Episode 3: Dr. Emily Rubenstein - Dermatology Demystified

Dermatologist, Dr. Rubenstein, is on the pod today providing Nell and Laine with one of their most dynamic interviews to date! Dr. Rubenstein generously provides technical knowledge (and unmatched candor) to many of our questions, which often root from the pedestrian standpoint . She also discusses the trends she's seen over the years, the current movement towards looking more natural, and most importantly, offers wisdom on all things dermatology.  

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Transcript

Nell: So we are super, super stoked to have a legitimate pro here with us today.

Laine: And one of the reasons this is so exciting is because we have a mutual friend that we share who has raved about you for years. And one of the, the fun.

Nell: from college for us, we, how long

Dr. Emily Rubenstein: Oh, I've known, this is Amy Incan. I've known her since, uh, we were like 10 or 11. So we've been, we're like

Nell: Childhood friends. Oh,

Dr. Emily Rubenstein: yeah. Down and dirty friends. Oh,

Laine: Wisconsin, which is, she was like, [00:02:00] we used to call her Auntie Amy because she was a senior when we were freshmen and we

Nell: And, and she reminded us of our Aunt Karen, remember?

Laine: Yeah. Yeah. Yeah. Yeah. So we call her

Nell: we were like, it's Auntie Amy. She was like a very maternal role.

Dr. Emily Rubenstein: Amy. I call her auntie Amy with my kids.

Laine: Oh, well, there you go.

Nell: But she was always very maternal. We love Amy. Okay.

Laine: but one of the other fun triangular moments for us is, is that Emily, you married a guy from Puerto Rico. So we love this. We

Nell: She's got the recon connection going on with me.

Laine: Yes. So this feels like,

Nell: how long has he been in the States though? Now?

Dr. Emily Rubenstein: he moved to the States when he was 12. So his family moved to Florida when he was 12. And then I convinced him to move north of Florida when we got married, which was kind of crazy. We were married down in Florida. So, and he is

Nell: got him up to the North.

Dr. Emily Rubenstein: yeah, he, he like loves the Midwest and I'm like, we could totally move back.

Like it's really cold here. And he's like, no, he absolutely loves

Nell: That's so interesting.

Dr. Emily Rubenstein: Yeah. It's, it's a little strange. He's a little sick. [00:03:00] So

Laine: Yeah, I know. Cause it's, it's,

Nell: like, just please let's go South. He's like, no, you've got me here. I would like four seasons

Dr. Emily Rubenstein: yes, he loves

Laine: Oh God.

Nell: Well, we're already planning our rendezvous here in Puerto Rico. Are we not Emily? We're going to make

Dr. Emily Rubenstein: are. I'm excited. I'm excited.

Laine: So let's just kind of start from the top. We kind of want to go through your career a little bit. One of the things we're very interested in is to kind of see how it's changed for you because you know, you've obviously, you, you've been doing this for how many years now? Have you been a dermatologist?

Dr. Emily Rubenstein: Yeah.

Laine: 15 years.

So, you know, when you started, I'm imagining that the focus, maybe even the bulk of, of revenue was coming from different things. And now we know how much of like interventions and beauty interventions are occurring. Kind of curious how your, how you got started and what you were focusing on in your practice when you first started.

Dr. Emily Rubenstein: So it's interesting. So my first job straight out of presidency was actually in the northern suburbs of Chicago. So I was on the North Shore in a very cosmetic practice, which is not a usual place to start. Um, so [00:04:00] I'm a little bit different and unique in that sense. But then I left. Um, the North Shore three years later and I came to the city and when I came to the city, it was very medical based with some cosmetics.

Now I grew the cosmetics because I had a cosmetic background. Um, but initially when I first started, we were very, um, it was interesting. So fillers had really made its place on the market. We were doing a lot of fillers on the North shore. Um,

Laine: so that's it. Before you go any further, I want to ask you when you say it was very cosmetic based, were you, were you treating like older women? Was it like, because that just surprises me to even hear that 15 years ago that there was already such an emphasis.

Dr. Emily Rubenstein: So I, my main patient population when I was on the North shore was probably women in their, um, now probably my age, late, a little older than me. So probably like late forties, early fifties, sixties, or women who like didn't want, like in their 70s who didn't want to have, uh, plastic surgery, or maybe they had done a little bit, but not, they didn't want to [00:05:00] have another facelift.

So we did a lot of fillers, not, not so bright. another facelift. Um, but it's not, it wasn't as much, um, younger patients. So I wasn't seeing like the twenties, 30 year olds coming in asking for cosmetic procedures or starting Botox or starting

Nell: Yeah. So it was, it was basically anti, like it was fighting aging and loss rather than proactively changing your face. Yeah. It was a

Dr. Emily Rubenstein: So yeah, so we weren't doing so much preventative. Um, and it may have been that in that patient population, not many 20 year olds live on the North shore. Like you're not seeing as many. of that. But I don't think in general that was really the, um, the trend at that time to, to do a lot of preventative.

Now, being a dermatologist, I started doing Botox for myself, probably at age like 26. So super young, super young because I was in that industry, right? So you're, you're learning about it. Let's try it out on each other. Let's do it. [00:06:00] And you know, you go through these like very ups and downs with it. So when we first started, you just start with your forehead.

And I was like, Oh my God, my lines are gone. I'm very expressive. This is fantastic. And then you start to like dabble a little too much. And so then, you know,

Nell: is so honest. I love

Dr. Emily Rubenstein: Oh, yeah, yeah. So I,

Laine: But wait, I want to wait before you go any further. When you say that, I'm curious about that. When you say. Your lines were gone because I remember when I was young going to a dermatologist in the city and I was just literally doing, I don't know, just skin care and skin checks and I remember some of the um, the younger, like

Nell: Like assistance, physician's

Laine: cute boys that were in the, you know, this, whatever, the physician's assistants in there and they were kind of like, well, nothing will work better than Botox.

And I was like, Oh, I'm not doing Botox. And they were like, well, you have a lot of expressive lines. And I was like, yeah, As opposed to what? As opposed to not having expressive lines? Like, I thought it was so strange. I'm curious

Nell: Yeah, so they were ahead of the movement because they were already like seeing so much of that or maybe

Laine: but like, how did [00:07:00] that start this concept of erasing expression? I just, I, I'm still fascinated by this.

Dr. Emily Rubenstein: I, I've kind of got, so there was this whole shift to go to like frozen, right? So we got, we went into this whole frozen mode for a while, where everyone was like, expressionless. Like, you're like, like, I'm so sad. And you're like, are you like, I can't, I'm not quite sure. Like, are they making a phase? I can't, like, trying to, you know, interpret people.

Um, and then there was like, studies done that showed like, Oh, well, do you have like lines around your eyes that actually show joy? And then that sometimes brings joy. But if you take out the expressions between your eyes, we call it the glabella area. It actually helps with happiness because you're not making that sad face.

So they did all these studies, um, looking at like when we do Botox in certain areas, how does it actually affect our mood? So certain areas became noticeable for that, right? So it was kind of interesting. Yeah. So they actually did. legitimate studies in our, in our journals for that. But what I've moved more [00:08:00] towards is having a little bit of movement.

I mean, if you take out all of the movement, you get this kind of shiny, waxy look, and it's not very natural. So you want to have a little bit of movement. You want to be able to move your, I mean, I have way too much movement right now. You guys can see me, but the people can't. Thank God. But, um, you want to have a little bit of movement.

You don't want to have too much movement though. So when you move, you want to be able to like move your brows up a little bit, but you don't want to like be like. Yeah, I can. I'm moving them right now. You're not seeing this, you know, right? No, right. Well, I'm kidding. Like that's what I'm saying. Like, you don't want to like, I can't, I can move it, but you don't want to have it where it's like zero movement.

You want to have a little bit of movement because it doesn't look natural. If you're talking to someone, you can't move your face at all. Um,

Nell: Oh. I've. It feels like you're in a straitjacket. I, I, like right after Botox, sometimes I'm like, I feel like I'm in a straitjacket. Like I'm just like, ah, like I, I feel so good. stuck.

Dr. Emily Rubenstein: Well, and I usually tell patients, like, let's start slow. Like, let's do a little bit, especially people, I call them virgins. I'm [00:09:00] like, if you're like a tax virgin, right. You've never done it before. First of all, you're my favorite patient because I'm so excited to see the difference. And like, just, The difference that you can see using something like, um, botulinum toxin to relax them.

Like, I usually like to say relax, not paralyze, because our goal isn't to paralyze you. Our goal is to make it like look natural and relaxed. the favorite patients because they come back and they're like, Oh my God, why did I wait so long? So the idea of preventative, like starting earlier, because it takes me a lot longer to erase those lines if you're 45 and starting versus if you're 35 and starting, okay?

Because at

Laine: okay. Talk about that because that I, I, you know, we, we mentioned this on our first time that we talked about the beauty and aging, this concept that it's getting. it's marketed to the younger and younger generations. The fact that there's like 20 and 30 year olds doing Botox, I'm always like, what? Like, and filler.

I just don't

Nell: Well, again, prevention, like

Laine: but is that a real thing? I want, I want to hear you talk about this. Like, well, why, why, [00:10:00] what, what happens if you wait till 45? I mean, why is it so hard to, did

Dr. Emily Rubenstein: so the lines on your forehead between your eyes, around your eyes, those are what are called dynamic lines. So dynamic lines are because of muscle movement, right? So if you continuously move that muscle, you start to etch in those lines. They become kind of a, An expression, they're expressive lines, right?

Whereas the lines around our, our, uh, nose to our mouth, we call those the nasolabial folds. Those are volume. That has nothing to do with expression.

Nell: expression.

Dr. Emily Rubenstein: That's, so people always come in and they'll say, I want to put Botox like between in my nasolabial folds. I'm like, well, that's not going to do anything.

