Cosmetic Procedures to Look Younger NOW with Dermatologist Dr. Debra Jaliman

Airdate: 8/22/13

Wondering about the latest dermal fillers or the "vampire facial"? New York-based celebrity dermatologist Dr. Debra Jaliman shares info on the latest cosmetic corrective procedures, plus we reveal the #1 thing you can do today to look younger tomorrow.

Paula Begoun: Hello. This is Paula Begoun and Bryan Barron. We are coauthors of "Don't Go to the Cosmetics Counter Without Me," actually, among other books, "The Beauty Bible," "Don't Go Shopping for Hair Care Products Without Me." But what we are best known for is "Don't Go to the Cosmetics Counter Without Me." We're part of the Paula's Choice Research Team, of which there are many more, but right now it's just us. We had an anniversary, just recently, 13 years.
Bryan Barron: Just passed 13 years together!
Paula Begoun: We've been working together, writing, researching like mad people.
00:00:38 We also have Paula's Choice skincare products, my formulas that I developed with my Research Team at We have a ton of information on Way too many websites. You can all find us at But, I mean, there's so much to tell you, but the thing I'm most excited about is we're going to be talking to Dr. Debra Jaliman who is a dermatologist par excellence.
00:01:12 New York City, gorgeous office on Fifth Avenue. She's a fancy dermatologist to the New York celebrities and just people from around the world come to see Dr. Jaliman. She is author of a book called "Trade Secrets from a Top New York Dermatologist," because she is.
Bryan Barron: And she's gorgeous.
Paula Begoun: She's gorgeous.
Bryan Barron: And she looks the way you'd think a female dermatologist should look in the sense that she, I mean, she clearly wears her work on her face.
Paula Begoun: Totally.
Bryan Barron: Not in the sense that Dr. Jaliman is in her office injecting herself, but maybe's doing that.
Paula Begoun: Well, they usually do!
Bryan Barron: But she clearly takes good care of her skin.
00:01:54 She practices what she preaches.
Paula Begoun: Exactly.
Bryan Barron: You're not seeing her frolicking on the beach with a deep, dark tan.
Paula Begoun: Without mentioning any names, I have definitely seen dermatologists who have over Botoxed their face, and over lasered their face.
00:02:07 They've got parts drooping or not moving. And Dr. Jaliman, she is just top notch, skilled at what she does, and very practical. And has her little dog sometimes in the office. Oh, she's a dog-friendly derm.
Bryan Barron: Cool!
Paula Begoun: So, we love Dr. Jaliman.
00:02:26 We're going to be talking to her about all kinds of stuff – face ironing, fat injections, La Vie Vampire Facials, Ulthera, Fraxel. Everything that…
Bryan Barron: All about what you can do beyond skincare. Non-invasive anti-aging procedures. And, Paula, I know that you can speak to this, but as much as we believe, and this is absolutely true, that a great skincare routine is paramount to skin looking and acting younger, skincare alone isn't enough.
Paula Begoun: Not enough.
00:03:01 It just only goes so far. Definitely it can get you pretty darn far. It can definitely help prevent. But, in terms of what women think of as really looking younger and preventing sagging and what to do about puffy eyes, because so much about skin – I mean, you can only protect so much from sun damage. And sun damage causes brown spots and wrinkles, and crepey skin.
00:03:26 And then there's other issues like fat pads under the eye that have nothing, you know, for puffy eyes, that have nothing to do with what a skincare product can help with.
Bryan Barron: Right.
Paula Begoun: Definitely there are over-the-counter acne products that are brilliant and can make a huge difference, but when you have severe acne, if you don't see a brilliant dermatologist then you would be hurting your skin. But, particularly in terms of cosmetic corrective procedures, when done in association with a great skincare routine, you got the best of both worlds.
00:04:00 And so the world…
Bryan Barron: Without having to go under the knife.
Paula Begoun: Without having to go under the knife. Although, as someone who has had a facelift, going under the knife is pretty darn impressive, although as Dr. Jaliman will tell us there's definitely some new procedures out there, cosmetic corrective procedures, that actually can tighten skin pretty impressively. But, yes, I am a woman with a facelift. So, Dr. Jaliman, are you there? We're carrying on about your.
Dr. Debra Jaliman: I'm here. Hi Paula.
Paula Begoun: Hi, Dr. Jaliman!
Dr. Debra Jaliman: Hi Bryan.
Bryan Barron: Hello!
Paula Begoun: So, how are you? How's the weather in New York right now?
Dr. Debra Jaliman: Very chilly and very windy. Good day to get a wind burn.
Paula Begoun: So it hasn't changed from when I saw you, what, a month ago or so, two months ago?
Dr. Debra Jaliman: Exactly.
00:04:44 We're still waiting for spring and it doesn't look like it's coming any time soon.
Bryan Barron: I was just in New York last week, Dr. Jaliman, on Wednesday/Thursday of last week. And we got that unexpected sun break. And then by the time I left it was very cold again.
Dr. Debra Jaliman: I know. Spring is trying to come, but not too successfully.
Paula Begoun: So, Dr. Jaliman…so, remind me the name of your cute dog? I can't remember.
Dr. Debra Jaliman: Oh, my dog's name is Truffles. He was named not after the chocolate but after the Italian Truffles, because that's his color.
Paula Begoun: Oh, the mushrooms. The real deal.
Dr. Debra Jaliman: The real deal.
00:05:23 The real expensive deal. My precious dog.
Bryan Barron: Oh!
Paula Begoun: Oh, it is precious. She loves me.
Bryan Barron: Is it a Yorkshire Terrier?
Paula Begoun: What is it Dr.? What is your dog?
Dr. Debra Jaliman: He's a Havanese.
Paula Begoun: Oh! He's a Havanese. He's so loving. We fell in love.
Dr. Debra Jaliman: He loves Paula. He wanted to leave with her, I think. He was calling right up to and out the door.
Paula Begoun: Dr. Jaliman went and did some procedures, and I'm sitting there with the dog. The dog was on my lap. And we're a dog-friendly office. Paula's Choice is a dog-friendly office, so we are definitely animal lovers.
00:06:05 So, Dr. Jaliman, we have so many questions for you. Dr. Jaliman is a New York dermatologist. It's a shame she's not all over the place, because she is one of the preeminent dermatologists in the country. Her book, "Skin Rules: Trade Secrets from a top New York Dermatologist." They're not really secrets because she tells you all about them. And she's going to tell us all about them right now.
