SPEAKERS

Raquel Frisella, Dr Lyon

Dr Lyon  00:01

Welcome to the Dr. Gabrielle Lyon show where I believe a healthy world is based on transparent conversations. In this episode, I sit down with Raquel Frisella, she’s founder of Raquel aesthetics and the RFA skincare line. She’s a Board Certified Nurse Practitioner with over 13 years of experience in the industry. I love Raquel I love her ever evolving knowledge. I’ve been using her products and going to her for skincare for the last five years. Everything from vitamin C to sunscreen to what to wash my face with how long it’s going to take to see improvements. In this episode, we sit down and I have the opportunity to really pick Raquel’s brain on all things skin related preventative aging treatment, the whole nine you’re going to love this episode you’re going to love Raquel. Can’t wait to hear what you think if you enjoy these episodes, please take a moment to subscribe to the youtube please subscribe Rate Comment the podcast this is how people find it. And if you want to hear other experts or other topics, please let me know I take everything that you say very seriously. Let’s dive in. With all this talk of skincare I think we should talk about hydration and that’s where one of the sponsors comes in. And that’s element spelled lm n t if you’ve been listening to the show, you know how much I love element and they have a tasty salty electrolyte drink with everything you need and nothing you don’t it contains science backed electrolyte ratio of 1000 milligrams of sodium, 200 milligrams of potassium, 60 milligrams of magnesium none of the junk none of the BS element is formulated to help anyone with their electrolyte needs. I frankly really struggle drinking water. In fact, I started this program called 75 hard and it calls for a gallon of water a day and that’s really hard to get down. So I’ve just been throwing in some electrolytes. Hopefully I’m not breaking the rules here. I’m gonna have to check on that. But element really does it for me, you can head on over to drink lmnt.com/dr Lyon. And right now they’re offering a free sample pack with any purchase that’s eat single serving packs free with any lmnt order. It’s a great way to try all the different flavors. I’m obsessed with their chocolate melody right now. Head on over to drink lmntt.com/a Dr. Lyon and it’s totally risk free. If you don’t like it. You can share with a friend they’ll give you your money back no questions asked. Let’s talk nuts. The other kind of nut which is macadamia macadamia nuts. They are rare only 1% of the nuts due to them being in high demand, it’s really created a stigma of them being the world’s most expensive not. For me the tastes and health benefits are worth it and in fact 30% less carbohydrates than almonds. So these nuts have as it relates to a health benefit if you are in a carbohydrate controlled diet. They have 30% less carbohydrates. They have more healthy monounsaturated fats than any popular nut, even olive oil and avocado. They’re the only nut rich in Omega sevens and that’s been linked to natural collagen production. There was a recent study released that shows and macadamia oil significantly beats olive oil and coconut oil for pancreatic health. And lucky for you, there’s a company obsessed with making this super food accessible to all and that is house of macadamias. They’ve partnered with over 94 Farms in Africa. They have recently formed the single largest producer of macadamias in the world. They are a Keto paleo vegan snack, they have white chocolate dip macadamias that took quite some time for them to develop and I’m telling you their products are amazing. They’re super fresh. go to house of macadamias.com/dr Lyon and use the code Dr. Lyon for a 20% discount. That’s 20% discount on your first order. Raquel Frisella, I am so excited to be sitting here with you and you’ve actually been my skincare go to for the last Gosh, least five years now.

Raquel Frisella  00:47

It has been thank you so much. I’m very honored. Thank you for having me today. Thank you for letting me be your skincare. Go to girl.

Dr Lyon  04:34

Yes! And you’ve actually been involved in skincare for what 13 years now?

Raquel Frisella  04:37

Yes. 13 years.

Dr Lyon  04:39

And You’re a nurse practitioner.

Raquel Frisella  04:41

I am a Board Certified Nurse Practitioner. I specialize in aesthetic medicine. So all things skincare, injectables. In our practice, we do lasers, facials, peels, microneedling all over skin health.

Dr Lyon  04:55

And just curious, how did you get interested in that?

Raquel Frisella  04:57

I have always loved aesthetic medicine. And I always knew I was going to be in the medical field. And as a nurse, I love taking care of people. And I love helping people. But I’ve always had a natural interest in the beauty, industry and aesthetic. And so aesthetic medicine is truly the perfect blend of medicine and beauty. And so I just love what I do. I love being able to help people feel like their most competent self transform lives. It’s extremely gratifying. I meet so many amazing people, you know, over the course of my career, and it’s just being a part of their journey, just helping someone feel competent in their own skin. It really is so much fun in such a blessing. And I just love doing it.

Dr Lyon  05:39

Well, clearly. And you’ve created an amazing business, which at the end, we’re going to talk about, do you remember before you were in skincare, and you either go into the drugstore or you go to the department store, and literally it is a warzone of skincare? There is toners, which I don’t even know what a toner is. There’s like 507 Different moisturizers. There’s this patch for your eyes, there’s this for your wrinkles and this for your breakouts. It’s actually really confusing, and 

Raquel Frisella  06:09

it’s overwhelming. 

Dr Lyon  06:11

It is overwhelming. And I’m curious when it comes to skincare. What are the things that everybody should be doing?

Raquel Frisella  06:18

That’s a great question. And my aesthetic philosophy in general, not only with skincare, but with injectables. And everything we do here, it’s truly less is more. And what I mean by that is you don’t need 100 products, you don’t need a 10 step routine to achieve your best skin, you just need a few of the right things for you. So it’s easy to get caught up in an even idea. If I go to Sephora, I really liked that store. But I get sucked in and I start looking at all the pretty labels. And that looks fun. This looks cool. And but to be honest, a lot of that stuff, it kind of is junk, you know, I mean, maybe they have a few great things. But we don’t want products that are fit, you know, packed with fillers. And what I mean by that is perfumes and parabens, and all these extra things that just beef up the product, less is more so with your skincare products, I am a huge advocate for medical grade skincare. And what that is, is it is skincare that is carried and sold by medical professionals. And that’s because it is a higher potency. So it’s more more pure active ingredients. So no fillers, no junk, no fluff, no perfumes, just pure active ingredients. So they’re very transformative. So you can use a few products like that. And they really work. And I think that’s what gets people when they try medical grade skincare for the first time. And they use a few awesome clinical based products. They’re like, Oh my gosh, my skin this works. It’s actually changing. I can’t believe this. Because like so many of us in the past, they’ve spent hundreds and 1000s of dollars on all this different stuff that they have in their bathroom, and nothing really works.

Dr Lyon  07:52

Yeah. So you’re essentially saying that it’s great to get makeup at Sephora, but perhaps not skincare.

Raquel Frisella  07:59

Correct. They have a lot of amazing products. And trust me, I have a Sephora account, but I think but um, I think when it comes to your skin, you know, if you really want to get serious about your skin, and you want to anti age and you want to have the most polished, clean, fresh skin, you really do need to invest in quality skincare, and not only good products, but also good guidance. And so seeking out an esthetician or a provider, nurse practitioner, an aesthetic practice where you can go and get the help you need to help someone understand, you know, what products should I be using? And how do I use them. Because even if you have the best products, if you’re not using them properly, you might not be getting the best results that you could be.

Dr Lyon  08:43

And there’s all kinds of different products right. So when I was thinking about coming and talking to you, I was looking at some of the stuff that I have and there’s glycolic acid and koji pads and salicylic acid and retinoids those would all be considered right topical acids.

Raquel Frisella  08:59

Yes.

Dr Lyon  09:00

Who needs them? What are they for? How could someone figure it out? Because I think that the landscape is pretty confusing. And also important, right everybody in let’s say we it’s not even just for vanity, it’s still something that you want to take care of you go and you exercise and eat right you get routine bloodwork, you should probably also take care of your skin, not just on your face, but on your body.

