Session 311: Your Skincare & Dermatology Questions Answered

Session 311: Your Skincare & Dermatology Questions Answered

Dr. Joy: Hey y'all. Thanks so much for joining me for Session 311 of The Therapy for Black Girls podcast. We'll get right into our conversation after a word from our sponsors.

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Dr. Joy: If you enjoyed our most recent session about black women in the beauty industry, featuring Blake Newby, you are most certainly in for a treat with today's episode. This week we expand our beauty conversation and explore some of the common questions you might have around skincare and dermatology, featuring the iconic board-certified dermatologist, Dr. Michelle Henry. In our conversation, Dr. Henry and I discussed the difference between certain cosmetic procedures like Botox and filler, the health benefits of regular facials, protecting yourself as a melanated woman, and how to vet dermatologists or surgeons, especially for darker-skinned women. If something resonates with you while enjoying our conversation, please share it with us on social media using the hashtag #TBGinSession, or join us over in the Sister Circle to talk more in depth about the episode.
You can join us at Community.TherapyForBlackGirls.com. Here's our conversation.

Dr. Joy: Thank you so much for joining me today, Dr. Henry.

Dr. Henry: Thank you for having me.

Dr. Joy: So excited to chat with you. We know that black dermatologists are incredibly rare, there are not many of you out there practicing. Can you talk a little bit about your motivations for getting into the field and your experiences in your field of study?

Dr. Henry: My entire life, I knew I would be a physician, since I was probably about seven or eight years old, probably younger. My mom did the Take Your Daughter to Work day and she was a nurse and I saw the little huddle of doctors and I was like, I want to be over there. And they got me a white coat and stethoscope, and that was it.

But I always thought I was gonna be a breast oncologist because my great-aunt died of breast cancer. In the last six months of her life, she sat me down, we talked about all the things, how to date, how to dress, to be, and what career to pursue, and that's what we decided. But when I got to medical school, it wasn't for me. I found that I am very much an empath and I would've become this like cancer fighting vigilante. It would've taken everything out of me and wouldn't have allowed for appropriate balance in my life. I met a mentor who was a skin cancer surgeon and I really liked the fact that I could cure cancer, there was an artistic component of closing the skin. I could talk to my patients, they're awake. I really enjoyed the variety of skin cancer surgery. I then learned it was a subset of dermatology. And so she said, if you wanna do this, you have to do dermatology first. So I found my way into dermatology rotation and absolutely loved it, and the rest is history.

So skin cancer surgery brought me to dermatology. Once you decide you want to do dermatology, you have to brace yourself because it's one of the most competitive specialties in all of medicine. It's lacking in diversity, which can be difficult because a lot of these residency programs are small, and so lots of people have the grades. In many ways, you have to fit the story, you have to be a good culture fit, people have to like you. And so you have to know how to not only get the papers, get the grades, but also find a way to get some face time if you don't have the connections. So that was a complex process, but yep, that's why I got there.

Dr. Joy: Can you say more about why it's so competitive, Dr. Henry? Is it just because there are so few, like training opportunities?

Dr. Henry: Yeah, there are very few training opportunities. Our residency programs are tiny, so like my class in my residency program, we had four students and that was the average. Some were like three, there are some programs that only take two. So, A, there's a very small amount of dermatologists, so the government doesn't provide as much funding for residency spots for dermatology. So that makes it competitive from a numbers standpoint. And then it's a great profession. You know, I really love it. It's so varied, we have very long careers. We can do everything from medical dermatology to aesthetics, to just purely surgical and skin cancer surgery. It allows for us to do a lot of research because a lot of the research we're doing, both clinical or you can do actual bench work or you're looking at genes and whatnot... But we have that variety. And so I would say if you love medicine, you love dermatology because you can do just infectious disease, you can just do immunology, you can just do hair, you can just do skin of color. And not many specialties allow for that level of variety. And so for many reasons, it has become extraordinarily competitive.

Dr. Joy: Got it. Thank you for that clarity. When we talk about cosmetic surgery, what exactly are we referring to? What kinds of medical professionals and practitioners should we be seeking out for this kind of work?

