Age-Related Cosmetic Procedures With Special Guest Dr. Naficy

Airdate: 10/13/11

Top cosmetic surgeon, Dr. Sam Naficy and world-renowned beauty expert, Paula Begoun discuss age-appropriate cosmetic procedures that deliver natural-looking results! Find out when it's too early (or too late) to start and what to consider in your 30s, 40s, 50s and 60s+.

Paula Begoun: Hello, I'm Paula Begoun, the Cosmetics Cop, with my Paula's Choice Team, Desiree Stordahl and Bryan Barron. Here to keep you Beautifully Informed as we do every week. And of course you can call in on 347-426-3783 when we are on live as we are on Thursdays in United States Pacific Time/west coast time. And ask us questions and we will do the best we can to keep you beautifully informed with the facts.
00:00:41 We never make it up as we go and we give you researched information, meaning published information about what is possible and what isn't possible for skin. What are the ads saying? What are the crazy things going on in the cosmetics industry? We will straighten it out for you because wasting money isn't pretty.
00:01:04 Actually wasting money is pretty ugly no matter what you buy, but it is particularly bad an unattractive when it is expensive products that don't work. So tonight on our "Keeping you Beautifully Informed" show we are talking about age-related cosmetic procedures and we are going to be talking to Dr. Naficy who is a very renowned plastic surgeon in the Seattle area.
00:01:35 He runs his own plastic surgery center called Naficy Plastic Surgery and Rejuvenation Center, very appropriately named. And the thing that is so amazing about Dr. Naficy, and as I go off here for a moment. So I'm having plastic surgery tomorrow at Dr. Naficy's office and I'm a wreck; I really should be drugged up right now and on some sedative medication because I am just very -- I go back and forth between thinking this is the best thing I have ever done and thinking I'm crazy.
00:02:21 I just...I don't want to do it...but I am going to do it because what I am having done tomorrow, and actually Dr. Naficy isn't the surgeon who is going to be doing my reconstruction work because he -- actually what makes Dr. Naficy so amazing as a surgeon who runs his own center is his specialty is the neck up. He is not a plastic surgeon who is a generalist. Most plastic surgeons are generalists. They do a little bit of everything. They do liposuction and they do breast augmentation and they do nose jobs and eye jobs and forehead lifts and face lifts.
00:03:02 And Dr. Naficy's surgery center, plastic surgery center, is unique particularly in the northwest but even around the country, around the world, because most plastic surgeons are generalists. He is a specialist. And so while he concentrates on the neck up, my physician who is in his office, Dr. Sattler, is going to be doing my work from the neck down because what I am having done tomorrow is I had breast implants put in, I mean oh my lord, 32 years ago, 30 years ago, something...just forever long ago.
00:03:38 And not to mention that my body has changed greatly since then. But one has actually has a little bit of a rupture on top and is leaking and getting flatter. It is filled with saline water, just salt water, so it is not a risk. It isn't leaking silicone into my body. So there is no health risk but I am getting flatter breasts...that isn't the best. And it is just going to keep going.
00:04:05 And actually breast implants only last so long. Mine have lasted ridiculously long. So I am getting them redone. I'm taking the current breast implants out. Getting a breast reduction and then putting new breast implants in. I'm re-sectioning a scar that I had a long time ago and then I am also getting...actually I am doing a whole bunch of stuff. But it is all from the neck down.
00:04:29 Oh, and I'm having some liposuction on my back. So, I'm nervous, I'm excited. I'm scared about the pain afterwards. Okay, all right, and I am so emotional. You know it is interesting. I have never had plastic surgery on my face. I have had IPL, intense pulse light therapy, and Fraxel and laser and different things like that. But I have never had plastic surgery on my face. There is something about all of a sudden redoing some of my body that just at this age and stage in life that is just so emotional. I could start crying.
00:05:12 Okay, I'm not going to cry. Well, maybe I will. I'm so emotional. Okay, so Dr. Naficy is not doing my surgery but he owns the center so he has to take very good care of me which I think is probably one of the reasons I made him come on the show today. But what he can talk about brilliantly and rated one of the best plastic surgeons, actually the best plastic surgeon in the northwest area by a local magazine in the area.
00:05:48 So he knows this stuff. And he is going to give us game plans for what to consider in your 30s, 40s, 50s and 60s about how your face is aging and what you can and can't do about it. But before we I making sense guys? Desiree and Bryan, am I making sense?
Desiree Stordahl: You are making sense.
Paula Begoun: And if I start sounding too crazy you are going to stop me.
Desiree Stordahl: We will take over.
Paula Begoun: And I will try not to embarrass Dr. Naficy and talk too much about the private parts of my body any more than I already am.
00:06:21 So the one thing I want to talk about before we talk to Dr. Naficy about what we are supposed to do with our aging, our faces, cosmetic corrective procedures mostly from the neck up because that is his area. Actually, you know on his website Dr. Naficy is a nose specialist. He specializes in giving women beautiful noses which I thought was just fascinating. So there is a magazine that everyone might have seen on newsstands or as they are walking through airports.
00:07:01 And it is called New Beauty. It started out just a really thin little magazine. And it has grown. And it started out mostly and is still mostly about plastic surgery procedures and cosmetic corrective dermatology procedures. And it is a huge list of ads for plastic surgeons around the country. It is a fascinating magazine. So it is kind of a blend of pushing plastic surgery and showcasing advertising doctors who do plastic surgery, showing big rear ends and then what happens when you make them small.
