Precision Skin Tightening: Understanding XERF with Dr. Jacquiline Hakim
Skin Anarchy
Dr. Jacquiline Hakim joins Skin Anarchy to discuss the biological drivers of facial aging, emphasizing that structural changes begin with bo
Key takeaways
- Aging begins with bone loss as early as the 30s, affecting the skin's structural scaffolding.
- Collagen levels decrease by approximately 1% annually starting in the mid-20s.
Main topics
- Biology of structural aging
- Radiofrequency technology (XERF)
Notable quotes
Aesthetics is a medicine.
Conclusion
The episode provides a scientific foundation for understanding non-inv
Transcript preview
Speaker 1 (0:00) Hey guys, welcome back to Skin Anarchy. Today is a very, very informative episode. We're gonna learn a lot today, and I'm super excited because we're joined today by Dr. Jacqueline Hakim, who is a double board certified dermatologist and cosmetic specialist, and she's also the CEO and founder of Davina Dermatology and Cosmetics Center of Beverly Hills. So Dr. Hakim is truly an expert in the field of aesthetics, regenerative aesthetics, restorative aesthetics, and so I'm so excited to chat with you, Dr. Hakim, today about everything that has to do with beauty. Welcome. Speaker 2 (0:28) Yeah. Thank you so much for having me. I'm excited for this convo. Speaker 1 (0:32) No, I'm very excited. And I know there's a lot to unpack. You have a phenomenal background, very, very impressive. I mean, you are truly immersed in the world of science. And I think for our listeners, that's what we want to like really understand. But to get us started, walk us down memory lane. What got you into medicine to begin with? Speaker 2 (0:48) Sure. I mean, ever since I was a young kid, I think I've always wanted to be a doctor and I wanted to be in a place of service to others. And The art and science of dermatology really was an attraction to me. I was a patient from a young age and it kind of honed in on my two strengths and I loved it ever since I've had exposure. I worked at a derm office in between college and medical school, fell more in love with it and knew that I didn't see myself doing anything else. And so... That's how I got into the field. And I've been blessed to be a part of the field and continue to grow. And it's such a cool field because it's always evolving. And so there's always constant learning, constant growth, which is really exciting. Speaker 1 (1:32) Yeah, absolutely. No, this is I, you know, I've said this a lot of times as well to our listeners, like, I feel like aesthetics and skincare and skin health is one of the only fields in medicine that is so it touches so much, you know, with with discipline. So Lots to unpack. Absolutely. And Speaker 2 (1:49) aesthetics is a medicine. I know it feels very glamorous and it trends and it's, you know, a lot of people are exposed and it's a strong interest, which is amazing. But at the end of the day, it's still medicine. And I think that's such an important factor to hone in on. Speaker 1 (2:03) Absolutely. You know, I want to start with actually understanding the skin because I think this is one of the most... It's one of the most complicated and also oversimplified, I think, topics. Speaker 2 (2:14) And Speaker 1 (2:14) I would love for you to really kind of dive into this with us in terms of understanding the biology of structural aging. Like, what is the skin's structure and what is it that's making us age? Like, if you were to explain. Speaker 2 (2:27) Yeah. And it's even great that you say that because I think that's part of the... Somewhat misunderstanding when we say skin, I think people hone in on just skin because it's what they see. And truly aging starts all the way down to the bone. And I think that's the most important thing is to realize that the aging process is happening in multiple planes of tissue. People look in the mirror and see their skin and they might not see like the bone loss that's happening, which is the scaffolding that's holding everything up. And we know that that naturally starts occurring in patients in their 30s. And then overall, there's structures from bone up to skin that are also changing, including connective tissue. fibrous septate, the SMAS, fat pads are changing and not at the same time. And then we get to the skin, which is truly what people are seeing and really show a lot of the signs of aging with everything going on below. And so obviously we have the epidermis to dermis and that's... the generalization in short, but they're made up of proteins. Everyone knows collagen. Everyone knows elastin. And when we're younger, we're born with so much and it, you know, continues to stimulate. But we do know that we lose collagen at about 1 % a year, starting in our mid-20s. And so, you know, within the world of aesthetics and... aging gracefully, it's always important to realize what's happening below, to be preventative so that you can take small steps to look your best at any age and to look natural and not overdone. And I think that's an important concept for women especially as well. we lose up to 30 to 40 % of our collagen into perimenopause. And so it's not like a slow, gradual slope. There's some peaks where there's drop-offs and we call them the pillars of aging. And there's a few studies around that, but we see that starting in our mid-20s and again in our 40s, later in our 60s and so forth. So a lot of that is driven by multiple factors. And I know that's kind of a loaded answer, but there's so much that goes into it. Which is important to understand