Um, other than it's going to screw up your smile. So. They don't quite understand there's a volume loss that happens with aging. There's elasticity loss that happens with aging and collagen loss, and then there's dynamic lines. So botulinum works with dynamic lines, but it also works. We use it. And especially like in experienced hands to manipulate the muscle movement.

So sometimes we'll use it on the upper [00:11:00] face. That's the most common area, right? Um, to stop that expression, to soften that up, and that's great for people. And they're, you know, starting earlier because we're not allowing that etching in to happen. Now, that doesn't mean that if we start you at 45, it's not going to work.

It just means it's going to take longer to relax that muscle and to get it weakened. If you started like 55, I might not be able to erase those lines. Those might be like very ingrained expressions.

Laine: I lose

Dr. Emily Rubenstein: With patients, okay, um, with patients who, um, we use it on the lower face, that's actually, we're using it to manipulate more than we are to do like lines. So that when we use, um, botulinum in the lower face, we're actually relaxing muscles to create, um, either lifts or depressions, depending on what we're trying to do.

So sometimes we'll use botulinum in the lower face. when you start to get a downward turn of your [00:12:00] mouth, your smile and your smile, as we say, the smile starts to turn upside down. It's because there's a muscle that actually pulls down the expression lines around the mouth. So when we use botulinum in the lower face, we're actually relaxing that muscle to allow for a movement upwards.

So it's interesting. Go

Nell: what is the difference between this botulinum? Like what would make you choose botulinum over Botox? It's an alternative. I'm

Dr. Emily Rubenstein: me. I'm sorry, I'm

Laine: Yeah. I'm like, what's that word?

Dr. Emily Rubenstein: Okay. So Botox is a type of botulinum toxin. So there's a lot of different, so when you, when Botox is like saying Kleenex, right? Whereas you can say tissue paper, but Botox is so smart because they really branded really, really well.

So Botox is, um, made by a company called Allergan and they've really have the market. So when people come in and they say, I want Botox, we've sometimes, I mean, I use a, a majority of what I use is Botox, but I'll also use Dysport. I'll also use, you know, ZMN. I might use, um, Daxify. So there's many different companies that make it and we choose it [00:13:00] based on what we're trying to achieve.

So sometimes, um, like I find in, in patients who are like, worker outers, right? So people who are these thin women who are like, I won't miss my, you know, orange theory class seven days a week. And my Botox only lasts like six weeks. Okay. They, they burn through their Botox. They metabolize very quickly. I might not use Botox.

I might use a different type of botulinum toxin. So I might end up using Daxify for those patients. Cause I find it's longer lasting for them, but they can't break through it because it's a different enzyme. Like it's a little bit of different makeup. And they can't break it down as quickly or their body doesn't break it down as quickly.

Some, some people will argue it's the amount that we're using that we need to use more for those patients. But I sometimes will just switch up which one I'm using because I have them in my office.

Laine: And then

Nell: me of like deodorant. Like when you use a deodorant and you're like, okay, my body's not responding to that deodorant anymore. I need to switch or

Dr. Emily Rubenstein: Yeah, absolutely. It's kind

Laine: but what, And what are the characteristically differences [00:14:00] other than, than the breakdown, like just for our listeners, if anybody's, you know, first time users are considering it, like, what are the differences in these different products?

Dr. Emily Rubenstein: So sometimes we'll use different products in different areas. So like for me, um, I like using Dysport around the eyes. I find that it's really nice and natural and smooth around the eyes, but I like Botox in other areas because I find it's more precise. So, um, When you're worried about dropping someone's brow, like you'll hear people say like, Oh, I got droopy brows.

I hate Botox. It makes me droopy looking. It's just the placement of the, of the material, the way that we injected it. It was a, a user error, which actually helps. helps us, but also all of us do it. At some point, you're going to drop someone's brow because not everyone's muscles like read the textbook and is exactly the same.

So sometimes depending on the patient's anatomy, you'll have to just tweak the way that you inject. Um, but I like to use like Botox in the upper face and, and maybe I'll use just put around the eyes or like I was saying, I'll, I'll use [00:15:00] Daxapai for patients who are Um, into working out more. So I'll, I'll switch.

Um, there's a new one that it hasn't hit the market yet. It's going to be hitting the market soon. That work, uh, it works within 24 hours. So let's say you're going to a big event and you want to have like really smooth for that event. Um, you can inject that and then, but that only lasts like two to three weeks.

So there's. interesting ways that they create, um, these products that will affect how we use them. So if someone doesn't want to try it for the first time and then never has done it, and they want to see what it would look like, that might be a new, that product hasn't hit the market yet, but that might be a product that they would try and it might not cost as much, but it's only going to last two, three weeks.

Laine: Wow. Okay.

Nell: Um, can I, I'm sorry, can I, I wanted to ask about, to go into a little bit, you started talking about the volume and the, that, the idea of like the loss of volume, because we're probably, my sister and I are starting to enter that phase where it's like, it's not even like, I don't mind again, [00:16:00] having movement or wrinkles, but now I'm like, Oh, I'm just starting to see different things, which by the way, is also part of just aging.

And I don't want to like erase that either. But.

Laine: No, I was gonna say, I don't know if I can relate with that. I don't feel that.

Dr. Emily Rubenstein: You don't

Nell: don't feel, you don't

Laine: yeah, I just don't feel, I, no, I just, no, I just have allergies and under eye issues. Like, I can't even focus on anything else. It's like, I just feel like my, yeah, I mean, just speak for yourself.

Nell: Well, basically I'm just saying that now we're, okay, whatever. I'm just saying that we're entering into the phase of possible volume loss because of our age purely, you know? Um, so I'm saying that now I've like looked at, I started doing some things like different laser things or plumping things.

I, I'd like to know what your opinion is on this. Like do these things work or is this all like witchcraft, you know, Oh, did you spend all these? I mean, they're expensive, these lasers that are for plumping and what do you call it, collagen production. Exactly. Lifting. I mean, there's so many different ones out there now.

It's like, to me, and then it's hard to stay refined. I'm like, I don't want to be like repeating things or crossing over. [00:17:00] Um,

Dr. Emily Rubenstein: So how I, how I explain it with like collagen production, anything that increases collagen production usually tends to be very good, but I, so there's like microneedling with radiofrequency that stimulates underlying collagen. There's lasers that we can use that cause injury to the skin to allow for healthy collagen to reproduce as well.

There's like, um, like M phase, right? That's the muscle movement, uh, laser that, or it's not a laser, but causes contractions to build up the muscles, to kind of lift. the face as well. So there's a lot of different modalities out there now. And how I tell patients is there's not one modality for everyone.

And then there's not one modality that does everything. So patients have to understand that when you do something, you have to maintain this just kind of like working out. Like you can get really in great shape. But then when you stop working out, you're going to slowly go back to where you were. So you have to maintain and you have to continue to do different procedures.

Now, does that mean that you'll never need a facelift? I mean, some people have great genetics, [00:18:00] right? You have phenomenal genetics. You're really good about sun protection. and you don't, because UV light is one of our bigger breaker downers of that and smoking, um, play a huge role in breaking down collagen.

So let's say you've never smoked in your life. You've never seen the light of day. Those patients tend to be better off. They have less collagen production, but in general, especially as like hormonally, we start to change. And as if we go into that perimenopausal part, like you guys are a little bit not there yet.

But as that happens, we do see less and less collagen support from our estrogen levels being lower. And so people are starting to look at, um, like estradiol creams, like does that help topically? And there's still studies that are going on about these kinds of things on topicals or using lasers to help with that.

But I find that I'm, I'm using a more and more, trying to stimulate collagen production through causing injuries to the skin. So doing like laser, [00:19:00] find lasers that might help with it. So doing, um, like some fractionated, um, erbium or using like some microneedling to help with that production to allow your body to do some of the work.

And sometimes like you'll hear,

Nell: what about the heat ones? Have you heard like, because I've done one that has like, it's heat. They put the gel. It's not a numbing thing, but it's just like the clear gel. And then they like push it over you like this in your face and it, and it gets hot and you have to hold it over there.

Dr. Emily Rubenstein: maybe radio frequency. It might be. So you want to heat up the, the

Laine: love that you don't know what you did now. I feel like I've done one that,

Dr. Emily Rubenstein: Well, it might be, I mean, it could have been that. So it's usually they try to heat you up to about 42 degrees to stimulate that underlying collagen.

Nell: And then you stay in it for four minutes or something. Like you have to try to stay in that, that temperature. They take the temperature of the skin and then.

Dr. Emily Rubenstein: So it might be thermage that they were doing or something similar in, in the radio frequency. So you stimulate it to get to that temperature and that helps [00:20:00] stimulate some underlying collagen to reproduce. So you break it down for it to rebuild up essentially.

Nell: Okay. And it's like a lower layer, a deeper layer of collagen, maybe rather than like you said, surface.

Dr. Emily Rubenstein: well, I mean, your collagen's a little bit deeper anyway, but what 'cause the, the top of the skin is just your, your epidermal.

Laine: you're getting very specific

Dr. Emily Rubenstein: sorry, sorry. Not to get on the science level, but

Laine: I know. Is this personal now? This is getting real personal here, girl.

Nell: cause I want to ask something about microneedling too, by the way. Sorry.

Dr. Emily Rubenstein: No, no, no. So

Nell: Can I ask this?

Dr. Emily Rubenstein: Yeah, go for it. Go for it.

Nell: Well, what is the difference? Cause now I've seen a lot of issues with like, there's all these day spots and I've seen a lot of warnings, like be careful with all these like, or medical spots, spots as they call them.

Like as compared to going to an office. I do go to a place for facials. And I've done some, like I've done that thing that I just talked about that is apparently a mystery procedure. Um,

Laine: so experimental, girl. Jeez.

Nell: I mean, I, I've been going to them for like, like 10 years or something. Um, so the point is though, is that [00:21:00] I've done microneedling there, but she doesn't do it very deep because of it being in a, uh, that setting.

