Look Younger Without Surgery, Dr. Leslie Baumann

Airdate: 9/1/2011

Back by popular demand! World-renowned dermatologist and best-selling author Dr. Leslie Baumann teams up with Paula to guide you through the most effective dermatologic treatments for sagging skin, discolorations, acne, wrinkles, and more.

Paula Begoun: Hello, I'm Paula Begoun, the Cosmetics Cop, here keeping you "Beautifully Informed." It is live Thursday in Seattle. I am here with my Paula's Choice Research Team, Desiree Stordahl and Bryan Barron. Hi Desiree.
Desiree Stordahl: Hi Paula.
Paula Begoun: How are you?
Desiree Stordahl: Good. Glad to hear you call us the research team.
Paula Begoun: Well, that's what all you guys do.
00:00:30 Except you do, by the way, now have one of the most – I had to wear sunglasses talking to you today because you got your teeth whitened and I could barely look at you without the gleaming brightness from your teeth.
Desiree Stordahl: I know. But let me tell listeners, "no pain, no gain." It definitely has given me some sensitivity and what they call "Zingers," basically shooting, throbbing pain. So we will talk about it on another radio show.
Paula Begoun: Did you take Advil? Did you take any anti-inflammatories?
Desiree Stordahl: I took three ibuprofen and they actually prescribed me Vicodin for later if I need it.
00:01:05 Can you believe that?
Paula Begoun: Oh, they obviously…clearly this is a side effect you might be…okay, no kidding, Vicodin? Boy, white teeth and you are drugged out for a week. And Bryan Barron who has the most adorable blonde highlights in his hair – you did good, Bryan. I'm liking Bryan as a blond.
Bryan Barron: Thank you very much.
Paula Begoun: You are welcome.
00:01:32 Because you were a redhead for awhile. Not red-red.
Bryan Barron: Well, yeah, I had some auburn and kind of honey streaks put in for my wedding and kind of kept that up for while and now that we are experiencing, what, two weeks of summer here in Seattle I thought my hair should look a little sun-kissed, even though my skin doesn't.
Paula Begoun: Yes, you are a…well, everybody here at Paula's Choice, pretty much that works with me directly would never show up with anything but a self-tanner induced tan.
00:02:08 But, yeah, you have been great about not tanning the whole 11 years that we have been working together. But those, I do like, I mean not that you didn't look gorgeous as an auburn, that auburn hair, but I do, I have to say, I think I like the little blond thing you got going. So just to let you know because I know you blush every time I tell you.
00:02:31 So this is an important show because we are going to be talking tonight with Dr. Leslie Baumann, a very renowned cosmetic dermatologist. It's actually interesting the term – I have to ask her about this term "cosmetic dermatologist" as if cosmetics and skin care…I don't know. Let's find out how she refers to herself.
00:02:57 But she wrote a book called "Cosmetic Dermatology" so she should know about this title. "Cosmetic Dermatology" is a best -selling cosmetic textbook in the dermatology world. Sorry, let me say that in reverse. It is a dermatology text book worldwide. If there is somebody who knows about the world of dermatology and how it applies to skin and cosmetic corrective procedure it is her. She is also author of "The Skin Type Solution" which is a national best-seller. Her website is Leslie Baumann is at the University of…well, she was actually at the University of Miami.
00:03:39 She has now since gone out on her own, away from the university, and is thriving in the Florida area in Miami area. So we will be talking to her. But before we talk to Dr. Baumann about how to look younger, really younger, without surgery in a real brass tax, how do you go about it, step one, step two, step three kind of way, there was just a couple of things I wanted to go over first.
00:04:07 And I'm not going to go long. I promise I won't go long but I can't help myself about this one. We got a letter from Roseanne and Roseanne was a panel test, participated in a panel test for Lancôme and for their Oscillating Lash Primer Mascara. And she writes, "I participated in a test panel for the Lancôme Oscillating Lash Primer.
00:04:37 Having participated in this testing gave me real insights into how manufacturers can claim X percentage of women say whatever about a product. When I have my chance to provide feedback after using the product it was via an online survey. What surprised me was that the questions forced me into a positive answer for each one even when I felt the product offered absolutely no benefits.
00:05:08 I couldn't answer 'none of the above' and each of the selections was only a positive response. With that methodology," she writes, "the manufacturer can make very positive claims about even the most ineffective product and sound like they did the research." And then she summed up by saying, "I think more women should know about how there can be very positive clinical results for something totally useless."
00:05:35 And she is 100% right. That's only one of the many ways that cosmetic companies can say we have done our Clinical test and the clinical test is meaningless. They can say "we got rid of your wrinkles, 100% of women said we got rid of your wrinkles" and on one side of the face they stripped your face with alcohol and soap and just stripped it out. And then leave nothing on one side and put their product on the other and go, "Oh, look how much better her skin looks?" That's one way.
00:06:07 They can also set up testing methods that assure that you get the appropriate result when they do it after the product is applied, etc, etc. I mean there are so many ways, so many ways to do it. But, nonetheless, I have never gotten a letter from a woman who said that not only did she participate in a panel but even if she wanted to talk about the product honestly there was no way to go about doing it.
00:06:37 And you know what this brings up for me is we do panel testing for every product we launch, between 50 and 100 women. And we never make claims about clinical testing because they are not the way I would classify a real clinical study. But, we take detailed feedback from the women who test our products for us and I know there are other companies that do that, too.
00:07:07 In fact I remember touring the Clairol facility for hair care many, many years ago and their, oh my god, their lab and the work they do for their hair dyes just blew me out of the water. I mean their research team was phenomenal. So it is not every company but this really, I mean, geez.