00:07:44 And then some stuff about skincare products that actually is a little embarrassing that a doctor would advertise in a magazine showing these kind of products that are just...but that is a whole other topic. But the thing that Bryan pointed out on the cover of the current is fascinating. I mean the before and after's of the's an interesting magazine that also pushes products, good and bad products just like any beauty magazine.
00:08:14 But what is interesting on the cover is Courtney Cox is on the cover of the...what issue was this?
Bryan Barron: It's the latest issue.
Paula Begoun: Oh, you know what it is, it is a quarterly magazine. It's the Fall/Winter 2011 magazine. And very airbrushed and beautiful, because she is beautiful, Courtney Cox is on the cover. And inside...Bryan what were you saying that you were stunned by another issue of celebrities that endorse products and then when they stop making money from it --?
Bryan Barron: Right. I don't have the magazine in front of me at the moment. But just like a lot of other people, when I look at those magazines I can't resist whenever there is that little sidebar chat about what products they might be using, whether it is on their face or even in their home.
00:09:08 We just have that natural curiosity so I, of course read about what Courtney Cox was using for skincare these days. And noticed that none of the products that she is using are from the Kinerase brand. And maybe as soon or as recently as a year ago she was the spokesperson for that brand and would go on television and magazines and in magazine ads claiming that it is all she uses on her skin and that is why she looks the way she does. And here we are about a year later and she seemingly abandoned Kinerase.
Paula Begoun: Or they abandoned her.
Bryan Barron: And not surprisingly we are not seeing her in magazine ads for the brand anymore so either her contract is up, they parted ways, and now she is free to say that I'm using something else.
Paula Begoun: Right. Is it Kathy Lee Gifford who over the years we have watched her do three or four different product lines that changed her face?
Bryan Barron: Kathy Lee Gifford. Cher dabbled in it for a while. Another one, oh gosh, now her name isn't coming to me...oh, Suzanne Somers has a new skincare line every 18 months or so.
Paula Begoun: It is...I thought that the Courtney Cox comment that you made is really astounding.
00:10:34 Separate from the airbrushing and we actually are doing an article about Zooey Deschanel. Am I saying her name right?
Bryan Barron: I think it is either da-shan-el or day-shan-el.
Paula Begoun: Day-shan-el? So, Desiree, you and Dana found a picture of Zooey Deschanel in a fashion magazine where...who is she working for, Cover Girl?
Bryan Barron: Rimmel.
Desiree Stordahl: Rimmel.
Paula Begoun: Oh, Rimmel. Rimmel.
00:11:03 And she had pictures right next to each other where clearly she had different people Photoshopping her face because they changed her nose and what -- she doesn't look like the same woman in the two pictures right next to each other. One she looks like she had a nose job...she does...she has two totally different noses. It is clear one is Photoshopped completely differently. They lowered her lips; in the other one she has far more chin. It is really...what magazine Desiree was that in?
Desiree Stordahl: I don't recall which particular magazine it was in.
00:11:36 But it's been running like crazy in all of the fashion magazines. And the fact that they would have the audacity to put the two ads side by side and so you can literally see from one picture to the next what they did differently to her, it is just astounding.
Paula Begoun: So whether, so the takeaway from this, because we need to talk to Dr. Naficy because he knows everything, is that you have to look at these things with a grain of salt...not a grain of salt -- you need to come to us. We are going to keep you beautifully informed. You are not going to get seduced by pictures that aren't giving you the whole story, that you can't keep track of.
00:12:15 We are going to keep track of it for you. But tonight Dr. Naficy is going to help us keep track of what to do in our 30s, 40s, 50s or 60s to look beautiful and hopefully young and refreshed and healthy and glowing. Dr. Naficy, are you there?
Dr. Naficy: Yes, I am.
Paula Begoun: Hi, Dr. Naficy, how are you?
Dr. Naficy: Great, thank you for having me.
Paula Begoun: Thank you for taking the time, although as I said this is a bit selfish because I got you on the spot.
00:12:48 I get to actually say to the owner of the surgery center I am going to be at tomorrow, "Take good care of me!"
Dr. Naficy: I will make sure that that happens. Although you know that you don't need to remind me.
Paula Begoun: I know. I know sweetheart. Actually I, as I said that what you do in the northwest is...I love the idea that your center is not...that you guys are specialists. That you concentrate on an area and you do that the best and you don't try to be an expert in everything which is actually relatively impossible.
00:13:29 And so Dr. Sattler is your guy from the neck down, although he is going to be leaving so you are going to get a new guy from the neck down. And you do the neck up. I also noticed that you had another surgeon on your website. Who is Dr. Amadi? What does Dr. Amadi do?
Dr. Naficy: So he is kind of in the third category of plastic surgeons called Oculoplastic surgery and they do even more specialized procedures around the eyelids, having to do with droopy eyelid muscles and things that are kind of in the gray zone between cosmetic and reconstructive surgery.
00:14:12 And we are very lucky to have him. He is part-time at our center and actually part-time he is faculty at the University of Washington and he spends some time there as well.
Paula Begoun: Oh, okay. So your area, aside from doing the neck up, you are a Rhinoplasty guy. You specialize in noses.
Dr. Naficy: Yes, my practice as you stated, Paula, is neck up. And I would say probably half of what I do is Rhinoplasty, is doing nose surgery, both for cosmetic and also reconstructive purposes. And I also do some actually reconstructions for skin cancers that are on the face and the nose.