What did we call it? A day spot setting or med spot. And I've read that that's good for people who get, um, like stimulate, stimulate like brown spots and whatnot. That sometimes when you do the medical grade, like in a dermatologist office, the microneedling with anesthesia that goes really deep, that it can actually stimulate, um, that melasma production.

And so I've always been like, Oh, that's good that I just do it like a very like soft kind of spa version, like a spa version, but then I'm like, I don't know, am I also missing like the big movement of doing it in a dermatologist office?

Dr. Emily Rubenstein: So the difference between doing something in a germs office or physician's office, um, like a plastic surgeon's is that, yeah, we can go to a different depth than you can without medical supervision. So, and we can do different things. a little bit more invasive. My esthetician does it. I don't personally do it, but [00:22:00] because she's under my supervision, we're allowed to do that.

The melasma component, like stimulating melanocytes, that's usually with heat. So lasers with someone who has melasma, we have to be very, very careful. You can do microneedling. It's very safe for anyone with melasma. A hundred percent. Go crazy with microneedling. When you start to heat up the skin, that's where you start to stimulate melanocytes.

So we can't do like IPL or BBL to patients with melasma, or at least you have to be under like someone who is extremely, um, experienced with that because you can cause aggravation or stimulation of those melanocytes, those,

Laine: Well, as you're talking about melasma, because we have a lot of younger listeners who are still in like the baby making years and we know we see melasma in, in those eight, in those stages. Is that something that, like, I think I had melasma after my second child and it went away and I never had it again.

Like, is that, do I need to think about those things? Like if I, if I had it when I was younger [00:23:00] or, you know,

Dr. Emily Rubenstein: Usually, I mean, most patients don't necessarily like if you, if it goes away right after, usually it's not necessarily going to reoccur. If you do a treatment, if you like, Elaine, if you've been out in the sun and you've gotten a suntan and didn't reoccur, most likely it's not going to come back. It's the patients who have like this chronic, like I had it all.

So I look like. Yeah, I had like lip liner. It looked like I had like, you know, and then like early 90s when brown lip liner was really in, it was like overdone. That's what I look like permanently.

Laine: Okay.

Dr. Emily Rubenstein: So I, I get that, that look, but yeah, most patients that if it goes away, it's just like only when they're pregnant,

Laine: Okay.

Dr. Emily Rubenstein: we don't have as much of an issue, but if it reoccurs when they get a tan, then yes, then they're a hundred percent.

We have to, um, yeah. suppress those cells that cause the pigment if we're going to do any kind of procedures, but something like microneedling, not an issue at all.

Laine: Okay. Okay. So now, and I want to kind of know about like, just because we're talking about all these ages and different people coming in with different things. Do you [00:24:00] feel like as a practitioner, are you rolling with the public's demand or do you provide pushback on specific ages or, you know, like just because at the end of the day, it could be a money grab, right?

If someone's coming in the, you know, now you, I was just in LA, you know, and I was just looking at like the young girls with like everybody, nobody has natural lips anymore. It's, it's. It's just bizarre. I'm like, what happens when you, when there's a demand for something? Are you ethically for it, against it?

Do you ever give opinions?

Dr. Emily Rubenstein: Oh yeah. Yeah. Oh, absolutely. So lips are a huge thing. Um, I probably do more lips than anywhere else for filler. Um, But I will tell my patients like, I have a lot of, um, like a lot of the medical reps will come to me for it or like their twenties to thirties coming in for the first time for it. And I do a very subtle lip for them.

I like give them a little boost, a little like judge, and then they'll come back and like, Oh, I love it. I want more. And I'll be like, okay, listen, you don't want to get to the [00:25:00] point where there it's not you. Like you want just a little boost, but you don't want to overdo it. So I, I have this kind of policy where I say, listen, I will be always very honest with you and I will tell you yes or no.

Because what will happen is you can leave me and you'll go to the next guy and they'll say, Oh yeah, let's do it. And they'll put another CC into your lips until you start to morph and you don't look like yourself. Like if you go to Europe, it's horrible. You see all of these crazy, my husband had to stop me because I was taking pictures of all the people.

And he was like, he's like, you can't do like Emily, stop taking photos of people. I'm like, but

Nell: But why?

Dr. Emily Rubenstein: Because why? Oh, because there's no regulation. in Europe. So anyone like can open a spa kind of place and you can start injecting fillers and you don't, it doesn't have, it's not a position and it's not like as regulated.

Even here, there's a lot of like

Laine: Black market? Yeah.

Dr. Emily Rubenstein: Um, like people come, I, I was talking to someone, um, preventative magazine about this, where you can go online, like if you go [00:26:00] online while we're talking and you can Google like buying, filler at home for home and you can actually buy filler. I, we don't know what you're buying or where you're buying it from because it's not legitimate and people are injecting themselves or they're watching videos.

It's insane. Insane.

Laine: Well, I remember seeing that like back when like the big, whatever it was, like when people were doing like the butt thing. butt implants or injections. What is that called? BBL. BBL. And I remember like,

Dr. Emily Rubenstein: Brazilian butt lifts. Yeah.

Laine: yes. And you'd see people who would get like sick from it because they did it like in the black market.

They would go and inject there and they were getting like literally getting poisoned. You know, like

Dr. Emily Rubenstein: So I saw a patient when I was a resident who went to someone, this was in Miami. So Miami is really the wild west. And she's like, Oh yeah, I saw a doctor. He injected me in his garage and it was with, um, I had to buy up to the extent to see what it was. Um, but she was injected with, with silicone. So medical, not medical grade, industrial grade silicone.

And literally it was

Nell: That is disturbing.

Dr. Emily Rubenstein: was very [00:27:00] disturbing and it was, and I said, I can't do anything for you. I can't reverse this. It was like a block. It was like solid. So her, she didn't have like a normal texture of the skin. You couldn't like pinch the skin. It was just like a block of,

Nell: Oh,

Dr. Emily Rubenstein: like cement. Yeah.

Laine: Well, that's what a lot of those, I mean, I feel like Cardi B's openly talked about this. Like people like in the, you know, in that world have talked about, yeah. And the industry about getting these, like these black market. You know, Amber Rose, I think, talked about it, like these black market, but, and, whatever it is, injections.

Thank you. I mean, oh my God. Okay. So that's interesting. Well, it's nice to hear that you, I mean, I'm sure it's hard sometimes to hold your line because like you said, you know, that at the end of the day, they're just going to go somewhere else to try to get it.

Dr. Emily Rubenstein: and sometimes those patients, like, if you know that they're, like, we talk about body dysmorphism, which is where you see yourself differently than everyone else sees yourself. So, like, what we see as our flaws really truly aren't visible to anyone else, right? I see my, like, my version of what I see of myself, everyone else would be like, are you [00:28:00] crazy?

And I'm like, yeah, I'm, I'm totally crazy. But like, people who have true body dysmorphism, It's a disease, right? It's a, a complete, um, screw it.

Nell: Like a percept it's like a perception issue.

Dr. Emily Rubenstein: it's a

Nell: A visual perception issue.

Laine: Well, I mean, you guys, if, if you, I just saw the photo of, I mentioned it to you earlier, Shania Twain, like was apparently at some, some country thing last night. Like that is, she has what you just described because like, she's unrecognizable. It is so frightening. You have to Google it when

Dr. Emily Rubenstein: I'm going to

Laine: off with this

Nell: Well, but what is your opinion then on that? Who doctors, who a lot I mean, I guess, who go there with you?

Dr. Emily Rubenstein: right. Well, the patients who come in with body dysmorphic syndrome, A, I can try to talk them off the ledge a little bit. I can be like, listen, we want to start slow. We don't want to overdo, but inevitably I, most of those patients I don't want to touch because I know they're never going to be happy with whatever you end up doing and they're always going to go somewhere else to do whatever you tell them that you won't do.

So sometimes I'll, I'll say it like, Oh, you know, you're so beautiful the way you are. I don't think my expertise are [00:29:00] going to be what's going to help you.

Laine: and trusting. Well, yeah, because that could be bad branding for you as well. Right? Like you probably have to think about that, that like the people who you treat, like they're going out and saying who you are.

Dr. Emily Rubenstein: well, oh yeah, oh no, I,

Laine: like a clown.

Dr. Emily Rubenstein: and I sometimes purposely ask, I used to do this, I don't do it as much anymore as a, as a professional adult, but like when I was younger and my early in my career, I would ask people who had like bad work done, like, Oh, who did you go to? Because I was curious on what, what was happening because.

Laine: Oh, yeah. Who did this?

Dr. Emily Rubenstein: right, who did this to you? I don't want anyone to be like, oh, Dr. Rubenstein did that to me. I never want my name associated with anything negative. Um, so I would rather be on the conservative side or knowing that someone doesn't have the right perception of themselves. I'm never going to make them happy.

And I don't want to morph them into something that I don't find to be beautiful. Um, Because I just want to,

Nell: a sense

Dr. Emily Rubenstein: go, go ahead.

Nell: Essentially, you [00:30:00] have to, like, it is very important for you to have your aesthetic essentially, like it's almost like branding for you. Yeah. It's like, this is, this is what I, this is what my work, let's say what your work looks like. And in that case, if you see someone who wants to go way over the edge, that isn't in alignment with your vision, you'll actually say like, I don't think I'm the doctor for you.

Dr. Emily Rubenstein: Yeah. Oh, absolutely. And, and I talked to a plastic surgeon about it and he does, um, and he's a very good plastic surgeon, but he does like, I call it like porn star boobs. Like he's, and, and legitimately he ends up seeing a lot of porn stars. That's some of his, his. his clientele. And he said, you know, yes, I don't personally find this is not what I would personally want to be attractive, but they're going to go to someone else and I might as well do my version of it for that.