00:06:33 So, the one that Bryan brought up to me, because there's so much out there, such crazy stuff out there. And dermatologists trying to get attention for new procedures and being the first one on the block, and getting quoted in a fashion magazine. Something called Face Ironing. Have you heard of this? Do you know what that is?
Dr. Debra Jaliman: No. What is face ironing?
Paula Begoun: Bryan, did you not... – Do we know what it is?
Bryan Barron: Yeah, from the article that you forwarded me, which was…
Paula Begoun: Oh, we didn't forward it to Dr. Jaliman.
Bryan Barron: No, we didn't because…
Paula Begoun: Oh!
00:07:11 I asked her the first question and she doesn't know about it. I'm sorry Dr. Jaliman.
Bryan Barron: Well, come to find out it's another name for Thermage.
Dr. Debra Jaliman: Oh, okay. So, I know what that is. We do that all day long. That's cool. I know what that is.
Bryan Barron: Exactly. I knew that Dr. Jaliman would be familiar with Thermage. But I wanted to find out is whether or not she knew that the UK press was referring to it as Face Ironing.
Paula Begoun: Oh, I see.
Bryan Barron: They did this article with Gwyneth Paltrow.
Dr. Debra Jaliman: Oh, yes, yes.
00:07:37 I actually read the article in The Daily Mail. So, I read the article, but I guess the face ironing – yes, so Gwyneth Paltrow said that at 40 she had Thermage and she was very happy. And Linda Evangelista had Thermage, which I had known, because she actually had hers in New York. So, yes, Thermage CPT, is one of our favorite procedures.
00:08:00 It's radio frequency.
Paula Begoun: So, now, Dr. Jaliman, when actually we talked about this, and I said that I had had Thermage, and I didn't like the results. I actually thought I didn't see anything particularly different. I had it done a couple of times. And you explained why I was disappointed.
Dr. Debra Jaliman: Yes. So, I will explain that to your listeners. And that's because if Thermage isn't done on a high enough setting it really doesn't work, because the way it works is it stimulates the fibroblasts in the skin.
00:08:36 So, if it isn't hot enough then the fibroblasts don't get stimulated. So, many times people come to me and they say, just like you did, that the Thermage didn't work. So, then we get their records, we look at the settings, and we see that the Thermage was on a very low setting. So, then we take the same patient, we drug them. You know, we medicate with them a Demerol, a pain medication.
00:09:02 And then we turn the machine up to the sufficient temperature, and then redo the Thermage. And then the person really gets a result.
Paula Begoun: So, the way you do it, it hurts more than the way I had it done?
Dr. Debra Jaliman: Well, basically if you weren't medicated, if you didn't have…
Paula Begoun: I wasn't medicated.
Dr. Debra Jaliman: …pain medication.
Paula Begoun: No, for sure not.
Dr. Debra Jaliman: Then I know that it wasn't on the right level, because nobody could tolerate it without pain medication.
Paula Begoun: Ah-ha!
Bryan Barron: Ah-ha!
Dr. Debra Jaliman: So, that's the giveaway to me. If I say to the patient, "Did you have pain medication?" and they say no, then pretty much I know that they didn't have the right setting.
Bryan Barron: You said Thermage CPT.
Dr. Debra Jaliman: Right.
00:09:47 So, CPT is the newer Thermage technology. That's another thing that you want to check, because if you have the older technology, it's not going to work either. So, that's two things you want to know – is what technology Thermage and what setting the Thermage was on. That's what you need to know.
Paula Begoun: How do you ask? You just say to the nurse or the receptionist when you call a dermatologist, unless I'm traveling to New York and seeing you, which is what I think everyone should do, and then go see a Broadway show after they recover.
00:10:24 So, the CPT, do I just say, "Hi, I'm looking or Thermage. Do you have the CPT machine?"
Dr. Debra Jaliman: Yes, but you know interestingly you could actually go on the website of Thermage, which is Solta, and you can look it up yourself because people have been known to say they had CPT when they didn't. So, actually on the website of the company it lists who has CPT and who doesn't have CPT. That's one way of finding out yourself as an educated consumer.
Paula Begoun: And Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist," because she is a top – I think the very top – New York dermatologist, what is the name of that website to find the Thermage CPT?
Dr. Debra Jaliman: It's called Solta, because Solta is the company. S-O-L-T-A. So, I guess it would be They have a website which has a physician finder.
Bryan Barron: That's correct. Yes, Solta.
Dr. Debra Jaliman: You could actually look up a physician that you know.
00:11:24 You could put their name in, and then it would tell you do they have the CPT machine or do they have the older technology.
Bryan Barron: All right.
Paula Begoun: Dr. Jaliman, just before we jump to all the questions I have, because it's always all about me, why would I do Thermage versus Ulthera, Fraxel, AHA peels, or other? I mean, given the range of things you have done, what does Thermage do – what do I need – why would I need it?
Dr. Debra Jaliman: What Thermage does is, think of Thermage as building a foundation of your skin. So, it's very good for sagging.
00:12:11 It's building the structure of your skin. Let's say people have a little bit of jowliness. Their face is starting to sag around the jaw line, for example. Or they have a little laxity in their neck. Or their eyebrows are starting to sag down, or sagging around the eyes. That's what Thermage is for. It's not for the texture of the skin at all.
00:12:36 It's for the deeper, underlying structure. So, I always tell people it's like building the foundation of the house. That's what we do with Thermage. And then we would take other lasers, or peels, or fillers, or Botox to do the outer layers of the skin, to do the surface of the skin.
Paula Begoun: So, this Thermage CPT in comparison to say Ulthera or Fraxel, why would – I mean, is there a reason to do Ulthera or Fraxel versus Thermage CPT?
Dr. Debra Jaliman: For example, Ulthera is meant to also do the deeper tissue, but I find that Thermage is more effective. So, with Ulthera people find that they need to do two treatments, whereas with Thermage you can do one. So, that's why I prefer Thermage.
Paula Begoun: What about Fraxel.
Dr. Debra Jaliman: Also, Ulthera is very painful. Very, very painful.
00:13:35 And then Fraxel is made by the same company as Thermage and it's meant to treat the outer layers of the skin. It's more for lines. It's more for discoloration and texture. So, we still use Fraxel, but we use it for the outer layers of the skin. It's more for the surface, not for the deeper structure.
Paula Begoun: I think that women get confused often.
