Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.163 Skin Confidence After 50: The Truth About Midlife Skin Care with Dr. Mary Alice Mina

• Michele Henning Folan • Episode 163

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The mirror doesn’t lie, but it doesn’t have to be your enemy either. As wrinkles, dryness, and sagging skin become a part of your reality, it’s easy to feel betrayed by your reflection. But what if midlife skin changes weren’t a crisis but a chance to evolve your skincare game?

In this episode, board-certified dermatologist Dr. Mary Alice Mina joins us to share what actually works for skin over 50 – and trust me, it’s probably not what you’ve been hearing on social media. With her extensive training from top institutions like Harvard and Memorial Sloan Kettering, Dr. Mina cuts through the noise with refreshing honesty, tackling everything from the sunscreen debate to the viral trend of putting vaginal estrogen on your face (spoiler: it works!).

We dive into practical tips for navigating midlife skin, including how to use tretinoin without the peeling nightmare, why evening out your complexion is a game-changer, and whether those pricey red light masks are worth it. Plus, Dr. Mina shares why having a positive mindset about aging can actually improve your skin and health.

Whether you’re dealing with thinning hair (we’ve got oral minoxidil covered), thinking about your first cosmetic procedure, or just looking for a skin routine that really works, this episode offers straightforward, expert advice. Get ready to improve your relationship with the mirror and start feeling confident in your own skin.

Like what you hear? Subscribe for more midlife health tips!

You can find Dr. Mary Alice Mina at  https://www.theskinreal.com/

https://www.atlantadermsurgery.com/

The Skin Real Podcast https://podcasts.apple.com/us/podcast/the-skin-real/id1638619358

https://www.instagram.com/drminaskin

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

Have questions about Faster Way? Please email me at:
mfolanfasterway@gmail.com

After trying countless products that overpromised and underdelivered, RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com

*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Michele Folan:

Let's be real for a second. If you're over 50 and still trying to eat less and move more, that strategy expired with your 30s. The weight won't budge, the energy is gone and your doctor's side-eye at your annual checkup yeah, that's not going away on its own either. Enter the Faster Way, the program that actually works with your midlife metabolism, not against it. We're talking strategic workouts, real food, and, no, you don't have to give up your wine or your social life. This is not a quick fix, though. It's a grown woman reset. So if you're tired of starting over every Monday, do something different. Check the show notes for the link or reach out with your questions. I'm here to help you make this your last start over Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is Asking for a Friend. Wrinkles, dryness, thinning brows, sun damage, sagging skin Sound familiar. If you're a woman in midlife, chances are you've stood in front of the mirror wondering is this normal or which product is actually worth it?

Michele Folan:

This week, on Asking for a Friend, I'm joined by Mary Alice Mina. She is a board-certified dermatologist, dermatologic surgeon and the host of the Skin Real podcast. She's here to help us cut through the noise and finally get clarity on what our skin really needs after 50. We're going to cover the biggest skin concerns for midlife women how to tackle them head on. The common regrets Dr Mina hears from mature patients the truth about sunscreen debates and how to use it smartly. Because this is a definite question I have why your skincare order matters, what ingredients and treatments are worth the money and what's not. And yes, we even talk about the trending use of vaginal estrogen on our face. If you've been overwhelmed by conflicting advice on wasting money on miracle creams, this episode is your no-nonsense guide to smarter skincare in midlife. Welcome to the show, Dr Mary Alice Mina.

Mary Alice Mina, MD:

Thank you so much, Michele. I'm super excited to be here and have this discussion.

Michele Folan:

Well, this is right up my alley. I love this and I know my audience also loves this topic, because anytime we talk about dermatology or skin treatments anything in that realm those shows always do very well, and you have a podcast of your own and I want to talk about that too. But I'd love to know a little bit more about your background, where you're from, where you went to school, to give us a sense of your roots.

Mary Alice Mina, MD:

Yeah, Well, it's great to be here and yeah, I feel like people women, right, Especially really all ages it seems like we like to talk about skin right, it's right there, it's fun, but it also can be challenging. So I'm glad we're here having this discussion. Let's see my background. I am from a family of doctors, but I did not decide to go into medicine until I was about 21. I actually was a ballet dancer up until then. I realized I wasn't going to be the prima ballerina at an amazing company and that maybe I should look to do something a little more stable and secure, and so I guess medicine dermatology was my plan B. But it worked out, and it worked out great. Let's see, I went. Were you asking where my training?

Michele Folan:

was yeah, like yeah, undergrad, and then yeah, where were your training?

Mary Alice Mina, MD:

Yeah, so I went to Vanderbilt for medical school and then I traveled up to New York Memorial Sloan Kettering Cancer Center for my internship and then I was at Harvard for my dermatology training and then I moved south to Atlanta at Emory to do my Mohs surgery fellowship and that's where I met my fabulous business partner, Dr Baucom, and I've been working. First I joined him, worked with him, and now we're business partners and I can't believe it's already been like 13 years. It's crazy.

Michele Folan:

Oh wow, so you got a little later. Start with everything too, which you know. You're the second doctor in a month I've interviewed who was a dancer and then kind of veered off the path and it's just fascinating that. But you know what, when you think about that, there's artistry involved in what you do. That's that aesthetic, and so I can see that?

Mary Alice Mina, MD:

Yeah, I definitely think so, and I didn't realize that I would get to pair the artistic side so well. But I think a lot of people think, oh, medicine, it's so data, analytical and all this. But we can do amazing things in medicine, but there is still an art to it. It's not cookie cutter. Not everyone responds and behaves the same way.