Raquel Frisella  09:21

Absolutely. Yes. And so all of those acids that you were kind of spelling out. Those are all in one category. So in skincare we have different categories. You have your cleansers, you have your moisturizers, you have your exfoliating acids, and so salicylic glycolic Kojic acid, retinoic acid, those are all different kinds of exfoliating acids. And so each one kind of has its own specialty per se. So you know retinoic acid is going to be great for turning over skin cells and just kind of a gold standard for anti aging, wrinkles, texture, texture, pores. Kojic acid is amazing for evening out your skin tone. So if you suffer from some damage, melasma, PIH or PIE, post inflammatory hyperpigmentation, the little spots that you get that are left behind an acne mark Kojic acid is amazing. It just it’s like a little magic eraser wipes all that away cleans the slate. When you’re talking about salicylic versus glycolic, again, that’s where it’s just getting the education or the guidance as to what’s right for you. So those are your hydroxy acids, you have salicylic, which is your beta hydroxy acid, and then you have glycolic, which is your alpha hydroxy acid. And so when you look at those, they’re different. Because your salicylic is going to dive a little bit deeper into the skin, it’s an oil loving molecule. So that’s going to think of it going in and kind of cleaning out those pores, getting rid of acne, I lean towards salicylic, when I’m looking at acne prone skin rosacea, when I want anti inflammatory properties, salicylic’s amazing. Whereas glycolic, that’s a water loving molecule, so it’s going to work better on the surface of the skin. So I lean towards my glycolic, when I’ve got a patient in front of me with just really thick, or, you know, weathered skin, and we just really want to turn that skin over if they have a lot of trapped closed comedones. And we just really want to bring things out glycolic is amazing. So knowing what you’re treating is going to you know, help us determine what exfoliating acids should you be using?

Dr Lyon  11:21

And do you treat them? Would you stop the acids?

Raquel Frisella  11:25

Absolutely. And that’s where we have to build a tolerance. So when you’re starting out, I have people start with just one. And then as your skin becomes acclimated and you get used to products and you build a tolerance for them, we increase use and or we stack different acids together. So for example when I personally love to use and I personally use retinoic acid and Kojic acid because I love the benefits of a retinol. It’s a gold standard, it’s going to tighten my core it works

Dr Lyon  11:55

so so you should and not some. So it’s a retinol, right? And that’s prescription is it prescription only for the most part.

Raquel Frisella  12:02

Well, so, retinoid is sort of the umbrella in which we have retinoic acid and retinol. And so there’s a difference there. So retinoic acid, for example. tretinoin is a prescription. However retinol, something that I carry in my practice, it is prescription strength in its nature, but it is essentially over the counter. If I give it out in my practice, it’s a little confusing, but basically to keep it easy for you. retinoic acid like a tretinoin prescription, for example is pure vitamin A. So it is the acid in its purest form. It’s very strong, and it’s very harsh. For the right patient, that’s okay. But when it comes to retinoids, I always explain to my patients it is a marathon, not a race or a sprint, you want to go slow with it. Retinol is going to be a more I don’t like to use the word dilute because it makes people think it’s not as good but it is not as strong. It’s a the way it converts in our skin. It’s that it converts to that retinoic acid slowly over hours. So it’s not throwing that harsh dose, it’s like 1/10 of the dose you know, so it’s not so pure, it’s not so harsh and drying. And honestly, in the years I’ve been doing this in the 1000s of patients that I’ve helped, I can definitely say using a retinol for most is much more effective than using something like a tret our retinoid and that’s because less is more we can build a tolerance we can go slow over time and allow your skin to adapt when people use ret. Usually what happens is they’re not compliant. It’s so harsh. It’s so drying

Dr Lyon  13:46

and their skin looks worse. 

Raquel Frisella  13:47

Yeah, 

Dr Lyon  13:48

I think that I probably did that before I knew you. And I kept hearing all this. Oh, you should use this retinage. You know, this stuff is great. Yeah, I’m like, Oh my God, this looks terrible.

Raquel Frisella  13:58

Exactly. And then what happens is you’re like you get noncompliant, because like it makes me too dry. I don’t feel like dealing with it, you’re walking around with this red shaped dry skin, you’re irritated, it’s uncomfortable. So if you use a retinal, that’s amazing. It’s going to take a little bit longer, but in the end. So with retinals, I say you really need to give your skin about 12 weeks up to 12 weeks to fully adjust and that’s going to depend on your sensitivity. If you’re somebody who was super sensitive skin or with a lot of acne, it’s going to take you longer than someone with a thicker, more resilient skin just a couple of weeks. I mean, you’re gonna see improvement immediately. But to get those full results, it definitely takes a few months, and then it’s just maintaining, but with a great retinol just like taking it slow over time getting your skin used to it, then you can bump up the frequency, but you can definitely anti age your skin. It’s a gold standard. It’s gonna help with pores, wrinkles, texture, tone, and so that’s something that you can do from home to completely transform your skin

Dr Lyon  14:55

and it’s not going to make any it’s it’s not going to make anyone look worse. So 

Raquel Frisella  14:59

no

Dr Lyon  14:59

you start it and someone is like, Oh, you didn’t I didn’t look good. It was probably because it was just too high of a dose or concentrated.

Raquel Frisella  15:07

Yeah, too harsh. Yeah. So I would just take it slow. And there’s things that you can do as you adjust to exfoliating acids, when you’re first getting used to them, you can go ahead and put a little moisturizer on top, eventually, we want you to get away from doing that. So you’re getting you know, the most pure dose. But when you do neutralize the acidity a little bit with a moisturizer, it will help you build that tolerance. So you can kind of go slow with it. And you may start with your explosions just three times a week, then they’ll slowly you’re gonna go every other night. And then we’ll get you to a point where you can go nightly. But even when you use an exfoliating acid nightly, I still have all of my patients take one night a week, as an off night. And on that night, you won’t use any exfoliating acid, you will just use moisturizer and Hydrating Serum to really balance out your routine.

Dr Lyon  15:56

What about so we should every everybody should use that at some, like some part of their skincare regimen?

Raquel Frisella  16:02

Yeah, that’s one thing too, especially, you know, I deal with all kinds of patients that college students that are on a budget, you know, some people have other things that they like to use, that’s fine. But if you’re going to invest in you know, something medical grade, I highly encourage that to be your exfoliating acid because that is the piece of your routine that is very transformative. Yes, we want you having amazing cleansers and moisturizers and serums. But your acid, that’s your workhorse that’s going to change your skin. So everyone should be on some type of an exfoliating acid because we want to turn over skin cells. That’s the big thing. As we age, we slow and slow the rate of which we turn over new skin cells. So if you look at a baby, our younger ours are so lonely and perfect. You can’t even see a pore. But as we get older, our skin becomes more dull, because we’re not sloughing off those cells as quickly. So when we use an exfoliating acid, they all have that same effect where they tell dead skin cells on the surface to go ahead and slough off. So then our body regenerates and makes new ones so keeps your skin more bright.

Dr Lyon  17:07

And this is important again, you know, I think a lot of women are really interested in skincare, but it really should be universal. Men and women can benefit it’s probably something that they just aren’t thinking about as much but guys out there, trust me you need this

Raquel Frisella  17:23

Men should look and feel amazing. And there’s 

Dr Lyon  17:26

yes! 

Raquel Frisella  17:26

and I have a lot of male clients that love their skincare.

Dr Lyon  17:29

i It’s I’m so happy to hear that that men are getting onto the bandwagon

Raquel Frisella  17:34

getting more popular. When I first started doing this 13 years ago, there was definitely not as many men walking through the doors. It used to just be wives pulling their husbands in but actually I had a scenario recently that was cool. The husband has been coming in for a long time now. And he finally just got his wife to come in. So that was cool

Dr Lyon  17:53

That’s amazing. So I want to talk also about so you’ve got the acid and what about sunscreen? Is that a key? Yeah, everyone needed because there’s a whole host of conversation about don’t get sun, get sun. 

Raquel Frisella  18:08

I know 

Dr Lyon  18:09

I mean sunscreen mineral versus

Raquel Frisella  18:11

I guess it is 2022 and everything is controversial but,

Dr Lyon  18:15

wasn’t like that before, right? 

Raquel Frisella  18:17

Yes! 

