#355 – Skincare strategies, the science of facial aging, and cosmetic-intervention guidance | Tanuj Nakra, M.D. & Suzan Obagi, M.D.

Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00]

• This is a topic that Peter gets asked a lot about and one that he knows even less than the general public about
• It’s super helpful to have not one but two experts on this topic because they each have a different specialty

Tell us a little bit about your training, your background, and what you focus on 

Dr. Tanuj Nakra 

• Tanuj’s core specialty is oculofacial plastic surgery
• He trained mostly  at UCLA in eye surgery and in facial surgery
  • His original background is ophthalmology
  • Then he did fellowships in ophthalmic plastic surgery and another fellowship in facial cosmetic surgery
• His practice is limited to eye and face plastic surgery
  • That ranges from reconstruction of children, cancer reconstruction for elderly, and all the cosmetic surgeries that we can perform on the face
  • This includes the nose and neck
• Tanuj moved to Austin 16 years ago after training at UCLA and joined a large group here [TOC Eye and Face], and he is also faculty of the Dell Medical School 
• He is actively involved with academics, teaching, and residents
  • The practice has two fellowship programs 

“It’s a real pleasure to be involved in academics because it’s the cutting edge of science, and we like to perform clinical research and in the academic community (which is how I know Suzan) there’s a lot of collaboration amongst specialties, and we have an opportunity to dialogue and further the specialty that we care so much about.”‒ Tanuj Nakra

Dr. Suzan Obagi 

• Suzan is a dermatologist by training, she did a fellowship in cosmetic surgery
• She is in academic medicine at the University of Pittsburgh
• She’s been there about 24 years ‒ she’s gotten to see the evolution of this entire field
  • They used to do surgeries and a few collagen injections
  • Now they have a plethora of tools at their disposal
• She trains residents, medical students, and visiting physicians from all over the world
• She loves the multi-specialty collaboration
• Both guests belong to the American Academy of Cosmetic Surgery, and they have a different approach from different specialists, sometimes even on the same procedure
• Suzan’s practice focuses on everything with regards to skin rejuvenation, peels, lasers
  • She does a lot of fat grafting
  • She does body liposuction, mini face lifts, eye lifts 

“Everything when it comes to the face is about really enhancing the appearance of the skin first, because my feeling is that’s the most important thing that everyone sees.”‒ Suzan Obagi

• When a patient comes in who has not had anything done or doesn’t know about the field, Suzan actually likes that because she can take that opportunity to really educate them and pick the right things for them

Peter jokes, “I appreciate you noticing I’ve had nothing done.”

Before the podcast, they were discussing the strategy Peter has taken towards his appearance  

• There is something about this field of medicine that Peter has such a block in his brain to understanding
• He has met Tanuj before: Tanuj helped him with a scar
  • Peter’s friend Brett Kotlus [guest on episode #13] introduced them
  • Peter face planted one morning due to some hypotension and sustained a pretty nice scar that for the most part is largely invisible today (probably in part because his face is leather to begin with)
  • In part that’s because he did some 5-FU microabrasion along with a whole bunch of stuff, and Peter was actually pretty diligent about staying out of the sun for the period of time afterwards
  • He’s also done a Botox treatment, which certainly reduced the wrinkles (obviously it’s long gone)
• Peter has taken a strategy towards his appearance that is probably illogical: he ignores it because he doesn’t understand it
  • He focuses on things he understands

Peter adds, “I would view it as an enormous win of this podcast if in a few hours, I decided to do something that was sustainable and going to help me look a little better at 62 than I should look. (I’m 52 today).”

• Peter looked at a picture of himself 10 years ago before this podcast, and what a difference 10 years has made
  • He looks so much worse today 
  • That’s probably not uncommon and would guess that 42 to 52 is a big reduction in appearance
• It made him realize that the reduction in the next 10 years will be greater if he doesn’t do something proactive
• Peter admits, “I can’t even bring myself to wash my face before bed.”
  • Which his wife finds disgusting
• Tanuj and Suzan have their work cut out for them because if Peter can be educated on this, they can change the world

The biology of the aging face [10:45]

• We’re going to limit our discussion to the neck up

Why did Peter look better at 42 than 52? 

• That’s exactly how Suzan’s patients come in; they say, “I feel like I look tired. I don’t know exactly what’s going on…”
• She uses diagrams of the face of someone who’s 20 and someone who’s in their late 60s to explain the changes
• If you look at a diagram of the face with the skin peeled off, you’ll see about 11 different fat compartments in the youthful face [shown in the figure below]
  • On each side of the face that are plump, they’re robust, they’re giving volume, and they’re giving a padding between the skin and the muscle and the underlying bones

Figure 1. Superficial fat compartments of the face. Image credit: MAIPS

• Then you look at someone who’s in their late 60s, and you peel the skin away, and you see a dramatic atrophy in all those fat pads
  • A few might increase in size, but the vast majority undergo atrophy

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