Michele Folan:

There's still so much we need to learn and know, and so yeah, there really is an art to practicing medicine as well, yeah, and then there's the off-label uses for things that we know work for certain things, so it's fascinating. A lot of it is intuition and experience. And then I'd also love to know what the path was to becoming a double board certified dermatologist and dermatologic surgeon, because that had to be extra time as well, right.

Mary Alice Mina, MD:

Yeah, the nice thing about medicine for people who might be listening, who are younger, have children, right, like sometimes I'll think like how do people become these jobs that are beyond, like teacher, doctor, nurse? You know these like jobs in business, but at least in medicine it's like once you decide you want to be a doctor, it's very laid out for you what you have to do. You've got to do first two years and you've got to take step one, board exams, and you do your clinicals and you take step two. It's very sequential and you know what's kind of expected of you.

Mary Alice Mina, MD:

And pretty early on I knew that I liked dermatology and probably a couple of things, probably my background in dance and the arts.

Mary Alice Mina, MD:

I'm very visual, I love to well, I don't do it so much now, but I used to love to draw and visual arts. And then probably also because I'd really only been to a pediatrician and a dermatologist in my 20 some years and I just I had acne when I was growing up and it wasn't as bad as some people. I didn't really have scarring from it, but it was really embarrassing and I'm normally an outgoing person and I wanted to fade into the background. I wanted no one to look at me. I did not want to put myself out there, so I knew what it felt like to have a skin issue that made you just want to disappear. And what I enjoy about dermatology is not everything is life or death right, but it is very impactful when you can help someone with their skin, because it's so visible and I think that's why a lot of women in this midlife phase can be struggling, because we notice the skin changes before a lot of the other changes.

Mary Alice Mina, MD:

And it's not just we notice. The outside world notices, right, and we might start being treated differently. We show up differently, right.

Michele Folan:

So that's why and I'm in my midlife now yeah, it interests me more and more, you know and here's the thing it's not about looking like someone else, it's not about making yourself look like not that person that you are, but it's just having that baseline confidence. You know, to feel good about yourself. I get Botox in my forehead. I know that I am not going to look like I'm 24, nor do I care to look like I'm 24, but I look more awake and that is what helps me feel better. So everybody's different and on this show we are open-minded and we don't judge anybody for anything that they wish to do to their bodies. We're all open about that. But most of my audience is 50 plus and it'd be good to know what are the most common misconceptions that you hear from women in that age group about their skin.

Mary Alice Mina, MD:

I think there's a lot of insecurity and a lot of self-hate in this period, a lot of negativity we speak really unkindly to ourselves, a lot of maybe shame and feeling like you're unworthy. And it's just. I do think, and I'm hopeful that this is improving, as we're actually talking about menopause and perimenopause and it seems like there's finally this movement where women are like wait a minute, just because I'm 45, 50, 55 doesn't mean my life is over, I'm going to be put out to pasture, I'm no longer worthy or beautiful. So I do think things are changing and I am hopeful about that. We're finally talking about it. I think that's really the first step, right, because for so long I think people just felt this sort of shame inside, dreaded every birthday coming up, and I think you sort of have a great perspective right, like you're not trying to look like you did at 24, but you just want to feel good, because when you look good, you feel good, right, and vice versa, when you feel good on the inside, it also is reflected on the outside. So I think helping kind of reshape the stage of life that this is not. You know, menopause is not a dirty word. It doesn't mean you're, you know, worthless and no longer of value and no longer beautiful. We have to kind of reframe it. It's different, yes, right, but it doesn't have to be bad, it doesn't have to be negative, and I think, just embracing this stage of life, studies have actually shown if you have a positive view about aging, you're healthier and you live longer and you have fewer chronic diseases. So this isn't just like think happy thoughts, right, like this actually does work, and so why I started my podcast and what I really love to do is just help women feel confident, right, get your confidence back.

Mary Alice Mina, MD:

Yes, you look different than you did at 24, but it doesn't mean bad. And I'll just say I had a beautiful woman as a patient the other day. She was 94 years old and this woman she did not look 24. She didn't look 50, right, you could tell she was 80 plus, but she had this elegance to her and she had wrinkles, right, she didn't have no skin laxity and no blemishes and all that. But it reminded me that you can still be beautiful and elegant and graceful and still look age appropriate and not look like an alien, right? So there's just lots of ways to think about beauty and aging and we need to sort of shift our mindset that we want to totally prevent aging at all costs and actually learn to embrace it and try to do more like preventative stuff. Really I think is like so key with so much.

Michele Folan:

You know, and, like I said, I don't judge, but I did see a woman today at the gym who had had a lot of work done and I'm thinking, wow, I could tell underneath all of that that she was a very pretty woman. But I don't know if you ever have patients that come in and they say, oh, I regret this, or whatever. But do you have a particular regret that you continually hear from your more mature patients? Yeah, Well.

Mary Alice Mina, MD:

So I think the number one regret that I hear is that they wish they had worn sunscreen and that is it. Now I do treat a lot of skin cancer, but it always comes up. They'll tell me we didn't know, this was back in the 70s and we had baby oil and iodine in the foil and they'll say I wish I had known. I wish we had known to sun protect. That's the number one thing I hear. I don't hear too many people coming in regretting, necessarily, cosmetic procedures and stuff like that. But I also think patients gravitate towards me based on kind of, I think, what I look like where I do cosmetic procedures. But my goal is always a very natural approach and for some they don't want that, like some people actively want a more exaggerated full look, and so I don't tend to see those kinds of patients because that is just not. I'm not really the best person for them. Okay, yeah, so I think there is some self-selection with that?