00:14:03 And I think a lot of dermatologists and plastic surgeons present the idea that, or medical spas, present the idea that one treatment, you know, do fillers and you're fine, do Botox and you're fine, do this laser and you're fine. And what you're suggesting is that it – just like skincare takes more than one product, that for real anti-aging, for really looking younger it's more complicated.
00:14:34 Gwyneth Paltrow doesn't look like Gwyneth Paltrow just because of Thermage. She's done other things.
Dr. Debra Jaliman: Exactly. Exactly. Because if you remember Gwyneth Paltrow, she had a lot of sun damage and she had brown spots on her face.
Bryan Barron: Oh yes.
Dr. Debra Jaliman: And she must have done a surface laser. She didn't just do Thermage. She had done a laser to address those brown spots. So, people may look at her and see that the brown spots are gone, and all the sun damage is gone, and they may think that's Thermage, but it isn't. She had to do a laser to address the sun damage. And that could have been anything from an IPL, an intense pulse light, or it could have been a Fraxel, or it could have been another laser to address the sun damage, but it wasn't the Thermage.
00:15:18 Because the Thermage just addressed the sagginess in her face. Or, maybe she didn't have sagginess yet. Maybe she was trying to so a preemptive strike on that. And maybe it was to prevent sagginess in her face, because she's only 40.
Bryan Barron: Dr. Jaliman, that's a very good point. One of the questions that we get from women is what is a good age to have a cosmetic procedure like that, and it seems the common thinking is, well, I should wait until it's really bad. I should wait until it's really noticeable and then do something about it.
00:15:52 But, in truth, the earlier you start, the less you're going to have to do later, correct?
Dr. Debra Jaliman: Exactly. I always think of it as weight loss. Like if you have five pounds to lose it's easier to lose than if you have 50 pounds to lose.
Paula Begoun: Ha! That's a great…
Bryan Barron: That's great.
Dr. Debra Jaliman: Yeah. And that's the way I look at it.
Paula Begoun: That's brilliant.
Dr. Debra Jaliman: And if you have a little sun damage it's a lot easier to deal with than if you have a whole face of sun damage.
Paula Begoun: Can I quote you on that? Well, obviously I'm talking to you, I could quote you. But do you mind if I use that one when I'm being interviewed? I think that's brilliant.
00:16:25 It's better if you're five pounds overweight, what do you want to wait until you're 100 pounds to do something about it?
Bryan Barron: Right.
Paula Begoun: It's easier to do something…oh, that's brilliant.
Dr. Debra Jaliman: Exactly. And so the other thing with Thermage that's very interesting is this – if you are younger it's easier to stimulate your collagen. So, if we take somebody who's 40 like Gwyneth Paltrow and we do Thermage, she's going to get a better result than I'm going to get because I'm in my ‘50s. So, even though I did Thermage and I got an excellent result, had I been able to Thermage when I was 40, but it didn't exist, I would have looked even better as I age.
Paula Begoun: So, just to be very clear…
Bryan Barron: Good for me.
Paula Begoun: And then I have a lot of…yeah, Bryan is the young one in the group right now.
00:17:11 But I have met Dr. Jaliman in person and when she walked in, and you know, Bryan knows I don't flatter; if anything I'm a rude son of a you-know-what. Because I was always say…
Bryan Barron: I prefer to say blunt. Direct.
Paula Begoun: I always say what's on my mind. I thought Dr. Jaliman was a woman in her mid-40s. And then when I found out she was closer to my age, I wanted to leave the restaurant and not talk to her again!
00:17:39 I'm thinking, oh damn! That's not fair. She's a gorgeous and obviously takes her advice to heart. Let's go back to the brown spots that you mentioned. And you said that there were several things that you could do of which Fraxel is one, an IPL. So, what do you do in your office when somebody comes in with brown spots, sun damage, brown spots.
00:18:05 What type of machine are you using in your practice?
Dr. Debra Jaliman: We use a variety of machines. If somebody doesn't want any downtime at all, which a lot of New Yorkers don't want downtime, we use a MedLite laser, because you can do it very gradually and there is no downtime.
Paula Begoun: What's it called?
Dr. Debra Jaliman: It's called the MedLite.
Bryan Barron: MedLite. M-E-D-L-I-T-E.
Dr. Debra Jaliman: Yeah. And MedLite is a YAG laser.
00:18:34 And it gradually takes the brown out. But the advantage of that kind of laser is that you're not only getting rid of the brown, but you're also stimulating collagen production at the same time, so you're getting rid of fine lines, you're improving your pore structure. So, you're improving the skin texture, the lines, the pores, and the brown all at the same time.
Paula Begoun: And how many treatments do you need to get the results?
Dr. Debra Jaliman: And it's anywhere from three to six treatments depending upon how much brown you have.
00:19:06 So, that is very popular in my office.
Bryan Barron: Dr. Jaliman, I'm sure you've heard female patients, especially those with more sun damaged skin, complain about the fact that along with the wrinkles, and the brown spots, and maybe some redness, they're also seeing enlarged pores.
Dr. Debra Jaliman: Right. So, that laser addresses the pores. That actually has FDA approval for pores, or lines because it's stimulating collagen.
Bryan Barron: Could you explain though how does sun damage cause enlarge pores?
Dr. Debra Jaliman: Because it's breaking down your collagen and your elastic tissue.
00:19:41 The UVA rays penetrate deep into the skin, so they don't burn you per se, but they actually destroy the collagen and elastic tissue, so then you don't have the structural support for your pore. So, it weakens the pore structure and enlarges the pore. So, if you can build back up that collagen, then you can strengthen the pore again, and you can shrink it.
Paula Begoun: We are here with Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist."
00:20:14 And they're not going to be secrets anymore because she's going to tell us all about them. And what is 100% true is she is a top New York dermatologist. We consider her the preeminent dermatologist actually in the United States. We think she's brilliant. So, we have lots more questions. So, when I was in your office I asked you, although Bryan thinks I'm being obsessive-compulsive about the brown spots on the back of my hands.
00:20:44 Because he thinks I don't have any, but I see them – what do you do for brown spots on the arms and the back of the hands? Is it the same as you do for the face?
Dr. Debra Jaliman: Well, you could also take, another favorite of ours is the LimeLight which is an IPL. And the LimeLight, what you can do is you can scan over the hands, the arms, the chest, the face, wherever you have brown spots, and you can – it darkens them. And then they imperceptibly peel off.
00:21:15 And then you can just peel those off over the next week or so.
Paula Begoun: So, L-I-M-E-L-I-G-H-T laser, or L-I-T-E laser?
Dr. Debra Jaliman: Light.