And that's his perception. Whereas for me, I'm not going to make your lips look like ridiculous because I don't believe that is the best choice for people. Cause I think we are morphing into this, like very superficial. Like if you [00:31:00] look, I hate to use them as an example, but if you look at the Kardashians now, Versus 15 years ago.

And not that they're not attractive girls, but the youngest one is 26 and she looks like she's 46. Like it's the perception of what is beautiful for 26 or this usefulness has been lost with all of this other

Laine: With the interventions. That's such a good point. We, we, we said this, that like, just like, and we talked about this last, last season that just, you start to see that, like, if you go through like the top list of like, I don't know, like Megan Fox. Lady Gaga, Beyonce, Shakira, even, you know, like everyone's just starting to look so similar because they do all the same things and adjustments and we're losing this kind of individual, you know, we're losing like individual beauty.

And when you talk about that, youth is just such a time of like individual beauty. It just, it just is, you know, it's inherently there.

Nell: and I do think there's a difference. So like the people you just referenced, Lane, have been aging. So in a way it's like, then they're checking the boxes like, okay, um, [00:32:00] regenerate the loss in the lip volume, loss of face volume, wrinkles, whatever it is, eyebrow lifts, who knows. But then what about these people who are coming in instead, who are younger, like the youngest, Kardashian Jenner or whatever that are actually just manipulating their face proactively, you know, that are just changing or dysmorphia, I don't know if it's dysmorphia, um, rather than fighting a loss, let's say aging, you know, I mean, that's, are you seeing a lot more of that proactive, essentially, like, I just want to look different?

Dr. Emily Rubenstein: COVID throughout a lot of it. Um, because like, Lane, how you were saying, like, I see myself in like these videos or whatever, and this is what I'm focusing on, right? This is all I can focus on. I think we saw a huge movement of that and filters that have really screwed up people's, um,

Laine: I read about, I read about that.

Dr. Emily Rubenstein: Yeah.

Laine: that people bring in like Snapchat filters of themselves and are like, I want to look like

Dr. Emily Rubenstein: yeah, they, they have no pores, they have no lines, like their skin looks like completely polished.

I'm like, that's, [00:33:00] Right. Thank you. And it's, and it's not reality. And so unfortunately, or you have now, there's this whole new thing with like these AI, um, oh, AI is going to tell you what you need to have done. Right. I don't know if you've seen this, but it's a little scary because like, what is AI's perception?

Are they going by whatever is considered popular on Instagram or Snapchat, or are they going on? Like, how's AI to see? deciding what is beautiful, right? And what is considered,

Laine: it's so funny because my, my sitter who I love, she's 22. She was just telling me how she has so many friends who are getting nose jobs. She's like, Oh, like a graduate college, like they get a nose job. So many friends. And she, she was saying that she had one friend come back from, I don't know, Europe or something.

Because she's, she's Eastern European, my, my babysitter, and she said that she came back looking like a Bratz doll. And I was just dying. Like, she's just like, it's like, she looks good, but she was just like a Bratz doll. Like, it's just so,

Nell: have to say something, I, I read that book or audio read that book, Breathe or Breath, and they talk a lot about the nose job situation, by the way, and [00:34:00] the, the, what do you call this? The, what is the

Laine: like the lining,

Nell: The lining of the nose, that, that tissue is like. I mean, they got very tech and not the cartilage, the actual tissue that is like so important that essentially for breath and for like, um, it's like, you know,

Dr. Emily Rubenstein: Oh yeah, yeah, yeah,

Nell: and how that with a lot of these nose jobs, they end up taking out really, really, really vital critical parts of the nose that they say there's so many nerves and all these things.

And then these people have what's called, they called it like no nose syndrome or something. Are

Laine: nose syndrome. Wasn't it naked nose syndrome? I remember you told me that because it was kind of traumatic

Nell: It was, they said that people go through like depression, like crazy things because it's like they feel like it's, it affects their wellbeing so much. So it made me really rethink the whole idea of, of people just going in for nose jobs.

You know what I mean? I don't know how many doctors

Laine: Well, and

Nell: in this and have studied

Laine: right? Sinus

Nell: All of that. Yeah. Because it's like, if you take out these vital parts that, that we didn't realize before, We're [00:35:00] so critical on wellness and health and filtering air and, and then affect your wellbeing or whatnot.

Laine: Well, when you told me that, that's one of the reasons why with my allergies and you know how it's affected a lot of my under eyes, like one of the reasons I would never look into like a sinus surgery is because of you telling me that, because I'm like, that's horrifying.

Nell: mm, mm hmm. Very scary.

Dr. Emily Rubenstein: yeah, I, I mean, you're kind of out of my, my expertise on, on the, on the nose job part, but can't really speak on that, that forum. But, um, I think people have, it's become, become so normalized. Like you were saying, like, Oh, I finished college. Like, instead of getting a car, I get a nose job. Right. It's a, it's a different, like, that was a big thing for us.

It was like, Oh my God, I got to use car. It's awesome. We weren't like, Oh my God, I'm getting my nose job. You know, it was, or I'm getting my boobs done. Right. So I think actually, luckily the, the boob job thing is like turned down a bit. It used to be like, right. That is. actually gone down and we're seeing much more reduction than we are seeing enhancement.[00:36:00] 

Um, so that's been nice in the cosmetic world, not

Nell: Yeah. It's funny. It's funny how the trends change so much. And now, like when I see sometimes these boob jobs, they look outdated. I'm like, Oh, it kind of like dates people the way that if they've had implants from 20 years ago, it

Laine: Or even just

Nell: like a style or a fashion.

Laine: Yeah, it's like when they don't move. Okay, wait, I did want to say that in general, when you get patients that come to you, are you seeing more like balls to the wall people? Or are you seeing people who are coming in like apprehensively? Like, what is the moment right now? Is the moment, you know,

Dr. Emily Rubenstein: I get more of the apprehensive initially and then I'll tell them. So when I do a cosmetic consult and you come in and what I always do is I'll give you a, And we start to talk about like, what are you seeing? Like what are, because what I see might not necessarily bother them. Like I'm, you might come in, like you guys both have beautiful skin, but I'll have patients come in and they have super sun damage, right?

They come in and they're like. freckled [00:37:00] everywhere. And there's, we call them lentigines everywhere. And they've got like fine lines and creepiness. And they'll come in and they'll be like, you know what I really don't like? I don't like the lines, you know, under my chin. I, they come in with something totally off.

And

Nell: You're like, and you're like, you're like,

Dr. Emily Rubenstein: I'm like, really, that's what you're in for? So, so I have to

Nell: you're like, I'm, yeah, you're like, I'm not going to mention the quality of your skin, but

Dr. Emily Rubenstein: Oh, I had, I had a consult come in and they were complaining about their arms and their chest. And all I saw was their, their face and all the sun damage. So I had to like, hold myself back a little bit and say like, okay, we definitely can address like your arms and your chest. I know that bothers you. But I think if we'd addressed that suddenly, The sun image on your face is going to be so obvious or so apparent that we need to address that too.

Kind of like patients

Nell: it's going to pop more.

Dr. Emily Rubenstein: right, and most of the time it's the opposite. Most people come in and their face is like porcelain and then you look at their neck and their chest and you're like, whoa. [00:38:00] Like they're, they've got a 30 year old face and then they've got like a 60 year old neck and chest.

Laine: Well, I remember reading this years ago about women in Manhattan starting to get hand

Dr. Emily Rubenstein: Oh.

Laine: and I just couldn't believe that and it was because it was basically like everything else was youthful, youthful, but then their hands would look old. I mean, I just almost died when I read

Dr. Emily Rubenstein: Oh no, it's true. We do fillers for the hands and I do lasers. So when I have a patient who's like in their 50s who comes to see me, and we're going to do let's say a laser treatment for their face and their neck. I'll like look at their hands and I'll be like, you know what? Why don't we do, so I'm going to do your face and your neck.

I'm going to throw in your hands for free because it, a, it makes a big difference. If you look at someone's hands and you see like all these brown spots, because, and this is what I tell patients when you're putting on your sunblock, when you're applying it, pump it to the back of your hands and then apply it to your face and then pump it and then take your two hands and rub them against each other to spread it.

Because when you're driving or when you're riding your bike, those are

Laine: who knows? Nell's listening to this cause I know in Puerto Rico she has that arm sleeve she puts on

Dr. Emily Rubenstein: I love it. I love it. Oh my God. You're [00:39:00] speaking my love language.

Nell: But I used to, I have to be honest with you, I have it in the car, but I don't do it as much anymore. But yes, at a certain point I would put this sleeve on for my left arm because it was always catching so much. I'm like, but now I do, like you said, I put sunscreen on my hands, but I'm like, I mean, I wash my hands 20 times a day at the same time.

It's like, does it really, you know?

Dr. Emily Rubenstein: Right. At least I see you get a base going, you know, get a base.

Laine: so Emily, tell us now like for our listeners, because we do have like a, a range of, of ages. Yeah. We want to know what the most common treatments and interventions are for like specific age groups. So I'm not even going to go to 20s because F that.

Dr. Emily Rubenstein: Okay.

Laine: that's just like, like, no, not,

Dr. Emily Rubenstein: your

Nell: self indulgent.

Laine: Yeah. Fuck off.

Nell: can we just say, before you say that, I have to say, I have said that to my younger girls who babysit. I'm like, remember, when people start doing interventions, they're trying to re find it. The twenties, like, just enjoy your twenties, like, there's nothing you, like, if you mess with that, it's going to make you look older.

Like, don't skip this

Laine: I think, I think [00:40:00] that's a noble conversation, but I think it's hard for, I think this goes so deep into like, What we're seeing in society, what we're being fed on social media on, you know, and just on the TV screen, the big screen. It's just like, but okay, we want to hear about like the thirties, the forties and the fifties.

Those are really the most. So what are you?