Michele Folan:

Oh, absolutely, I definitely do, and we're going to take a quick break and when we get back, since we started talking about sunscreen, I want to dig into that topic. How many drugstore products are you going to try before you finally decide? You deserve better for your skin. Listen, if your skincare drawer is overflowing with half-used bottles that over promised and under delivered, it's time for a change. Rimon is the number one skincare line in South Korea for a reason.

Michele Folan:

This isn't about hype. It's about results Clean, effective, science-backed formulas designed for grown-up skin. No harsh chemicals, no trendy gimmicks, just visible, lasting transformation. I've seen it in my own skin and my clients and friends. They're sending me selfies because they can't believe the difference either. If you're ready for skincare that actually works and feels good to use, rimon might be your glow up in a bottle. Want the details? Shoot me a message or check the link in the show notes. Okay, we are back. Before we went on the break, I mentioned sunscreen, and If you are on social media right now, you are hearing a lot of conflicting advice about sun exposure, and we all know that getting light in the morning is great for resetting our circadian rhythm. But there seems to be some information out there, dr Mina, about the fact that eliminating sun exposure is actually detrimental to our health. Can you talk about that a little bit and what you're actually hearing and what your opinion is Right? So?

Mary Alice Mina, MD:

I feel like there are people who you know. I remember when I was a resident, like I do feel like there were days I probably never saw the sun. But depending on where you live at least here in Atlanta, like I'm sitting by a sunny window the sun is coming in. So my view is you should wear sunscreen every day, because it might be cloudy, it might be raining, you might forget, but it's like brushing your teeth, it's just a habit, and to me my sunscreen is like my moisturizer, so it kind of like kills two birds with one stone. I'm also very pale, so my skin cannot tolerate any sun. Versus someone who has more melanin, they can handle a little more without burning and I've been burned before plenty of times. I've tried to tan and it didn't work out well.

Mary Alice Mina, MD:

I think the I'm not saying don't ever like expose any part of your body to the sun and like live in a basement, right, but we get sun through car windows, we, you know. So if you have a commute 30 minutes a day, you're getting sunlight. If you know most people, they might do a quick walk with their pet outside or water their plants. They're outside. So I think most people are getting more sun than they realize. And if you don't think you are, you can look at your stomach or look at the inside part of your arms. And look at the outside part of your arms, and if you see a difference, that's the sun doing that to you. So I think a safe bet is to wear sunscreen. You're still going to get exposed to sunlight. No one, including myself, wears as much as we should. I have to say I'm not reapplying before I get in my car to drive home, you know so we're not, as we're not as diligent and good as we say we don't wear it, we don't apply it enough. So what we do know, though I mean I see this thousands of patients with skin cancer, and I see how some are very easily treated and then others are sometimes life-threatening. So I just think it's not worth the risk, and if you just get in the habit of wearing sunscreen, great.

Mary Alice Mina, MD:

Other options are to like I don't love to slather sunscreen on, you know, multiple times a day either, but what I'll do is if I'm going to be outside with my kids or taking a walk, I wear a hat, and that's a great way, and I just try to never feel like I'm like a rotisserie chicken roasting in the sun, right, yeah. And if you're not worried about skin cancer, then premature aging right. Like, one of the biggest things that causes premature aging and accelerates aging in us is UV radiation. So if you are like I'm a minimalist, I don't want to do anything then if you just sun protect and don't lay out, go to tanning beds and get tan, you're going to look way younger when you're older than someone who doesn't.

Mary Alice Mina, MD:

So, yeah, I mean, if you want to look at the UV index and go outside when it's lower than three or not, I mean I think there are some people who take it too far. Right, you see their outfits, they wear in the car and all this and that, but it's just hard for people to know what's this. We don't really know what is a safe amount of sun, Okay and yeah. So that's kind of it.

Michele Folan:

Do you have a preference on sunscreen? I mean, you've got kids, yeah, so do you pick a particular brand based on safety and that? So mineral versus, I guess, physical sunscreen?

Mary Alice Mina, MD:

Yeah, yeah, so chemical versus physical. So there's a lot of. There've been studies in rats not in humans where the rats ate it. They licked it, they ate. You know, you'd have to wear sunscreen for 200 years to get anywhere close to the amounts that they were exposed to. But there have been no studies in humans showing harm from sunscreen and there are copious amounts of studies showing the harm of sun damage. For my children they're 10 and 11 now. I really try to get them to wear hats and we wear rash guards at the beach and I'm fine with mineral or chemical sunscreens. So the main issue with the physical sunscreens the zinc and titanium is that it's uh, has a thicker feel a lot of the times, a chalkier like residue. So people with darker skin, um, can look almost like gray or purpley you know, the worst look ever.

Michele Folan:

Let's just admit that white ghosty look.

Mary Alice Mina, MD:

Yeah, again, we don't apply it enough. There've been zero studies in humans showing any harm, even the studies about reef issues and all that. It seems it's more global warming than anything else. But if you are worried, then just stick with zinc and titanium. You may have to shop around a little more to find one that you really like. I actually. I just got this from my office. It's the Elta MD spray and I believe, yeah, this is 100% zinc and I do really like this one because I can spray it, it's really light and it rubs on really well. So it is possible to find the physical blockers that are nice. It just takes a little more trial and error and I would just tell the audience, like, don't go crazy, you are okay if you use chemical sunscreens. The only people I wouldn't use it on is maybe a teeny, tiny little baby. Then we recommend just using really we use truly physical blockers. Like put the awning up, put a hat on stuff like that.

Michele Folan:

Yeah, so what is the cutoff age for using sunscreen on babies?

Mary Alice Mina, MD:

So really six months and older is when we recommend it. But I actually was just doing a podcast with a pediatric dermatologist and he was saying we put a lot of diaper rash creams or zinc oxide, which is sunscreen, right, and we do that at one day old. So really we say six months and older, but really the most important thing is that you're protecting their skin.