Paula Begoun: Light. And so there is some amount of downtime because the brown spots actually start looking worse than they actually are.
Dr. Debra Jaliman: Right.
Bryan Barron: I've had that happen.
Paula Begoun: So what's happening? How is that…why? What's going on?
Dr. Debra Jaliman: It pulls, it pushes all the pigment up to the surface, and then it peels it off.
Paula Begoun: And, there's no, and, why – I'm stuttering here!
Bryan Barron: I've seen this happen on my own face. When I had a series of IPL treatments, and I've probably had 11 or 12 of them by now, because I love what they do, but I remember the first few times the technician said, "Look, don't be surprised if later on tonight you see that your skin looks a lot worse. And that you're noticing brown spots that you never had before. That's a good sign."
00:22:25 And she explained it to me that it stimulates the pigments to come to the surface where they can easily be sloughed off as opposed to staying in the lower layers of skin where they'd be visible on the surface, but out of the reach of topical products.
Paula Begoun: Why does this – and then the skin stops making the brown spots? How does that happen?
Dr. Debra Jaliman: Well, it isn't that it stops making them. It's that the sun damage damaged your skin to a certain level, and if you can lift it up and out then it's gone. So, that's what we try to do.
00:22:55 And usually in our office it takes for most people anywhere from one to three treatments, because that's the level of the IPL that we use, because it's probably stronger than the one that Bryan had being that he had to do so many. And then people are done with their sun damage. So, we could actually do somebody's entire body if they had sun damage, you know, on their legs, or their arms, or their necks. And so it's like resurfacing the whole skin.
Paula Begoun: So, I could come in, again, I'm back to moi – to me! – so I could come in and you could do –
00:23:30 I don't have many brown spots on my face, but you could do the few brown spots on my face and my chest and my hands and arms all at the same time?
Dr. Debra Jaliman: Yes. Now, that's an interesting point. Let's say you only have three brown spots on your face, I wouldn't do it that way. The way we would do that is with a different laser. It's called an Accutip, and you just take this Accutip – it looks like a pen – and you just do each individual brown spot, because why do the whole face if you could just do three little brown spots on your face.
Bryan Barron: Right.
Paula Begoun: Oh, I got it.
00:24:07 Okay. Okay.
Dr. Debra Jaliman: And then they just peel off in a couple of days, those three spots. And it's really nice. And you can do it even on Asian skin.
Paula Begoun: I am fairly certain everybody listening to us right now is just planning, they're all going on Expedia and booking a trip, trying to see what the best bargain time is to go to New York.
Bryan Barron: Oh my.
Paula Begoun: So, let's talk about broken capillaries, Dr. Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist."
00:24:46 Broken capillaries around the nose that drive me crazy and for a lot of people it could be all over their face, or if they have Rosacea. What do you do about that? There really aren't any skincare products that I know of that are effective. So, it must be in your realm of work.
Dr. Debra Jaliman: What we do is first we determine whether somebody has background red, or whether they just have individual broken blood vessels. If you have background red it's best to get rid of the background red and then go for the broken blood vessels.
Paula Begoun: What do you mean by background red?
00:25:24 What do you mean by that?
Dr. Debra Jaliman: Meaning that let's say you have like a red face with broken – so some people just have broken blood vessels. And some people have a red face and broken blood vessels. You know what I'm saying? They have like a whole red. So, if they have a red face and broken blood vessels, what we do is take a Genesis laser, which is also a YAG laser, and get rid of the background redness. Because if you just try to get rid of the broken blood vessels and you haven't addressed the background red, then I find the broken blood vessels don't stay away because they're fed by the background redness in the skin.
Bryan Barron: So, a classic example of this scenario would be a patient with Rosacea?
Dr. Debra Jaliman: Right.
00:26:10 Exactly. But some people have background redness, because let's say they had bad sunburn, or bad windburn, they just have a lot of red. So, you really have to get rid of that red. And there's a few ways to do it. One, is you can do it with a laser. Some people have a lot of inflammation in their face, I've seen it. And you can take a blue light, a red light, and put them under that light a few times and take the red out of their skin.
00:26:38 And then you can take a laser, like a CoolGlide laser and do each individual blood vessel. And that you usually wait four weeks in between sessions and it may take anywhere from one to three sessions, and then you can seal up the blood vessel.
Paula Begoun: So, the red…wait, are you saying to get rid of a blood vessel, how long? You have to do more than one treatment? Or, are you talking about the background red?
Dr. Debra Jaliman: Usually. It could. It could be one treatment, but it's anywhere from one to three treatments for the blood vessels.
Paula Begoun: I would take it it would depend how much you have.
Dr. Debra Jaliman: Exactly.
00:27:17 And also the size of the vessel. Interestingly, the bigger the vessel the easier it is to get rid of. It's the opposite of what people think. The smaller the vessel, the harder it is to get rid of.
Paula Begoun: Really? Why is that?
Dr. Debra Jaliman: Because if it's a big vessel it's easy to put a lot of heat on it and just get rid of it. If it's a small vessel you have to very careful. You can't put too much heat on it.
Paula Begoun: Oh, because of the surrounding tissue? Oh, because it spills over. The heat would spill.
Dr. Debra Jaliman: Yeah.
Paula Begoun: Oh, I lost my train of thought! I hate losing my train of though. Oh! Well, here, when I've lost my train of thought, let me just remind everybody we're talking to Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist."
00:28:07 So, let's talk about a few, one of the things that we've run into, a lot of this stuff, some of the stuff like face ironing, that kind of stuff, it always seems to come from the British Isles, from the United Kingdom. But, one of the things I've read about is something called the Vampire Facial, or Vampire Injections?
Bryan Barron: Yeah, Vampire Facelift.
Paula Begoun: Vampire Facelift.
00:28:35 What the heck is that about?
Dr. Debra Jaliman: Well, that's very interesting. So, what they do is they take your blood out of your veins, like a vampire, and then they spin it down and they take some of the cells, and then they take hyaluronic acid, you know, from like a filler, like a Juvederm or Restylane, and reinject with some of your cells back into your face.
Paula Begoun: And?
Dr. Debra Jaliman: And the way they got this concept was, you know, if you have knee pain they spin down your cells and take some of the cells from your blood and put it back into your knew. And they say it could help heal your knee.
00:29:20 So, somebody took the same concept from orthopedic and then added the Restylane or the filler and put it into the face. But there's never been a study that any of these blood components added to the filler do anything to enhance the filler. So, nobody ever did a study on this. What do I think? I think that it's the filler that helps your face; I don't really think it's the blood component.