Dr. Emily Rubenstein: I would say we're starting with obviously Botox. That's like, I mean, everyone does Botox 30s, 40s, 50s. They're all doing Botox or a version of it. But now at the 30s, we're starting to talk about doing like light peels. We're starting to do. something like diamond glow or hydro facials, those on the regular to kind of hydrate the skin.

Cause we're starting to see some loss of hydration happening.

Laine: Mm hmm.

Dr. Emily Rubenstein: Um, and I would not go with fillers at that age. I would say we're starting to do maybe a light laser peel. So maybe doing, um, we call them like nano peels or lunchtime peels. Those are starting to happen. Now into the [00:41:00] forties, we're starting to do BBL or IPL or starting to do a little bit more invasive laser.

So we're starting to do, um, a little bit deeper in our resurfacing. So you may do, so when we talk about resurfacing, you can do very superficial. Like when I say we're doing like a nano peel, you're doing a peel that's about four to six nanometers, which is like, I don't know, ten, um, sticky notes deep. Okay.

So very, very thin, but you're starting to get some surface, like getting into that little collagen stimulation in our

Laine: So this is when you talk about like injuring the skin.

Dr. Emily Rubenstein: Correct.

Nell: And then you use like a actual number or

Dr. Emily Rubenstein: Yeah. Yeah. We do topical numbing. Yeah. We do topical numbing.

Laine: And just so we know, BBL, is that like the photofacial or what's

Dr. Emily Rubenstein: Yeah, so BBL is broadband light. So IPL and BBL are intense fossilized and broadband light. It just depends on the filters they're using. [00:42:00] So, and also sometimes it depends on how it's branded, but that's basically not technically a laser. It's a light therapy that targets the light.

a specific wavelengths versus lasers are a specific wavelength. So when you're talking about laser, you're actually talking about a 1064 laser or a 755 laser. You're talking about a specific wavelength when we're talking about IPL or BBL or, um, a light treatment, we're talking about a range from. 350 to 450 or 620 to 630.

So you're talking about a range of light that hits browns and reds. So it's more, um, broad, but it's not specific to your need. So for patients who have sun damaged skin, a lot of times doing a, um, IPL or a BBL, you're going to really is great because it, it gets this kind of, it's like [00:43:00] a whitewashing, right?

You get like a very light treatment where you can erase a lot of that sun damage in a series of treatments. So for anyone in their thirties and forties, Um, they can sometimes get away with one or two treatments. When we're hitting our fifties, we're talking about doing a series and maintaining a series of treatments.

So, because the aging process doesn't stop, and I try to explain this to patients because they'll like say, they'll ask me, well, how long is this going to last? Right? So.

Nell: your dad.

Dr. Emily Rubenstein: Right. You're

Laine: Well, wait, but just, you know, didn't you just see the huge study that came out that said that they're finding that you do not age over time, that it's more like these specific bursts of aging and they were listed as 44 and 60. And I was like, That it said that, like, literally that

Nell: Slash not funny because we're 44. I was like, what?

Dr. Emily Rubenstein: No, it's only funny because my cousin came to me. She's like, what happened this year? And she's like 44. So she came into my office and she's like, it's this year. She's like, I don't know what happened, but look at what happened. And so we did actually for her, I did a, a, [00:44:00] a BBL with a nano over it. So I did like a combination of lasers to help with, I said, listen, it's not a one and done you're coming back to me.

And And people want no downtime. And it's like, well, you can't do, yeah, you can do

Nell: You can't do effective things that, that don't have zero, that always have zero downtime.

Dr. Emily Rubenstein: It's just not, it's not realistic. You're not going to get a result. And I have to give people expectations because if they're like, well, I only have like a day or two to heal. I'm like, well, in a day or two, you're going to do like a thousand treatments because you're not going to, you're not going to get to where we need to get you.

And sometimes you're going to have to have a little downtime, be it like we're doing, um, we call ablative. So in your fifties, We start to talk about using more ablative. So we talk about doing more injuries to the skin deeper in order to get the results that we want.

Laine: This is crazy. All the

Nell: this is all for, but that is all for like, like you said, like texture, collagen

Dr. Emily Rubenstein: yep.

Nell: and I guess clarity of [00:45:00] pigment.

Dr. Emily Rubenstein: Cause I'll, I, I do what are, a lot of times I'll do what's called a stack treatment. So I'm not just doing one thing. When you come in, I'm not only doing BBL, I'm doing BBL plus this. I'm doing, um, Multiple treatments at the same time to get a better result, to get a synergistic result, but it also means sometimes you'll have a little bit more downtime.

Nell: Okay.

Laine: This is great. Thank you. I hope that everybody can take a little bit out of what they, if they want to look into something. I hope, people are taking notes.

Dr. Emily Rubenstein: Well, you know what's interesting, too, is you're seeing with the GLP 1s, so you see like this massive weight loss that's happening with everyone, right? And It's, it's kind of fascinating to me because

Laine: but it's the drugs,

Dr. Emily Rubenstein: the drugs, right? The injectables. So, I mean, there's, there's a lot of people who are of the belief like, well, there's no reason to be obese anymore because you have these medications that can intervene and can help.

And these drugs are really, truly amazing and they're life changing for so many people on a medical level and also on an emotional [00:46:00] level. And they're causing, um, you know, Patients who always struggled with, you know, compulsive eating or, or genetically, they were more predisposed and suddenly you're able to have this.

dramatic weight loss. But when you have these dramatic weight losses, there's a dermatologist who coined the phrase ozempic face,

Laine: Oh yeah, I've read about

Dr. Emily Rubenstein: who have lost a lot of weight and they have all this volume loss. And now we're trying to like pump volume back into them. So it's kind of an interesting, so these, we're seeing this in the patients in the forties and the fifties where, You have them suddenly looking 10 years older, obviously they've lost a lot of weight.

How do we, how do we put some volume back in? Because we used to say, well, you can be fat and young or you can be skinny and old. Because you lose the volume, right? You lose the volume. These skinny people, they look like gaunt. And we

Nell: I always think

Laine: not better. Yeah. It's not better to get as you get older, you don't want to get skinnier because you just, you know, you

Nell: Even some of the actresses you see that you're like, Oh, if they're a little bit thicker, they look younger, you know, as they get [00:47:00] older and

Laine: Well, we've always said that about mom. She has like such a round face. Like she just had like, yeah, it is. Yeah, she

Nell: we, can I ask, speaking of this filling up, you know, loss, can you talk to me about this random thing called Sculptra that I just feel like I hear so much about now and it's, to me it falls into such a mystery category because I'm like it's a filler, it's not a filler, it stimulates collagen, like I don't fucking understand what this

Dr. Emily Rubenstein: okay. So sculpture is actually, this is, it's a, it's a perfect, injectable for these patients who have lost a lot of volume, um, who we don't necessarily want to just like, like plump filler into. So most fillers per se are hyaluronic acids, but we also have calcium hydroxylase. We have other fillers that we use too. Um, so you have your, we've heard of Restylane and Juvederm, and those are our hyaluronic acids. You've got Radiesse, which is more of our calcium hydroxylase. And then you've got, um, Sculptra, which is a totally different, um, entity or biostimulants. So Radiesse is technically a [00:48:00] biostimulant, but so is Sculptra.

And Sculptra much more than even Radiesse, because Radiesse is actually in the filler category. So what we use Sculptra for is it creates your own collagen matrix. So it's like scaffolding. Okay. So you're injecting scaffolding into the skin. So when you do it, it's usually also in a series. When you do it, you're creating a scaffolding for your own collagen to build on.

So it's not necessary, it's not filler in that you're going to leave and you're going to be like, Oh yeah, I'm full and it's, it's that you're putting something in that's going to stimulate your own collagen to build on top of it. So it's a much more natural,

Laine: pay, our pay grade.

Dr. Emily Rubenstein: right? It's, it's, it's a much more natural, um, injectable, but It's also not reversible.

So there's, there were issues when it first came out that we would get these nodules where people would be like, Oh, I can feel like these bumps in my skin. That was in the very beginning because we weren't feeling, we weren't mixing it correctly and we weren't doing the right dilutions. We were still learning with it.

And when the, when [00:49:00] sculpture first came out, it was in the late 80s, early 90s where we were seeing patients with, um, HIV and they were getting this gaunt look. Um,

Nell: That's where it started. I mean,

Dr. Emily Rubenstein: Right, that's where it started because of the, um, medications that they were taking for HIV, the heart medications. And so Sculpture came out to the market for, not for them, but that's where it was originally, and it was covered by insurance for them because you were having the gaunt face.

And so you would inject it, and it would allow for, rebuilding of collagen in those areas and it would normalize it for them. So you wouldn't like look at something like, oh, they have HIV

Nell: yeah, it's

Dr. Emily Rubenstein: there was such a, there was such a stigmatism then. I mean, now it's like, first of all, we don't see it as much because we have medications that prevent it.

Right.

Laine: hmm.

Dr. Emily Rubenstein: So it's, it's a whole new, um, we're in a whole new era in the HIV world, but for Sculptra, then it moved into the cosmetic market for women and, and for men, um, in this loss of volume aging. So by creating your own scaffolding, you [00:50:00] allow for your own collagen to build on that scaffolding. Now, when you leave a patient, When you leave the office after having it done, you look like you had filler because you have the volume of the, the solution.

And then the next day you wake up and you're like, well, that was a waste of money. And then over time you build that collagen on it.

Nell: But when you say it's not reversible, what does that mean? It's like, once you have it in there, like it's going to build, like it could build in crazy ways or like you could have

Dr. Emily Rubenstein: I mean, it's not. Yeah. If someone just like put like a big chunk right in one area, that's probably not going to be a good thing. But we, we use it where we, we fan it into the skin. So it's not. it's, it's, it's not done. It's the injection techniques is very uniform in that you're, you're not going to look like a crazy person.