00:15:03 And the other half is facial rejuvenation. And as you stated that is kind of a...there are multiple areas involved in facial rejuvenation and we tried to focus just on things that we are good at and you are good at skincare and skin products and we don't do that.
Paula Begoun: That is what I'm insane on.
Dr. Naficy: We try to focus basically on surgery and injections and that is basically what we do, and we do it well.
Paula Begoun: So I take it that in your practice, obviously women come in in all ages, right? They come in to see you in their 20s, their 30s, their 40s, their 50s. Are all women coming to you in all ages? Is there like a sweet spot where women just are lined up out your door, the 40 year olds, the 50 year olds?
00:15:58 Are 20 year olds as interested and 30 year olds? How does that work in your practice or in any plastic surgery practice?
Dr. Naficy: Right. I think by far I would say that the majority of our patients fall in the mid-30s to maybe 60 range. But we certainly do occasionally see twenty-some year olds who are very much in the preventative mode in terms of anti-aging and so forth where they start with some injections.
00:16:37 Or maybe they are just getting injections because they want to have plumper lips. But the majority of our patients I would say are in their 30s and up.
Paula Begoun: What I was going to ask was when these different decades, women in different decades come in, in their 30s, 40s, 50s, and 60s, you must tell you tell them different things? Is the game plan different depending on your age?
Dr. Naficy: On your age. Well as you very well know there are certain kind of critical aspects of the game plan that are true regardless of what age you are at.
00:17:20 And I would say probably one that spans all ages, all generations, is using a good sunscreen.
Paula Begoun: Yes!
Dr. Naficy: If you are taking your newborn to the beach you want to put sunscreen on him and that is something that even in your 60s/70s you are going to do. Beyond that, I would say probably somebody in their 20s, up to the age of 30, typically the thing that they would do at least at our center would be Botox. I think that is kind of the entry level treatment so to speak for anti-aging as far as injections goes.
Paula Begoun: So is the research...
00:18:11 So you know it is interesting, this just came up recently because one of the things women often do my age when they get together is they talk about plastic surgery. If you are starting to get Botox, I have been doing Botox for, oh my gosh, at least a decade, maybe more. I can't even quite remember when I started. Is that okay Dr. Naficy?
00:18:36 Obviously you must think it is okay because women start in their 20s and 30s. It's not preventative; you have to keep doing it to keep the results, right? So I take it you can do it long-term and there is no research showing it is a problem to do it on end?
Dr. Naficy: Yeah, I mean as you always point out it is always good to have the information and the science behind statements that we make. And with Botox, it is has been around since the early 80's. and it was used off-label for over a decade actually before it was approved for cosmetic purposes. I think there has been somewhere around 30 million treatments of it that they have documented just in the US alone.
Paula Begoun: And everybody is doing fine?
00:19:40 Is there really no research about --?
Dr. Naficy: It has an extremely high patient satisfaction rate and it has a very slight risk of anything that goes with getting a needle poked into your skin, meaning minor redness or irritation or bruising and so forth. But in terms of long-term effects there has been nothing to my knowledge and there has definitely been a lot of studies.
00:20:07 There's been nothing to show that there are any adverse effects. Now there have been some long-term studies looking at identical twins where one twin sister gets Botox and the other one doesn't which shows that there is definitely a preventative role in terms of getting wrinkles years and years on after. So it is definitely, I think, as far as cosmetic treatments goes it is kind's a very high bang for your buck.
00:20:40 It's very high satisfaction rate and --
Paula Begoun: Do you have to do it...I'm sorry, go on Dr.
Dr. Naficy: Most patients who get Botox come back for it which I think again is a good statement that it works, otherwise they wouldn't be coming back.
Paula Begoun: Once those little lines start creeping in, yeah, I'm back on your doorstep.
Dr. Naficy: Right.
Paula Begoun: So I'm 30 years old, and I walk in, and I'm starting to see, just like any 30 year old pretty much, I'm starting to see wrinkles around my eyes.
00:21:15 I've got some wrinkles on my forehead. I've got some brown discolorations -- not much, just a little bit. So, what do you tell...oh, and maybe a little red veining, a little red splotches. What do you tell me to do? What is my game plan?
Dr. Naficy: In that age range I would say first of all we would make sure that you are using a good sunscreen. And we talk about that. We ask about your smoking habits. Hopefully you don't smoke, but if you do we give you a lecture about the effects of smoking on your skin and on aging.
00:21:56 In terms of the wrinkles around the eyes, a good way to be able to determine whether Botox would be a good treatment option is whether the wrinkles that you are inquiring about are what we call dynamic wrinkles, meaning wrinkles that you are getting with expressions, with smiling, or frowning and so forth. So if they are dynamic wrinkles, meaning they are caused by muscle activity, then Botox can help improve those.
Paula Begoun: So I got Botox, sorry, there is airplane flying overhead. I'm wondering if it is the Dream Liner. We have the Boeing Dream Liner plant is just down the street from us. Never mind.
00:22:45 Sorry about that. Just a distraction, forgive me. So what I was going to ask, so I get that Botox for the dynamic lines, the lines you make when you are moving your face. That is great. So you said some women in their 30s, do they have the nasal-labial fold lines, those laugh lines that go from the corner of the nose down to the mouth?
00:23:09 Do some women in their 30s come in wanting you to do something about that? Would that be something you would run into?
Dr. Naficy: Yeah, I think that is typically like you said is maybe more kind of in the 30s or early 40s. And typically if you are in good shape, meaning you are leaner, and you have less percentage body fat then your face is going to probably show those folds and creases at a younger age then you would otherwise.