Paula Begoun: Right. Because what you're getting is you're still getting the Restylane, you're still getting the hyaluronic acid filler, and the blood, and they've never done a comparative study, like put hyaluronic acid in one side of the face and the vampire stuff in the other to see which did better?
Dr. Debra Jaliman: No.
00:30:05 But it's a good way to charge you more money for the Vampire part.
Paula Begoun: Oh geez.
Dr. Debra Jaliman: And I really don't like when people do things that have no science behind them.
Bryan Barron: Yeah. And it was made popular by one of the Kardashians.
Paula Begoun: Oh, we should all do what the Kardashians do!
Bryan Barron: But apparently there's another dermatologist, or a cosmetic surgeon – is she in New York? Well, maybe she isn't. Have you heard of a woman named Amiya Prasad?
Dr. Debra Jaliman: I don't know her.
00:30:39 But I just know there's a picture of Kim Kardashian with blood smeared all over her face talking about how she gets the Vampire Facelifts, which you wouldn't even have blood smeared all over your face because it's a blood component. It's not your blood.
Paula Begoun: That's such a…
Dr. Debra Jaliman: You wouldn't have blood smeared on your face. First of all, it would hopefully be in the syringe. And it would be a blood component, so the whole thing seems ridiculous.
Bryan Barron: And this particular dermatologist or surgeon is charging $1,200 for what he calls a 45-minute Blood Facial.
Paula Begoun: Oh geez.
Dr. Debra Jaliman: Yeah.
00:31:13 I mean, and what's so ridiculous is the Restylane, let's say, would be anywhere from $500 to $750, so they tacked on a heft increased to the price just by taking your own blood.
Paula Begoun: Well, you had to pay for Kim Kardashian's endorsement, because she does not come for free. That is for sure.
00:31:34 We won't trash Kim, too much.
Dr. Debra Jaliman: No.
Paula Begoun: So, speaking of injections, the Restylanes and the hyaluronic acids and whatever, so one of the things, and again, I talked to you about this when I saw you in your very fancy Fifth Avenue New York – which actually isn't really down – I got to say, for a fancy location you have a very down-to-earth, friendly…
00:32:02 Really, it felt so comfortable there. I got to say I was expecting to see a lot of women in big fur coats and dripping diamonds given the location, and it just felt so, I mean, I'm sure they're hiding in your rooms somewhere, but it just felt so friendly. The women in your office were just – everybody was professional. I didn't feel – just as a Northwest girl I just felt very comfortable.
00:32:30 So, that was lovely. But, one of the things that we talked about was in terms of fat injections, because when I had my facelift they took some fat out of my knees. And I got this strange dent in where they took the fat out of my knee area. And they did whatever they did to it and they injected it in my face. Now, it's worked really well in some areas and I'm not happy with what's happened around my eyes with it.
00:33:01 And you had an explanation for why fat injections sound more interesting than they may end up being.
Dr. Debra Jaliman: Well, you know, the problem with fat injections I've always found is they don't always take equally. That's always been the problem we've seen with fat. So, while fat can be good in certain areas, like you noticed it doesn't always take evenly. So, I've seen a lot of people who have problems because they're uneven from the fat.
Paula Begoun: Well, mine are definitely uneven. And it has moved. I mean, I've got for lack of a better term, I've got bunching.
Dr. Debra Jaliman: Yeah. And I see that a lot. So, I now have a woman who wants the fat out of her face, because she has bunching where she's fat on side of her face and totally asymmetrical. And for years we've had this problem, how do you get the fat out of the face? Like, at least if you don't like your hyaluronic acid you can dissolve it out with an enzyme. But what do you do if you don't like the fat? You don't want to cut it out and have a scar. And I think I finally came up with a solution for her, after all these years of people unhappy with fat lumps in their face.
00:34:17 But, you know…
Paula Begoun: Wait! Wait! You can't get away with that. What's the solution you came up with?
Dr. Debra Jaliman: Oh, what's the solution? So, we just got a new machine, because we're always buying a new machine. And the new machine that we bought is for melting fat. And there are a lot of melting fat machines, but this one is FDA approved that you can use it on the face.
00:34:42 So, I think what we could do is use it on a low setting and try to just touch it to the areas where she has the excess fat.
Bryan Barron: Is this ultrasound-based?
Dr. Debra Jaliman: Yeah. Well, this actually is radio frequency and it has mono-polar radio frequency. It's Exilis. You can use it on the body. You can use it on the face. But it melts – it tightens skin and melts fat.
00:35:05 So, if we could tighten a little bit of her skin and melt a little bit of the fat at the same time very slowly, maybe we could melt out the lumps that she doesn't like.
Paula Begoun: So, have you done that yet?
Dr. Debra Jaliman: No. Because what I want to do is get the trainer for the company to come because it's not such an easy thing. This is a complicated face. I don't want to do this myself.
Paula Begoun: I want to come too!
Bryan Barron: Are you volunteering to be the test subject?
Paula Begoun: So, Dr. Jaliman, is the company saying they've done this successfully?
Dr. Debra Jaliman: Well, I don't know.
00:35:43 You know, I want to get the person who really has the most experience to see if we could do this. And if we can I'll certainly let you know and we'll certainly add you to our list. Because I think it really seems like it could help her, because she really has a lump, you know, a half a lump of a face – like half her face looks smaller than the other, half looks really distorted. [crosstalk]
Paula Begoun: So, can you just put more fat in? Or put mother fillers in to balance it out?
Dr. Debra Jaliman: Well, you could, but her part that has the fat, it's so distorted and really doesn't look good, that I think you have to take that part out. That's what she wants. She wants it out.
Paula Begoun: And then what other injection under the eye would you use to smooth out wrinkles there?
Dr. Debra Jaliman: Well, you could use hyaluronic acid under the eye. It really works quite well and it lasts a long time because, you know, there's not much stress under the eye.
00:36:36 So, when we put hyaluronic acid in under the eye it really stays for a long time.
Paula Begoun: All right. So, I am going on Expedia now.
Dr. Debra Jaliman: Ha! Wait a little bit! Let's wait till we solve her problem.
Paula Begoun: Well, okay. All right, so I won't book my ticket just yet. So, we are talking to Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist," because she is, over on Fifth Avenue and I forget where…
Dr. Debra Jaliman: 74th.
Paula Begoun: 74th and Fifth Avenue.