00:07:29 The other think, oh, okay, before we talk to Dr. Leslie Baumann, one of the shows we are going to have coming up because I have been catching up on my research. I have medical journals like you wouldn't believe all over my home that I have been meaning to get to. But we are going to talk about an anti-aging diet coming up. Because I was reading some interesting stuff about Resveratrol that is supposed to be in grape skin and is supposed to be one of the only research, well well-researched foods that has been shown to slow down genetic aging by effecting something called the Sirtuin 1 gene.
00:08:12 Too complicated, not going to go into all of that. But the point is most people know that Resveratrol is in red wine and you will hear people say red wine is healthy. According to this study I read this researcher said that there is no way you can drink enough red wine to really get the benefit of Resveratrol. And then, of course, in red wine you get the negative effect of the alcohol if you drink too much. So I thought that was interesting.
00:08:36 So we are going to get some information about Resveratrol in terms of supplements for another show. But another thing is something called glycation. And when you eat sugar it does something to the proteins in your body and it doesn't do a good thing. So, you want to block glycation, whatever that is we are not going to get into the details of it, but glycation is bad.
00:09:00 It is definitely triggered by sugar and aside from not eating sugar which is a very good thing, not to eat sugar, processed sugar, is that supplements such as vitamin B-6 and vitamin B-1 seems to have incredible benefit for preventing glycation. A fascinating little study here. So we are going to do an upcoming show. Desiree, I did mention that we are going to do an anti-aging supplement diet anti-aging show, right?
Desiree Stordahl: Yes.
Paula Begoun: You have that down? Okay, good.
Desiree Stordahl: We have that down.
Paula Begoun: All right.
00:09:37 Let's talk to Dr. Leslie Baumann, author of "Cosmetic Dermatology," worldwide textbook. And author of "The Skin Type Solution," helping women understand their skin type. Dr. Leslie Baumann, are you there?
Leslie Baumann: Yes, hi Paula, how are you?
Paula Begoun: I'm good, Dr. Baumann, how are you?
Leslie Baumann: Good. You are talking about all of my favorite topics, Resveratrol and Sirtuins and all of that. I love that stuff.
Paula Begoun: So, Dr. Baumann, I think I screwed up your introduction.
00:10:11 Because you were at the University of Miami, Division of Cosmetic Dermatology which you created but now you have since left the university and opened your own separate facility some place in Miami. That's right, isn't it?
Leslie Baumann: Right, that's correct.
Paula Begoun: And so what's the name of your clinic down in Miami?
Leslie Baumann: It's Baumann Cosmetic and Research Institute.
00:10:36 Our website is But an entire group of, there were 22 of us at the University of Miami, and we all left together and we took their entire research center with us. So we still do all of the research trials for all of the different pharmaceutical and cosmetic companies like I was doing before. So I still do all of the same things I do before, I just do it faster and more efficiently.
Paula Begoun: You took the whole department with you and the University of Miami didn't get mad at you? What did they do that you took your department with you?
Leslie Baumann: It's kind of a long story, but they had all of these crazy rules where you couldn't do a research project if a company provided the materials for the project. So let's say I am doing a project on lasers, the company has to loan you the laser to do the trial.
00:11:31 So it got to where it would take six months approved through the research board. I'm kind of making this story short, but it was making my trials take too long to start. And, you know, when you are looking at a product, the company wants those trials to happen very quickly and I do research trials for at least 50 different companies. And we did the trials that got Botox approved and Sculptra and Juvederm, plus a lot of the light devices and we have done a lot of work with all different kinds of skincare products.
00:12:04 But one of the things I think you and I are going to talk about is Ulthera, we are doing research on Ulthera which is one of the hot new things.
Paula Begoun: Right. So just to get started I have a couple of aching questions that I keep meaning to ask you and you need to help me and some of our listeners get through this one before I get you to walk through a treatment plan. But Nadia, one of our regular listeners, asked about the benefits of chemicals peels.
00:12:38 Dermatologists love talking about their machines and their lasers and their Botox and their injectables and you don't hear much talk anymore about alpha hydroxy acid peels, glycolic acid peels, or salicylic acid peels. So the question is who should be doing them, you or an aesthetician? Should you be doing them? How often should you get them? Do you think they are good, do you think they are bad? How do you feel about chemical peels like glycolic acid or salicylic acid?
Leslie Bauman: Well peels have been largely replaced by different kinds of light therapies except in darker skin people because darker skin people can't have different kinds of lasers and lights. It will cause problems with their pigmentation.
00:13:22 So chemical peels are still used a lot in African Americans or people with very dark skin. But for light skin people, intense pulse light and some other things really work better, unless you are talking about acne. Once you start talking about acne then glycolic and salicylic acid still play a great role in the treatment of acne. But that is why you are not hearing much about it and you are not seeing a lot of new peels getting developed because they are a little antiquated. And as far as whether a derm should do it or an aesthetician, absolutely aestheticians can do peels.
00:13:57 The only problem is if the dermatologist has you on Retin-A or doing different light and laser procedures that maybe your aesthetician doesn't know about, they could accidentally burn you so you have to make sure that you communicate to your aesthetician what kinds of things you are doing with your dermatologist so that they don't accidentally burn you.
Bryan Barron: Dr. Baumann, real quick. I was under the impression that aestheticians, of course, like you mentioned they can do peels but aren't they limited to the strength of peel they can perform versus what a dermatologist can administer? Or have those guidelines been loosened?
Leslie Baumann: Well you are correct.
00:14:37 I was talking more about superficial peels. As far as medium depth and deep peels, we really don't do them anymore. They don't work as well as something like the fractionated laser. So, I mean I haven't done a medium depth peel since probably 1999. And we would have to put people on Vicodin, it was very painful. So, there just isn't really a need to do that anymore.
Bryan Barron: Got it.
Paula Begoun: So you actually think that from a deeper peel point of view, that glycolic acid and salicylic acid take a backseat to the light machines, Fraxel and IPLs or whatever other kind of machines you are using on your patients that they don't have the same bang for the buck, so to speak?