00:23:45 So, exactly, those nasal-labial folds or kind of parentheses that you see are typically the most common area that we use for injectable fillers which as you stated are different than Botox. They are just working to add volume to parts of the skin where you have just lost collagen and lost some of your fat and are starting to basically show early signs of what we call volume loss.
Paula Begoun: So actually, you know it is interesting you talk, just as a departure Dr., we have a caller who is asking about the Vampire Facelift.
00:24:31 Do you know about that technique of taking your own blood and mixing it around and spending a lot of money to inject it back into your body?
Dr. Naficy: Yeah.
Paula Begoun: It's getting a lot of play because it is so dramatic. It sounds so gothic.
Dr. Naficy: Exactly. It's got a very cute name and it is very dramatic. And basically the concept behind it is like you said to extract some factors from your own blood and re-inject it back into the face. And because of the aspect that they are drawing your blood to isolate those products from, it's got the name Vampire Facelift. I can tell you that it is not something that a lot of plastic surgeons and dermatologists are rushing to do.
00:25:19 It's something that has a fairly low percentage of followers just because there are so many other safer, equally effective ways to lift the face with injections. I mean the whole concept of a liquid facelift has been around for a long time when basically that means that you can give many people a facelift like result by injecting their face with volume.
00:25:52 And for people who don't like to use synthetic fillers, which is kind of one of the appeals for people wanting to use the Vampire Facelift, probably the most effective option is their own fat. And I would say that is probably where most leading plastic surgeons in this county are really doing in terms of an [unintelligible] way to do a non-surgical facelift is via fat transfer or fat grafting as we call it.
Paula Begoun: When you do fat transfer or fat grafting does that mean that you also get liposuction at the same time?
Dr. Naficy: Exactly. Yes.
Paula Begoun: You are kidding!
Bryan Barron: But how much would they really be taking in terms of using fat as a filler? Probably not enough to make a difference in your thigh right?
Paula Begoun: You might as well get excess! I mean take the whole thing out. I'm sorry, Dr. Naficy.
Dr. Naficy: I typically when I do fat grafting, most of the time I get the fat from the inside of the thighs, just above the knee.
00:26:59 And many people have just that little extra fat pad just above the knee on the inside. And I pretty much contour that area very nicely for them with the amount of fat that I need to remove.
Paula Begoun: So you don't take away my backside to fill my face?
Dr. Naficy: Well, again, many people will say, "Hey, I want fat grafting but while you guys are there could you just clean the rest of it out?" Can certainly that can be done.
00:27:30 But as your assistant asked me earlier, you certainly don't need to take pounds and pounds of fat to be able to graft. Typically the most that you would need is about a pound to remove and of that you probably get maybe about an ounce and a half or so of actual healthy fat that you can inject.
Paula Begoun: In terms of using your own fat, which just sounds so...but using your own blood sounds odd to me. Actually, the whole things sounds odd. But separate from that, using your own blood, is there...does it last any longer than fat? Does using your own fat last any longer than using Restylane, hyaluronic acid fillers, synthetic fillers? I mean which is your favorite? What is the best filler? What do you like?
Dr. Naficy: In plastic surgery there is always the saying that you replace what is missing with something that is identical or as close to it as possible. It's called replace like with like.
00:28:37 So when you look at how the face ages, we certainly lose everything from the face, meaning our dermal collagen thins, our fat thins, our muscle atrophies. And actually the bone of the skull, our facial skeleton actually atrophies with age. But all of those, the easiest thing to replace is the fat. And that is my favorite. I mean I will be honest with you, Paula, I do a lot of facelifts and facial rejuvenation. It is almost unlikely for me to do a facelift these days without simultaneous fat grafting.
00:29:14 And I have followed my own patients now for as far out as ten years and I have very convincing photographic documentation that the injectable fat does last. Products that are synthetic in terms of Restylane, Juvederm, so forth, typically you are going to get about six to maybe 12 months out of them depending on where in the face they are injected. In terms of the Vampire Facelift, that has really not been proven.
00:29:45 And my guess is honestly that the improvement is going to be not much in duration than the synthetic fillers like Restylane, Radius, Juvederm, which is probably in the order as the most a year.
Paula Begoun: So it is funny, one of the things you see in these plastic surgery articles and in articles in fashion magazines is when they talk about Restylane and Hyaluron and Perlane and all that stuff is they always refer to them as being natural because of their relationship to hyaluronic acid.
00:30:21 And you are saying it is synthetic?
Dr. Naficy: Well they are synthetic. Yes, both statements are true in a way meaning that hyaluronic acid is something that naturally occurs in all of our tissues. But the hyaluronic acid that is commercially prepared for injections has been synthetically prepared.
Paula Begoun: Ah, got it.
Dr. Naficy: So in that standpoint, for example the advantage of hyaluronic acid is that you don't need to do any allergy testing, meaning that it is something that we all have in our bodies. Where you probably recall in the 90's the only filler that we had was bovine collagen. It was collagen from cows.
00:31:15 And you actually had to skin test people for that. You couldn't get the treatment the day that you went to your dermatologist or your plastic surgeon's office. You had to first get a skin test where they would inject into your arm just a small amount of collagen. And you had to wait a month to see if your body's immune system reacted to that.
Paula Begoun: If you swelled up. And you could still have a reaction. Right, I remember those days.