00:37:09 Beautiful neighborhood on the park, on Central Park. We posted that you were going to be talking to us on Facebook, and we have questions from our Facebook fans that like us. Some actually don't like us, but they talk to us anyways. But we have some questions for you, Dr. Jaliman.
Bryan Barron: One of our fans named Marge wants to know about LaViv.
Dr. Debra Jaliman: So, LaViv is very interesting to me because ten years ago or so LaViv used to have a different name.
00:37:45 And I used it a lot because many years ago we didn't have any other fillers. It was just collagen. And if you were allergic to collagen, cow collagen, you couldn't really have anything else.
Bryan Barron: Right. You were out of luck.
Dr. Debra Jaliman: You were out of luck. And it used to be called [IsoLagen].
Paula Begoun: Oh, I remember that.
Bryan Barron: LaViv used to be called IsoLagen?
Dr. Debra Jaliman: Yeah. Uh-huh.
00:38:08 But we used to take skin from behind people's ears and send it to the company and they used to send us back vials we used to inject it. And people liked it a lot. Then it got taken off the market by the FDA, not because it was bad, but because they didn't like the laboratory, because they felt that they never went through the FDA. They just sort of snuck it onto the market thinking that it didn't need approval because it was the person's own skin. [crosstalk].
Paula Begoun: I don't know like the lab either. That's a bizarre…what an excuse! Okay, so go on. So, now LaViv comes along.
Dr. Debra Jaliman: So, now LaViv went through the FDA. They did everything right. And it's back on the market. And it's really a great technology. I mean, it's just expensive.
00:38:59 So, you take the skin, you FedEx it to the laboratory. They send you back the cells which are fibroblasts, so the fibroblasts are the cells that make your collagen. So, they send you very high concentration of fibroblasts. And I think they've really perfected it from when I used to do it years ago, because they send you very highly concentrated fibroblasts. And you inject them into the person's skin. And then you have these powerhouse cells making your own collagen in your skin.
Bryan Barron: So, one of Paula's questions when we discussed this awhile back was how do those concentrated fibroblasts know where to go?
00:39:44 How do they hook up with collagen that's already in the skin?
Paula Begoun: Well that's depleted.
Bryan Barron: Or damaged.
Paula Begoun: Right. How does it know to just stay, like for example I don't need more collagen in my cheek bone to grow and make that area bigger. How does it know to just go in the lines that run from my nose to my mouth, the nasal labial folds? How does it know to just go there or jut stay in the lines between my eyebrows so that everything doesn't pooch out?
Dr. Debra Jaliman: So, your dermatologist has to know where to inject it.
00:40:16 It's a little like solution and somebody has to carefully inject it exactly into the spots where you want it to grow. And if they injected it into your cheekbones, then it would grow there.
Paula Begoun: So, it knows when you put the fibroblasts in, it connects to the collagen where your…
Dr. Debra Jaliman: Right in that spot. Only in the spot that you put it.
Paula Begoun: Right in that spot. So, there must be something sticky that…
Bryan Barron: That keeps them from migrating.
Paula Begoun: …that keeps it from migrating.
Dr. Debra Jaliman: Yeah. It just stays in its spot.
Bryan Barron: Okay.
Paula Begoun: So, you've been using this LaViv, you've been using this filler?
Dr. Debra Jaliman: Well, since we got the new LaViv, I have to say there are many other alternatives because now we have hyaluronic acid.
00:41:00 So, it's interesting to me – years ago I was one of the biggest users of IsoLagen. And now that we have LaViv, it isn't as easy to tell people to spend $5,000 to get an injection.
Paula Begoun: $5,000? And does it last any longer?
Dr. Debra Jaliman: Well, that's a good question. They only say that they have studies for maybe up to a year.
Paula Begoun: A year for $5,000?! I thought Restylane…I'm yelling. I got to stop. I'm sorry.
Bryan Barron: Poor Deva. He's looking at the board like, "Whoa!"
Paula Begoun: Well, but, I mean, Restylane and Hyaluronic and all those, I mean, there's a dozen other injections that last, you know, I don't know, at least a year, up to 18 months.
00:41:46 And some depending on where you inject it and how much you use your face, two years. Why would you do LaViv?
Dr. Debra Jaliman: That's a good question. That's why I'm saying I haven't used it because I would use it if somebody wanted it, but I can say anybody has come around saying I want this. And we have so many other options. In the old days we did – when people were allergic to collagen, this was their only option.
00:42:14 And now I notice interestingly the media that they're using is made with cow collagen. Like I'm allergic to cow collagen. I had a severe allergic reaction, so I couldn't even have LaViv if I wanted to because the media has cow collagen in it which a lot of people are allergic to.
Bryan Barron: Oh, how funny.
Paula Begoun: So, when you say media you're not talking about television. You're talking about the ingredients that are…
Dr. Debra Jaliman: They grow the cells in.
Paula Begoun: They grow the cells in.
Bryan Barron: Yeah.
Dr. Debra Jaliman: So, I don't even know, by the way, if you wanted to have this done, and you were an allergic person, I wouldn't be inclined to tell people to do this, because 3% of the population is allergic to cow collagen. Less people are allergic to hyaluronic acid. So, I'm not so inclined to tell people – it's not like they're sending me batches of the media, the cow collagen media to test people with.
00:43:08 So, I don't even know what would happen if somebody spent this money and then they were allergic to it because of the media they grew it in.
Paula Begoun: And so it doesn't necessarily last any longer than these other injections. You have a higher likelihood of being allergic to it. And it's more expensive. So, other than reading about it in a fashion magazine, you'd be – why bother.
Dr. Debra Jaliman: Well that's what I'm wondering. I mean, I don't know. Some people like the concept that it's natural.
00:43:35 I don't understand why they're growing it with cow personally.
Bryan Barron: So, Cindy on our Paula's Choice Facebook page wanted to know what your thoughts were on the PaloVia at-home laser device. And, of course, we get a lot of questions about the growing crop of at-home light emitting devices in general. Our typical advice is, especially for the LED-based treatment, is that they're simply not strong enough, mostly for legal reasons.
00:44:08 You know, they can't control the use once it's in somebody's home. That they're not going to produce the same or even nowhere near the equivalent of what a dermatologist could do. But specific to the PaloVia, what are your thoughts on that.
Dr. Debra Jaliman: You know, I know a lot of the at-home ones. The PaloVia? I don't. I've never seen that one.
Paula Begoun: What is PaloVia?
Bryan Barron: That's the one, Paula, you had that done – they wanted you to talk about it on the Dr. Oz Show.