Leslie Baumann: Right.
00:15:32 Well for medium peels or deep peels, the fractionated lasers and ablative lasers are definitely better. As far as superficial peels, even in that case I feel light treatments are often better than the light peels. Now it is different, though, I am a huge fan as you know of salicylic acid and glycolic acid and I love your salicylic acid products. Those are used on a daily basis. So that is a whole different story.
00:16:00 I love those used on a daily basis. But as far as coming once a month and getting them in the office, they are not used as often unless somebody has darker skin. So people with Melasma and pigmentation problems that have darker skin, we use peels a lot because it is not safe to use the light treatments on them.
Paula Begoun: Okay, got that. So – oh wait. So I take it that if an aesthetician is doing it and it is a really light peel you are cool with that as like a sun thing?
00:16:32 Actually do you recommend it at all?
Leslie Baumann: As long as the aesthetician is very clear about what other procedures you are getting done with your dermatologist. So, I have seen bad things happen when maybe I have a patient on a very strong Retin-A or regimen with an exfoliating glycolic acid or something like that. And they go to the aesthetician and the aesthetician doesn't go over their history of what they are using and they can burn.
00:17:02 I would prefer that they go to the dermatologist who is treating their skin so that they are familiar with what kind of products they have them on. So I am not against aestheticians doing peels, I just prefer it whenever it is aesthetician in a dermatologist office so they have the patient's records and they know what the patient is doing. But if you are just using over-the-counter things and you are not on anything strong and prescription, it is probably fine to go to an aesthetician to do a superficial peel.
Paula Begoun: Then how often can you get it done?
00:17:31 Because they often push it once a month which I personally feel is at best overkill.
Leslie Baumann: Well it depends on what you are treating. If you are treating pigmentation, we often do that once a month for people who can't do the light treatments. So I mean it all depends Paula on the strength of the peel and the pH of the peel and I mean that's why it is so hard to answer your question in just a couple of sentences.
Paula Begoun: So the issue is –
Leslie Baumann: But you are right that sometimes aestheticians really don't know a lot about the peel and then other aestheticians are fantastic and they would be great at doing peels. So it depends on the particular aesthetician as well.
Paula Begoun: Which is why seeing a dermatologist, seeing an aesthetician in a dermatologist's office which actually isn't that much more expensive than just going to a salon or a spa to get one of those treatments.
00:18:25 So that really is the strong recommendation is to go to an office where there is somebody who is really paying attention to the evaluation of the person coming in.
Leslie Baumann: Right. And in some cases your insurance will cover it, too, depending on what your diagnosis is.
Paula Begoun: Yeah, what diagnosis covers it with insurance?
Leslie Baumann: Well, children who have acne, under 21, depending on who your insurance is, your chemical peels can get covered.
00:18:57 Oftentimes people think a dermatologist is so expensive but they don't realize that their insurance will often cover the visit. So it depends on what state you are in. Now I heard you saying you want to know what the definition of a cosmetic dermatologist is. I joke that a cosmetic dermatologist is somebody who does things that insurance doesn't cover. Anything that is called cosmetic is something your insurance does not pay for.
Paula Begoun: Okay, I got it. Okay, one other question before I have you give me a treatment plan. This has been nagging Bryan and I a lot when machines talk about – machines –
00:19:39 When treatments talk about tightening skin, or even skincare products for that matter which I actually think it depends clearly on the product. But for the most part we are talking about lasers or peels. When there is a claim about tightening, where does sagging skin go?
00:20:03 What happens to skin that it goes from a sagging jowl to a less sagging jowl? How does the excess skin or the muscle – when skin sags it is sagging, some of it is because of extra skin, right, and some of it is sagging because of extra fat movement, muscle movement, how do you get the skin – where does it go? What happens to the fat and the skin and the muscle? How does that get tighter.
Leslie Baumann: Okay.
00:20:36 So there are three main things in the skin that you have to think about. The first is collagen and collagen is like the scaffolding in your skin; it gives your skin its strength. The second one is elastin, and just like its name sounds, it gives your skin its elasticity. So if you think about an older person when you pull on their skin, on the back of their hands, it takes a lot longer to snap back, they have lost elastin.
00:21:02 And then the third thing is hyaluronic acid which is a sugar and it binds water and it makes your skin very plump. So if you think about a baby's skin, how plump it looks compared to somebody older who gets all of the bruises on their arms, they have less hyaluronic acid. So aged skin really loses all three of those. And so as a dermatologist our goal is to try to bring those three things back. So these skin tightening devices that you hear about that are used in doctor's offices, they work on collagen.
00:21:34 So right now nothing works on elastin. You don't make any more elastin after puberty. No matter what skin creams claim nobody has been able to figure out how to increase production of elastin. So we can't make our skin bounce back faster, at least not yet. There's a lot of research going on but nobody has mastered it yet. And the only thing we can do with hyaluronic acid is inject it, that's what it is Restylane and Juvederm, or take supplements. You will see hyaluronic acid in a lot of products, but it doesn't really get absorbed when you put it on topically.
00:22:10 But whenever you take supplements orally, Chondroitin and things like that that will actually increase your production of hyaluronic acid. In fact in arthritis when people take the Chondroitin supplements, that helps hyaluronic acid formation in your joints. That's why it helps arthritis. So these are the ways we can help elastin, hyaluronic acid.
00:22:33 But the only way you can really help collagen is to turn the cells on and make them make more collagen. Or you can tighten up the collagen. So, all of your glycolic acids and your retinol and all of those great things in your anti-aging products, what they are doing is they are turning on your cells to make them make more collagen.
00:22:56 But the way that these skin tightening things work is think of collagen as a triple helix. So it is actually three ropes that are wound together. Think about it like that. I like to think of it like a Slinky where it opens and closes like a Slinky.
