Does this work and what do we do?

DR. AZADEH SHIRAZI: There are so many different types of skin tightening, and so the way I like to look at it is the technology that’s used. You can go Thermage, like radiofrequency is a big one for skin tightening. A lot of devices insert into the skin and fire the radio frequency waves and that tightens the collagen underneath. Thermage is less invasive. So, there’s nothing going into the skin, but those are classically great for skin tightening and rejuvenation. There’s also ultrasound therapy, like ultherapy. Have you heard of that?

DR. MIKE MORENO: Yes

DR. AZADEH SHIRAZI: Popular one as well. Ultherapy uses ultrasound to specifically take a layer of skin and cause that tightening. Now, one thing to be aware of with ultherapy is it’s very technique dependent, because if you get too deep and you go below the dermis and you get into fat, it can kind of melt your fat, which is not what you want because that is what keeps our skin plump. So be very careful on the ultherapy and who does that because it could be a little tricky.

Then the other, which is my favorite skin tightening device, is laser resurfacing with CO2 or erbium lasers that penetrate into the skin. I just love this procedure. I do something called the contour laser and I can just see with each pulse taking that skin and kind of shrinking it and tightening it. So those are kind of the big three classes in terms of skin tightening technology that’s available right now. It depends on what kind of skin you have, how much downtime you want to take and how old you are and how much tightening you really need, but those are all great treatments and advances now in skin type thing.

DR. MIKE MORENO: Ok, let me ask you a question, my girlfriend has this like it looks like a mini rolling pin. A little like marble stone is what it looks like.

DR. AZADEH SHIRAZI: Oh, yeah, a Jade Roller

DR. MIKE MORENO: Yeah, exactly. That’s exactly it. Yeah. It’s Jade. It’s stone.

DR. AZADEH SHIRAZI: Yeah, you’re going to have to go home and say that to her. She’s going to be very impressed that.

DR. MIKE MORENO: Yeah, you know, I’ll be brushing my teeth and she’ll be like, hey, you should just try this thing. And I’m like, get away from me with that thing. I’m like, I don’t…And it’s like a weird little mini… It’s like I can make a mini tortilla with it. It’s a little thing, but so that’s a good deal. I mean, are you are you into that?

DR. AZADEH SHIRAZI: It’s not going to tighten your skin, it’s not going to get rid of your wrinkles, but you know, what I think it might help with is lymphatic drainage.

DR. MIKE MORENO: Yeah, okay, to her credit, she has said that she’s like, this helps the lymphatics.

DR. AZADEH SHIRAZI: That’s right, the lymphatic drainage. Now she can do facial exercises. Have you heard that? Facial exercises.

DR. MIKE MORENO: No, what is this?

DR. AZADEH SHIRAZI: Or so we have all these muscles in our face and if you build the muscles in your face, it’s kind of like putting volume and putting fillers in. There are these spatial exercises that women can do that helps build their muscle. The muscle that I think is worth building is the cheek muscles, because a lot of us lose so much volume in the cheeks as we age, which causes the sagging and so forth. So facial exercise and strengthening the muscles of the cheeks could help kind of pump up that skin. There’s been actually articles written on this, and I have done an Instagram story on it before. I think there’s some science to that and I think there’s some truth to that.

DR. MIKE MORENO: Hmm. All right. I mean, there’s so much I could go on forever with all this stuff. All right. Now, the ever so popular or I should say hated cellulite. You know, first of all, how much cellulite is genetic?

DR. AZADEH SHIRAZI: So, 90 percent of women have cellulite and 10 percent of men.

DR. MIKE MORENO: Yeah, guys don’t have it.

DR. AZADEH SHIRAZI: Yeah they don’t have it. It’s so common and a lot of people think cellulite is a disease of the fat, but it’s not. It’s actually a disease of the skin. I shouldn’t call it a disease because it’s normal. Right. Cellulite is normal. I should call it a condition of the skin. It is a condition of the skin. The reason people get cellulite is because they have these fibrous bands that pull on the skin and that pooling causes dimpling and a lot of cellulite treatment involves cutting those bands that are causing the rippling effect in the skin. It’s funny you bring up cellulite because just recently the FDA has approved the first injection or the treatment of cellulite. So, I’m super excited.

DR. MIKE MORENO: That’s huge.

DR. AZADEH SHIRAZI: It’s called Qwo, and it comes out in the spring of 2021.

DR. MIKE MORENO: Wow, that’s going to be a blockbuster.

DR. AZADEH SHIRAZI: I can’t wait to use it. I know, it’s going to be awesome and what the injection that you injected under the temple and it dissolves those little fibrous bands that are responsible for the dimpling of the skin.

DR. MIKE MORENO: So, it melts them away.

DR. AZADEH SHIRAZI: It melts those fibrous bands away. Which is awesome, because we have treatments, there are great treatments, but there are little more invasive than that. It is going to be really nice to just have a little injection into the skin.