Paula Begoun: Oh god. Ha!
Bryan Barron: And it burned you.
Paula Begoun: Ha!
Dr. Debra Jaliman: Oh no!
Bryan Barron: It burned your arm.
Paula Begoun: Oh, the poor marketing department at PaloVia.
00:44:44 It's a laser. I mean, it is a real live laser. And I'm not remembering – Bryan, could you look it up real quick what the type of laser it is? So, Dr. Jaliman, I'm about to go – so the Dr. Oz Show really thinks it's cool, these new at-home devices, and here's this company saying they've got this new at-home device that's just like what a dermatologist uses. And sure enough, I can't remember the technology it was, what kind of laser it was, but it definitely had, you know, definitely was…
Bryan Barron: 1410 nanometer wavelength.
Paula Begoun: 1410 nanometer?
Dr. Debra Jaliman: Really?
Bryan Barron: Yeah.
Dr. Debra Jaliman: So, it's made by Palomar it says. It's a real laser company.
Paula Begoun: So, they gave it to me, and I followed the instructions the day before I was going on the Oz Show.
00:45:35 And I didn't use it on my face, because I didn't trust what it would do. And my arm, where I tested it, swelled up and cracked and peeled. And I only did it once. I mean, I got…
Dr. Debra Jaliman: Oh my goodness.
Paula Begoun: And so when I went to the Oz Show and I said, "Look, I'm willing to talk about it, but if you want me to do it on Dr. Oz, I'm not going to do it on Dr. Oz. You've got to get someone else, because look what happened to me! I'm not burning Dr. Oz on national television.
00:46:11 I mean, it was a whole thing. I mean, I feel bad for the marketing department for PaloVia, but yeah, it's actually – you can buy that thing and…
Dr. Debra Jaliman: How could they approve that? How come people don't get burned?
Paula Begoun: Well, I have no clue.
Bryan Barron: It's specifically an at-home laser device approved for treating fine lines and wrinkles around the eyes.
Dr. Debra Jaliman: I see that. I'm looking at it on my iPad.
Bryan Barron: I'm just thinking if Paula had the reaction that she had on her arm…
Paula Begoun: I would never.
00:46:44 I'm still a little shocked.
Bryan Barron: Ouch!
Paula Begoun: Okay, so we are talking to Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist," because she is a top New York dermatologist. She's my dermatologist now. She doesn't know it yet, but I am coming back to New York and she will be my dermatologist. Bryan, do we have time for some more questions – yeah, we have time for some more questions.
Bryan Barron: Dr. Jaliman, Denise on the Paula's Choice Facebook page says she's heard of a new non-surgical gel facelift, is there anything you can tell her about it?
Dr. Debra Jaliman: I'd like to know about that. A gel face?
Paula Begoun: Does she say what it is?
Dr. Debra Jaliman: I don't know. Do you, Paula?
Paula Begoun: No, it doesn't sound... – I mean, it sounds like a Dr. Brandt product, or Dr. Sobol.
00:47:31 You know, a lot of dermatologists who have their own brands come out with products that even though they use lasers in their practice and they use Botox and who knows what else, love….
Dr. Debra Jaliman: Oh, I found it on the internet. It says it's a firming gel, so you know what that is.
Bryan Barron: Ah, okay.
Paula Begoun: So, it's a skincare, okay, all right. So, we'll tell her forget about it.
Bryan Barron: So, Karen wants to know about Ultherapy and fillers for fine lines on the upper lip.
Paula Begoun: What do you do about the upper lip, which I am watching my lips go – can I say hell in a hand basket? I don't know!
Dr. Debra Jaliman: There are three things that do very well for the upper lip.
00:48:18 One is Botox, but you have to go to somebody very experienced or else you won't be able to drink through a straw or whistle, or speak very well. So, I use Botox a lot on the upper lip, so that you don't purse your lips as tightly, because then you don't get those harsh lip lines. That's one. The other is there's a new filler that just came out a few months ago called Belotero.
Paula Begoun: Spell that, Dr. Jaliman?
Dr. Debra Jaliman: It's Belotero. And it is a very thin hyaluronic acid that can fill those very fine lines.
00:49:03 I did a lot of that today. Filling a lot of lip lines is very popular.
Paula Begoun: So, how long does that last?
Dr. Debra Jaliman: It lasts a long time actually. Probably six to nine months.
Paula Begoun: Forgive me, just so – it's called Belotero, B-E-L-L-O-T-E-R-O filler for lip lines.
Dr. Debra Jaliman: One L.
Paula Begoun: One L.
Dr. Debra Jaliman: B-E-L-O.
Paula Begoun: Let me ask you a question, given that I am still on Expedia looking for airfares to New York, because I'm going to spend a lot of money in your office and I'd like to get a good fare. If I come in - if – like when I come in how much can I get done all at once?
00:49:52 I'm coming in from out of town. I'm not a New Yorker. I want to see Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist," and I don't just want the book. I want her to work on my face. How much can I get done while I'm in town that's reasonable and I won't look too strange for too long. Like I have a week, what can I get done?
Dr. Debra Jaliman: You mean you're in New York for a week?
Paula Begoun: Yeah. How much can I get done reasonably at your office without, like for my brown spots, the broken capillaries, the lines around my lips, which are the major things that drive me crazy given the other work that I've had done.
00:50:37 How much can I get done at your office all at once?
Dr. Debra Jaliman: Well, it's interesting. You can do quite a bit. Because let's say you could do brown spots in one day. And then the next day you could do blood vessels. You wouldn't want to do them on the same day. And then you certainly could do your lip lines on the same day as either of those lasers. We numb you with a cream, a topical cream anesthetic and you can do the lip line.
00:51:03 So, there's quite a bit you could do in one day very safely.
Paula Begoun: Okay. Cool! All right. Next question, Bryan.
Bryan Barron: Brenda wants to know about ways to firm skin on the neck without surgery?
Dr. Debra Jaliman: Yeah, that we're back to radio frequency. I mean, I find radio frequency is the best for firming, again.
Paula Begoun: So, which machine are you talking about?
00:51:30 Is that the Thermage CPT?
Dr. Debra Jaliman: Yes.
Paula Begoun: And you found good results on the neck?
Dr. Debra Jaliman: Very good results.
Paula Begoun: What about the bands? You know how as you get older you get those circle bands, like necklace bands around the neck which, first, why does that happen, and two, what do you do to get rid of them?