Paula Begoun: I love that. I can relate to a Slinky. I got it, okay.
Leslie Baumann: I hope they still have Slinky's. I haven't seen one in a long time. But whenever you heat collagen those three ropes in the Slinky tighten up. And the way that you can know what I am talking about is if you throw a steak on the grill, you know when it sizzles and it goes [sizzling sound] and it tightens up --
Paula Begoun: Oh, don't tell me!
Leslie Baumann: That's collagen tightening.
Paula Begoun: No. Really?
00:23:41 Wait, so let me get this picture. As somebody who has had Fraxel and separate from glycolic acid and retinol products and those things, you are telling me that when I get a Fraxel treatment or some other forms of light treatments, that the metaphor analogy you are using is a steak on a barbeque that shrinks up?
Leslie Baumann: Yes, but not all of those things do it.
00:24:11 There are certain parameters. They actually have studied the best way to get collagen to shrink up. But, yes, it is exactly like that steak when you first throw it on the grill and you see it visibly get smaller.
Paula Begoun: Ah! Okay. I don't know that I want to know this. So go on. I'm sorry. So these machines –
Leslie Baumann: Patients will say, "Well how long does it last?" and I tell them, well think about it, once you cook your steak it stays that size. It doesn't go back to the size it was before you cooked it.
Paula Begoun: That's true. But skin still ages, right? So it is not a permanent fix?
Leslie Baumann: Right, skin still ages.
00:24:52 But the collagen that was shrunken by the heat stays small. So basically they studied a lot about it and the collagen has to be heated to about 65 degrees Centigrade which I think is 135 degrees Fahrenheit. But I haven't done that calculation in my head. But it is very, very hot.
Paula Begoun: Yes, it is higher than that. Because 40 degrees is about 100 – wait, maybe it is about 140, come to think of it.
Leslie Baumann: I have to go calculate and know, but I know it is 65 degrees Centigrade.
00:25:32 So the whole goal is to try to get collagen to get that hot without damaging the surrounding skin. So that is why you have all of these different treatments. So Fraxel was one of the first things, and it would poke holes in the skin and the holes would be hot so it would heat the collagen a little but mostly it would tighten your skin because as you are healing when you think about a wound, how when you cut yourself and the wound starts to contract together and get tighter – that was really how Fraxel was helping your skin.
00:26:06 The helping tighten your skin. And that is really not, in my opinion, the best way to tighten your skin because you are injuring your skin and you are causing a wound.
Paula Begoun: Wait one second.
Leslie Baumann: Oh, I'm sorry.
Paula Begoun: No, no, no. It just triggered a question that we get a lot from our listeners. And let me just remind everybody that we are talking to Dr. Leslie Baumann, author of the "The Skin Type Solution." You can find her at
00:26:33 She's a world renowned cosmetic dermatologist which means that what she does for a living isn't covered by insurance. But what she does is brilliant anyway. But you mentioned that Fraxel through a machine pokes holes in the skin and heats up the skin kind of loosely defined. But you know Rodan + Fields came out with, and some other companies have come out with a little lawnmower looking device with little pokey things on the end.
Bryan Barron: The Dermarollers.
Paula Begoun: Dermarollers that make claims about doing what, wounding the skin to build more collagen.
00:27:17 And have you seen these Dermarollers, Dr. Baumann?
Leslie Baumann: Yes. And they do make you make more collagen by wounding the skin. But so does glycolic acid and glycolic acid has a lot of other benefits that the Dermarollers don't have. And retinol also speeds up that collagen production.
00:27:37 So wounding the skin works, but it isn't the best way to achieve the tightened skin.
Paula Begoun: So technically it does what it says but it does it by doing something that isn't so nice for the skin in the – because it hurts, that sucker hurts. I mean I just used it on the back of my arm and thought, damn, I'm not doing this to my face.
Leslie Baumann: Right, it seems a little archaic.
00:28:06 But have you seen on television some of the celebrities that their skin looks really white and porcelain, almost like they look fake like a doll?
Paula Begoun: Yeah. Yeah.
Leslie Baumann: What they have done is they have done an ablative laser that has taken the top layer of their skin off and really wounded their skin at such a deep level that when it heals it heals tighter but it is almost like a scar, so it has that white shimmery look that a scar has.
Paula Begoun: Right, right. Like what Dermabrasion used to do to skin?
Leslie Baumann: Right.
00:28:42 Remember in the, I guess it was early 2001, 2002 when the rage was to get those lasers and you would be red for six months and it would smooth your skin texture but in the long run as those people got older their skin started to look white and tight like an old scar would look.
Paula Begoun: Got it.
00:29:03 So one other question, oh my gosh, look at the time, so you mentioned about taking Chondroitin, or orally taking hyaluronic acid. So I remember – so what I was going to say, so there is actually hyaluronic acid pills you can take or you take Chondroitin instead?
Leslie Baumann: The hyaluronic acid pills break down with your stomach acid so they are worthless. It is the Chondroitin, because Chondroitin helps make – I'm trying to remember what else goes in Chondroitin. It's late here and my mind is blanking.
Paula Begoun: Isn't it glucosamine.
Leslie Baumann: Right, glucosamine, right.
00:29:45 So it is the glucosamine in the Chondroitin – those turn on the production of hyaluronic acid. So you want to take those and then your body will make your own hyaluronic acid. If you take these drinks that have collagen and elastin in them, your stomach acids just break it down and they don't work.
Paula Begoun: So it's funny you mention hyaluronic acid, glucosamine/ Chondroitin, I have had knee problems most of my life and I had a – what they do to protect your knee, one thing if they can do it as a way to prevent further deterioration is to inject your knee with hyaluronic acid.
00:30:31 So I take it they are not injecting Restylane or Hyaluron like you do with dermal injections. Or is it the same as what they are injecting in my knees?