Dr Lyon  18:17

the last 10 years probably. There hasn’t been a lot of controversy about should you use sunscreen or shouldn’t do

Raquel Frisella  18:23

yes and truly I firmly wholeheartedly believe everyone should use SPF every single day. Sunscreen does not cause cancer you know is it prevents cancer and that’s the main reason honestly for using SPF daily is we know now in 2022 the risk of skin cancer and so to keep your skin and your body healthy you need SPF and then second to that of course the anti aging benefits are huge. Sun is truly like the number one thing that causes aging, photo aging. So even when you’re driving in your car, the sun coming through your window is aging your skin so that causes wrinkles, it causes sun damage, it causes laxity, it eats away at our collagen. So SPF not only will it protect you from cancer and you know from getting sick, but it’s amazing for aging. So

Dr Lyon  19:11

What number SPF do you typically recommend?

Raquel Frisella  19:13

I use every day of 40 and so you know in theory, the higher the SPF, the longer you can go without needing it. But I really recommend that people reapply their sunscreen every two hours when they’re in the sun if they’re in the sun. Yeah, if you’re gonna be at work all day and you know you’re not necessarily in this in the sunlight, you’re okay if you don’t reapply as often. There are things you can do that can make application really easy like we have awesome powder kinds now that you can just kind of swipe on throughout the day. But if you just do in the morning, you’re done you’re protected. But if you’re on vacation and you’re gonna be outdoors and you’re at the beach or outside with your kids, you really should reapply every two hours so that you are ensuring that you’re protecting yourself.

Dr Lyon  19:54

Do you think that the sun or the the lights that were under make a difference? Do you think that the lights even if It’s indoors. Does that? Do we know does that affect the skin?

Raquel Frisella  20:02

Well, in theory through windows and things like that we shouldn’t be getting the UVB rays, but you definitely still could be getting UVA rays. So I think that, you know, at some point, if even if you’re inside, you probably are going outside to get inside your drivng

Dr Lyon  20:17

lights and the lights overhead. That doesn’t seem to impact aging, you don’t think?

Raquel Frisella  20:22

not the way that the sun does now. Yeah, I think as long as you are, you know, protecting yourself with your SPF, you’re protected throughout the day as well.

Dr Lyon  20:30

And in terms of mineral versus synthetic, is there a difference? Or is

Raquel Frisella  20:35

Yeah, that’s one of the big debates chemical versus mineral sunscreen. And, you know, my opinion is, I think that there is a so to break it down mineral sunscreens are going to be your sunscreens that have titanium dioxide, and zinc oxide, those are kind of known more for reflecting the sun off up your face. Chemical sunscreens are going to contain chemicals that, and this is where it gets tricky. When you hear the word chemical, some people think that’s a bad thing. But I’m like, chemicals are not all bad. Everything in moderation, right? So contains a small percentage of chemicals that will absorb those bad rays. And they’ve essentially turn them into heat and get them off your body. So they’re just two different ways of protecting yourself from the sun. And so I think if you’re somebody who’s really, really concerned with the chemical ingredient, and it’s something that bothers you then just use a mineral sunscreen. So I think they’re, you know, I see people’s point there, why they would maybe not want to use a chemical sunscreen, but again, in my professional opinion, with the small amount that we use everything in moderation. I think it’s doing more good than bad. And I think it’s totally fine.

Dr Lyon  21:41

And would someone just would you say the best case scenarios to cover up and the places that you can’t cover up? You should use it?

Raquel Frisella  21:48

Absolutely, yes, if you are, you know, fair skinned and you are going to be in the sunny Australian sun all day, you should be wearing a long

Dr Lyon  21:55

You shouldn’t go. 

Raquel Frisella  21:57

You know, cover your body as much as possible hats, you know, sunglasses, especially if you’re melasma prone or you have pigment on your face. Sunscreen is great, but you still need to cover from the sun as much as possible.

Dr Lyon  22:09

Let me ask you this, the, the shade of the skin, does that make a difference between how much sunscreen that you need? Or in terms of wrinkle resistant or sun protective?

Raquel Frisella  22:21

Yeah, no, that’s a good question. And so the more melanin you have in your skin, so the darker your skin is naturally, technically the you are a little more protected from the vulnerabilities of the sun. So you’re more fair skin types, you are at a higher risk for you know, photo damage, skin cancer, things like that. But that doesn’t mean that you shouldn’t wear SPF because you’re darker skin, because you’re still you still can get skin cancer, it’s just not as likely, but also to think about anti aging so and just the appearance of your skin. I have many dark skinned clients who suffer from pigmentation issues melasma hyperpigmentation and hypo pigmentation. So in order to prevent that, if you want that flawless clear skin, you definitely need to wear SPF, regardless of your skin color.

Dr Lyon  23:09

You bring up a really interesting point. So there’s the hyperpigmentation and that would be things like melasma what else? Is there anything else?

Raquel Frisella  23:17

Melasma PIH, which is postinflammatory hyperpigmentation, and that’s when if you have acne, or any kind of injury to the skin and it leaves behind those little dark spots, a lot of people deal with that. And then there’s just your freckles, sun damage, things like that.

Dr Lyon  23:33

And you said something interesting, it hypo pigmentation and are you talking to you? Is that would that be like vitiligo or are there other things that cause hyperpigmentation,

Raquel Frisella  23:42

a lot of times it’s injury of some sort, that will strip the skin of melanin and then you are left with white spots. And the hard thing about that is once that happens, there’s usually no coming back from that hypo pigmentation. It’s really difficult to treat. But what happens is if you have spots of hypo pigmentation, and then you get a lot of sun, the skin surrounding those areas get really dark and it makes the hypo pigmentation look worse. So to keep your skin even, you have to protect the parts that aren’t hypo pigmented, but hyperpigmentation can happen from injuries. Some people are born with it like bettaligo, things like that. So it’s not as common as hyperpigmentation

Dr Lyon  24:23

So there are there are treatments for both the hyperpigmentation and the hyperpigmentation.

Raquel Frisella  24:28

Yes, and the biggest thing is going to be SPF and then topical correction. And then we also do have some lasers that work really well to lighten the pigmentation

Dr Lyon  24:39

And lasers are amazing. And I think that people don’t talk a lot about that you don’t really hear it is just so frequently. You guys do lasers here. Are there particular lasers that you think that everybody should do at least once or twice a year for

Raquel Frisella  24:55

Absolutely. I’m a huge proponent of lasers. And so when I have a patient come into my chair or, of course, I’m doing, you know, their injectables and their skincare. But I also refer pretty much all of my patients over to our esthetician to had our laser department. And I try to incorporate laser into everyone’s skincare plan, because it’s so amazing for just overall skin health. So lasers are going to well there’s so many different lasers and how to actually really

Dr Lyon  25:21

It’s actually really confusing!

Raquel Frisella  25:24

It’s the common theme here. So there’s a lot out there. So it’s confusing, but it’s all about, you got to find a provider that you trust who can help guide you what is going to be best for you. So a couple of gold standard lasers and ones that we have here as BBL, our IPL that is my favorite has been around forever and it truly is the gold standard for hyperpigmentation.

Dr Lyon  25:44

And what does thast stand for? that the Broad

Raquel Frisella  25:45

broadband light or intense pulsed light, they mean the same thing, you’ll also hear it called a Photofacial. But that is basically where we use a filter and different wavelengths of light, it’s going to travel through the skin and pick up on the pigmentation. So for example, if we’re trying to get rid of sun damage, that laser is going to be able to see the dark spot against your natural melanin and pull that dark spot up and out of your skin. So it’s a way to even your skin tone. And what will happen is we’ll treat the face and all of your pigment will get really dark and peppery for a few days and then it falls off.

Dr Lyon  26:18

So don’t do that before a big event.

Raquel Frisella  26:20

Any kind of laser any kind of aesthetic treatment, I recommend doing at least two to four weeks out from your events.

Dr Lyon  26:28

So what are the other Lasers?

Raquel Frisella  26:30

I love so I love my IPL BBL for evening your skin tone.

Dr Lyon  26:33

And how often do they do that?