Dr. Henry: When we say cosmetic surgery, we use that term widely. There are some things that we call cosmetic surgery that aren't really surgery, they're more like minimally invasive procedures. In my mind, I don't consider things like Botox and fillers (as) cosmetic surgery. They're more like minimally invasive procedures. I consider surgery things that are more invasive, so things like breast augmentation, rhinoplasty or a nose job. Liposuction, I consider cosmetic surgery. But we kind of use that term broadly to include any modification of the body.

Dr. Joy: Got it, okay. And if somebody was seeking a consultation with yourself or another cosmetic surgeon, what kinds of things could we expect?

Dr. Henry: I recommend board certified dermatologists, board certified plastic surgeons, especially for things that are more complex. Of course, if you're doing something that is… And also vet whatever you're doing. If you're going to someone who's not a surgeon or a dermatologist who you know has a board certification, who you know has spent years and years studying anatomy and complications and things like that, you wanna vet them and make sure they have done tons of procedures. But you can feel confident if you're going to a dermatologist or a plastic surgeon that they have been adequately trained for the most part. The way your consultation is gonna look. So I'm a dermatologist, but I do a lot of procedures. I do both aesthetic and medical but in my practice, we're known for aesthetic procedures. So I do fillers, I do Botox, I do liposuction, I do hair transplant. I do blepharoplasty, so when you have extra skin on the upper eyelid, I remove that. I do lip lifts – as we get older, that upper lip gets longer and longer and longer, so we do lip lifts to shorten that, so I do that as well. I do ear repairs.

I do a lot of procedures and so it depends on what you're here for. When you come in, I'm gonna check your full history and physical because your safety is the most important. I'm gonna take some pictures because I want you to look at you as I'm looking at you so we can really pinpoint exactly what our concerns are. I wanna hear how you feel, I wanna hear what bothers you. Because patients don't have the technical language, so I wanna hear you describe everything that you feel so we can really specifically use the same language to meet your concerns. I want you to bring in photos, I wanna bring in inspiration. If this is like an anti-aging procedure, I wanna see you 10, 20 years ago. I wanna see what your baseline is. Because I wanna make you look like a better version of you, not like someone else, right? We wanna work within like your physical parameters. I wanna see your family, I want you to dump all the information on me so I can kind of give you the best, the safest, and the most natural as well.

Dr. Joy: Dr. Henry, can you talk with us about a time when you've had to tell a patient no?

Dr. Henry: Every day I have patients. Because Instagram and social media makes patients think that everything is for everybody, and it is not. One of my patients joked and said she's gonna make a hashtag #Dr.HenryToldMeNo, and I was like, please do that. Tell others I will tell you no. I am very busy and your face is my calling card, and I am not here to collect a few dollars to damage you or make you look unnatural. That's not my aesthetic. And I'd rather you go to someone who is aligned with that aesthetic than have me perform something that I feel like is not the best for you. So I tell patients no each and every day. I tell patients no, I tell patients let's go slowly. But I also tell you if you need a lot more and if you're wasting your money if you're doing too little. So I take special pride in being very honest with my patients, but I will absolutely tell you no. I have patients that hop in, they've been probably just popping in every six months for like over a year or so, just to have me tell them, no, it's not time yet. And that's important. I think part of the damage that's been done to our field are the people who won't say no. And you have people out here looking like humanoid, you know, because someone won't say no to them. And I think part of our job is to have that ethical core.

Dr. Joy: Something you said about taking pictures and having them see themselves as you see them. My mind went to, with something like body dysmorphia, that may not be realistic. What kind of assessment are you doing for those kinds of concerns to make sure that you are kind of keeping in line with what will actually be helpful for the client?

Dr. Henry: For body dysmorphia, I wanna hear how disruptive your ideas about how you look are to your life. And does the “defect” that I'm seeing align with the amount of anxiety it gives you? And if it's wildly disproportionate, then I know that what I'm doing alone is not going to fix you. And so then we have to have a conversation about what is realistic and what is this fear, anxiety, concern rooted in. And that's kind of the psychological part of dermatology. I was also interested in psychiatry for a very long time cause it's something I'm very interested in as well. But in many ways, dermatology, scratches that itch because there's a lot of psychology in dermatology. So I wanna see if their views of themselves, if it's disproportionate to what we're seeing. So that's a conversation.