Dr. Naficy: Right, exactly. But with hyaluronic acid fillers that really, it's very unlikely. And if there is the rare reaction, it's not to the hyaluronic acid. It's probably due to one of the preservatives that are mixed in there.
Paula Begoun: So fat grafting is more natural than any of those other procedures?
Dr. Naficy: Absolutely. There is nothing more natural than your own tissue. So from that standpoint, yes.
Paula Begoun: So when you take the fat out of my thigh, what do you do to it to stick it back into my face? You mix it with flour and egg white? What do you do to my fat?
Dr. Naficy: There are a few considerations. One is traditionally when you take fat out using liposuction you are sucking that fat out with fairly high vacuum which kind of destroys that fat and renders it useless. With fat grafting you have to be very gentle in terms of how much negative pressure you use to be able to extract that fat.
00:32:54 You still are using a technique that is similar to liposuction, you still make small poke holes on areas where you want to harvest the fat from, but you are using a syringe and basically very minimal negative pressure to try to keep those fat cells health. There are a number of ways that you can process the fat, but we basically just will wash it with some saline and transfer it into small 1CC syringes and then it just gets injected under the skin just like you would --
Paula Begoun: It's that simple...relatively that simple?
Dr. Naficy: Relatively simple, yeah. I mean it's a process that I would say for example I had a woman that I did a brow lift, facelift and fat grafting on. And she had those nice kind of healthy pads above her knee.
00:33:45 And the whole process of harvesting and injecting the fat probably took 30 minutes. But it is something that can make the results of a good face lift outstanding because of just that volume and fullness that it adds to the cheeks and sometimes to the hollows of the temples.
Paula Begoun: Dr. Naficy, how do you do a brow lift? Do you do cut and pasting or do you do lifting the muscle, little micro-surgery? What do you do for a brow lift?
Dr. Naficy: Well brow lifts, looking at kind of the age range, that is typically kind of a 40s/50s procedure. Certainly typically followed after the eyelid lift which is the one that you just cut the extra skin in the crease of the eye.
00:34:34 The brow lift is really you have to think of it as a forehead lift. So it is really kind of like a facelift for the upper third of your face. So the incisions for that are really at your hair line or behind your hair line. And there are a few different modifications of it based on how high the person's forehead is, what their hair density is, how much lifting you are trying to get. So there are a certain number of modifications.
00:35:04 But basically you don't really do anything, any cutting, at the level of the brow or below the brow. You start from up top and you lift the whole forehead up. And it is something that in the right person can really do a nice job of opening the eye up. And, again, it is something that you have to use with caution because if it is overdone it is one of the things that can definitely give a fake look.
Paula Begoun: I've seen it over done. And we know many of the celebrities that have it over done.
00:35:33 So before I take, I want to...Denise from California is asking about neck surgery. But before we talk to her, if you will forgive me, Dr. Naficy, because I was on the Dr. Oz Show last week and Nelly from Pennsylvania, it was an interesting show. Desiree, can you let us talk to Nelly real quick here. Hi Nelly.
Nelly: Hi, Paula. It's so great to talk to you.
Paula Begoun: Thank you.
Nelly: It was the first time I got to see you actually on TV and you look fantastic with no makeup. I just couldn't believe it. It was amazing.
Paula Begoun: So let me...
00:36:05 So it is funny you say that and I want to hear more about how gorgeous I looked in just a second, so just to let everybody know, so the Dr. Oz Show that I was on last week that aired, the thing about the show was that nobody on the show was supposed to wear makeup. Nobody in the audience. Some people tried to sneak and they took off their makeup. And I went without makeup. I didn't have any...for the first time in my 30 years of television and when I was a reporter...I have never gone on air without being in full makeup.
00:36:38 And I didn't even...well maybe I snuck a little. I did put a little lip gloss on. But I was au natural. No foundation. No blush. And it was a little traumatic I've got to tell you. But Nelly, what I want you to know is that one of the things I realized after doing that show, and I'm 58 years old. Well actually I will be 58. I will be 58 in November. I actually have stopped wearing makeup. Except mascara.
Nelly: Whoa.
Paula Begoun: I realized that when I wear makeup I look older. That the foundation and my concealer popped my wrinkles. And if I try to use more sheer products, then they just slip into lines and so I have actually stopped.
00:37:28 I pretty much don't wear makeup very often. I mean I wear a tinted moisturizer with sunscreen a little bit, but it changed my life. That show actually changed my life. So tell me how good I looked, Nelly.
Nelly: You did look fantastic. You talked about how you had the eye lashes and your eyes looked pretty. Your skin looked beautiful. Because I had never really seen you on a television program before. I know you have been on other programs but that's the first time I really saw you. And I just thought, well, this is amazing. You just looked beautiful.
00:38:00 And I want to thank you -- in this job of helping people. Just listening to you, that has really helped me so much. I just want to listen to you and think what a benefit you are doing for so many women. I wish I would have known you years ago. You talked about your acne condition and years ago I was using the incorrect products and to think how I was just traumatizing my skin. And if you had been around then for us it would have been wonderful.
Paula Begoun: You are a doll. Nelly, you have done so much for my ego.
Nelly: But like I said, you are fantastic. I just think you should feel so proud of yourself. And it's just so neat to see you on TV. I thought that was great.
Paula Begoun: So Nelly, before I let you go, tell me your skin type and let me send you some Paula's Choice products. Are you using my products right now?
Nelly: Actually I have so many problems. I'm hoping maybe you can answer one question for me though. You typically talk about exfoliating your skin and I have Rosacea. And can a person with Rosacea use exfoliating products or is that not something I should do?