Dr. Debra Jaliman: Well, the bands are on the neck a lot of times, come from muscle and the constant wrinkling from the muscle.
00:52:03 And sometimes you can also take a Fraxel laser for the bands, because it's actual wrinkling. It's just tightening. You actually have wrinkling. So, you could take a Fraxel laser and get rid of some of those lines.
Bryan Barron: How many Thermage treatments would someone need on their neck?
Dr. Debra Jaliman: It's interesting you ask that, because I find more often than not on a neck, whereas a face oftentimes people need one, on a neck you could need two Thermages, because necks seem to take more stress than a face, you know, and show more signs of aging than faces do.
Bryan Barron: Okay.
00:52:48 So, sagging skin under the chin and the neck area, that's Thermage?
Dr. Debra Jaliman: Thermage.
Paula Begoun: Next question?
Bryan Barron: Let's see. I'm weeding through some people who are commenting that they're so happy the radio show is back.
Paula Begoun: Ha! Well, they like us and they love Dr. Jaliman. So, they'll be listening because of her.
Bryan Barron: Mila wanted to know what we think about the one-hour lift, and removing the fat pads above the eyes which give you a hooded look. I've not heard of the one-hour lift.
Dr. Debra Jaliman: Well, the one-hour lift I think she may be referring to like the Lifestyle Lift, the very quick facelift.
00:53:33 But I would caution people about speedy surgery. I'm not a big fan. You know, the only person that's a big fan of the speedy surgery is the surgeon because they can just make more money doing more surgeries. If you're going to have plastic surgery I would go with a slower surgeon, you know. If you really want plastic surgery, and certainly for some people it is the correct solution, don't do it based on speed.
Paula Begoun: Oh, so you're thinking she's referring to, because that wouldn't take one hour.
00:54:06 I mean, do they literally like put you in, cut you up, and get you out in an hour?
Dr. Debra Jaliman: Yeah, they have these Lifestyle Lifts where they put threads in your face, like a puppet, and then they pull it up and send you out. But it's not a good…
Bryan Barron: Yeah. I've seen ads for those in like those newspaper supplements, like Parade Magazine.
Paula Begoun: Yeah?
Bryan Barron: And, yeah, it's an impressive before and after picture, and it's always taken in profile. And the woman in the before shot, she's got the turkey neck, she's got kind of the sunken cheeks. And then in the after picture everything is pulled up and she's smiling.
Paula Begoun: So, Dr. Jaliman, you're saying they literally take you in, you're under mild sedation, and they cut you up and get you in and out that fast?
Dr. Debra Jaliman: They do.
00:54:51 But I had a patient who had it done, and you could literally see this string coursing through the side of her face. So, of course she was coming to me to ask me how we could camouflage the string.
Paula Begoun: Oh my god.
Dr. Debra Jaliman: So, you don't want that procedure.
Paula Begoun: Oh my god. Oh, so it's not cutting and pasting. You're talking about where they kind of stitch you up and anchor things up?
Dr. Debra Jaliman: Yeah. It's like a fake facelift.
Paula Begoun: Oh! You're not talking about, because they have those cut and paste things that you see on television where it is literally cosmetic surgery, but you're talking about, I think they call that the Feather, where they kind of run stitching under the skin and it can pop through the skin, right? That's what you're referring to?
Dr. Debra Jaliman: Well, sometimes they call it the Lifestyle Lift. It has all different names. But what it does is it's a fake way of doing a real facelift. But it does make you – it can make you look better, but you can also have all kinds of complications.
Paula Begoun: Right.
00:56:03 The strings can come loose and poke through the skin and you can see the strings.
Dr. Debra Jaliman: Yeah.
Paula Begoun: Yeah, I've heard of that. I think we have time for one more question?
Bryan Barron: Let's do one more. I have a question from G. And she wants to know if there are any products or treatments that help aging skin that is also thinning. I'm sure there are multiple ways that someone could go here. So, Dr. Jaliman, what would be your top two or three suggestions for skincare and then for procedures that would really help shore up thinning skin?
Dr. Debra Jaliman: So, for products, I'm a big fan of peptides for thinning skin.
00:56:42 You can use peptides. You can use growth factors. You can use retinols. Those will all help thinning skin. And then in terms of procedures, any of the lasers that stimulate the fibroblasts, so any of the non-ablative lasers. You don't want to have a CO2 laser. You don't want to have a laser that's taking off skin. But any of the lasers that stimulate skin, so anything that says it's non-ablative that's not breaking your skin and it's stimulating your skin will help to thicken your skin.
Paula Begoun: Can you name a few of those lasers?
Dr. Debra Jaliman: Sure.
00:57:18 Sure. So, you could have like a Genesis laser. You could have a MedLite laser. You could have Clear and Brilliant laser. You could have any of the Fraxel lasers. They all help to stimulate collagen production.
Bryan Barron: But not Ulthera? You mentioned earlier in the show that Ulthera was very painful.
Dr. Debra Jaliman: Yeah. That's what I mean. I've never had it; that's what my patients who've had it have told me. We don't really do Ulthera because we never saw great results from that in looking at the demos.
Paula Begoun: Yeah.
00:57:48 And you definitely have to knock somebody out from Ulthera from the research I've seen. So, we have been talking to Dr. Debra Jaliman, author of "Skin Rules: Trade Secrets from a Top New York Dermatologist."She is now our dermatologist and you can visit her on her website. And you can definitely take a look at her book on as well as on her website. Dr. Jaliman, it's always ridiculously enlightening. And frustrating that we don't all live in New York next to you.
00:58:22 And you're wonderful. Thank you for taking the time.
Dr. Debra Jaliman: Thank you so much. It's always great to talk to both of you.
Paula Begoun: All right. We look forward to talking to you again. Take care, doctor.
Bryan Barron: Thanks Dr. Jaliman.
Dr. Debra Jaliman: Thanks a lot. Bye.
Paula Begoun: Bye-bye. So, boy, I don't know, I didn't want her to go. We love her. We didn't even get to Botox, oh my god, and some of the new injections that are competing, coming up and competing with Botox. Next time.
Bryan Barron: Well, she talked about Botox for the upper lip.
Paula Begoun: No, no, but there's new forms of Botox coming out, the FDA is approving. But, we could talk, I mean, there is so much. But, she did a beautiful job. We love Dr. Jaliman.
Bryan Barron: As always.
Paula Begoun: We are Paula Begoun and Bryan Barron, authors of "Don't Go to the Cosmetics Counter Without Me," keeping you beautifully informed. Come visit us at
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