I wanna get a full history. What are the things that you're doing? If someone comes into my office and they're 21 and they haven't had some major injury or some congenital defect or anomaly, and they've already had 10 or 15 surgeries, I'm concerned. That's a rare case. One can create a scenario where that might be reasonable, but that’s very, very rare. So I want a full history of all the things that you've done and if I feel like you're doing too many procedures, then we have to dive into a little bit around the psychology of why you're doing this. It's all about just having that open conversation about what are your goals. Do you think you'll be happy with this? What do you wanna do next? What have you done in the past? Where are you consuming information? You know, a lot of people are on Instagram and they see these celebrities who will do these like massive changes, and they think that is for everyone. So I really wanna get a firm idea of where they're consuming information and what their desires are.

Dr. Joy: Is there any case in which you would require some kind of evaluation with a psychologist or other mental health professional before you would perform a procedure?

Dr. Henry: If I feel that strongly, I probably won't do the procedure. Because at the end of the day, what we're doing is elective and your mental health is so much more important. If I feel like I'd want you to go there and—I guess be completely stabilized, but that's a far process—I'm probably gonna say let's revisit this in a year, let me refer you to some people that I think about. So, yes, but I think it's not often that I will do a screening and say, come back in a month and let's fix this. If I feel that strongly, then I trust my instincts and my medical acumen to know that they need to be with someone who can handle these psychological issues for some time before they come back. So I usually don't just do a screening. It's usually I'm gonna pass you over to someone else who can handle this and stabilize you, and when that is done, then we're gonna come back and address these cosmetic issues.

Dr. Joy: Got it. So you've already mentioned stuff around like Botox and fillers. We definitely hear a lot of stuff about that. Can you break down for us what is Botox and filler? What are we talking about there?

Dr. Henry: Botox is short for botulinum toxin, and that's scary when someone who is the toxin word. But what the toxin does is it paralyzes the muscle, but not completely. It just softens the muscle. Our muscles have all of these receptors and these receptors are how the nerves communicate with the muscles. And we block that ability, that's what Botox is doing. It's blocking that ability for the nerves to communicate with the muscles in certain areas. And so when we block that communication, then those muscles can't move as aggressively. Right now, I can raise my eyebrows and I can wrinkle my eyebrows, but I'm not making deep lines. At this stage in life, I should be making deep lines but that's my Botox that's keeping me from doing that. That's what Botox does, it just kind of softens it. Botox is a liquid. We inject that liquid into the muscle in patterns that align with what we're looking to attain (so based on how you wrinkle and how your muscles move) and it softens the contraction. Because those wrinkles are just wear and tear. It's just from animating, animating, animating, you get wear and tear and then you get these lines. So if you stop that wear and tear, then the lines will go away. That's what Botox is doing now.

Filler is totally different. Filler is a gel. If you look at filler in the syringe, it's a gel. If we squeeze it out, it's thicker than like ultrasound, it's thicker than hair gel, a little thicker than, I think most people here will know that Eco Styler gel. It's a little thicker than that, right? So it's a little bit more viscous, but it's like a gel and because we're looking to fill volume. So I usually say that Botox is for lines that you see with motion, that worsen with motion. Filler is for lines that you see at rest because it's a volumizer. So like these lines, like you could see them at rest, I'm gonna put in filler and raise them up so you don't see that line anymore. I'm gonna fill that space so that the line's not sunken, and that's the difference. Filler is for volumizing, literally filling, and Botox is for paralyzing those muscles.

Dr. Joy: Got it. And is there an ideal age for somebody who might want to start with Botox?