Paula Begoun: What are you doing to take care of your Rosacea right now?
Nelly: I'm doing what my dermatologist told me to do. And he did give me retinoid cream which has caused a lot of havoc with my skin and I got a flare-up, so I stopped using that. So right now I am using this MetroGel. And I'm using CeraVe as far as a lotion for moisturizing. And I use sunscreen which is called Solbar Zinc that he told me to use. It's a 38 number.
00:39:12 And that's all I use because I'm afraid to do anything again because of that retinoid, which is a good thing, is not working for me.
Paula Begoun: I have a lot of disagreement with dermatologists about using retinoids, whatever they are. Some women are successful with them; I think it is worth experimenting. For the most part that is all I never heard is about the irritation it can cause. But there is definitely documented research showing that it can be helpful. But if it doesn't work you stop using it.
00:39:40 How is the MetroGel working for you?
Nelly: I have been using that all along. And that worked well. And then when he introduced that Tretinoin, that is when I had problems so I decided not to use that. But I was just wondering because you talked about exfoliation being so important, and I was just wondering if that would be something I should try.
Paula Begoun: Nelly, how old are you?
Nelly: I'm 66.
Paula Begoun: 66. So, a couple of things. Rosacea is hell. And it just gets worse as you get older. Even if you try to keep it under control. None of us were great about sunscreen years ago.
00:40:10 I mean there are many reasons why it is just difficult on skin. I think CeraVe is great. What cleanser are you using? Are you using the CeraVe cleanser?
Nelly: No, right now I am using something I have used for years because it is working is just a Neutrogena Facial Cleanser.
Paula Begoun: The brown one?
Nelly: Fragrance-free. Amber color.
Bryan Barron: Liquid from Neutrogena.
Nelly: Liquid pump.
Paula Begoun: Yeah, I know it has been around. You are right. I think it was when you were a child it was made, Nelly. So Nelly, here is what I am going to do. I do think that it is worth testing a salicylic acid-based exfoliant. My product line, we refer to them as BHAs, beta hydroxy acid. Salicylic acid is a great exfoliant. It also has anti-inflammatory properties because it is related to aspirin.
00:41:05 So what I am going to do is I am going to send you...I would like you to try one of my cleansers. I am going to send you my Skin Recovery Cleanser. I would like you to try that. I am going to send you my Resist, my new Resist SPF 25 Sunscreen that uses titanium dioxide. I think that is absolutely worth trying. It is a very elegant formula. And then I am going to send you my 2% beta hydroxy acid lotion. As I said, I think that that will make a huge difference in your skin, if your skin can tolerate it. And the way to start is to start every other day, only at night. And see how your skin does.
00:41:50 If your skin likes it, then go to every night. Don't use it twice a day. You might get a little bit of flaking initially. It should go away. It should never burn and it should never make the Rosacea worse. If it does I would say return, except I am giving it to you for free, so you can't return it. But for my company if you had bought it, return it. So I would like you to play with those things and I'm also going to have you try my antioxidant serum from my Resist line and see how that does for your skin.
00:42:21 And you will let us know how you are doing, Nelly. Thanks for calling.
Nelly: And keep up the good work. Thank you so very much.
Paula Begoun: Thank you sweetheart. Thank you for that departure; my ego needed that, Dr. Naficy, because I'm having surgery tomorrow and I'm having fears and, oh my god. By the way, I have to tell everybody, so Dr. Naficy who is our guest tonight, who owns and runs the Naficy Plastic Surgery and Rejuvenation Center here in the Seattle area. It's a fascinating practice. He is one of the few in the northwest, actually one of the few in the country because most plastic surgeons are generalists.
00:42:56 He is a specialist. He specializes in the neck up and then he has other surgeons who specialize in other parts of the body, neck down. Or even more specialized for some parts of the face. It is a brilliant concept. I think his practice is one of the, well absolutely one of the best ones in the northwest for this concept of specialization. And Dr. Naficy, I'm having surgery at your place tomorrow. I am.
00:43:30 But, so I'm thrilled that I actually get to talk to you and maybe I should have taken some Valium before the show. But I didn't. So Denise. Desiree, Denise from California has a question for Dr. Naficy. Can you put her on?
Desiree Stordahl: Denise, go ahead.
Denise: Yes, hi. Hi Dr. Hi Paula.
Paula Begoun: Hi, what's your question?
Denise: Okay, I'm 57. I'm thin, I've always been thin. And now that I am getting older my neck...well, you know it starts sagging a little bit. But it looks like actually you can see the veins coming through now because my skin is thin.
00:44:14 And my granddaughter looked up at me the other day and she said, "Oh grandma, you are so old." And I was mortified. She just looked at the neck because she is small and she looked up at me. And I thought, oh my god, why did you have to say that?
Paula Begoun: So Dr. Naficy, what would be your recommendation for Denise?
Denise: What can I do about this?
Dr. Naficy: Yeah, Denise, treatment of neck skin in a thin person is actually one of the more difficult things that we do as plastic surgeons. It is almost kind of like skincare and Rosacea. There really is no one treatment that is going to be a magical fix.
00:45:04 The reason for the changes that you are noticing in your neck really has to do with your age and with hormonal shifts in your body that make your skin collagen gradually diminish. Assuming that you are either menopausal or perimenopausal, one of the things that happens as we reach in our 50s, the amount of sex hormones, estrogen and testosterone that end up rejuvenating skin diminish significantly.