Um, usually, I mean, you don't want to overdo anything, but,

Laine: Okay. I want to ask you about, overall, just because you've had this career now, are you, do you see trends that really come and go? I know we just did. I just touched on like the, the boob job thing, which [00:51:00] is outside of what you do, of course. But do you see things like within the beauty? Just because like, I actually just read an article that talked about, uh, filler having like a bad PR moment because there's like people are bringing in photos of celebrities who got like overfilled or under eyes and they're bringing in these photos and being like whatever she did, I don't want to do.

And I'm just curious, like, so what, what are the, what do you see coming and going? And what does that tell us? with trans beauty, trans coming and going.

Dr. Emily Rubenstein: I am seeing more people. We're not filling as much. We're not using And when I first started, I would use six cc's of filler on someone's face. Like it was, we used to call it, um, a full rejuvenation. It was crazy. The, so to give perspective, one cc is a fifth of a teaspoon. So it's a very little amount.

in perspective, but when you start building it, it starts to get overdone. And so we're definitely moving away from filler in that sense. I think [00:52:00] I'm seeing less. So people were putting a lot into the cheeks. And so suddenly you were starting to get these like really large appley patients. It's almost like their eyes are like closed because they had so much like when they would smile.

Nell: Yeah.

Dr. Emily Rubenstein: Um, so that's, we've moved away from and you're seeing like the amount of filler people using in general is like one cc, two cc's maybe. Um, you're not seeing that we're doing more jawlines. Like people have been focusing on jawlines lately. I'm getting this snatched jawline. I think it's a little overdone where it's so extreme.

Um, it doesn't look natural anymore.

Nell: And they do that, but they do that through filler.

Dr. Emily Rubenstein: They're doing it through filler. Yeah. Or they were doing for a while, um, threads were a thing for a little bit. Those aren't really talked about

Nell: one. That one makes me want to vomit. Oh, that's a rough one.

Dr. Emily Rubenstein: Yeah. So those have fallen a little, I haven't seen a lot of, um, patients, patients aren't coming in asking for threads anymore.

Like they were before. Um. Yeah. As far as, like, things are also going out, I would say, [00:53:00] like, the cat eye look, there was, like, a while where people wanted this, like, weird, like, elevation and lateral elevation of their eyes, um, which I don't do, it's actually a surgical procedure, or they were doing, yeah, it was, they were doing this, Thread lift there, um, I'm not seeing that as

Laine: God. People just really don't want to look like themselves. That's what trips me out is, is that it's like, again, There's like this, this fine line between like trying to maintain something that once was and then there's the difference between someone who wants to actually go and like be something they never were, you know,

Nell: doesn't this get into the social media? It's like, we're seeing these images that are so refined and so, as you say, like filtered and manipulated that the norm is just, you know, shifting and changing. So it's like, yeah, people are like, Ooh, that looks amazing. I want to look like that. I

Dr. Emily Rubenstein: And, and that's not what they actually look like. Right.

Nell: yeah, exactly.

Cause it's

Dr. Emily Rubenstein: filters, right. They use filters or they're even altering their [00:54:00] photos. you know, to look a certain way. So it's, it's sad because what our perception of beauty is, is really truly changing. But I feel like people are starting to realize that it's becoming so called out that we're moving more toward a natural look.

And

Nell: I really hope so. I really hope so.

Dr. Emily Rubenstein: but I think we're trying to,

Nell: So, uh, along that line then, when people are coming to you with these ideas or even whatever it is, how, do you ever talk to them about the long term plan? Because sometimes you can be like, Oh yeah, you have a little, like, I know even with the filler situation, it'd be like, Oh, you can, we can fill a little bit under the eyes, but it's like, well, what does that look like long term?

Are you just going to fill under your eyes forever? Like, do you guys talk about plans? I guess if you start doing something, what does that look like in the future? Because if you start something, you can't just, like you said, you can't just stop it sometimes.

Dr. Emily Rubenstein: right. Well, we're, we're certain things. So like, Fillers under the eyes is a great example. Um, when I do filler under the eyes to someone who's like 30 or 40, [00:55:00] okay, because they have volume loss or they're starting to notice like this kind of, um, trough, yeah, under the eye. Um, I will talk about, okay, we can do the filler and we'll see how you do.

If they're coming in in their fifties and they have what's called, um, like fat herniation, where they're getting the bulging under the eye, I see, Truly, this is a surgical intervention where you need to have what's called a lower bluff where they have to take out that fat pad or redistribute the fat under the eye.

Um, I can do filler to mask it, but that's not going to ultimately achieve what you're going to need in the future. So we have a discussion about that. I can always erase filler, um, that we use like hyaluronic acids. We can actually use something called hyaluronidase that will melt it away. And I've actually on my own self melted away.

I had filler under my eye that for some reason it, um, It moved over time. And so when I would go up to [00:56:00] altitude, it would swell. So I'd have this like weird bulging under my eyes when I was in the high altitude. And I go up, we go skiing every year. So every year I'd have like big eye swelling. So I, I erased it.

I actually hyaluronidase myself to get rid of the filler there that was still there that I couldn't see other than taking a photo of myself up there. Correct. So I took photos of myself with the bulgy spots and when I came home, I injected those spots to erase it.

Laine: Oh my God. Wow. Okay. I want to ask you like, do you miss the old days of dermatology when you start dealing with all this stuff or is it just hard to, are you just still catching your breath? I mean, do you miss the,

Dr. Emily Rubenstein: more fun. I think I have more options. I have more ways to do it more naturally. I think I've got so many more, um, toys in my basket to play with that I can kind of intervene. And I think skincare really truly is, um, so important in this whole [00:57:00] process too. And I was very fortunate that my, in my first job straight out of residency, I worked with a woman who, I mean, had a skincare store and who was really passionate about skincare.

And she taught me so much about it that I incorporated it into everyone's routine. So I think that. people who come in and they do a treatment and they're, I say, you've got to protect your investment. Like if you're going to do any of these treatments that I'm recommending, and then you're not doing skincare, you're really hurting yourself longterm.

Like you're not going to get the most benefit out of what we're doing. So I think with skincare and the innovations

Nell: I think that's such a good point.

Dr. Emily Rubenstein: Yeah. People don't do

Nell: see a lot of people who, it's like they, I think the answer is just like doing Botox and it's like, well, Botox can achieve one thing, but if, if you're not taking care of your skin, it's just,

Dr. Emily Rubenstein: yeah. And I

Laine: Now, do you remember, Nell and I went to a dermatologist in our twenties who she was German. Her name was Dr. Kohler. She, I don't think she has a [00:58:00] practice anymore. She was a little older, but she was so fun because she was very natural. She had us do things like

Nell: She was like holistic.

Laine: She was holistic, you know, fish oils.

Um, she would have us chew on like licorice root, things like that to settle the stomach, like the gut. And she would have us, she had, she would compound stuff, like she would compound like an orange, orange peel type thing. I know she did like lactate, which is always in the French pharmacies. Like she had us doing all these really like, you know, like good for cellular turnover.

I believe you can correct me if I'm wrong. But like, I always loved that. It was hard when she closed her shop because I loved her approach because she was so well, we were young too. So she was definitely giving us a natural approach, but I love that she addressed the skin and what's going on the inside and how you eat

Nell: Yes. She had done that. She was like, she told us not to eat like tomato and chocolate and

Laine: She told us not to sweat. I remember she was like, don't get too hot. And I was like, wait, like we do Bikram

Nell: But I was just going to say that we stopped, we literally both stopped doing Bikram yoga because she was like doing exercise.

Laine: Well, we did. I don't [00:59:00] think we, I don't have that anymore. And I think that what might've been like just dietary, just maybe eating too much gluten or dairy or inflammatory

Nell: But I would, that doesn't say like, yeah, here in Puerto Rico, I try to always use like a, I always have facial mists around, like in my car, my purse at home, because just to constantly try to keep the skin cool, even in the winter, I mean, excuse me, in the summer here, like when it's really hot, I'm just like, oh my God, I have to just mist, even though I'm sweating and like, but um.

So keep the skin cool because I feel like redness, yes, it's just like such a side effect of the heat and kind of being aggravated and caffeine. But yeah, when she gave us that list of things, I was like, this is everything fun in

Dr. Emily Rubenstein: Right. Everything enjoyable. Right. Caffeine, red wine, chocolate. Yeah. All of that. So I, my husband, I don't know, I told you this Lane, but my husband is a internist, but he does a lot of functional integrative medicine. So a lot of what their practice teaches is anti inflammatory like gut health and, and skin health.

[01:00:00] So it's always interesting to me because when I approach patients who have, um, certain inflammatory diseases, I will explain what we're seeing on the outside is also what's happening on the inside. So you have to consider what we're doing to the inside. And a lot of times that's the approach of treating, I hate to say, but when we're, when we use medications, biologics. I have to address what's going on internally. Like some of the inflammation they can't control by diet. It's just, it's, it's actually a genetic or it's chromosomally changed. So people will say, well, I don't want to do this. And I said, we can treat you, you know, your gut and help your gut. But ultimately, like, we also have to address the chronic inflammation that you're under because long term.

Yes, we're seeing it in your skin, but we also know that it's also happening with increased risk of heart disease and increased risk of other inflammatory diseases because you're under chronic inflammation. So taking out like, um, the [01:01:00] tomatoes or, um, what do they

Nell: Citrus.

Dr. Emily Rubenstein: Yes. Certain, certain foods or

Laine: Is it the nightshades? Are you going to say the nightshades? Yeah. Yeah.

Dr. Emily Rubenstein: taking out those play a huge role.

Nell: Star.

Dr. Emily Rubenstein: gold star on that one. Yes. Nightshades are, I love nightshades. So, but yes,

Nell: But I didn't know that. I didn't know that nightshades are known as being like very inflammatory, like mushrooms and eggplant, like, oh

Laine: So yummy.