because that's how you can give patients very personalized results when you understand the whole picture and you can see what's going on. Speaker 1 (4:35) Absolutely. No, I mean, I love what you said and I love how you explained it. Thank you for that. Because I think we hear a lot about things like collagen loss. You know, that's a huge, huge topic. But the percentages, no one understands. And also, you know what I've heard a lot of, and I'd love for you to kind of clear this up. People say, you know, when you're 40. everything still looks fine but when you get into that 45 range it's like your face starts to change and you almost like a lot of people have said you look in the mirror and you almost don't recognize yourself anymore i mean what do you do is that what you were explaining like the collagen loss like what is that Speaker 2 (5:07) Absolutely. In our early 40s as women, we have an estrogen drop-off. And so that's within the perimenopausal phase. There's a hormone shift and one of the biggest shifts is estrogen loss. We have estrogen receptors in our skin that are responsible for helping stimulate and upkeep collagen. And so when you have a decrease in estrogen, much of that is decreasing. So that's when you start... hearing patients and people complain of like, I woke up one day and all of a sudden I saw this. And it can be that drastic as we enter in our like early 40s is generalized time for that. Speaker 1 (5:45) Yeah, no, that's what I keep hearing that. And I'm approaching 40s. Yeah, she's like, what do I gotta do? Speaker 2 (5:53) Oh, Speaker 1 (5:54) absolutely. Speaker 2 (5:54) Well, there's so many things. And we, you know, that's like the concept of collagen banking. I know that's kind of a trendy term, but you want to kind of maximize on your body's capabilities. And prior to the age of 40, a lot of... men and women do treatments to stimulate collagen, which we have proven fact that they can, whether it's lasers, energy, injectables. And so we call them collagen banking to store up as much so those shifts aren't so drastic. Speaker 1 (6:22) Yeah, no, that makes a lot of sense. And, you know, I know that in the last, you know, few years, I would say even like... five years at least, we've seen a lot of people go towards aesthetics in a more, I guess, rigorous way. You know, a lot more people are opting in for injectables. There's a lot more people that are open to procedures now. And that's, I mean, that's its own group. But I mean, I would love for you to talk about, like, where is it that we might be missing the mark when it comes to understanding the true role of injectables versus something that might not be invasive, but still give us results? Speaker 2 (6:54) Yeah. You know, there's so much out there and that goes to what we were saying earlier about the aesthetic. world of medicine is constantly evolving and constantly getting better. And it's such a great time to be in this space and a patient in this space because there's so many options. And I think it truly like to break it down, it truly comes down to finding a specialist that understands all those layers of aging that we kind of briefly talked about to truly understand your goals and to come up with a very personalized plan to maximize on your overall skin health, collagen stimulation, and just the goal of aging. gracefully as you continue to age. And in the world of injectables, there's truly still a place, and I know there's some back and forth on social media. There's some fear mongering. There's people that support it. And, you know, we have so much scientific data and research with safety, efficacy, and correction. And sometimes that's the best solution for patients. There's true volume loss with... Our fat pads decreasing. And we see a lot of that now too with the GLP-1 wave of everyone really losing weight. They're calling it Ozumbic phase. That's very different from natural aging, which happens in different phases because all of it's happening together. And so the speed of aging is actually accelerated. And there's such a great place for volume replenishment with injectables, whether it's fillers, but then there's also the biostimulatory types of injections, which are not the gel type of fillers, but they stimulate your body to stimulate collagen. And so there's a place for everything and it truly comes down to... every specific patient. But the great thing is we have probably the most safety data at this point because it's been around for so long. And we have such amazing technology that's advancing over the last 40, 50 years, and it's getting better and better and better. Speaker 1 (8:45) Yeah, that makes a lot of sense. And I think, yeah, you're right. There's a lot of fear mongering, actually, on social media. It's, you know, for me, I mean, I never was. interested in getting fillers or Botox or anything for a long time. And I remember going on social media, it was before my podcast, and I was just terrified. Like it terrified me, you know? And I think it was a lot of the things that are kind of sold to us, you know, how everything is a bought job and like, there's just so much conversation. And so, yeah, it's Speaker 2 (9:13) a Speaker 1 (9:13) very... Absolutely. Speaker 2 (9:14) And you know, good work, I always say good work is not noticeable work. Like you shouldn't walk around and people should say, oh my gosh, she had X and Y done. And And it's an unfortunate, like we're blessed at a time where there's so much information, but the other side of that is that a lot of it