Raquel Frisella  26:34

So when you’re just starting out, if you have a lot of pigment, or goals that you’re trying to reach, you may need a series typically that’s going to look like three treatments spaced about four weeks apart. When you’re doing maintenance, you’re going to come in like once a year for that. So and that’s with all skin health, I related a lot to to working out one treatment, one workout, you’re not going to be ripped, you have to if you’re you you’ll be ripped. But you have to commit to the process. So you have to keep you know doing your due diligence you have to be consistent with your skincare at home, you have to be consistent with your maintenance plan. So coming in and getting that annual laser for skin health. You know getting your injectables every few months, doing your skincare at home those things are all going to add up over time and you know allow you to have the best possible skin year round. But back to your wish with the lasers. I also love the v beam

Dr Lyon  27:27

What’s it called? 

Raquel Frisella  27:27

that’s another gold V beam beam. That’s another gold standard laser been around for forever. And that is really the best laser for redness, rosacea, broken vessels, anything like that. So if you’re dealing with reds in the skin, broken capillaries rosacea and the anything inflammatory It’s an amazingly different

Dr Lyon  27:46

And how does that laser work?

Raquel Frisella  27:49

So it targets the Oxy hemoglobin in the blood. So it will pick up on redness and kind of pull it out of the skin. So it’ll also treat it’ll kind of cauterize little vessels. So if you have little broken vessels on the skin or by the nose that will get rid of those as well.

Dr Lyon  28:04

And I’m sure the listeners thinking, oh my gosh, you know, does this hurt? And if so, is there concern about the provider doing it? Because it just seems lately that there’s so many med spas? And I don’t know how hard it is to acquire laser if they require training? But, do you need to be concerned with the capacity of the provider?

Raquel Frisella  28:25

Yes, for sure. And so it not all of these things, you know, a laser is a little bit painful, but there’s definitely comfort measures that we take. We use numbing cream, we use ice and fans, and we keep you so comfortable. So it’s over before you know it, but I’m not gonna lie and say it’s completely painless.

Dr Lyon  28:43

Oh, come, on, guys, toughen up, man is

Raquel Frisella  28:46

beauty is pain. So

Dr Lyon  28:50

on the spectrum about everything, it’s it’s it totally doable.

Raquel Frisella  28:54

It is and a good provider will help you stay as comfortable as you can during the procedure. But yes, it totally matters. And I always say with, with an injectable with a laser, the treatment that you’re getting is only going to be as effective or as amazing as the hands that’s holding it. So you know, lasers are very powerful. And so we need to make sure that the right settings are being used that the way that that laser is used is going to be totally different on someone with dark skin and light skin. And you know, it depends on your skin type, your skin tone, all those things we take into account. So it needs to be someone very educated, who’s not going to burn you or cause injury or make your skin worse. And so that’s where it comes to vetting a really great aesthetic provider. And there are places out there. You know, honestly, Instagram is an amazing tool. There’s a website called Real self.com It’s a forum where you can vet providers, and you just have to do your due diligence and word of mouth is huge. Find providers in your area and do your research. Make sure their experience that they been doing it for a long time. Look at their before and afters, you know, you want you This is my big thing, you never want a Groupon your face. If there is like, 

Dr Lyon  30:08

Did you say you never want a Groupon your face?

Raquel Frisella  30:10

1,000% I cannot explain to you how many people will be like, Oh, well, this laser is $100 How amazing that should be a huge red flag 

Dr Lyon  30:18

Got it. Got it 

Raquel Frisella  30:19

an amazing provider will not be Grouponing their services you’re paying, you’re not paying for the laser, you’re not paying for Botox, you’re paying for the years and time that that provider has poured into their education and their experience and becoming the best provider that they can be. And so you’re really, you know, amazing professionals out there are not going to be the ones doing Groupon deals and all this stuff, you know, so you just have to really pay attention to where you’re going. And it definitely matters you know, your safety is A number one and in our practice here like that is that always comes first patient safety and so we want great results, but we have to keep you safe first

Dr Lyon  30:57

and then after the VBeam what’s next.

Raquel Frisella  31:00

Okay, next will be a resurfacing type,

Dr Lyon  31:03

which I’ve actually I’ve done that.

Raquel Frisella  31:04

though. Moxie, right. Did you do that? I did.

Dr Lyon  31:06

I did. I’ve done a Moxie laser, which I only did because you told me to do it. Yeah, I did it locally where I am. And then I did a co2 fractal which by the way, I looked like.

Raquel Frisella  31:19

Pretty good. 

Dr Lyon  31:20

Yeah. Yeah. That was intense.

Raquel Frisella  31:23

Yeah. So both of those I love and it depends on how aggressive you want to go. But a resurfacing laser is going to be the kind of laser that you go for when you want overall texture, you know, improvement in texture of your skin and it kind of like an overhaul for you skin.

Dr Lyon  31:38

is aMoxie a newer laser.

Raquel Frisella  31:39

Yeah, it’s newer. It’s been around for a few years. But it is such an incredible technology. We have it and we use it all day every day.

Dr Lyon  31:45

How does it work? I don’t even know how it works. I just did it because you told me Yeah, I mean,  I take direction, well, yeah, yeah.

Raquel Frisella  31:51

You’re amazing. Um, Moxie targets the water molecule in the skin. So it’s a really neat technology because all skin types can can get Moxie. So with certain lasers, darker skin types can not get it done. But Moxie all skin types, which makes it really cool. It’s great for melasma because of the way it targets the water and not the melanin it doesn’t heat it up. So we can actually treat melasma, which is really the only laser that I recommend for Melasma is Moxie. And that’s not because we haven’t here, it’s truly the only technology out there that is good for melasma. But it also resurfaces the skin. So think of it as like a shrink wrap like effect on your pores and your texture and it’s just amazing gives a great collagen boost. And that’s the thing with a lot of these lasers, they’re going to stimulate collagen growth and production. So when we injure our collagen with heat, your body’s response to that is to build it back up bigger, better, stronger. So you get a collagen boost, you’ll see that initially after a couple of weeks, you’ll get a little glow. But that collagen building keeps coming for weeks and months to come post laser. So Moxie is going to be one that you can do for resurfacing that’s on the less aggressive end in terms of downtime, you’ll be you know, you probably were a little rat a little swollen, but you can throw some makeup on you can kind of see and this is for everybody, right? Everybody could benefit from honestly, pretty much everybody could benefit from Maxi I mean, there’s going to be the exceptions to the cause. But Moxie is a pretty well rounded laser, 

Dr Lyon  33:15

Will you say it’s safe?

Raquel Frisella  33:16

very safe when when in the hands have the right person it’s a safe place for all skin types. It really is co2 is different, that is very, very aggressive and 

Dr Lyon  33:26

VERY aggressive 

Raquel Frisella  33:28

and only good for certain skin types. You know, very dark skin should not get co2, someone with a history of you know, hypo or hyperpigmentation should probably not get co2 There’s we take a very thorough and take for co2. It’s a big downtime, you’re looking at 10 to 14 days, burn victim status, it’s it’s intense, but if you’re someone that really needs an overhaul,

Dr Lyon  33:51

And who would need and who would need so is Fraxel just the brand name, or is it called a co2 resurfacing

Raquel Frisella  33:58

Fractial is a fractionated laser. So kind of in that same category, someone that needs that is going to be your more mature skin. Somebody who has a lot of laxity, fine lines and wrinkles, who just really wants to kind of turn over skin cells and just maybe it’s that person that just hasn’t been taken care of their skins like I need the big guns, you know. So if you’ve been doing really really good with your maintenance treatments along the way, you can save that for later. It’s honestly nice. A lot of surgeons will pair co2 with a facial surgery, they can recover all at once, but more mature skin more for wrinkling things like that. Some people will do co2 for acne scarring, but it’s just one thing to do for acne scarring, acne scarring is so hard to treat and I tell patients you’re only gonna get about a 50% improvement with co2 and acne scarring.