Michele Folan:

Okay, I'm asking because my listeners have grandkids and I figure they often have to chime in on those things, so all right. So we did touch on menopause a little bit and that estrogen loss does show up on our skin as we age. Huge trend right now of using vaginal estrogen on our faces, and there's even some brands out there now that are including estriol in their formulation. What's been your experience and how are you feeling about the science behind it?

Mary Alice Mina, MD:

I am loving it. So I have, and I've been talking to some of my older patients and they'll say, oh honey, we've been using this for decades. Right, like they've been using. This is nothing new for a lot of ladies. They've been using their vaginal estrogen cream on their face, on their chest, on their hands, so they've been doing it for a long time. We know it's very, very safe and actually super protective, decreases risk of UTIs in women and helps hydrate the skin, the perineum, the vulva, and so it makes sense. Our skin has estrogen receptors to put it on skin of your face, your hands, your neck, and now companies are making it, formulating it specifically for the skin.

Mary Alice Mina, MD:

I haven't tried vaginal estrogen to know the difference between the facial one and the other one, but I do know the facial creams that I've tried are wonderful. I think of them as like a moisturizer, so I have been getting a lot of requests for it to use and I think it's great. I would say the only people I maybe would use a little caution with is someone who has really, really bad melasma. Where they flare, they get those brown discoloration on the face. The data is sort of like hit or miss on that, whether it truly does exacerbate it, but we do know estrogen can make melasma flare, along with sunscreen or sun. So if someone had really severe melasma I would definitely just talk with them about that. But otherwise super safe. I think it's wonderful. I think if you're in perimenopause or menopause you should be putting it on your face. Whether you get one that's just for your face or you use your vaginal one, it doesn't matter to me one.

Michele Folan:

It doesn't matter to me. Okay and this is my plug kind of off the topic but for women that are not on vaginal estrogen, I don't care how old you are and if you haven't had a sexual relationship in 20 years, the data really shows that probably every single woman should be on vaginal estrogen after menopause and it's preventative for so many things. And I've had this discussion with my friends and they're like, nah, I'm fine, I'm like no, no, you say you're fine, but things get shriveled up down there and it causes all kinds of issues. So, anyway, that's okay, I'll get all kinds of issues. So, anyway, that's okay, I'll get off my soapbox, but anyway all right, yeah, and it's so safe.

Mary Alice Mina, MD:

It's so safe. So I think, yeah, use it on your face, use it in the vaginal area. It's wonderful.

Michele Folan:

So for women that are experiencing skin changes in midlife okay, we're talking dryness, dullness, loss of elasticity, because I think those are the main concerns I always hear. Where should they focus their attention first?

Mary Alice Mina, MD:

Gosh, I would say your best bet if you want to save time, frustration and money is see a dermatologist. I think a lot of times people sort of piecemeal well, I'm going to go here for this, I'm going to go here for that. I got a group on for this. So I would say see your dermatologist. Like this is a skin, your skin expert. If you've never had a skin check, you should get a skin check, because this is when we start to see skin cancers pop up and you may have things that are more medical.

Mary Alice Mina, MD:

You may be struggling with acne believe it or not, it happens. You may be having rosacea flares. Again, get the skin checks. So I would start with your dermatologist and then they can help you come up with a plan on what really should be the first thing I do, if anything right, Like maybe it's just getting on a skincare regimen, Maybe it's adding estrogen cream, estriol cream, Maybe it's adding tretinoin. So I just feel like, rather than kind of shopping it out to lots of different people who your friend went to and all that, I would say start with the skin experts, like a dermatologist.

Mary Alice Mina, MD:

And a lot of times if a patient asks me like well, what should I do, what should I do? I started off with saying, well, what bothers you? Right, Because what I see might not be what bothers you, and this happens all the time. So I like to hear what bothers them. And if it's that, they just feel like their skin's not bright or they've got some loose skin here or there, you know. So it's helpful to know well, what bothers you, Because if it doesn't bother you, you don't need to fix it.

Michele Folan:

You brought up tretinoin and I know I've tried it in the past and my skin got super dry and they say, oh, just use it every three or four days, whatever, give us your strategy for using tretinoin and how people can be more successful with it.

Mary Alice Mina, MD:

Right, and I hear this a lot too. In fact, I had this conversation a couple hours ago, so I'm a big fan. I mean, I think it's probably, other than sunscreen, the most powerful potent topical cream that we have, especially for anti-aging. I mean, the data is abundant. It increases your collagen 300% versus know, versus collagen powder we're debating does it work, does it not? We don't know, we do know. Tretinoin does it and retinoids. So the main issue is it is irritating, especially if you have real sensitive skin. It's wintertime all these things can make it harder. So my trick is you can start with over-the-counter like that's going to be weaker. You can start with over-the-counter that's going to be weaker. You can start with over-the-counter adapalene or Differin that's a little bit stronger if you want. So those are ones you can start with.

Mary Alice Mina, MD:

I recommend using it on clean skin at night. I like the skin to be really dry, because the more moisture it has, it's going to absorb more deeply and cause more irritation. So this is a time where we actually don't want you to put it on your skin wet, so let it dry. Sometimes what I'll do is after I shower, I will wait even like 30 minutes or so, because I tend to have oily skin. So within 30 minutes my skin already has a little oil to it and then I put it on. But you could also put a moisturizer on and then wait a little bit and then it's just one little P on your finger, not big at all. Dab it across your whole face. I do my neck, tops of my hands, you could do your chest too, if you want, and then you can put a moisturizer on afterwards.