Leslie Baumann: It's the same! That's how Restylane and Juvederm were invented, it's the same company. It started out as joint injections.
Paula Begoun: No, kidding. So, just as a game plan, because we are going to do this anti-aging show and I want to make sure that we add this to the discussion – diet and anti-aging – so Chondroitin/glucosamine isn't just good for my knee?
Leslie Baumann: No, it's good for your skin as well.
Paula Begoun: Dang I'm glad to know! Whoa! I love double purpose. Double purpose is like such a turn on.
00:31:17 Okay, so here is what I need from you doc. Dr. Baumann, author of "Cosmetic Dermatology" and, two best-selling books, well, "Cosmetic Dermatology," her book is a textbook for dermatologists around the world. And also her "The Skin Type Solution" book is a national best-seller. You can find Dr. Leslie Baumann in her clinic in Miami but also on So, what I need from you, and then we need to take questions because I know we just have so many people waiting. So I come into your office, I am 58 years old – I should have lied and said I was 50, but I will be 58 years old.
00:32:00 And I come in and I have got all the problems, I have laugh lines showing, nasal/labial folds, the ones that run from my nose to my mouth. I've got some jowling going. I've got some wrinkles that are especially obnoxious when I smile. I've got some sagging around my eye area. I've got wrinkles on my forehead. I've been using some pretty darn good skincare products but I'm still, I'm growing up, I'm growing older and I'm not thrilled.
00:32:33 Help me out. What do you tell me to do? What is my game plan and starting from cheap to expensive? What do I do? What do you tell me to do? And I'm taking notes. I'm taking notes.
Leslie Baumann: The first thing you do is you have to find out what your skin type is because you have to be on the right skincare. If you are not on the right skincare, I say it is like when you buy an expensive outfit and you don't send it to the dry cleaners.
00:33:03 You are spending all of this money on Botox and Restylane and if you are not using the right skincare you are really wasting your money. You go to
Paula Begoun: Yes, to figure out your skin type. But let's assume that I am using the right products. And you are happy with my skincare routine. What do I do?
Leslie Baumann: So you are using retinol and antioxidants and all that.
Paula Begoun: And salicylic acid or glycolic acid and sunscreen. I'm religious about using sunscreen.
00:33:41 And I'm taking Chondroitin/glucosamine even. So I'm on the right track. What's next?
Leslie Baumann: And you are getting your Resveratrol, you are doing all that?
Paula Begoun: I'm doing B-1, B-6, yeah.
Leslie Baumann: So the next thing is, well, I don't know if you said you do, but you were imagining someone would have jowls, so that is where the skin tightening comes in.
00:34:05 And we were talking about before. And luckily the technology has gotten to where it works because they finally have been able to figure out how to heat that collagen to 65 degrees. So [a solution] called Ulthera which is, the name comes from Ultrasound Therapy, so Ulthera, U-L-T-H-E-R-A, and it focuses to ultrasound beams to heat your collagen and shrink it up.
00:34:32 The only problem with that is it takes three months to see the results. So usually we do that first and then for anything that wrinkles when you move, so for example around your eyes, your crow's feet, your frown lines, we would do something like Botox or Dysport, that takes about a week to work. And then for your nasal/labial folds, in terms of lines around your mouth or any deep wrinkles you have we would do Restylane or Juvederm or Sculptra.
00:35:01 And Restylane and Juvederm are nice because they are instant gratification. And you can tell that right away. And then we would look at the color of your skin and if you have broken blood vessels we would laser those off with a vascular laser which is instant. If you have little brown spots we would laser that off with a pigmented lesion laser and that gives you [scabs for about]. So basically in three months I can have you looking significantly better.
00:35:32 You can look better in a week but if you give me three months I can make a really big difference.
Paula Begoun: Without cutting and pasting?
Leslie Baumann: Right, without cutting at all.
Paula Begoun: Without surgery, without cutting and pasting. So tell me, what is this going to cost me? What is the outlay?
Leslie Baumann: Well, knowing you, you have probably been great about preventing so you probably don't need a lot of filler.
00:36:00 You probably don't have a lot of sagging because I've known you for years and you just keep getting younger and younger looking. Let's say you need Botox and Dysport in two areas, so your frown lines and your crow's feet, that is going to be about $600 to $700. And then for every syringe of filler that you need is about $500.
Paula Begoun: So, Dr. Baumann, for the nasal/labial folds, the lines that run from your nose to your mouth, what is the average cost that you would get for a woman for Restylane, Juvederm or Sculptra to fill out those lines?
00:36:45 How much…what would be the typical?
Leslie Baumann: In your age group, about $1,000.
Paula Begoun: And how long does that last, the new ones?
Leslie Baumann: The first time you do it it lasts about six months. But the more you do it probably the longer it lasts. So eventually it will start lasting nine months and you won't need as much. So $1,000 the first time and then, so about $1,000 twice a year.
00:37:09 And then if you do the Ulthera, that is a one-time thing. Some people choose to do a second one at three months, but then you don't have to do that anymore. That lasts, we believe it lasts at least three years. It has only been out three years, so it is hard to say longer than that. But the Ulthera is about $3,000/$4,000. So $3,000 for the Ulthera. $1,000 for your filler. $1,000 for your Botox.
00:37:37 That's all about $5,000 which is a lot but it is without any surgery at all. So that is why you have to use good skincare is you don't want to go waste all that money and then not be doing the right thing at home.
Paula Begoun: But does any of this work, does Ulthera work around my eyes? Do I really want my eyes like a steak on a barbeque? Does that work on my eyes? What do I do about the sagging around my eyes?
Leslie Baumann: On the bottom lids it works. Your top lid, it doesn't work yet because they haven't been able to develop the correct eye protection yet to protect your eye from the ultrasound.