Dr Lyon  34:46

That’s um, that is important to know right? So that way you’re kind of laying what the potential is for improvement. This episode of The Dr. Gabrielle line show is brought to you by first form I want to highlight call ajan I’m sure you can guess why because this is an episode on skin and skincare. Collagen is not great for building muscle but it sure is great for skin and first form has a low temperature processed hydrolyzed collagen. It’s very high quality, very bioavailable, they sourced five different types of collagen. And I am telling you, it has a very diverse profile, you can mix it in anything, I mix it in coffee, sometimes I’ll throw it in a yogurt or cottage cheese. I love this, it has 50 milligrams of dermavall in it. And this is a Phyto nutrient rich complex. And the goal of it is to help maintain healthy levels of elastin in the body collagen is a great building structure. While elastin is responsible for the elasticity and firmness of the skin. There is only so much you can put on topically you have to get the rest internally need to have a diet rich and fatty acids, collagen, we definitely don’t eat enough of it. So adding it in really can help the effect on the skin definitely is in the science. And I really, really appreciate it I think you will too. Head on over to first form that’s one st P H. O R m.com/dr. Lyon. They have different flavors, I go with the natural collagen. I’ve been doing that lately. I know that you’re gonna love it, and they’ve got the best customer service on the planet. Thank you to insidetracker for sponsoring this episode of the show, head on over to inside tracker.com/dr Lyon right now 20% off for anything in the store. And why do you care about this because you care about what’s going on inside the body. Especially if we’re talking about skin health. Skin Health is definitely related to Hormonal Health as well as inflammatory markers is really important to know what’s going on inside hence the name insidetracker. It provides all your personalized information, a plan to improve your metabolism, reduce stress, even improve sleep. It’s created by leading scientists in aging genetics and biometrics inside tracker analyzes your blood DNA and even fitness tracking data. In fact, I have many patients that choose to go to inside tracker and get bloodwork and then bring those results to me. We love it. And it’s important to know what’s going on. And for a limited time only you’ll get 20% off the entire insidetracker store. Just go to insidetracker.com forward slash Dr. Lyon. That’s insidetracker.com forward slash Dr. Lyon. When I did the the Fraxel I really wanted something that was going to work fast and not have a ton of maintenance. Right? So you can do it once and from what I understand you have to do it for a couple years. If you ever do it again. I don’t know if I’ll ever do it again.

Raquel Frisella  37:50

I know. It’s kind of like having a baby you have enough time goes by and you’re like yeah, I’ll do that again

Dr Lyon  37:57

In terms of acne, what are some of the biggest causes of acne? You know, guys always ask about back acne, hormonal acne, how do you treat it? Both? I do recommend Spironolactone which is oral Is that something that you guys use? Are there more topical type treatment

Raquel Frisella  38:15

Acne is so it’s so tough. It’s it’s a, it’s a four letter word that’s like a punch to the gut. It’s just acne is so debilitating for so many. And I’ve watched so many patients that really just ruins their confidence. And I hate acne so much. But it’s tricky to treat because it depends on is your acne inflammatory? Is it non inflammatory? How inflamed is it and that’s going to dictate which products we’re using. But really finding the cause of acne is so important. And so that’s probably where Dr. Gabrielle you help so many people with gut issues, diet stress, all of those variables that lead to acne, there’s we can help a lot on this side of things with treating it and making it go way faster and helping with some of the residual effects. But a lot of times we are trying to direct people to figure out okay, what are what’s going on with your diet? How clean is your diet, how is your gut health like lifestyle, those pieces matter so much if it’s coming with hormonal acne, like birth control is it 

Dr Lyon  38:15

Doesn’t birth control help the acne or? 

Raquel Frisella  38:28

you see it both ways. You see it almost like a bandaid for some and then the minute they come off the birth control it goes crazy. And it usually takes people three to six months after coming off of a birth control or any kind of hormonal agent to like re you know, level out. So hormones can definitely play and play a role and depending on the time of your life, if you’re pre menopausal or you know you’ll see changes in your skin with those things. So depending on the cause of the acne, it will also help us dictate how are we going to treat this acne.

Dr Lyon  39:47

So what are some of the top treatments for acne or even be one you know, I take care of a lot of women and maybe they’re Peri menopausal or menopausal and they’ll be they’ll say to me, How am I having acne right now I haven’t haven’t since I was a teen, what would you do with them,

Raquel Frisella  40:02

they need a good skincare plan. So if it’s that hormonal acne that’s coming up, you know, cyclic, cyclical with their, with their cycle, they need just to be on a really good skincare routine so that they are exfoliating and hydrating properly at all times. And that will really cut down on the breakouts and it will cut them down and it’ll make them go away faster when they do come. And so good skincare will kind of Curb acne in that way, in terms of like a Spironolactone and things like that. Sometimes your dermatologist might put you on that if you’re having a lot of cystic acne and things like that. But we try to avoid people needing that if we can with topicals first and then we use that as more of a second line of defense. Same with Accutane, we try everything we can before people go to prescription drug, an oral drug that makes sense.

Dr Lyon  40:49

So for hormonal acne, the best way to do it is to do one of those exfoliating agents would that be salicylic? Acid?

Raquel Frisella  40:56

Yeah. salicylic will be an amazing choice. We have you know, like weekly at home treatments that you can use with medical grade skincare getting regular facials is very helpful.

Dr Lyon  41:04

They help because people always Yeah, facial is just to make you feel good, but

Raquel Frisella  41:08

not not a good medical facial. So if you go to like a spa like four seasons, and trust me, I love doing this too. That is definitely going to be more like oh, let’s get pampered and wash our face. This feels so good and relaxed.

Dr Lyon  41:21

Are you kidding me? the idea of pampering is like don’t touch me Leave me in the hotel room. 

Raquel Frisella  41:25

We were just talking about this!

Dr Lyon  41:26

no children. No just like. I am not coming out of this hotel room. I just wanna watch a movie in order room service. I would feel totally serviced.

Raquel Frisella  41:34

you’re talking in my love language right now that sounds dreamy. But yes, those kinds of facials, you’re right, those are more pampering those are feel good facials. If you go to a medical practice that is more treatment based like hey, this facial the goal is anti aging or the goal is to help me with my acne or my rosacea, that that facial is going to be more geared for skin conditions. And so within that facial, there’s a lot of treatments going on. There might be peels going on extractions, chemical treatments. So there’s things that we’re doing to treat and prevent acne and things like that.

Dr Lyon  42:09

One of the listeners asked about a chemical peel they asked Do they work? Is it used under the eye? Is it used all over the face? How do you know what to ask for?

Raquel Frisella  42:20

Chemical peels are amazing. That would definitely fall wonderfully in the acne category are acne patients. Typically we do have on a series of chemical peels. And it’s going to depend on what you’re doing your appeal for but pretty much everyone out there can benefit from a  peel at some point. And what appeals is going to do is exfoliate your skin so it’s going to slough off that outer layer of dead skin and it’s going to kill bacteria. You know acne is going to brighten you up, it’s going to get rid of that dull skin and polish your skin. So how aggressive do you want to go that’s up to you. If you’re like I want to do this huge, crazy peel, you’re going to be peeling like a snake for like seven days. If you want to do a lunchtime peel, you could come in and get just a very light peel where you don’t actually even peel from that but you’re still going to reap those benefits it’s going to tighten up your pores it’s going to give you a great glow. So if you’re somebody dealing with acne getting on a series of regular peels will actually purge some of that old gross acne out of your skin.

Dr Lyon  43:17

That’s interesting. So it does take a bit of work 

Raquel Frisella  43:19

Yeah, 

Dr Lyon  43:19

are you ready for the number one okay, I want to know the I’m putting you on the spot here number if I can read my doctor writing nobody else can read me the decoder ring. The number one thing you should avoid when going to the drugstore for skin

Raquel Frisella  43:35

Oh from the drugstore. I would say anything with like, be careful with those I feel like right now masks are super hot. I just think it’s ike a trend.

Dr Lyon  43:44

I may or may not have about 10 in my bag.

Raquel Frisella  43:48

Masks are really popular right now. You know skincare comes in trends and in waves too. And so I’m seeing a lot of those crazy like jelly masks and stuff like that. And I would say just be careful with that kind of stuff because although it’s fun, that stuff just sits on the surface it doesn’t really penetrate and it causes a lot of irritation. So you know just dermatitis irritation, rashes and just aggravates your skin so then when you go to do your skincare routine or use good products, you’re almost like working against yourself. So just keeping it simple and try not to add those fluffy things in. The other thing I get so crazy about that patients get from the drugstore are those dermaplane blades that they do themselves and I’m not a fan of any kind of little at home devices like the at home rollers or blades or anything like that

Dr Lyon  44:29

Which I did get the roller I think I sent you a picture of that 

Raquel Frisella  44:33

I think I was like NO! 