Nell: my

Dr. Emily Rubenstein: mean, but it's, but not everyone means, needs to be on those, you know,

Laine: Yeah. Not everybody's. Um, so. I was going to ask then, do you have a, what's your, what's your advice then for listeners who, one, just skin care routines, like are there any simple things, like I know you're going to talk about sunscreen and I do want to actually just segue to just ask because I've read articles about like, we know that there's sunscreens that have ingredients that are really not beneficial to us.

In other ways, they're toxic. So it's like, what's your, your view on the skincare, the sunscreen? What can you tell listeners as they walk away today [01:02:00] about the things they can do at home that have nothing to do with

Dr. Emily Rubenstein: Okay. So there's four things that I usually recommend in your skincare routine. If you're going to have like a comprehensive skincare routine, okay. Sunblock, obviously. Um, the, the, thing that you were asking about toxic, um, chemicals in the sunblock. It was the reason why that came out was that there was a study done where they were putting an insane amount of sunblock on their full bodies continuously for like two to three weeks.

And then they tested their blood levels to see if there was any of it in their blood. And it did show up in their blood. What does that mean? We don't know, but I have yet to see anyone actually use a proper amount of sunblock on their body. But what I usually do recommend is I, prefer physical blocks. I think most dermatologists will.

Physical blocks are zinc based sunblocks. Zinc,

Nell: Oh, I was like a hat.

Dr. Emily Rubenstein: Yes, we do like hats too. No. And we, and we do like UPF clothing, but zinc based sunblocks. So physical, or they call it mineral, blocks are really important because they actually reflect the light versus absorbing and scattering [01:03:00] it. And they block out all of the UVB and most all of the UVA rays.

And we always like to recommend a 30 percent 30 SPF and a 5 percent of zinc or higher.

Laine: Oh, love this. Okay.

Dr. Emily Rubenstein: um, antioxidants. Okay. So antioxidants help repair some of the sun damage and help prevent it too. So that can be anything from vitamin C, but there's also a whole slew of other antioxidants that are out there, but adding an antioxidant and you have to be careful with antioxidants because a lot of times they're not stabilized, they're harder to stabilize.

That's one, one

Laine: They turn

Dr. Emily Rubenstein: I'll tell, yes, they'll turn or they won't be effective or they just sit on top of the skin. So I'll tell patients that might be the one place where you're spending a little bit more money is on your antioxidant.

Laine: Cause you want it to be stable.

Dr. Emily Rubenstein: Correct. You want it to be stable and you want it to be effective.

Nell: How do you know what it, wait, can I just ask, how

Dr. Emily Rubenstein: I

Laine: Asked your germ.

Dr. Emily Rubenstein: ask your dermatologist. No, I, I think there's, there's certain companies that are, are known for antioxidants and [01:04:00] that have done legitimate studies with them and looking at sun damage. So, um, Skin Better Science, um, SkinCeuticals, they're known for some of their antioxidants, uh, as far as stability, but they also did studies where they put it on the skin, exposed to UV, and then looked at, uh, the damage that was done and the prevention that putting the antioxidants on the skin during UV exposure was done.

uh, was done. So legitimate companies, other than just buying the ingredient and putting it in a bottle, they're looking at that, at the stability, the penetration into the skin. Like, are you just sitting on top of the stratum corneum on the top of the skin, or are you able to penetrate down, um, to get that kind of, uh, protection throughout?

Laine: Okay. Good to know. Okay.

Dr. Emily Rubenstein: next up, then I would go with, uh, peptides or growth factors, and that's going to stimulate some of that underlying collagen as well. And that can be a multitude of different products out there. [01:05:00] Um, in dermatology worlds, we use a lot of like Revision or Skin Medica or, um, Zio. There's a lot of different growth factors on the market or peptides on the market.

And then lastly, using some sort of exfoliating product. exfoliant. So using like a retinoid or an alpha hydroxy acid depending on what you can tolerate, um, that helps stimulate the collagen turnover and cell turnover.

Laine: Got it.

Dr. Emily Rubenstein: So if you're going to get a comprehensive having those four components in your skincare routine and it doesn't necessarily mean every night you have to use a retinoid, but having some sort of exfoliant, I don't like personally, I don't love physical exfoliants like beaded things where you're causing damage to the skin.

That's not my favorite. There's certain products that are better than others, but, um, Like what we all used in high school. Oh God, what was it called? St. Ives. Not to, not to talk badly about a product, but that just caused a lot of damage to the skin. We use that apricot.

Laine: oh, yeah, I know exactly what you're talking about

Dr. Emily Rubenstein: Oh yeah. We [01:06:00] were all brutally, I mean, luckily we had really good skin to repair, but we caused, right.

We caused a lot of damage, like micro injuries to the skin, then bacteria and couldn't enter. So a lot of our acne wasn't helped by some of these scrubs that we were using.

Laine: Wow, okay,

Dr. Emily Rubenstein: I would say those four things are really important to incorporate into your skincare routine.

Laine: I love that those all seem so doable. Okay, and then what about what would your advice be for? Anybody from their like, you know 30s 40s 50s with interventions. Are there any like warnings or like when you, when you're choosing a, a dermatologist or a injector, what are the things that you think people should be asking or should be looking for, you know, other than not going to someone's garage?

Dr. Emily Rubenstein: So, right. If they're doing it in their

Nell: Stay out

Laine: Is this a home, home practice

Dr. Emily Rubenstein: Right, right. If they're doing that, I don't love these parties at people's homes either. I think that's horrible. And

Laine: okay, good to know. I've never [01:07:00] gone.

Dr. Emily Rubenstein: yeah. So like Botox parties or filler, I mean, first of all, who's coming to your home? Like why are they coming to your home?

Uh, you, you just got to start to question a little bit their legitimacy. I don't know many dermatologists are going into people's homes unless maybe you're like Beyonce or whatever. You can't go, even when I was in Miami, there was, um, celebrities that would come to the dermatologist who I, uh, worked with and they would come after hours into the office.

Like it was all done in a legitimate setting. It wasn't done like, you know, on their couch at home. Although I, I will say I've done a lot of my friend's Botox on the couch in my house.

Nell: I love that you just said that.

Dr. Emily Rubenstein: Um, after I said that, but, but that's a different story. They're not totally different, but, um, So, when you look at like med spas, who, who's doing the procedures?

What are their training? Did they take a weekend course? Are they? with [01:08:00] residency, when you're talking with a dermatologist or a plastic surgeon, this is part of our training. This is what we do for four years. Um, some of us do fellowships in cosmetics as well. So there's a lot of, depending on our training, how much experience they have.

Some people, when they're doing a weekend course, like, is it your psychiatrist who's doing the Botox, but now they own a med spa. These are things that you have to ask, like who's doing the procedures? What is their training? Who's overseeing it? So You only need a medical license to oversee a practice. So a lot of these med spas will have a doctor, um, quote unquote overseeing it, but they may not know how to deal with complications.

They may not have the training, but they're getting paid just to oversee these. practices. So it might be a side gig for them. So you have to ask who, who are the physicians doing it? What are, or are they, a lot of times it's not physicians. Not to say there's not a lot of wonderful nurse injectors or PA injectors.

There are, there's some very, very highly skilled, um, nurse and PA [01:09:00] injectors. And I've learned also from them too. I think that experience plays a role in it, but you have to know who's injecting you.

Laine: Okay. Okay. And would you say it's a true fact? I was reading when I read that article about the, um, the filler having like a bad PR moment. It was interesting because they had like six different doctors weighing in. And one of them was saying like, look at your doctor, look at your dermatologist, look at your injector, because if they have a look that is just, like, unappealing to you and is, like, overdone, that is their aesthetic.

You know, that's, I thought that was really interesting, just the concept, because I, I remember when, again, when, I think I mentioned earlier in, in this interview that when I was younger, I went to a dermatologist and the, the, all the, the boy PAs were like, Oh, well, you have a lot of movement. Well, the derm, she had no movement.

And it was like, I just, I couldn't understand why you would want to look like that. Like, so that was always a bad, I was like, I'm not, I'm not, I don't think I should go here anymore.

Nell: When they say to look at the patients, too, in the waiting room, I've read that, like, look at the patients, look at the product that they're putting out, [01:10:00] essentially.

Dr. Emily Rubenstein: Well, that's also the idea of like, you don't want to overdo someone, right? Or if someone walks into your offices and they're already overdone, what do you do or how do you approach that patient? Um, I think, yeah, look, I mean, It's hard because as a female dermatologist, it's a little unfair because females versus males, when you look at, at males, males can age continuously and no one's going to be judgmental of them.

Right. But if I suddenly never did anything and like half my face was like, you know, melted on the floor, people would be like, I don't think I'm going to go to her. Like she doesn't look so good. Right. Or, or like if I was,

Nell: That's a good point, though. You're basically saying like, you can't, you have to do some interventions because people are coming to you for intervention. So if they're, well, this lady's doing nothing that, you know,

Dr. Emily Rubenstein: Right. Like, what does she know about it? Right. And, and, and you don't want to like, I hate to say it, but sometimes like if you're looking at someone and they're naturally attractive, right? You have a naturally attractive person. That's not always necessarily also [01:11:00] like those injectors, that could be someone who has no training, but a lot of

Laine: But they're beautiful

Dr. Emily Rubenstein: right?

They're beautiful naturally, right? They're, that's just their aesthetic. So it's hard to say that someone who's not attractive naturally, that's a hard one. It doesn't mean that they're not going to be a great injector.

Laine: right, right. All right. Now let's hear this last question

Nell: this is okay. Last one. Cause then we'll wrap up. We'll just that. And I can't remember if we had talked about this lane on our original chat, but that idea of like the accumulation of things like. Is there, you know, does Botox have a, this is part, two parts, does Botox have a timer? After 50 or once you're 60, like, no, Botox is done.

That's part A. Part B is, is that when there's accumulative procedures done, I have a close friend who told me about her mom. She's like, when I was younger, I always looked up to her. She's like, always did procedures and she looks so beautiful. And she's like, but now that she's 73, let's say, she's like, she just looks insane.