00:45:45 And so part of that thin, crepey kind of paper-like aspect to the skin, it really has to do with quality of your skin due to loss of collagen. So even surgery, even though it may make it look smoother as you are pulling that skin back, it is not going to bring thickness back to that skin. Certainly in your situation I would say, one, consider hormonal therapy, if you haven't already done that.
Denise: I am on estrogen.
Dr. Naficy: Great. Consider treatments, and these are non-surgical treatments that help replenish your skin's collagen. Definitely take Paula's advice in terms of skincare products that have been scientifically proven to stimulate collagen.
00:46:33 Because really that kind of thin, aging neck condition that you mentioned, it is not something that surgery does a slam-dunk treatment for, unfortunately. It can make it better, but only so much. What you need to do are things --
Paula Begoun: So Dr. Naficy, you can't inject fat into the neck like you can --?
Dr. Naficy: Yeah, actually it is a great question. And fat injections in the neck are a little difficult just because, again, it is a huge surface area.
00:47:10 You are talking about a lot of surface area. There are a lot of important structures in that area and the blood supply in the neck is not as strong, even though there are some large main blood vessels that you see in terms of the jugular vein and so forth, the skin of the neck itself is not as vascular as the skin of the face. So in terms of survival of the fat graft. It really hasn't been a success story in terms of fat grafting.
00:47:39 One of the things actually that I am not a huge proponent of, I mean we offer in our practice and it does help some people, is called Thermage, which is a non-surgical way to try to boost up collagen. And that is one thing that I have seen in that crepey skin. It doesn't lift it, but again, it just plumps it a little bit.
Paula Begoun: What about...we have had other dermatologists and a plastic surgeon on that have been carrying on about Ulthera. Is that --?
Dr. Naficy: Yes, same principle. That is basically a focused ultrasound which again the purpose of both radio frequency which is Thermage and focused ultrasound, the purpose is to try to create a thermal injury, thermal stimulus to your collagen to basically generate more collagen. And I think either Ulthera or Thermage would be certainly a worthwhile endeavor with that kind of a thin, crepey neck that Denise is referring to.
Paula Begoun: But would a neck lift and then those other procedures you are talking about, would that be the direction?
Dr. Naficy: Exactly. It would be a combination.
00:48:47 A neck lift would definitely help because usually along with the changes in skin quality with that thin, crepey skin, there is also kind of an apparent excess quantity as well. So the lift can certainly help re-drape that excess quantity of skin and pull it back. But, again, I think if Denise's concern is the fact that her neck skin is so thin that you can see her major blood vessels and veins underneath it, a neck lift alone is not going to take care of that obviously.
Paula Begoun: So it is a combination.
Dr. Naficy: Exactly.
00:49:30 And then the other thing, Denise, you mentioned that you are thin. And that is something that after the age of really 45 or so there is something to be said about being a little overweight, or meaning if there is an optimal range at which --
Bryan Barron: Cold Stone Creamery.
Dr. Naficy: You want to be at the upper end of that range. Because certainly your face and neck is going to look better if you have a few extra pounds.
Paula Begoun: I'm sorry, Bryan, what did you say? Open a creamery?
Bryan Barron: I said Cold Stone Creamery, the ice cream store.
Paula Begoun: Inject that into my body!
Bryan Barron: I can't think of a better way to put on a few pounds.
Paula Begoun: So Denise, tell me, are you using Paula's Choice products right now?
Denise: Well of course I am.
Paula Begoun: Oh you are so wonderful.
Denise: I love your Skin Recovery line.
00:50:26 I have used the Resist. It's good, but I really love the Skin Recovery the best.
Paula Begoun: Oh, then we will send you some more. So we are going to send you an assortment of the Skin Recovery products including the serum. Are you using any of my exfoliants? Did you try the weekly --?
Denise: Yes, your Resist, I'm almost out of it, the Daily Smoothing Treatment and your Weekly Resurfacing Treatment. And real quick I wanted to ask the doctor, what if you put -- and I don't know if this is too harsh -- Retin-A or Renova on the neck?
Dr. Naficy: You know as Paula mentioned, all sorts of retinoid treatments can irritate skin.
00:51:13 But she also mentioned there has been scientific evidence that long-term use of retinoids can actually stimulate collagen production. So, I would say to the extent that your skin can tolerate it and maybe start with a lower percentage Tretinoin and maybe do it every other night as opposed to every night -- you certainly can get I think a small yet noticeable amount of collagen production. And that is something that you certainly want to do under the direction of a dermatologist.
00:51:49 But yes, the problem that you have is actually one of the few things that there really is no perfect solution for.
Paula Begoun: The neck is the hard one. The neck is the hard one.
Dr. Naficy: Exactly, yes.
Paula Begoun: So, Denise, I am going to send you some of the Skin Recovery products. And I also want to encourage you not know, we are doing an article for the website that says your face starts at your boobs. So I want you to, whatever you are putting on your face to put on your neck and your chest and start doing that now. Because all of the antioxidants, all of the exfoliants, if you can be successful using a retinoid like Renova or Retin-A or Tazorac, whatever your physician decides works for you, then do it from your chest, your neck, your face. It works.
00:52:48 Skin is pretty much skin and it deserves all of the great ingredients and it doesn't need special ones. You don't have to dissect your person up. So start using my products that you are using and the new ones I'm going to send you from the boobs up. That will take good care of you. Take care, Denise.
Denise: Thank you! I appreciate it.