Dr Lyon  44:34

that’s exactly right in areas just playing with I’m like oh god, we’re just

Raquel Frisella  44:37

Be careful with those because a lot of times they just cause irritation they introduce bacteria. They’re not really doing what you want, like people want a good dermaplane Or a good needle and

Dr Lyon  44:48

But I will show you the Tik Tok videos with them all make it look like it’s amazing.

Raquel Frisella  44:52

That’s why tik tok and all these videos are a blessing and a curse. It’s a blessing because I love that people are getting educated but then they see some crazy stuff and then they try to go do it

Dr Lyon  45:00

anything invasive at home, don’t try the derma planing the derma rollers, what about what is the most important thing you should get from the drugstore?

Raquel Frisella  45:08

That’s a great question. And something I have all my you know, instruct all my patients, if you medical grade skincare is more costly, it is an investment. But I will tell you less is more and you don’t need a lot of it, you get to use it very sparingly. So a little goes a long way. Typically the products, you know, should last you three to five months. But with that said, maybe you’re going to have some of your routine that’s medical grade, and some of it’s not. And if it’s not, I recommend keeping the things that you can very basic so cleansers and moisturizers from the drugstore are perfect. When you do Cetaphi, Cerave or baniwash. Those are my three top recommended drugstore brands because they’re very vanilla. And what I mean by that is there’s not any junk in them. They’re clean. They’re basic, they’re going to do a great job of cleansing and moisturizing your skin without irritating which hair. 

Dr Lyon  45:55

Which is the goal right? You don’t need to have a big fancy cleanser. Yeah, if you’re just trying to keep your your skin clean. It’s not like the exfoliant, which seems to be much more important. Exactly. So what about moisturizer?

Raquel Frisella  46:08

From the drugstore? or just in general, I would say from the drugstore stick with those Cerave, cetaphil, or 

Dr Lyon  46:15

so they’re also moisturizers?

Raquel Frisella  46:16

cleansers and moisturizers 

Dr Lyon  46:18

Okay, got it. 

Raquel Frisella  46:19

The difference in a medical grade moisturizer is going to be they’re going to hydrate you just like those drugstore ones will but they contain the anti aging components. So ours are going to have medical grade moisturizers are going to have highly euronic acid in them that plumps and hydrates an anti aging of the skin. It’s going to have peptides, cholesterols fatty acids, things that really just nourish and anti aging along with hydrating.

Dr Lyon  46:44

How long would you use these products before you know how before you know if they’re working or you should switch? Do people talk about skincare holidays or I use this conditioner and then I had to switch it in a month. You know, I’ve used this skincare for two months. And then I want to switch it How long does it take for someone to know if it works. 

Raquel Frisella  47:01

So, you have to be patient. And consistency is key with all skin care. And some products you’re gonna see Honestly, after one use like an at home peel pad or something like that, you’re going to notice a difference the next day. So you’ll feel some of them more than others right away. But on average, I would say a good two to four weeks, you’re going to really see some great change. But to reach goals, you really need eight to 12 weeks of consistency. So I tell people don’t change it up too much. Sometimes you have to get through purging, you have to get through shedding of dead skin and stay consistent to your plan so that you can really see the real results. And then once you’re you know acclimated to those products, then you can shake things up, add things, change things, whatever, but you don’t want to change too much in the beginning.

Dr Lyon  47:44

So that’s actually a long period of time. That’s about three months.

Raquel Frisella  47:47

Yeah, I can take people through once, especially if you’re an acne sufferer. And you’re, you know, you’re gonna see some it looks worse before it gets better. It’s gonna pull some of that acne out. And so that’s where my acne people, they always want to throw that, Oh, this isn’t working for me. Like no, no, this is a good thing. Keep going, give me 12 weeks and then my 12 weeks like, This is amazing. I love this so much. I can’t believe I must quit.

Dr Lyon  48:08

That’s like how it is with my patient. If you’re my patient, you better not be doing that. In terms of how long they can actually stay on that before they should switch it up. Does the skin actually get acclimated to a particular routine where maybe it becomes ultimately less effective?

Raquel Frisella  48:24

Yes, you can plateau. And so if you get to a point where you’re like, I just feel like nothing’s changing, I’m feeling kind of dull, I need to shake things up, then we need to maybe switch products up increase the intensity of the way you’re using it, stack products, things like that. And then also we take into account the time of the year because your skincare routine might change a little bit so in the winter, just you know by nature of things we’re going to be a little bit more dry the heaters are on the air is more dry. So you need more hydration. So we’re going to change things with the season and then as you plateau.

Dr Lyon  48:56

Do you think that hydration makes a big difference like oral hydration in skin? 

Raquel Frisella  49:00

Oh yes, 

Dr Lyon  49:00

it does

Raquel Frisella  49:01

so much, so much and more. So please do as I say not as I do. I am the worst water drinker ever. I’m trying to be better. But you have to drink so much water, you will notice a noticeable difference, especially in your under eye area. I mean, when you’re dehydrated versus hydrated, your skin naturally is going to be more plump.

Dr Lyon  49:20

And what about alcohol does it

Raquel Frisella  49:23

big time!

Dr Lyon  49:24

Because I’m just oh it’s so controversial now about alcohol but again, we’ve said that we are now in 2022 and everything is very it’s controversial. What about alcohol?

Raquel Frisella  49:33

Alcohol will do a number on your skin too. And I’m not talking about like if you have a glass of wine at dinner, I don’t think you’re going to see too much there but if you’re consuming alcohol regularly, your skin will be more dehydrated. And you’ll also just struggle more with issues in volume on the face when your hydration levels change like that. Particularly the under eye area. We have a malor fat pad here and so that’s I get a lot of that where patients come in and like somedays my eyes look horrible something They look good. And as a lot of that has to do with the fluctuation of your water, how much water you’re holding on to, for example, if you have, you know, margaritas and Mexican food like I’m puffy the next day does that by my rings are tight, my eyes look a little puffy. And then when you’re eating super clean, you’re gonna notice less of that. So water  intake is definitely it matters.

Dr Lyon  50:21

What about the topical vitamins, vitamin C, vitamin E, we talked about vitamin A, or do those make a difference?

Raquel Frisella  50:28

Yes, big time. Really, everyone should use a vitamin C, and a lot of the vitamin C serums are going to have the vitamin E in them, they’re usually combined. But that is just a great staple for a skincare routine. And it’s for overall skin health. So with a vitamin C serum, it’s kind of different than an exfoliating product where when you use it, you may not necessarily see what’s happening right away. But you have to trust the process and know that it’s working inside your skin. So vitamin C in by topical vitamins in general are going to really protect you from the sun, it kind of builds your own natural UVA and UVB protection inside your skin. And then the big thing they do is they fight off free radicals. So pollution, smoking, alcohol, just environmental dangers, all those things that make those little unstable molecules it fights that off. So it keeps you healthy from cancer and just anti aging and all of those things. So it’s a way to really keep the inside of your skin healthy. And with vitamin C, the big thing to know about that, that’s another one where when you asked about drugstore, I would not do a drugstore, vitamin C, a lot of those types of vitamin C’s are not going to penetrate. So a medical grade Vitamin C is important because with vitamin C formulation is key. It’s a very unstable molecule molecule. So in order for it to get into your skin, it has to be made stable through the formulation of the product. So there’s certain ways we formulate a vitamin C, to make sure that it actually gets into the skin and you’re getting the full dose. And so a good vitamin C, you want to look that it has a high percentage of vitamin C, like 21%, or more vitamin E, verulic acid. And a little verulic acid is just another one of those brightening acids and it’s going to help with skin health. And then it’s also just going to brighten your skin and that’s going to pair and help the vitamin C to penetrate into the skin. So when we pair things with an acid, the acid is kind of like the vehicle that will drive it deeper into the skin. And that’s why I loved for half my retina users also use it with vitamin C and help drive it into the skin

Dr Lyon  52:36

Do they use it together? Or do they have to wait a couple of minutes? Does it cancel each other out? does it decrease the potency if you’re taking it

Raquel Frisella  52:42

I say it’s kind of like peanut butter and jelly, they go together really well. 