00:38:10 So your top lids you can't do it. But you can do it almost anywhere else. I'm doing some research for the company, so I'm not allowed to talk about areas besides the face and neck, but basically you can imagine that if it tightens skin it can possibly work in lots of places. That's one problem with being a researcher for these companies is I'm not allowed to talk what is called "off label."
00:38:37 So that means if it is not approved by the FDA I am not supposed to talk about it. But Ulthera is approved for the face and the neck area.
Paula Begoun: Okay, so before we take our first question I just need to ask, what laser are you using to zap brown spots on the back of hands and on the face?
Leslie Baumann: The 1064 nanometer which that is the wavelength of light. There are a lot of different brand names.
00:39:02 A lot of times, there are so many lasers out there and so many brand names that a lot of times dermatologists go buy the wavelength or the number of the color that the laser produces. So we use the 1064 which is also called the Nd: YAG. So a lot of people have 10 to 12 lasers in their offices because each laser does a different thing.
Paula Begoun: Oh, but this $5,000 price didn't include getting rid of my brown spots and red veins, right?
Leslie Baumann: Right. We forgot to throw that in. So another $250 for each of those, so another $500. So maybe $5,500. But you will look amazing in three months without any surgery.
Paula Begoun: Right, right.
00:39:47 So I have to get down to Miami. So, Dr. Baumann, we are going to take our first calls. So just to remind everybody who we are talking to, this is the most beautiful dermatologist and young – you can't imagine, she looks like a child. I'll never forget the first time I met Dr. Baumann; she walked in and I thought where is your mother?
00:40:07 And it turned out, and she still looks that way. I swear, you haven't aged an hour. Dr. Leslie Baumann is author of the dermatology textbook, "Cosmetic Dermatology" and also the best-selling author of "The Skin Type Solution." And you can visit her on…wait, your book is "Skin Type Solution" or "Solutions?" It's plural, right, Dr. Baumann?
Leslie Baumann: Well the book is "The Skin Type Solution" and the website is
Paula Begoun: Okay, well, we have to fix that. You have to get your website to match your book. But that is a whole other topic, not for tonight.
Leslie Baumann: If they Google it they will find me.
Paula Begoun: They will find Dr. Baumann. Okay. God, there is so much to talk to you about.
00:40:56 Desiree, let's take our first caller.
Desiree Stordahl: We have Ellen from California on the line.
Paula Begoun: Hi Ellen.
Ellen: Hi.
Paula Begoun: Hi. What's your question for Dr. Baumann?
Ellen: Well, I can't believe I am talking to you, Paula. I'm such a fan. Oh my gosh!
Paula Begoun: Thank you, dear. What can we do for you?
Ellen: Well, I am a 43 year old mother of four. My last two children were twins, three years ago. And after I had the twins I had gastric bypass surgery and lost 100 pounds within the last ten months.
Paula Begoun: Congratulations, you make me tired to think four children. I'm exhausted. But congratulations; that's just phenomenal Ellen.
00:41:44 You must be feeling great.
Ellen: You know, I am feeling fantastic except I am so self-conscious about my neck now. So I wanted to ask Dr. Baumann about what I can do about my neck. It's killing me.
Leslie Baumann: That is a great question. We see that a lot. And rapid weight gain, it does take your skin awhile to bounce back, and sometimes it doesn't as I have kids, too. You and I are close to the same age, so I know that after having kids your stomach skin just is never really the same, and especially after losing 100 pounds.
00:42:20 But, Ulthera can help. It depends on how saggy your neck is. And without seeing you it is hard to know. It definitely can improve it, but if there is too much sagging surgery is really a better option for you.
Ellen: It's not awful.
Leslie Baumann: And a lot of times you will have sagging on your arms and a lot of other areas as well. But ten months is not a lot of time. Your skin is probably going to tighten up a little bit more over the next couple of months. But without seeing you I would guess that you would probably rather get a neck lift which is in the $4,000 or $5,000 range because you are probably going to need several Ulthera's and so it ends up costing about the same.
Ellen: Oh, okay.
Leslie Baumann: If you have minimal sagging, or like what we call mild-to-moderate sagging, the Ulthera works great. But once you start, when you lose that much weight and the skin sags a lot more, it's really not quite as effective for that.
Ellen: Okay.
Leslie Baumann: Now I have tons of patients who have gone and gotten neck lifts after losing 130, 140 pounds and they look great.
Paula Begoun: I like the idea of getting double benefit.
00:43:36 And so when you do have that much sagging and you do have surgery instead of Ulthera for the money, given what Dr. Baumann just said, you can also lift up some other stuff while you are at it. You know, people always say to me, "You don't need cosmetic surgery, you don't need cosmetic surgery." And I'm thinking, so what am I supposed to do? I'm supposed to wait until somebody says to me, "Dang, your face is hanging down to your neck. You really need cosmetic surgery!"
00:44:05 The idea is that you want to do it before it gets bad. You don't want people going, "Geez, get yourself to a plastic surgeon." So I would absolutely take Dr. Baumann's advice. I would get an opinion from a dermatologist but I would absolutely consider seeing a very good plastic surgeon. Ellen, what Paula's Choice skincare products do you use? Or are you using somebody else's? What can I send you?
Ellen: No. You know I just started to use your products and I love them.
Paula Begoun: I love you.
Ellen: I'm normal-to-oily and aging, so I use some of the Resist. But I haven't gotten all of the products. And I would love to try…
Paula Begoun: You are not allowed to get all of them.
00:44:53 So I'm going to send you my Skin Balancing Antioxidant Concentrate. I'm going to send you my Skin Balancing Cleanser. I'm going to send you my new Resist Hydrator which is specifically designed for normal-to-oily skin. I think you will love the texture. And Ellen, thanks for calling. Take care. Good luck with staying healthy and keeping that weight off and not letting the twins drive you crazy.