Dr. Henry: No. You know, everyone ages differently. I started needing a little bit of Botox when I was 28. And it's just a familial line that I have on my forehead, everyone has it, it gets deep and it gets dark. And I was like, I know it's coming, I don't want it. And I've stopped it, I don't have it. But then there are some people, my mother who's 68, doesn't need a drop of Botox. She's perfect. She has not a single line on her forehead. And so it's not really about your age, it's about how you age. That's independent, everyone ages differently. And sometimes it's a function of your facial structure, it's a function of how aggressively you animate. I have patients in their sixties that still don't need Botox, and so there's not a specific age. Like I tell my patients, I treat what I see. If you have it, I'll treat it. If you don't have it, I won’t.

Dr. Joy: Are there natural ways to achieve those same effects?

Dr. Henry: I wish there were. By the time you have them, you've already surpassed all the natural ways. The natural things that you could do – eat well, sleep well, wear your sunscreen, use your retinol if you consider retinol natural. But there are like, you know, minimally invasive things you could do. But really once you have those etched in lines, you can eat as many vitamin C-containing oranges as you like. You can do all of those things, but once they're there, you're gonna need more aggressive treatments to get rid of them. But good lifestyle, healthy diet, sleeping well, reducing your stress, is going to limit how soon you get there. So diet is important. Natural things are important to keep you from getting there, but by the time you've gotten there, you're probably gonna need some more aggressive treatments.

Dr. Joy: Got it. A newer thing that I've been hearing more about is people getting Botox around the hairline to stop from like your edges kind of puffing up as you're working out. Can you talk a little bit about that?

Dr. Henry: Yeah, you know, it works. We use Botox for hyperhidrosis or excessive sweating, and we've done that for a very long time. So we do it under the arms. I mean, there are some people who sweat so aggressively on their face. I have a patient who's a truck driver, sweats so aggressively on his face, he can't see. It comes into his eyes and so his insurance actually will cover that because he has such aggressive hyperhidrosis. So we know that it works for sweating, and we've used it for sweating for a very long time. And so, yeah, we use it on the hairline. It helps reduce some of the sweating. People get worked up about that. It's like telling women to reject their natural hair texture. It's not that at all, it's that women, whether they wear their hair curly or straight, they want their hair to look the way it looked when they styled it.

It’s about just maintaining your style, not necessarily changing your hair texture or avoiding your hair texture. Because whether you're curly or straight, you want things to be the way you styled it before you went to the gym. So a lot of women will do that and a lot of women will do it also because that's a common area when they sweat. You know, I'm really lucky to have a lot of really successful women that are in very visible positions that are speaking in front of incredible stages and in boardrooms and whatnot, and they also don't wanna sweat. And so yeah, it's something that I do. Is it gonna stop all the sweating completely? No, but it diminishes it to a significant enough way that you have a little bit less difficulty with styling after you have a good workout.

Dr. Joy: Got it. Can you break down the differences for us between oily skin, acne prone skin, dry skin? What are some of the signs of these different kinds of skin types?

Dr. Henry: Good way to test your skin is after you wash your face, how do you feel? After you wash your face, do you feel like your skin is super tight? Do you feel uncomfortable? No, after I wash my face, I have dry skin. After I wash my face, it feels like if I smile, my face could shatter. That's how dry I am, right, I feel super tight. If you're oily, you're not gonna feel that way. You're gonna wash your face, you walk away, you don't put on moisturizer, soon enough, you're gonna feel a little oily again. Because oily is more genetic. So oily is you inherit how active your oil glands are. Then there's dehydrated. Do you have enough water? Do you have enough hydration? But oily, your oiliness is something that's genetic, and you could really tell that by how oily you become or how comfortable you are after cleansing your skin.

Now, acne prone is different. Of course, people who are more oily are gonna tend towards having more acne because that oil can clog the pores. And oil is really just bacteria food, like the bacteria that causes acne loves oil. Like that's it. It's just having a feast when we're oily. That's part of why we get more acne in the summer because the heat increases the activity of our oil glands, we get moist and this wet, moist, oily environment is just like a bacteria buffet, and that's why we get more acne. So not everyone that's oily is super acne prone. It's gonna depend on how much bacteria they have on their skin, the kind of acne they're having. But you're more likely to be acne prone if you are oily.