Mary Alice Mina, MD:

So the sandwich technique is moisturizer, tretinoin moisturizer, and sometimes I will do for that second moisturizer. Like my eyelids tend to get really dry, I will just put on Vaseline or Aquaphor in those areas, or like around the corners of my mouth. I'll add what the kids call slugging and I will put the Vaseline or Aquaphor there, and then I still get dry. I mean, I'll tell people I've been using tretinoin, except for when I was pregnant, since I was in my 20s and you know, because I had acne and then I kind of stopped it for a few years but then got back on it as soon as I became a dermatology resident. So I still get dry.

Mary Alice Mina, MD:

So I don't use it every night. I used to use really strong strengths, but now we realize, even the lowest strength is good. It's not like you have to get to the top layers or at the top highest percentage. But if you really really can't you know, if you really can't tolerate it doing all those things, then try over-the-counter or try. My patient today was telling me she uses Bacushiol, which is a plant version that acts similar to retinoids and we don't have as much data on it but it's certainly gentler to the skin, gentler to the skin. So those are just some tips and tricks to try, and usually by using less and really bulking up the moisturizer I can get most patients, most of my patients, to tolerate it?

Michele Folan:

Do you use it at night or in the morning?

Mary Alice Mina, MD:

So tretinoin or retinoids you want to use at night, got it All right? Yeah, so you want to use those at night and then you want to use your sunscreen and maybe vitamin C in the morning.

Michele Folan:

Okay, and then in the evening you use your Tretinoin, and then what else would you use at night Moisturizer? Okay, all right, so you keep it pretty simple.

Mary Alice Mina, MD:

I keep it very simple. Now I know there's a lot of talk and I have to say I've been doing that for like decades, but in the last like six months I have gotten really excited about exosomes and so I am using a product called Plated, which I really do love. So I do, I wash my face, I use my Plated, then I use my Tretinoin and moisturize. So I would say, at night, try to be on a retinol, retinoid of some sort. You can use your Estriol cream as your moisturizer if you like. I think that's a great idea. And if you are someone who really enjoys skincare and you want the latest, greatest and all that and you want to play around with stuff, then try some peptides or exosomes or growth factors. So that's something you can throw in in the evening. But it can be as simple. I mean, my mom just uses moisturizer okay, so it can, and she has beautiful skin, so it can be simple.

Michele Folan:

All right, where are exosomes derived?

Mary Alice Mina, MD:

Yeah. So exosomes are little, think of like a little envelope. So the exosomes get little messages from stem cells and deliver it to other cells of the body. So an exosome can be good or bad. Just saying this is an exosome doesn't really tell us much. What you care about is what's the little message in that envelope? So you don't want the message to be cell death or, you know, cancer growth, right, right, or like pro-inflammation.

Mary Alice Mina, MD:

So what I so you, you know with what people are looking at with skincare is little messages in the exosomes that tell the cells to get rid of these things called zombie cells, to eliminate those that are sending out bad signals to our other healthy cells. You wanna stimulate things to decrease inflammation, to increase collagen fibroblast activity. So I think we're gonna hear. Your audience should know we're gonna be hearing a lot about exosomes in the near future if you haven't already heard about them. And I would say, take it with a grain of salt, because there's going to be a lot of snake oil out there, a lot of people pushing exosomes as injections or IVs and, first of all, that's not FDA approved, so I wouldn't go see anyone for that. But I do think there is some good science and data behind it. You just need to make sure you're not spending a lot of money for a moisturizer.

Michele Folan:

All right. And then my other question is when we do microneedling, do you ever do?

Mary Alice Mina, MD:

PRP, yeah yeah. So it's a great option. That's called the vampire facial and so PRP is kind of like one step after exosomes, so you could think of like stem cells as being like the most potent, and then exosomes carry the messages from the stem cells and then PRP are some of those stimulate growth factors too. So it's like kind of the next level. So PRP is wonderful. It can help with healing. You can do it after lasers. You can do like kind of the next level. So PRP is wonderful, it can help with healing. You can do it after lasers, you can do it after microneedling, you can do it to help with hair growth on the scalp.

Mary Alice Mina, MD:

The only thing where PRP can get a little tricky is there's a lot of variability. It's not like you pick up this jar and you're like okay, I know what's in there, I know how many platelets are in there. I know Our bodies are very variable. So even within month to month when you get your treatments, you may have more platelets one day, fewer another. The older you get, there's thought are the platelets not as effective. Is it better to get platelets, platelets from younger people? So I do think we're going to see that evolve. But certainly, especially if you are someone who likes the idea of a very natural approach, using your own blood and platelets, is, I think, a great option for you.

Michele Folan:

So for anyone that hasn't heard of this before and they're kind of grossed out by this conversation because it's a little different, right? Yeah, they draw your blood and they spin out the platelets, correct? Yeah?

Mary Alice Mina, MD:

Okay, yeah, exactly, because the platelets are the key signals. If you injure yourself, those platelets are activating that wound healing cascade, and so what we're doing is we're taking those platelets and activating the growth factors, the messengers stimulating healing. And yeah, it is. So I've never done it myself, but when I've done it to my staff and patients it does feel a little bit weird, and you do have to leave it on for about an hour before you wash it off. So it's kind of a different sensation, but in the long run it does help you heal faster.

Michele Folan:

All right, I might have to do that I haven't done microneedling in like two years, but I always look like I'm drugged behind a bumper. After I have it done, I think she goes kind of hard on me. But I'm curious what PRP would do in my healing process because yeah, yeah, it should help it heal faster. It scares the hell out of my husband when he would come home and he sees me after I've had done it, he's like oh my God, what happened to you?

Mary Alice Mina, MD:

Like, don't worry about it, I know, but you know, it seems like do you feel you heal pretty quickly, like the next day you're looking significantly better, or do you have more downtime?