Ellen: Oh, thank you both.
Paula Begoun: Take care, Ellen.
Leslie Baumann: Bye-bye.
Paula Begoun: Next caller, Desiree. Bye-bye. Next caller, Desiree.
Desiree Stordahl: We have Laura from Montana.
Paula Begoun: Laura, how are you doing?
Laura: Hey Paula. Well, I'm doing as well as a 56 year old can do with sagging skin that used to be beautiful and I just need to know what the doctor's recommendation would be for, you know, a simple small town girl who cannot afford the expensive surgeries and treatments for my sagging, the marionette lines.
00:46:04 The sagging eye lids. The lines, you know, I used to be very pretty and now I don't feel so pretty.
Paula Begoun: Oh, first of all, Laura, get that sound out of your voice. I can tell you are adorable. And let me tell you this right now, I don't care what they do to you to make you look beautiful, whatever Dr. Baumann has, and it's brilliant, it's really going to not look beautiful when you don't live it.
00:46:39 Live it first and then go see a great cosmetic dermatologist. Dr. Baumann, can you help Laura out?
Leslie Baumann: Well, Laura, it depends on what city you live in, but if you go to, you can find what clinical trials are going on in your areas. It is possible that if there is a medical school in your area, maybe they are doing a study on the Ulthera. We just did a study where we enrolled 40 people and they had their entire face and neck done free on the study.
00:47:15 So you can Google "clinical trial Ulthera Montana," just go to which is the government website for all of the research trials going on. So back in 1998 when we did the Botox trial that got it approved, people got free Botox for about a year. In fact, they got paid to get Botox for about a year. So it is wonderful to get on a clinical trial. So just look and see if there is one going on in your area.
Laura: Thank you so much.
Paula Begoun: So Dr. Baumann, this, is this for all clinical trials for any medical procedure going on around the country?
Leslie Baumann: Yes. Any company that is applying for FDA approval, whether they are Phase 2 or Phase 3 has to register on So you can search there as a patient or as a doctor performing trials to see what different trials are going on.
00:48:17 And it is a great thing the government has done to keep people from more than one person being on a clinical trial. I mean there are all kinds of reasons that they did that. So there are all kinds of information on that website about clinical trials and what the purpose of clinical trials are and you can search by, like I said, by Ulthera and see what is going on.
Paula Begoun: So, Dr. Baumann…go on, I'm sorry.
Leslie Baumann: There are so many amazing things that are getting researched right now that I can't tell you the names of them. So just go search around on there…let's say you have any kind of problems you have, go to and see if there is a trial starting in your area to try to solve that problem.
Paula Begoun: So, Dr. Baumann, on your website do you have any of the clinical trials you are doing on your website?
00:49:09 Or are you not allowed to do that?
Leslie Baumann: If we are enrolling for a clinical trial, you will find it at So, we post, we will post on there what we are enrolling. So right now we are enrolling people who have crow's feet, wrinkles around their eyes.
00:49:29 For my trials you have to live in the Miami area. So if you don't live in the Miami area, that is why you would look on and see if there is somebody in your area who is also a researcher. And we are one of the biggest research centers in the country, but there are people in other cities like LA and San Francisco and some other places that also do trials as well.
Paula Begoun: So is your website? That's your personal website?
Leslie Baumann: Right. That is the website for Baumann Cosmetic and Research Institute. And we like it because it is easy to remember.
00:50:01 Just Derm like Dermatologist, And you will see, just click and it will say research trials. And if you click there we will post what is going on. Now you also can follow us on Facebook at Baumann Cosmetic and we post on Facebook what trials are coming up as well for Baumann Cosmetic.
Paula Begoun: So and, Laura, are two websites you should take a look at. I don't think it hurts to see a cosmetic dermatologist in your area and in some areas cosmetic dermatologists actually do payment plans.
00:50:45 I don't want to push cosmetic dermatology too much, well maybe I do. Actually, I do want to push cosmetic dermatology. As somebody who believes strongly in great skincare, I also believe up to a point without great cosmetic dermatology to push off getting plastic surgery, you might want to talk to a cosmetic dermatologist and it sure as hell beats wasting money on bad skincare or overpriced skincare. Laura, do you use Paula's Choice products at all?
00:51:15 Can I send you…?
Laura: I do. I love your 5%...
Paula Begoun: Alpha Hydroxy Acid? The one from the Resist line?
Laura: Yes. I love that. It seems to keep….go ahead.
Paula Begoun: Are you kidding? You are about to give me a compliment. I'm going to want you to finish.
Laura: I love it. It seems to keep the little white bumps away you know that you get on your skin. And it keeps my skin, as far as that goes, it is keeping my skin clear and pretty as far as that goes. But I just have, ever since I had breast cancer 15 years ago, that's when it all started. And I just…
Paula Begoun: The loss of estrogen.
Laura: My skin just started going downhill. I just started aging immediately, you know.
Paula Begoun: That lack of estrogen.
Leslie Baumann: Right, they took you off of estrogen and that will do it every time. So…
Laura: I cannot take estrogen, right.
Leslie Baumann: So something like an alpha hydroxy is a smart thing for you to do.
Paula Begoun: So I'm going to send you, Laura, I'm going to send you, and by the way I'm glad you got to 56. I want you to be happy about being a 15 year survivor, that is incredible.
Laura: Survivor. Cancer-free. Thank you so much.
Paula Begoun: That is brilliant.
00:52:30 You are a blessing. You are a blessing. So, Laura, I'm going to send you a few more of my Resist products. I'm going to send you the cleanser and the toner. I'm going to send you the 10% weekly, once a week treatment, the Resist Super Antioxidant Concentrate. And our new Hydrator and I think that will get you in the right direction. And I don't think it hurts to talk to a cosmetic dermatologist. Laura, take good café of yourself, okay?