Dr Lyon  52:46

So that sounds good. 

Raquel Frisella  52:48

You can separate them and that’s okay. But I like to have my patients do your retinol and then put some vitamin C serum on top or vice versa you can there’s really no right or wrong way. And that’s where a lot of people get hung up to with skincare. Some of it’s just trial and error on your own skin, you have to see what you like. There are certain rules to follow thin to thick, clear to cloudy when you’re layering products, but I always remind people your skin has no idea what time of day it is. So if you prefer vitamin C at night versus morning, that’s totally fine. You know, just kind of pairing it in there.

Dr Lyon  53:20

Okay, just curious how many times a day should someone actually wash their their face.

Raquel Frisella  53:25

Um, it depends on how your day is going. But one for sure, maybe two, maybe three. So before bed, everyone should wash their face

Dr Lyon  53:34

Really? I mean, I’m just thinking maybe there’s a skin microbiome that we just leave as is

Raquel Frisella  53:41

well if we weren’t putting makeup or anything on her face, but you have to think if you go all day long, just from outside the air is dirty. So we’re our skin is not cleaned by the time you’re going to bed. So and this is we’re talking about a gentle cleanser. So just a nice gentle cleanser nothing harsh just to simply clean your skin off from the just the junk that might be sitting on top and for us women especially who wear makeup, we have to do a double cleanse at night. So the first cleanse is just simply think of it as just getting the makeup and just the layer of of junk off the skin and then you’re gonna pat dry and then the second cleanse is actually the deeper cleanse that’s really cleaning your skin and it’s going to prepare your skin to accept all the products you’re about to put on.

Dr Lyon  54:24

I have not been doing that. 

Raquel Frisella  54:26

Okay, now you’re gonna do double cleansing

Dr Lyon  54:29

people always ask me about cellulite and stretch marks. What do you got for me?

Raquel Frisella  54:33

Hot topic, they’re very hot topics. Okay, so my stretch mark answer is not doesn’t make people happy. But there’s no cure or magic remedy for stretch marks. Stretch marks are extremely genetic, extremely familial. So if your mother or grandmother had stretch marks through pregnancy, or maybe like a huge weight loss change, it’s possible that you could have them to it’s more likely not necessarily, you know, factual but you can and have them.

Dr Lyon  55:01

Do you ever see that and guys stretch marks from growing?

55:04

Yes, I should have mentioned that too. Yes, it’s just definitely a genetic component. There’s a tie. They’re not always. But with that said, there’s no cream, there’s no treatment that we offer like needling or anything like that. That’s just gonna get rid of them to be honest and so

Dr Lyon  55:19

Interesting, because that’s what I’ve read is needling would be the

Raquel Frisella  55:23

needling would, the one if you were to say what’s one treatment you could do, it would be needling 

Dr Lyon  55:28

That sounds so painful. 

Raquel Frisella  55:30

It’s not that bad. It’s, it’s, it’s honestly not It feels more like a vibration than anything. It’s a little pen and the tip oscillates very quickly. So the little needles make little micro focused injuries that will then build collagen, does help with scarring could lighten stretch marks, but it’s not going to erase them the way people think that they will. So with aesthetic procedures like that, we have to really set clear expectations, like maybe give you some improvement, but definitely not perfection. And so really the only way if you have stretch marks, you know, in a certain area from pregnancy or weight loss and you really want them gone. It really requires surgical excision. And so that’s where you know, a plastic surgeon can do and abdominoplasty and remove some of that skin.

Dr Lyon  56:09

Yeah, that’s interesting. I had a mentor and a really good friend, his name is Charles Poliquin. And he created this. I don’t know if it was the sub supplement formula of removing stretch marks over a period of time and I swear some people say yeah, this totally works and other people are saying, you know, it’s there’s nothing that you can do for stretch marks.

Raquel Frisella  56:29

Yeah, I feel like if I knew of it, if I knew of something that really worked, I would, I would have a line out the street right now. 

Dr Lyon  56:36

What about cellulite? 

Raquel Frisella  56:37

Cellulite can be improved with certain aesthetic procedures. And again, with all these things, it’s improvement, not perfection, but Cellulite is another one that is very genetic. And I’ll have people come in that are this teeny, tiny and they have cellulite. So it’s not always something that has to do with weight per se. But that can definitely be a factor

Dr Lyon  56:56

And it’s not magic fat, right? It’s not some kind of 

Raquel Frisella  56:58

No, it’s just normal fat, it’s the fibers. So if you look at what Cellulite is, we have little fat pockets. And on on the side of the fat pocket, there’s little fibrous connective tissue, think of them as like rubber bands. And then once that fat pocket is full of fat, the rubber bands, the sceptic get pulled down under pressure. And so where they’re pulled down, you see that dip in the skin or that dent. And so Cellulite is more so the kind that you could like, kind of stick your thumb in and see that it’s like a little denture spot. And that’s a cellulite dimple. So those we do have some aesthetic treatments, there’s no topicals that will reduce that what you have to do is you have to either release those bands,

Dr Lyon  57:37

and would that be that would be surgical or not necessarily 

Raquel Frisella  57:39

not necessarily surgical. There’s treatments out there called cellfina. And there’s an injectable now that we have that actually eats away at the college and of those bands that will give you some improvement, or weight loss sometimes will help. But again, if you’re somebody who’s already at your goal weight and super tiny and has it weight loss really isn’t the answer for you. So that’s why just kind of depends on you know, if it’s a weight loss issue, or if there’s certain targeted spots, then you would be a really good candidate for one of those treatments.

Dr Lyon  58:06

Basically, what you’re saying is that there is no magical topical cream. 

Raquel Frisella  58:10

Yes,

Dr Lyon  58:10

that is

Raquel Frisella  58:11

maybe someday though, that’s the cool thing about aesthetic medicine. This world is ever evolving, and we have new technologies and treatments literally every day. So I’m confident in this lifetime we’ll see something good.

Dr Lyon  58:28

I get a lot of questions about Botox, injectables, do I think that they’re safe? And you know, it’s interesting in I think this space of health and wellness, you will have people that are super healthy, doing their whatever juice cleanse, but definitely in line for Botox and filler. You look at some of these comments online and people are, you know, they’re so judgmental about injectables. I don’t know if you’ve experienced that if you have thought about it at all because it’s so ridiculous in my perspective,

Raquel Frisella  59:03

Yeah. it is and it’s it’s not about vanity, it’s just like anything, do you color hair, have you painted your nails you put some makeup on, it’s just about taking care of yourself is the same people who work out because they want their bodies to be in shape and healthy want their skin in their face to be healthy. And so injectables are completely safe when they’re done properly and when they’re done by the right medical professional. Botox, for example, has been used in the human body for ages and we use it for a lot of therapeutic reasons. Time Magazine did a really cool article on this years ago on like, I think it was like the 1000 uses of Botox and it’s the prostate, the bladder, neuromuscular disorders. It’s using the human body for all sorts of things and when we use them on those larger organs for that kind of therapeutic cause we use, you know, hundreds and hundreds of units. When we’re doing little cosmetic Botox on the face we’re using like, you know, 25 to 50. So it’s a very small amount. But even in those larger doses, it’s very safe. And when you break it down The way that the drug acts on the body, it’s actually safer than Tylenol. And I’ll explain that to patients like wow. So it’s very safe. And again, it’s all about the aesthetic outcome, and that’s where it matters who is administering it. So if you’re going to some random Botox party and the person doesn’t understand the anatomy of the face, or the muscles that should and shouldn’t go in, that’s where you get into trouble. Or when you see people who over just anything in moderation, anything in excess, you see people who are overdone, it looks ridiculous. But you probably see people everyday all day who have beautiful set dreams, you wouldn’t even know

Dr Lyon  1:00:33

Right. In terms of Botox, who is there someone that is not for now Botox is not systemic, right? It is a local injection yeah to neuromuscular paralyzer. Who is it not for?