Dr. Joy: Got it. More from our conversation after the break.

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Dr. Joy: You know, as we're talking about skin, let's talk about facials. What are the benefits of facials?

Dr. Henry: I love facials and I have a lot of like amazing estheticians in my world who I think do beautiful work. When I'm seeing a patient, I'm seeing them by the time they've come to me, they have some sincere problems. They have acne, they have significant hyperpigmentation. And so I always say that I'm here to treat your major concern and then the aesthetician is there for maintenance so that you're not coming back. You're not getting back to that place where you have those really significant concerns. So we're kind of like sisters in that way, we share patients in that way. So I think facials, it depends on the stage of your skin concern. You have really aggressive acne, a facial’s not a must have. It can be a nice to have, it's not a must have. But once we've gotten you to a good place, it's really great to have facials to keep you there.

Dr. Joy: Got it. I love that. What are some of the essentials of an effective skincare routine? I mean, there are no shortage of products people are marketing toward us. What kinds of things do we need? What are the essentials?

Dr. Henry: We're gonna talk about basic, basic, basic. You need a good cleanser. You need a good moisturizer (everyone needs a moisturizer), and you need a good sunscreen. Now if we're gonna step it up just a little bit more, and then we wanna think about actives. You want your cleanser and maybe something like an antioxidant in the day. I like vitamin C, I always call it insurance for your sunscreen. Especially as we're aging, it's gonna help to protect us from whatever little free radicals our sunscreen doesn't protect us against, it's gonna help to protect our collagen. And at night a retinol, if you can tolerate it, especially if you're thinking about anti-aging. Retinol's gonna help in our twenties with any residual acne. In our thirties, it’s gonna help with fine lines and wrinkles.
It's gonna help with any hyperpigmentation, especially in black skin and skin of color. It's also gonna help with stimulating some collagen. So as we get even more mature skin in our forties, our fifties, it's gonna help with stimulating collagen and helping to combat all that collagen loss that we get as we get older.

Dr. Joy: And for retinols, are you talking about something that is like over the counter, or are you talking about something that would be prescription grade?

Dr. Henry: Both. It depends on what you tolerate. Of course, the strongest you could tolerate, the best, but not everyone can tolerate the strong prescription grade. So if someone's really sensitive, I'll start them with over-the-counter retinols. That's great. And lots of people who are sensitive, they can never escalate to using something that's prescription. And then maybe also cost is a factor as well. You know, there are a lot of great over-the-counter, even drugstore retinols with good efficacy too. I try to work my patients up to the strongest that they can tolerate, but if the strongest that they can tolerate is an over-the-counter retinol, that's fantastic.

Dr. Joy: Got it. Can you break down what medical grade skincare is? Are there some over-the-counter things that are more custom?
Dr. Henry: It's hard. Medical grade skincare is a little area of controversy. Because skincare, there's not a governing body in terms of determining what is medical grade and what is not medical grade.
So it's kind of like a designation that's made by the companies. But typically, if we're gonna consider something medical grade, it’s something that has more active ingredients, something that the company has at least, although the FDA doesn't force them to do clinical trials, they've tried to do their own trials that are substantive. Like enough patients, they have enough data where we can look at as physicians and say, you know what, this was a robust trial. We trust this data. This is more data than we're getting from mainstream over-the-counter companies. And the level of activity that we're getting from these active ingredients, we think it's a little bit higher than what we're getting from what we get at the department store or at the drugstore. And so we also agree with you guys that this deserves a designation “medical grade.”

Most companies that are medical grade have some sort of physician advisory board, I serve on a ton of them. And we're doing just that on the board. We're talking about the data, we're looking at the studies, we're looking at biopsies of the skin. We're deciding, do you guys deserve this designation of medical grade? If you're gonna use our title and say dermatologist-tested, if you're gonna use our specialty to get legitimacy for your product, we wanna be there to make sure that you deserve it, so a lot of us around those like advisory boards helping to make sure. But typically, if we call it medical grade, it's because it has more active ingredients, higher concentrations, smarter delivery systems to get deep into the skin. And, you know, really great before and afters in outcomes before we'll give it that designation.