That's So it's this idea that it's like, can you continue [01:12:00] to accumulate these things? And, and then by the time you're 70, like, should you have just kept yourself aging naturally? And then you just look like a beautiful 70 year old that looks natural rather than someone who's fought it in so many ways and looks like an insane person now.

Dr. Emily Rubenstein: well, it's, it's interesting because I had this discussion. So let's, okay, part A, Botox. You can continue to do Botox continuously. That's, I have patients in their 80s who come in for Botox, um, yeah, versus I also have patients in their 20s. So I, I see the whole spectrum, um, and it also depends on their aesthetic, right?

It depends on. They're movement and, and how much sometimes we'll use it, um, in the masseters per se. So like what helps us bite down can cause a white, if you have a very strong master, it can cause a widening of the face. So I have some patients where I do it there to kind of slender down their face because they feel like it's masculine eating to have

Nell: And for grinding, I know for grinding teeth.

Dr. Emily Rubenstein: Oh yeah.

For grinding. Absolutely. And that will, that helps them too, but it also will kind of like narrow down the face. [01:13:00] for fillers, um, and for like procedures, you can definitely get overfilled. I feel like the fillers does stay there longer than we initially thought when we said it's gone in a year or a year and a half.

I don't believe that. I believe it's still there. So I will oftentimes be a lot less aggressive as time goes on. And I'll say, You know, maybe we're going to do one CC or maybe we're not going to do any or, you know, maybe we'll do a different procedure on that. Um, it really depends on the individual. The crazy look can happen in their 40s.

It could also happen in their 80s. So that's really kind of like if you look at someone like Dolly Parton, right? Dolly Parton. I was talking with my daughter about this, uh, today. That was really, really good. I mean, I think Dolly Parton, she's beautiful, right? But she's had so much cosmetics, you can't really tell her age.

But that's her, right? That's, what if Dolly Parton never did

Laine: wanted to be, yeah.

Dr. Emily Rubenstein: If you, if she wouldn't be recognizable. So for her, that's [01:14:00] her beauty. And not to say she's not beautiful. Someone like, um, oh, who was it? Uh, Joan Rivers, someone who also did, you never knew her age, right? But to her, that was her, Madonna, well, Madonna, okay, she's an interesting.

She went over

Nell: case study?

Dr. Emily Rubenstein: right? Definitely an interesting case study, but Madonna 65, um, and she overfilled for a while. Like something happened either. She went to, cause her original injectors actually a very good cosmetic dermatologist. Either she went somewhere else or, and just kept going and people can't say no to Madonna.

And then she got the backlash where she looked like almost like the cat lady.

Laine: yes.

Dr. Emily Rubenstein: then had to erase it. If you look at her now, she looks a lot better. She looks, I think they erased a lot of it or Courtney Cox. Courtney Cox kept getting filled and then at a point it was like, Oh no, I've gone over the top.

And then she erased a lot of it. So they hyaluronidized her face to a more natural look [01:15:00] and a prettier aesthetic. Because when you start morphing your, your features.

Nell: Yeah.

Dr. Emily Rubenstein: Like you said, Shania Twain, I have to look her up. What doesn't look like herself anymore. It, it starts to look unnatural or it doesn't look like the person anymore.

So you

Laine: I

Nell: Yeah. And you can get away with

Laine: picking on the,

Nell: but, but you can get away with it when, when, when you're, when you're 50, you can get away with it. But then when you're 60 and 70, that's like Lane, how mom told the story about someone sitting in front of her and she was, you know, who'd had a lot of work done. And she was like, you know, what about just the, the woman who takes care of herself?

She's 78 years old or something and just looks like a beautiful 78 year old. I

Laine: But who said that? Who are you referencing?

Nell: didn't mom say something

Laine: Mom said no, no, my mom was saying, I was having a conversation with

Nell: my mom, too.

Laine: Yeah, our mom. Because

Nell: She's like, no, my mom. I was like, well,

Laine: truly I was talking about my

Dr. Emily Rubenstein: I did the same thing with my brother.

Laine: It's our mom. My mom and my sister's mom. We were talking about my [01:16:00] allergies and how it's

Nell: Our allergies are your allergies.

Laine: my allergies, for Christ's sake, okay, um, and how I have these allergic shiners that it was so cute because my mom afterwards, she heard me having a consultation with legitimately an eye surgeon.

And she was like, you know, I just think there's really something about, you know, you're, you're beautiful and you're always going to be beautiful for your age. You're going to be. prettier than, I mean, it's so sweet. She's my mother. You're, you're going to be, you're always going to be beautiful for your age and maybe above average, but there's something about coming to the table with just like who you are, like without like being, when you're 50, you're 50 and this is what you are.

You have no other things holding you up. It's just, but you're beautiful. And I was like, God, it's so true. It's such a, it's such a, a wise sentiment. It's just a wise sentiment. And it's a, it's like, again, from that, like the 20 foot ceiling where you're looking at it from below, like it must be so crazy to be you.

The age, like my mom is almost, you know, she's in her late seventies and for [01:17:00] her, she missed that. She wasn't of the genre of, you know, she has friends who have had facelifts, but she wasn't of that genre. She didn't do that. She's never done Botox and she's really beautiful. She's aged well. So for her to just look at it like that, I was like, God, that is so, it's so simple.

I think it's really important to always have that other bird on your shoulder. You know, you can have the, you can have the, the looking at social media and seeing everybody perfect, but you should always have that wisdom too, because that's the balance.

Dr. Emily Rubenstein: I think, I think that's a great advice. Cause I, I think about how, even like as, as we age and we see men aging too, and we're looking at. What's attract, like who's attract, like what I see now, like what I saw with someone who's really old 20 years ago, I'm like, Oh, well, they're actually, they're very attractive.

And they might be a 50, 60 year old man. I, it, our perceptions start to change of what is beauty or what is attractiveness because you know, not that someone who's 20 isn't still attractive, but it's, it's, our perception starts to change. And I think women who [01:18:00] age without doing anything, some of them are very beautiful.

I think confidence, honestly, is one of the biggest. things that we can see in someone, someone who's confident in them and who has their own style. It's extremely attractive. Um, and I,

Nell: plays a whole, a huge role in everything, in things, I think.

Dr. Emily Rubenstein: like figuring out what is your style and what is your, you know, how do you feel beautiful?

Nell: And how you put yourself together in general. Like, it's less about, than the specific details of the face, let's

Laine: Of the Botox or the placement of the

Nell: yeah, but like, how do you, like, from the hair to the, like, how do you put yourself together, let's say? How do you walk out of the house?

Dr. Emily Rubenstein: Right. How do you walk out of the house and, and how do you perceive how you feel? Right. So if you come out, if you're the most beautiful, if you're say someone like me, Christy Brinkley. Okay. She's, she's aged beautifully, but if she doesn't think she's attractive, that becomes unattractive

Laine: Oh God, yeah.

Dr. Emily Rubenstein: you know, because it's like the people who are like, oh, I'm so fat.

And you're like, no, you're beautiful. Your body's [01:19:00] beautiful.

Laine: Oh, it's so true.

Dr. Emily Rubenstein: but if you have someone who loves their body and who can and it might not be everyone's perception of beauty. That's so much more attractive. Someone like,

Nell: a

Dr. Emily Rubenstein: you know, embracing it makes a huge difference.

Laine: Absolutely. We've all had like the gorgeous friend who just like hates herself. I know I've had that. Like, and it's just like, girl, come on. I just want to say, I think so. The good takeaways are we now have a good skincare routine.

Dr. Emily Rubenstein: Yes.

Laine: We know what we,

Dr. Emily Rubenstein: and buy good. Don't necessarily,

Laine: products.

Dr. Emily Rubenstein: don't rely on Tik Tok or, or what, you know, a 20 year old is necessarily. Selling you online. Like, do

Nell: That's good advice.

Dr. Emily Rubenstein: behind. Yeah. I had a girl come in the other, a woman, not a girl, a woman come in with all of her products that she bought into text.

Doesn't know what she's bought or what she's using. And I said, well, let's break down what you need to start in your, regimen and what's actually legitimately good products.

Nell: And streamline. And that's, I definitely feel like I, I'm always like, I don't want to overcompensate with other things and [01:20:00] doing two of the same thing and not even realizing it. It's

Dr. Emily Rubenstein: Correct.

Laine: So we have our good skincare routine. We have what we're looking for in a dermatologist and or someone who would potentially be doing any injectables. And we also now know that we have to tap into our own confidence and our own sense of self in order to, you know, be,

Dr. Emily Rubenstein: If you, if you believe you're beautiful, you will display that out to the world. And I think that we're all beautiful in different ways. So I think it's just, sometimes it's just like highlighting your beauty.

Nell: yeah.

Laine: Hopefully we can get back to unique, unique

Nell: I was gonna say old school wisdom right there. That's it.

Laine: Okay.

Nell: you so, so much, Emily, for joining

Dr. Emily Rubenstein: you guys for having me. It was fun. I can

Nell: sharing all your

Laine: I know we just, we really went there. We, we've been chitchatting a lot lately. This

Nell: Well, we'll see you in December. Can you bring some of those things down, those laser machines when you

Dr. Emily Rubenstein: Oh yeah, no problem. I'll just pack up my, think, I think we're flying Southwest so I can

Laine: Nell, Nell, do you have a garage? Nell, do you

Nell: a very nice, you know, a very nice living room and bedroom. [01:21:00] You can accommodate me anywhere,

Dr. Emily Rubenstein: Oh, on the couch. Done. Done and done. That's like an old school friend.

Nell: I love it.

Laine: All right. Well, thank you so much. I'm going to, I'm going to end this session, ladies. It's hard to say goodbye.

Nell: Thank you. Don't hang up the line. Okay, bye.