Michele Folan:

I mean downtime. Define downtime because I never have any downtime and I'm the one that goes to girls night out after I have microneedling and they make fun of me but I don't care.

Mary Alice Mina, MD:

You know that it always makes me laugh because, just to your point, patients will say well, how much downtime I'm like. You know everyone's different. Yeah, because our staff come to work the next day. But you may be like oh no, I don't want anyone to know, I'm going to hide out at home.

Michele Folan:

So, yeah, everyone's different, yeah, okay. Well, yeah, I'm like whatever, I really don't care. I want to talk a little bit about things that are just a total waste of money, and I'm going to ask you first about beef tallow.

Mary Alice Mina, MD:

Yeah, so I mean, I've never used it but I'm like I don't need to use it. I think this concept of food for skincare don't use it on your skin if you wouldn't eat it is kind of ridiculous, I mean. I guess I kind of see it does sound appealing like nature and natural and all that, but we have amazing products formulated just for what your skin needs. So I don't know, you know, why we're going back and using something that's never been meant to be used on the skin. It can clog pores, you can have irritation. It's just unnecessary, so I don't recommend it at all.

Michele Folan:

All right, that was my first one. What about red light masks that you see all over?

Mary Alice Mina, MD:

Yeah, so we do know. In dermatology we use a lot of light therapy. Lasers are a form of light amplification, so red light therapy is helpful. It does help reduce inflammation and you know, I think it's cool People like it. It's relaxing.

Mary Alice Mina, MD:

The issue with the face mask it's kind of like exosomes it's hit or miss. Some can be really good and some can be really bad. So you want to find a mask that truly is red light. You want to make sure there are enough dots in the mask so that your skin is adequately covered. You don't want a mask with like four dots that you're putting on, so you want lots of dots to cover your skin. You want it to form to your face.

Mary Alice Mina, MD:

You know I've seen those like little wands and I think those are like ridiculous. So if you're going to do it, get like the scalp one, get the one for the face or the neck that your skin is covered. They do work. You just have to do it consistently and for me I'm like I could get better results by using my tretinoin and my sunscreen and maybe a laser once a year, once every couple of years. So I don't personally do it, but if you want to do it you can get good results, but you just have to be consistent, you have to do it and you have to stick with it, and I think that's where people you know they sort of fall off using it after a certain amount of time.

Mary Alice Mina, MD:

So this is back to my I don't care what people think bucket, you go to the grocery with it.

Michele Folan:

No, I would not go to the grocery, but I've filmed myself on social media with it on my husband I'll wear it when I'm watching TV at night and he just he doesn't even blink anymore because he's like, oh Jesus, what next?

Mary Alice Mina, MD:

Yeah, here she goes again. Yeah, yeah, like, do it while you're journaling or meditating. Yeah, yeah.

Michele Folan:

I don't know. It feels like self-care to me, so whether it works or not, I don't care. Yeah, this phase of life is frustrating because not only do we lose elasticity in our face, but we're also our eyebrows and eyelashes and our hair are thinning, and this has come up on my show before I interviewed Dr Bauman, who does a ton in the hair rejuvenation space. When patients come to see you, what are their options now in terms of, you know, rejuvenating hair, particularly? I mean, let's talk about the hair on our scalps, because that is such a source of consternation because of our you know our confidence.

Mary Alice Mina, MD:

Oh, for sure, For sure. Yeah, like hair, I think this one, like women who have breast cancer, right Like they already are hit with that and then it's like, oh, you're going to lose your hair, right Like our hair. For so many, it's our femininity and it can be really distressing to lose it. And the thing is, whether you have thick hair or thin hair to begin with, if you notice hair thinning, like I noticed, I mean people would look at me and say you have thick hair, but I noticed I felt like my forehead was going farther back and I was seeing more of my scalp than I'd ever seen before and I was like this is different. I'm like I don't like this. So the good news is I do feel like we actually have treatments now that can help.

Mary Alice Mina, MD:

So if you're noticing hair thinning again, see your dermatologist because first of all, it could be a medical condition, so it could be several things. So vitamin D could be low. We're reading, learning a lot about vitamin D and our immune system and just our overall health. So most people are vitamin D deficient, especially people with darker skin, and if you live in like climates where the sun sets really early, you don't see the sun. So get your vitamin D levels checked, get your thyroid checked and again, if you have symptoms, right for thyroid Iron, you could have low ferritin. So these are all like common things that can be. Just a quick blood test can look at it, so your dermatologist can also assess. There's something called telogen effluvium, where your hair just falls out in clumps and you see it. So that's different from like female pattern balding or androgenetic alopecia. So telogen effluvium, where the hair is truly shedding and falling out. The good news is that is reversible, so it will come back, but it can really freak you out when you see that, yeah.

Mary Alice Mina, MD:

So see your dermatologist, perhaps get some blood work, perhaps supplement as needed with, maybe iron a multivitamin work, perhaps supplement as needed with maybe iron, a multivitamin vitamin D that can be super helpful. Look at your diet. So if you are vegan or really calorie restricting, then you are probably going to have more hair loss. So you just need to make sure you're getting enough calories and you're getting enough protein Protein, I know right, our hair is protein. So that is, you know, keratin is protein. So those are things you can do. And then there are medical treatments and I was just talking to a patient today about it. So it ranges from topicals. So minoxidil is super powerful. Rogaine is the brand name. I think most people have heard of that, but we can compound even stronger versions of that. So your dermatologist can get a strong, compounded formulation if you don't like the minoxidil or you feel like it's not working enough for you.