DR. MIKE MORENO: You bring up a great point, because, you know, I tell patients all the time that want to go through with, you know, a lot of whether it’s procedures and it could be a dermatological thing or it could be other things, gallbladder disease, whatever it may be. I’m like, always be careful for what you are doing, because you a lot of times when you do something with this ideation that it’s going to always be better, it doesn’t always work. So, you know, you got to know go to someone who knows what they’re doing and really weigh the benefits. Everything is a risk benefit, right?

DR. AZADEH SHIRAZI: Absolutely.

DR. MIKE MORENO: That’s life. So, I think it’s important. But wow, Qwo.

DR. AZADEH SHIRAZI: Qwo.

DR. MIKE MORENO: And when is that coming out?

DR. AZADEH SHIRAZI: Spring of 2021, so look for that.

DR. MIKE MORENO: Right around the corner.

DR. AZADEH SHIRAZI: That’s right. I’m so excited.

DR. MIKE MORENO: Ok, we can’t finish this without playing a game, so it’s game time.

DR. AZADEH SHIRAZI: Okay great I love games.

DR. MIKE MORENO: All right, okay, so the game is called “would you slather,” as in slather a product on your skin? Okay. Instead of would you rather we’re talking, would you slather. All right. So, I’m going to just give you some things and you’re going to say yay or nay on these things, Okay? And, you know, we as a doctor, we hear crazy stories where people come in and say, hey, you know, my doctor said I should just drink like one hundred ounces of pineapple juice every day for a month. Is that a good idea? I’m like probably not. I mean, you know, sometimes intuitively things sound like bad idea. So here we go. Distilled white vinegar. Would you slather that?

DR. AZADEH SHIRAZI: Yes, I love white vinegar, but for what I guess, I wouldn’t just put on normal skin, I would dilute it down.

DR. MIKE MORENO: Ok, good. And it would probably not smell very good, do they make like a vinegar? It doesn’t smell like that. Probably not.

DR. AZADEH SHIRAZI: I think so you should dilute vinegar one to 32, so one ounce of white vinegar to four cups of water. If you’re a baker, you’ll know.

DR. MIKE MORENO: Wow.

DR. AZADEH SHIRAZI: So, if you use it at that concentration, it shouldn’t smell very bad. But I love vinegar because it’s antifungal. It’s antibacterial, especially against pseudomonas and it’s a great way to hydrate the skin resurfacing. We actually have people mist their skin, with that dilution of vinegar as their wounds are healing.

DR. MIKE MORENO: I tell my patients to rinse their ears out with vinegar and rubbing alcohol. It’s the best thing ever. It’s a great thing to do. How about coconut oil? That’s a common one.

DR. AZADEH SHIRAZI: On the hair I would slather.

DR. MIKE MORENO: Not on your skin?

DR. AZADEH SHIRAZI: Well, coconut oil is actually pretty comedogenic, so if you are prone to acne and we are in the age of Maskne, I am not sure if I would put it on my skin. I think it would be good for the arms and legs, not really on my face. I love it on the hair. It’s great for the hair.

DR. MIKE MORENO: Ok, how about charcoal based products?

DR. AZADEH SHIRAZI: I love charcoal, one of our bestselling masks called the detox mask and it’s charcoal based, and it has sulfur in it and charcoals great at removing oil and impurities from the skin. So, yes.

DR. MIKE MORENO: So, yes, thumbs up on that. How about facial scrubs? It’s like everywhere, everywhere you go, the facial scrub out in the grocery store, there’s like a hundred different facial scrubs, like.

DR. AZADEH SHIRAZI: No.

DR. MIKE MORENO: No, go, on the facial scrubs.

DR. AZADEH SHIRAZI: I don’t know why they’re so popular, like my most hated product is that apricot scrub.

DR. MIKE MORENO: Yeah, we had that growing up.

DR. AZADEH SHIRAZI: They’ve been around forever. It’s still on the shelves. It’s pretty crazy. It’s still around. I don’t like scrubs because you know what they call these little micro cuts in the skin, and that’s how organisms get into the skin. They’re also very irritating. I would much rather use a glycolic or a Salicylic acid or even a Retin-A to exfoliate my skin than a scrub or even those brushes, you know which ones I’m talking about.

DR. MIKE MORENO: Yeah.

DR. AZADEH SHIRAZI: The facial or like the electronic brushes that people use, those devices. I just think of all these organisms growing in the lining of the brush over time in a damp bathroom. I don’t know. I think just use your hands. Use your fingers.

DR. MIKE MORENO: Yeah, you know, it’s something about the scrubbiness it makes you feel like you’re taking. You know remove those dead skin cells. And I’m like yeah, that’s right. Let me have some of that.

DR. AZADEH SHIRAZI: So, there is one brush, though I do like, have you heard of dry brushing?

DR. MIKE MORENO: No.

DR. AZADEH SHIRAZI: Dry brushing actually works well, it’s used for cellulite, but it works great for lower extremity circulation. It’s a dry brush, so that makes me feel better because it’s not like any moisture or water sitting on it, but you start at your ankles and you brush towards your heart. So, these body brushes, you kind of work your way up the legs and it’s supposed to help with circulation and that sort of thing. So that’s the only brush I think I would do on my body. The dry brush.