Laura: Thank you so much, Paula. Love you.
Paula Begoun: Thank you sweetheart. Take care.
Laura: Bye-bye. Thanks, Doctor.
Paula Begoun: Dr. Baumann, you got thanked.
Leslie Baumann: Oh, I didn't hear that. I was just sitting here thinking about, Paula, I haven't talked to you since…I went to the World Congress of Dermatology in Korea where the dermatologists all around the world go. There is about 20,000, 30,000 people there. And your products are hot in Korea.
00:53:26 And they are a very savvy cosmetic market there. And I was very impressed with how loved you are in Korea.
Paula Begoun: I'm just…my ego is loving this. Thank you. Yeah, it's fun. Koreas has been wonderful; the product acceptance there has been great. Thank you, Dr. Baumann. So, I want to get in one more call. What do you think, Desiree, can we get one quick call in?
Desiree Stordahl: We have JP from Oklahoma on the line.
Paula Begoun: Hi JP.
JP: Hi. I am sitting here with Dr. Baumann's book and I have done the skin type questionnaire. And I am an OSPT.
00:54:09 And what I'm dealing with, and I guess what I was really calling to see if I could get some help with is that I am dealing with kind of monthly breakouts and then brown spots after the breakouts. But then the products that I use also seem to cause dryness. So I am trying to, I guess I need help with a regimen that can kind of help with some of these problems that the products kind of seem to compete with each other.
00:54:33 And so I was just wondering…
Leslie Baumann: Absolutely. So OSPT, what that means is Oily Sensitive Pigmented and Tight. So when she tells me she is an OSPT, when she tells me that that is her skin type, I have a really good idea already of what her skin issues are. So for you something that, salicylic acid is perfect for you because it will help exfoliate off some of those brown spots, and benzoyl peroxide can help lighten a little bit too.
00:55:06 But like you said, those can be very drying. Have you tried anything in the Retin-A family in the past or what types of things have you tried?
JP: I have, it's been a few years, and it seemed like I remember getting some peeling pretty quickly after trying it. And so I didn't go back to it. But I am kind of open to any suggestions including going to a local dermatologist. We just don't really have any cosmetic dermatologists around my area, that I know of anyway.
Leslie Baumann: What area are you in?
JP: I'm in the Oklahoma City area.
Leslie Baumann: Okay, I have family in Oklahoma City. I'm a Texan, but they have a lot of good dermatologists there. You need to get on something in the Retin-A family, but you can get on an over-the-counter retinol and start out.
00:56:02 And it is normal to peel in the beginning because that is your skin cells speeding up. So I would do a mild cleanser, some kind of a milky cleanser that does not have any glycolic in it at first. So do a mild cleanser, something with benzoyl peroxide in it. There are many different ones, whether it is prescription or something over the counter, and then a good sunscreen. And then at night the same milky cleanser and your retinol to get you started.
00:56:35 And then after a couple of weeks you can handle that retinol, that is when you will start adding in the salicylic acid cleanser. But there is something new on the market I am really excited about, and Paula, we never talked about it, but it is called TRIA, T-R-I-A. And it is a blue light device that you buy on the internet. It is about, I think, [$150] and I think Amazon has it and HSN maybe even.
JP: What's it called?
Leslie Baumann: It's called TRIA. And it is a light device that kills the bacteria on your skin. So for people who really dry out too much from acne products, it is wonderful.
00:57:13 So by just doing some retinol and the TRIA line…
Paula Begoun: So real quick, because then we are going to have to go, the Tanda is similar to the TRIA right? The Tanda? Have you heard of that one?
Leslie Baumann: Yes, but it doesn't let off enough energy. The TRIA is so strong, it is actually stronger than what we use in dermatologist's offices.
00:57:33 So the Tanda, it lets off a wimpy amount of energy while the TRIA is a lot stronger. So you kind of move it around your face for three minutes twice a day. And by the way, I don't have any financial interest in any of these companies or brands or things I am talking about. But TRIA is one of those ones where I wish I did because it really does work well. So I think if you go to…
Paula Begoun: So, Dr. Baumann, forgive me, but I'm running a little short on time. JP, I'm going to send you everything from Paula's Choice that Dr. Baumann just recommended to you. Desiree will take care of you. I don't have time to go through the list of products we are going to send.
00:58:14 But it is going to include a retinol product, a salicylic acid product, a gentle cleanser. So we will take good care of you, meeting Dr. Baumann's Skin Type Solutions suggestion. And I'm going to say thank you and goodbye to Dr. Baumann because we are almost done. Dr. Baumann, a brilliant cosmetic dermatologist. Go visit her at Dr. Baumann, I have to say goodbye. We will talk again. You are brilliant as always. Go get some sleep because it is about 10 o'clock.
Leslie Baumann: Okay. Come to Facebook if you want to ask me some questions. Thanks, bye.
Paula Begoun: Take care, Dr. Baumann. Bye-bye. So, it is done, it's almost done. We are wrapping up. I just have about a minute left. I'm Paula Begoun, the Cosmetics Cop, keeping you Beautifully Informed here in Seattle live on Thursdays with Desiree Stordahl, my assistant and producer of this hour, and Bryan Barron, my coauthor.
00:59:14 Next week we are going to talk about is a facial really worth it. Do you bother seeing an aesthetician? You are going to be shocked at the benefits and risks we are going to tell you about. On the 8th we are going to talk about five money saving teeth tips for whiter teeth. Why Desiree is smiling so brightly now and what are the positives and the negatives from the drugstore, from a dentist. On the 15th, six skincare products that make wrinkles worse. You can actually make your skin worse just by buying a product. So we are going to help you with all of that. Again, I'm Paula Begoun, the Cosmetics Cop. Come visit me at Talk to you next week. Good night.
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