Mary Alice Mina, MD:

I'm a big fan of oral minoxidil and at really, really tiny doses just 1.25 milligrams it can make a huge difference and I don't know if your audience like I, have all this little baby growth from my minoxidil, so it truly does work. I know some people are like I don't want to take a pill, but it's a half tablet. It's tiny, very safe, even if you're on blood pressure medicine. I mean, of course you want to talk with your doctor, but I've never had someone's PCP or cardiologist say they didn't feel comfortable with someone being on it. So that's a great option. Is it prescription? It is a prescription, yeah. And then for menopausal women, there are even more choices. So let's see I'm trying to not use the trade names, but dutasteride is an option, finasteride, which is propesia these are options as well for women who are postmenopausal that they could be on.

Mary Alice Mina, MD:

So we've got medications. We've got topicals. People are looking at exosomes for hair growth. So the company I was talking about before, plated, does have a hair product, so that works. And then PRP we were talking about before. There have been some good studies showing that that increases hair regrowth. And lastly, hair transplants. I had a hair transplant surgeon on my podcast and I didn't really realize women did hair transplants. I had a hair transplant surgeon on my podcast and I didn't really realize women did hair transplants. I thought it was just for men, but he was telling me women make up half his patients and they even do hair transplants on your eyebrows, so I thought that was really interesting.

Michele Folan:

So fascinating. And Dr Bauman did talk about that a little bit and I was like, oh wow. He said it's amazing He'll do eyelash transplants as well.

Mary Alice Mina, MD:

Yeah, yeah, I'm a bit so Latisse, or what is the? Yeah Latisse, it's the prostaglandin. Yeah, Latisse is great for eyelashes. I know there are a lot of like Rodin and Fields and other companies making serums, but yeah, I always had very, very short eyelashes and I use Latisse a couple times a week. I was really nervous about using Latisse because I have green eyes and there have been, when people use it as drops in the eye, that it can change the color of your iris. But knock on wood, so far so good.

Michele Folan:

You know, I think, if you're only using it a couple times a week. I know my eye doctor, because I have dry eye and all sorts of things she's so I have to find another option, A different one. But you know, I saw someone the other day, of course on social media. Yeah, they were using Rogaine or Minoxidil on their eyebrows.

Mary Alice Mina, MD:

Yes, yeah, you can totally. Okay, which I like that idea. Yeah, you can use that. And I've been amazed too, how you can get really good eyebrow tattooing. You can even get some tattooing, like on your scalp or hairline, or if you have a scar, they can tattoo some pigment in, and there's some phenomenal artists out there who can do that too in a very natural way or microblading for your eyebrows. So it seems like there are tons of stuff we can do nowadays, and a lot of it. It's not just one thing, and I didn't mention supplements, and your audience probably is thinking about supplements like Nutrafol, and there's another one called Interglow Vitamins, and I think there's certainly no harm in doing a hair supplement. I think if you just do a hair supplement, you're going to be disappointed. But again, a lot of these they all kind of work together and it's not like there's one magic cure for it.

Michele Folan:

Okay Now, thank you for that, because it does come up and I, you know, in my circle of friends and stuff talking about hair thinning and it's really frustrating for some people and I wanted to make sure we covered off on that. In terms of professional treatments that you offer in your office or procedures, what are you most often recommending and I guess it depends on what the patient's concerns are yeah, but what are you probably doing most often?

Mary Alice Mina, MD:

So I think for a lot of people, especially if they're new to getting things done, evening out the complexion I think is number is like so key. I think it makes such a big difference and I think why that patient I told you about earlier, who was in her 90s and she looked just so beautiful and elegant. It wasn't that she didn't have loose skin and wrinkles, but her just overall complexion was very even and uniform. She didn't have a lot of discoloration. So to me a beautiful canvas makes everything look better. So I usually like to start with that, whether it's with skincare products, whether it's with a chemical peel or laser treatments. But I think evening out the complexion makes the skin brighter. You're gonna look in the mirror and feel better about yourself. It's gonna reflect light better. So that's a great option For some people who aren't maybe quite ready, because there can be a little bit of downtime.

Mary Alice Mina, MD:

Microneedling is a great way to kind of have a little pick me up. But again, if you have a lot of like discoloration on the skin, you really do need like a laser or chemical peel. But I think a great gateway drug, if you will, is Botox, because it's not reversible but it wears off right, it's not permanent. The results, especially if you do it in the correct way, at low doses, it can be very natural, very subtle. You can still emote, but it just brightens your skin. Right, like you said you'd have done Botox. So it just the light reflects off of it, it just gives a brightness and if you know, every now and then I'll meet someone who's like no, it's not for me, you know. And it's like, okay, you tried it, it wears off. No harm, no foul, you don't have to do it. So I think that's a great one for, like, dipping your toe if you want to see.

Michele Folan:

You know, and back to the Botox thing, and I've been doing it for 14 years probably and just in my forehead, but I'm telling you, that alone is such a pick-me-up in terms of just looking a little more brighter and refreshed.

Mary Alice Mina, MD:

So, yeah, well, and here's something cool They've actually done studies to show that it helps with depression. Yes, so you know, we don't fully know 100% why, but it kind of makes sense, Like if you're constantly scowling and people think you're angry, they might treat you differently. You look in the mirror. You feel you look angry, you feel angry, but when that softens that, people feel better about themselves and they're happier and they're less depressed. So there's real science behind it.

Michele Folan:

I think we generally feel less depressed when we feel confident about our skin. I mean, I think there's that's kind of a no-brainer, but I again. I saw this on social media. I hate saying that because it sounds like that's all I do. I do way more than that. But there was a woman who is showing her. I don't know if she had a laser treatment or chemical peel, but from her tip of like her hairline down to her chest here she looked like a hot mess. I mean to tell you looked like she had been in one of those old we do you, we used them way long ago A tanning light. What did it? You know what I mean? Like the foil, yeah. Like she had been bait, yeah. So what did she have done?