DR. MIKE MORENO: Plain old, like hydrocortisone. So, over the counter is going to be one percent beyond that, two and a half percent and up, you’re going to have to get a prescription, but what about say, one percent OTC for pimples or like skin, itchy skin.

DR. AZADEH SHIRAZI: Yeah, unless you have, like, a really bad red rash like poison ivy or like a bug bite, that’s really irritating you. I wouldn’t even put hydrocortisone on my face for sure because one, long term it can thin out your skin and it could cause these breakouts called Perioral dermatitis, where it almost looks like acne around your nose and mouth. I see that very commonly because hydrocortisone, as you know, makes anything that’s red go away.

The problem is it masks a lot of skin condition and then ends up making it worse. People get dependent on the cortisone and it just becomes a hot mess after. So, I would say do not use it unless you’re consulting with the doctor or dermatologists.

DR. MIKE MORENO: Perfect. OK, lastly for us sun monsters out there, when we overdo it and don’t apply our sunscreen as we all should know better. What about good old-fashioned milk? Do you rub that all over yourself?

DR. AZADEH SHIRAZI: Milk if you have a sunburn?

DR. MIKE MORENO: Yeah. So, for a summer. Yeah. Like let’s say you fall asleep. So, do you just dump milk on you.

DR. AZADEH SHIRAZI: Well yeah or yogurt is good and Aloe actually it’s probably the best. The least messy. Maybe drink the milk and get some Aloe and put it on your skin. Yeah, I love aloe for sunburns. It cools the skin. People should not use heavy ointments, like for Vaseline on a sunburn because it’s very thick and it will trap the heat and so avoid heavy thick cream. So, aloe and milk or some people use yogurt is great for that.

DR. MIKE MORENO: Listen, I learned so much, you’ve just enhanced my dermatologic practice as a primary care guy.

DR. AZADEH SHIRAZI: Oh, good.

DR. MIKE MORENO: This is awesome. And I can now tell my girlfriend that the little jade roller is the real deal.

DR. AZADEH SHIRAZI: She is going to be very impressed.

DR. MIKE MORENO: Yeah. Wait till I pull out all this other stuff you’ve telling me. You’ve been amazing. I cannot thank you. This has been like super fun. I could go on and on. So where can we find you? How can our audience find you on social media? Tell us about your podcast. Let’s hear the whole deal.

DR. AZADEH SHIRAZI: So SkinbyDrAzi is my handle on Instagram, and I’m also now on TikTok because I have a tween daughter who’s put me on TikTok. But my podcast is “More Than a Pretty Face” and you can find it on iTunes, Spotify, Google Play and it’s short episodes. I love doing it because I just love educating the public. As you can see, I’m very passionate about skin care and skin health and all the fun cosmetic rejuvenation technologies that are out. I also have a YouTube channel. Again, it’s Skin by Dr. Azi, and it’s not like Ozzie Osborne. It’s Azi.

DR. MIKE MORENO: Azi, everybody. Remember, A-Z-I.

DR. AZADEH SHIRAZI: Yeah, so, follow me on any of those platforms, and I hope that this was valuable for a lot of your listeners, it was really fun for me to do.

DR. MIKE MORENO: It was a ton of fun. So, there we go, natural looking, flawless skin, what I love, I’m going to stress the natural looking because that’s what we all want. And the other thing I absolutely learned that I love is that I still can’t believe that only 10 percent of men get cellulite. No wonder why I never see that. I had no idea.

DR. AZADEH SHIRAZI: It is not fair.

DR. MIKE MORENO: I know. Listen, guys, we’re such babies. I’m one of them, so I can say it, but yeah, I’m with you. Listen, Dr. Azi, it’s been so much fun. I really appreciate your time. I learned a ton and I hope everybody who listened today did as well. So, thank you so much.

DR. AZADEH SHIRAZI: Thanks for having me.

DR. MIKE MORENO: Thank you. So that’s going to do it for you guys. Remember to subscribe, download and listen to Wellness, Inc with me, Dr. Mike Moreno, today. I want to thank everybody and look forward to next time. Thanks so much, guys. Take care.

The Wellness, Inc. with Dr. Mike Moreno podcast is for informational and entertainment purposes only and is not intended as a replacement or substitution for any professional, medical, financial, legal, or other advice, diagnosis, or treatment. This podcast does not constitute the practice of medicine or any other professional service. The use of any information provided during this podcast is at the listeners own risk for medical or other advice appropriate to your specific situation, please consult a physician or other trained professional. Thank you.

About This Episode:

In this episode Dr. Mike talks to world renowned skin expert Dr. Azadeh Shirazi who will help you learn everything you need to know about how to manage healthy skin and keep yourself looking great – from sunburn to eye lifts and lip fillers to cellulite, as well as the best products available and what products to avoid.

You’ll also get expert advice on how to tighten skin, reduce discoloration and how to keep your skin healthy under your Covid-19 mask.

Connect with Dr. Azadeh Shirazi:

https://www.instagram.com/skinbydrazi/
https://www.facebook.com/doctorazi/