Raquel Frisella  1:00:48

there, believe it or not, there’s not many contraindications with Botox. There’s a few things. myasthenia gravis is one that’s an ultimate No, and then sometimes gowanbrae. But outside of that pretty much everyone is a candidate for Botox, and we will do a thorough health history and just make sure that nothing stands out. There are certain times I have people refrain if they’re breastfeeding pregnant.

Dr Lyon  1:01:10

Just to be clear, even though it’s not in, you know, it’s essentially contraindicated in pregnancy and breastfeeding it again, it’s likely because those studies have not been in those populations. But it’s not because it actually goes to shenick

1:01:25

 True that that is true. It’s we don’t have those FDA approved trials to say as a, as a practitioner, I can’t say yes, this is completely safe, because we don’t have the clinical data to support that. But what we know about it is exactly that. It does not get into your bloodstream, it does not get to the baby. Actually, I have a story when I was pregnant with the twins I was seeing in MFM, and maternal fetal medicine specialist because identical twins are high risk. And she actually became my patient during the process. And I was doing her Botox, and I said something like, oh, I cannot wait to get mine. And she’s like, you’re not doing it. And I was like, Well, no, I’m pregnant with the twins. And she’s like, Oh, you can do Botox. So I was like, it’s so interesting. You know, here’s a high risk OB telling you Botox in pregnancies, it’s fine. But it’s more of a liability as the provider and also for my patients mental health, because if something were to happen, 

Dr Lyon  1:01:33

absolutely. 

Raquel Frisella  1:01:34

I don’t even want them to have to think through could it have been my Botox, so I just have them wait until they’re done.

Dr Lyon  1:02:23

Other injectables, it seems like there’s a new injectable coming out all the time.

Raquel Frisella  1:02:27

Yeah, there are, it’s we’re getting more and more the portfolios are getting bigger and bigger, which is a great thing because we have more options and the products are getting the technology is getting better. Filler is a big one. And so those are gonna be your highly hylaluronic acid fillers. And those are made from hyaluronic acid, which is a carbohydrate that’s in our bodies, it’s naturally occurring. So they’re very safe, and they actually are completely reversible. So that gives a lot of people peace of mind knowing if you try filler and you don’t like it or you want to tweak something we always keep the enzyme on hand is called hyaluronidase. And that’s an enzyme that can be injected into the filler and it just breaks it up. But without it fillers lasts a long time. So your fillers lasts anywhere from one to two plus years. And billers think revitalization. So, the big thing that happens to the face as we age is we lose volume. So our fat pads in the face those atrophy and as we lose fat,  why does it have why can’t it atrophy in your butt? 

Dr Lyon  1:03:29

makes no sense. There’s that’s a massive design flaw.

Raquel Frisella  1:03:32

Yeah, that’s not fair. So we try to restore those fat pads because you have to think when you lose the fat in the face. That tissue that was once supporting and lifting everything up is now gone. So it’s like the balloon has been deflated. Everything is just dropping our folds get heavier, we feel more laxity in the lower face. So when we revalue as with fillers, we kind of lift everything back up a little bit restore those volumes.

Dr Lyon  1:03:57

Now speaking of aging, is what is the first sign of aging and a male versus a female?

Raquel Frisella  1:04:03

Oh, that’s a good one. It’s gonna depend, but I would say just with society, I think males get away with certain things that females don’t and males can have certain lines and wrinkles, and it makes them sexy. Where as distinguished Yeah, as like the salt and pepper, you know, hair whereas a female it’s like, oh, we can’t have those lines. We look mad or mean, you know? So, I think it depends because on males, I would say more of them are concerned with their crow’s feet around their eyes. I feel like I get a lot of men who have the deep smile. 

Dr Lyon  1:04:38

Do guys do botx or they’re more interested in prevention of deeper lines and maintaining their elasticity?

Raquel Frisella  1:04:45

I have a lot of male patients but I would say I would say that my male patients aren’t as good about preventing as they are correcting. They’ll come in once the lines are there and they’re like, Hey, I’ve been noticing these lines. I want to minimize them.

Dr Lyon  1:04:58

do they have a stigma like Don’t tell anyone I’m coming in to get Botox.

Raquel Frisella  1:05:02

It’s probably 5050 I feel like some do and then some just own it and they’re like, Hey, what’s up, I’m on my way to my Botox appointment, you know, I want to look good to you. So especially, you know, business professionals, people out in the workforce, you know, they want to look good, and they want to look their part. And so they want to feel good. So I think that the stigma has definitely gotten so much better over the years. I mean, 13 years ago, nobody talks about these things. It was so hush hush, and now everyone talks about it, everyone does it. And hopefully people will just share what they do. They can help other people.

Dr Lyon  1:05:33

Well, I love what you do. And I think that you’re an amazing provider and so knowledgeable on all things skincare, not even just skincare, but the you know, exercise. Being a mom running a business. This business is beautiful and amazing. And you’ve created an incredible line of skincare, which, again, I’ve been using for quite some time. Where can people find you?

1:05:54

Thank you so much. Our website is Raquel esthetics.com. And on our site, you can shop our skincare. And I think the biggest thing that we try to do with our skincare it’s called RFA skincare, is we offer complimentary consulting with the product. So if you look and you feel that overwhelming feeling or you don’t know where to start, you can fill out a form where we’ll collect some photos and some information about your skin type your goals, what’s going on. And then we can help guide you to not only what products to use, but how to properly use them so that we can help people get the best results. So you can do all of that on our website and also on my Instagram which is just my name Raquel Frisella

Dr Lyon  1:06:33

And I’ll link everything links there what is that in my last question is what is the number one thing you do for prevention for your skin? Yeah,

Raquel Frisella  1:06:41

Let me get out the wonder list! Honestly,

Dr Lyon  1:06:47

by the way, in order to work here you have to look absolutely flat out and I’m like, God, what’s wrong with this? Perfect you know, so what is what is the No 1

Raquel Frisella  1:06:58

What I do, I think for me it’s honestly just consistency with a few things. So I’m I do my skincare every single day like holy grail obsessed with my skincare. I’m regular with Botox, I do Botox every three to four months. And I do filler once a year. And I don’t do a lot. I just do a little bit’s in areas where I’ve noticed, you know, volume kind of going away. I also do an annual ct i told you get a laser every year. So I’m gonna do BBL and Moxie in a few weeks here. And that’s just to, you know, maintain overall skin health. So there’s no perfect order, or rhyme or reason to do it, but just chipping away at your skin all the time just kind of getting routine with those maintenance treatments. But above all, just doing your skincare every night.

Dr Lyon  1:07:42

You know, I know I said that. That was my last question for you. But I have another question. With the Botox and the fillers, do you have to keep it up or so for example, if you put more volume in and then it goes away? If so if the filler only lasts two years or the Botox lasts a period of time, three months or something, do you have to continue to do it? Will your skin look worse?

Raquel Frisella  1:08:04

That’s such a good question. I get asked that a lot. No, so good and bad. It just slowly goes away over time. I always explained to my patients, it’s like coloring your hair. If you colored your hair and then you never did it again. Eventually that color grows out and you’re back to baseline. The same things happen. The same thing happens with injectable. So if you do Botox and filler, and then you just suddenly stopped doing it, just slowly over time you are going to return to baseline, you’re not going to be any worse than you were for doing it. But you slowly will creep back to where you started. And so that’s why it does require maintenance. But the maintenance gets easier over time. So the first time you do injectables, you may need a little bit more depending on when you’re starting. Unless it’s preventative, then you can just start doing a little bit here and there and then you kind of never get to that point where you have to play catch up. But then if you just kind of get routine with it, it’s just you kind of just slow the aging process turn the turn the hands of time back a little bit and it just gets really easy to maintain. You don’t need a whole bunch.

Dr Lyon  1:09:02

Everyone is very happy to hear that. Thank you so much for spending time with me. I’m going to link all your information here. Again, I send almost everybody who asked me about skincare to you I’ve been using your products for a really long time fact I’m gonna link my wife Dr. Gabrielle, I’m gonna put what I’ve been just obsessed with and using and thank you so much.

Raquel Frisella  1:09:26

Thank you. Thank you for having me. You are a total badass I’m very very honored to be on your amazing podcast.

Dr Lyon  1:09:34

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