Mary Alice Mina, MD:

Well, hard to say. I would imagine if I mean it could have been either, and both can give some pretty. You know it definitely takes some counseling. That's why I say it may not be the right first treatment for people who have never done it because there is some downtime. But oh my gosh, like the results are phenomenal. They can be phenomenal with the right laser at the right settings, with the right laser at the right settings.

Mary Alice Mina, MD:

So she probably had either a medium depth chemical peel like a TCA acid peel, or she had like an ablative laser peel. So either CO2 or Erbium laser that really was the chemical peel is going to take off the whole top layer of skin and the lasers that we use nowadays make these little channels in the skin with normal skin intervening. So the lasers tend to heal a little bit faster because you do have that intervening skin Chemical peels. I usually tell my patients it's seven days for the face, a little bit longer off the face, but the results are phenomenal. So I usually tell my patients like on day you know tonight and tomorrow you're going to be questioning your life decisions, but by day four or five for a laser you're going to be loving me. And day seven on a chemical peel. I get these smiling pictures and they're so happy and they're like you know, they're so happy and they're so glad they did it.

Michele Folan:

Yeah, why did I wait so long? It was a sun lamp my sisters Sun lamp. Yeah, now my sisters are in their late 60s, but they would use a sun lamp and I remember some pretty hellacious burns from those. But, yeah, I mean, I'm looking at this woman and I'm thinking, oh my God, even as confident as I can be about stuff like that, I am not leaving the house for weeks. Yeah, because it was that bad. But I'm sure, I mean, her results will be spectacular. I'm sure, right, I'm just not there yet.

Mary Alice Mina, MD:

And that's okay.

Michele Folan:

Yeah, we'll get there. We'll get there. All right, you are also the host of the Skin Real podcast. What inspired you to start a podcast? What were you thinking?

Mary Alice Mina, MD:

A midlife crisis. I suppose you know what I'll tell you. It was 2020. Okay, you remember 2020?

Mary Alice Mina, MD:

And I was stuck at home, like so many people and my patients a lot of them were older, they were scared to come in. My partner and I were splitting up so we were on different days. So I had a lot of free time and I started listening to podcasts and I had really never been a podcast listener until then and I also was turning 40. And I was noticing changes and a lot of my friends were turning 40. And it was kind of like whoa, what's going on? We had a lot of time to look at ourselves, right Like I don't think we ever stared at ourselves like we did starting in 2020 on Zoom cameras, different angles oh my gosh, my neck. I didn't think I looked like that. Where are my filters, Exactly?

Mary Alice Mina, MD:

So I started getting a lot of questions. I was having questions and I thought you know what, when I went to see what was out there and also I sort of felt like, well, don't people know this? But I realized there's so much just nonsense out there and so much noise, a lot of stuff. Just buy this, buy that, do this product, do this crazy 12-step routine, and so I just wanted to be like a voice of reason for someone who is just giving people good skin information. I know it's hard to see a dermatologist. I know our visits are rushed and short and you don't always get your questions answered, and so I wanted to provide a resource for people where they can get this information.

Mary Alice Mina, MD:

And I also feel like skin health. We think of it as what we put on our skin. What products do I need? What procedures do I need? But I think a huge part of your skin health is how you take care of your body, how you take care of your mind, your physical health, how you think about aging right and how you take care of your body, how you take care of your mind, your physical health, how you think about aging right and how you speak to yourself. So all of these things impact your skin, not just am I using the right retinol or vitamin C or peptide right? So I'm hopefully giving people, you know, just good information, science back. You know I'm like we're not doing gimmicks, we're not doing hype and just give people like my age, older, perimenopause, menopause who are like what do I really need to do? This is it, this is what. Listen to this and you'll get some good hopefully some good information.

Michele Folan:

Yeah, it's beauty from the inside out, right. Start with what you're putting in your body. You know it's funny. You talk about 2020, that's when I devised this idea of doing a podcast too, but I've had so many guests on the show who have written books or done things because of that downtime during the pandemic, so I giggled when you said, oh, you know 2020, like oh Right, A lot.

Mary Alice Mina, MD:

Yeah, shocking. Exactly, I think 2020 made a lot of people sort of think wait a minute, like what am I doing? Let me think about my life, and I think also that's midlife right Like you've maybe been doing something for 20, some years, but you're like where do I see my life in the next 20 years? And and I think midlife is a great time to kind of reinvent yourself.

Michele Folan:

So we talk about that all the time on this show. There's a lot of women, you know, like post menopause, they're starting to look at their husbands and they're going yeah, what am I doing? I mean, it's it's careers, it's life's life. It's everything that we start to kind of reassess. So, all right, dr Mary Alice Mina, where can the listeners find you online and on social media?

Mary Alice Mina, MD:

Yeah, so you can listen to the podcast called the Skin Real. I have to spell it out to people. Nowadays R-E-A-L and I'm at Dr Mina Skin and if people are wondering, I get this question a lot like where do I start? What do I really need to do? I have a little PDF you can get for free at theskinrealcom forward slash habits where I break down how you can create healthy skincare habits without spinning on the hot girl hamster wheel, as I call it.

Michele Folan:

Perfect, I'll put that in the show notes. Thank you for that, and it was great. Speaking to you, I'm so happy you got to be here today with us.

Mary Alice Mina, MD:

Yeah, this was a lot of fun. I could talk about this forever. It's just something I love I could, too. Thanks for being here.

Michele Folan:

Thanks so much, hey. Thanks for tuning in. Please rate and review the show where you listen to the podcast. And did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.