Paula Begoun: I have one more...there was one question, oh, I love this question from Rita, from Illinois. Real quick. Rita, we need to help you with your after care for the facelift you have coming up.
00:53:19 Rita are you there?
Rita: I'm right here, Paula. And thank you. You have given me great advice. I have read great advice over your website and your book over the years. You have been wonderful. You have been spot on. But that is my question -- what should I do, what does the doctor recommend, what do you recommend for post-op treatment? What type of products?
Paula Begoun: So what kind of facelift?
00:53:41 Tell me first of all, when. Are you having the surgery tomorrow like I am?
Rita: Oh no. And best of luck to you tomorrow. November 2. And I have got my plastic surgeon. I think he is wonderful. He has done beautiful work. He said I really didn't need a full facelift but I don't want to have to come out of that and see neck lines or anything so he said, okay, we will go with the full facelift. He explained everything he would do.
00:54:07 I have been fortunate. My skin is in good shape. People tell me I look younger than I am. I'm in my 50s and I am on hormone replacement which seems to be working really well. But I wanted to know what are the best products I could use without going overboard and buying a lot of hype and ridiculous things. I'm big on cleansers and sunscreen. I will try your products.
Paula Begoun: Rita, are you also getting your eyes done? Are you also getting blepharoplasty?
Rita: Yes I am. He is going to address that, too. So there are still some fine lines there and a little, what is it, the dark circles. I think it is hereditary.
Paula Begoun: So Dr. Naficy, what do you recommend for your patients after a facelift?
Dr. Naficy: Well really Rita I would generally just recommend that if you have a skincare regimen that you are using and you are happy with it, there is no reason to change anything really.
00:55:14 Sometimes the surgeon depending on whether you are using any skincare products that may have exfoliants or things that might be potentially slightly irritating to newly operated skin, they may ask you to maybe take a week or so break. But really, there is no reason for you to make any modification going into surgery. The only things that we care about are people not taking things that affect their clotting systems.
00:55:44 So somebody who is taking high doses of vitamin E or aspirin or ibuprofen. But really in terms of skincare regimen, if it is working for you I would stick with it before and after.
Paula Begoun: And actually I would strongly, assuming actually, the only thing I would modify from what Dr. Naficy is saying is that assuming that you are using great skincare products, meaning you are using a well-formulated sunscreen that only contains titanium dioxide and zinc oxide, no synthetic active ingredients on your face just before or just after a facelift.
00:56:21 Actually I have a strong personal preference for not using synthetic sunscreens --
Bryan Barron: Synthetic, yeah, I just wanted to make that clear that you mean synthetic active sunscreen ingredients, not synthetic ingredient in general.
Paula Begoun: What did I say?
Bryan Barron: I think you said no synthetic ingredients.
Paula Begoun: Oh god, I so did not mean that. Because there are a ton of irritating plant extracts. See, I am anxious. I need a Valium. So I just have a --
Rita: Don't worry Paula.
Paula Begoun: I just have a couple of minutes left. I'm going to send you my Resist SPF 25 which is pure mineral sunscreen.
Rita: Thank you so much.
Paula Begoun: Because the major thing you have to do is protect your fact from the sun, especially after a procedure, and synthetic sunscreen ingredients on the face can cause irritation. And I'm also going to send you some of my Skin Recovery products. I am big into fragrance-free. You can't put anything irritating on your face, ever, but definitely not after plastic surgery.
00:57:20 So I'm going to run because I need to say goodbye to Dr. Naficy and I wish you the best of luck.
Rita: You too, Paula.
Paula Begoun: Can you call back at some point? I want to hear all about how your surgery went.
Rita: Okay. Okay. Best of luck to you tomorrow and thank you both. Thank you very much. Bye.
Paula Begoun: Take care.
Bryan Barron: One more quick comment for Rita and the post-surgery. Dr. Naficy I'm sure you would agree that anyone undergoing that type of procedure needs to be very upfront and honest with their surgeon about any supplements they are taking, even something that doesn't seem like a medicine, like a natural plant supplement could interfere with clotting and how their skin heals.
Dr. Naficy: Absolutely yes.
Paula Begoun: Like fish oil. You guys told me not to take fish oils.
Dr. Naficy: Yes. There is an increasingly expanding list of supplements that people need to avoid. And we actually have a list that keeps growing every year.
Paula Begoun: So thank you, Dr. Naficy. I have to say goodbye.
Dr. Naficy: Oh, you are welcome.
Paula Begoun: Dr. Naficy from the Plastic Surgery and Rejuvenation Center in the Seattle Northwest area. Brilliant practice. Brilliant surgeons. Specialists, not generalists. My kind of place to consider going. I can't recommend Dr. Naficy and his team strong enough. I will see you tomorrow, Dr. Naficy. Wish me luck.
Dr. Naficy: We will see you tomorrow. Sleep well.
Paula Begoun: Take care, dear. I can't believe that Dr. Naficy...he is lovely...we have to have him back on. Just incredible. I'm Paula Begoun, the Cosmetics Cop, with my Paula's Choice Team -- Bryan Barron and Desiree Stordahl -- getting me ready for surgery tomorrow.
00:59:13 So come visit me at All of our information, our past shows, you can find them there. Next week we are going to be, and hopefully I will be able to talk next week more cogently, more cohesively. On the 20th we will be talking about beauty risks versus rewards. And on the 27th, 7 beauty tools to transform your look. Everybody really take care. We should all be healthy and well and feel beautiful every day of our lives. Take care. Till next week.
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