Dr. Joy: Got it. You've already talked about the ways that Instagram kind of enters your office with people coming in with inspiration. What are some of the biggest myths, biggest skincare myths that you've seen talked about on the internet?

Dr. Henry: What's a good one? I think one of them that people get really worked up about sunscreen and that we don't need sunscreen if we're black. That's a big one, but I think we all need sunscreen. I always say if I can't appeal to your concerns about skin cancer, let me appeal to your concerns about aging. You know, sunscreen is gonna help us with hyperpigmentation, which can be disfiguring in black skin and brown skin. It's gonna help with fine lines and wrinkles, and it will help to reduce the burden of skin cancer. If we're concerned about ingredients, I always say, just get a mineral sunscreen. Zinc and titanium dioxides, they're not chemical, we're not absorbing them. So there is a way to do sunscreen safely.

What's another myth? Another myth is that more is more, but sometimes less is more. You know, a lot of people have gotten into these, like 14-step regimens. And I'm like, that's a great moment for self-care, I don't know how you find the time, but it's not necessarily necessary. If you enjoy it, go for it. But especially if you're someone with sensitive skin, sometimes those 14 steps can be damaging. I have a lot of my patients that I call kitchen chemists, they're like little mad scientists. They're mixing things up and they're trying to do more and more and more, and they come in red and angry, and inflamed. And sometimes more is now more. You want a nice, simple regimen, you want a few active ingredients, you wanna see what they're gonna do. And then after you see if that works, then you add to it. But more is not always more.

Dr. Joy: Thank you for that. So we asked our community what kinds of pressing concerns and pressing questions they had about cosmetic enhancements and skincare, and the thing that came up the most was hair removal for dark skin. So what kinds of options exist for us in terms of hair removal?

Dr. Henry: Lots of options. I am doing hair removal each and every day. The lasers are smarter, they're better, and if you go to someone who knows dark skin. Because with dark skin, I'm never asleep when I'm doing the laser, obviously. But what I mean by that is you need to be really focused on every section, to watch the skin, to watch how it's responding. Because in dark skin, even if you have an ingrown hair, now that area is getting double the energy, double the heat. Because it's getting heat from the top of the hair and the bottom of the hair. And someone who's not used to our hair curvature and how our skin responds to too much heat can cause significant burns. In the best hands, burns can happen. But especially in someone who doesn't understand those critical factors about us, you can really, really get burns. We have a laser hair removal, I do it every single day. We have hundreds and hundreds of patients, thousands of patients at this time, with great outcomes. So it can be done and we have the devices to do it.

Dr. Joy: Are there certain kinds of lasers that should be used on darker hair?

Dr. Henry: Yeah, there's a laser called the 1064 Nd:YAG laser and that's a long wavelength. So what you wanna do is you wanna bypass all this melanin and get to the melanin that's hiding in your follicle. So if you use the lasers that are shorter wave length, they're gonna get to this melanin, they're gonna be so excited, they're gonna cause all this heat. You're gonna get a burn. So you want a laser that's not interested in the melanin on the surface, that's gonna bypass that and go right to the follicle. The 1064 laser is a long wavelength that can get right to the follicle so that's typically the safest for dark skin.

Dr. Joy: You talked about hyperpigmentation, that was something else that came up with a lot of questions. You've talked about sunscreen that can be helpful for that. Are there other things that are helpful for hyperpigmentation?

Dr. Henry: Oh yeah, there's a ton. Your retinol is helpful. Vitamin C is helpful. Niacinamide is another ingredient that's helpful. Arbutin is another ingredient that is helpful. Kojic acid is a mushroom extract that's helpful and you're gonna see a lot of that. Licorice extract is another ingredient that's helpful. There's another like Hydroquinone competitor called Cysteamine or Cyspera which has become competitive to Hydroquinone. Hydroquinone, of course we've used for years. There's some controversy around it. I still use it. I think when used correctly, it's really safe. But of course there are people that will abuse it. So Cysteamine is around as a competitor to that. It's an antioxidant, but it also helps to kind of lighten the skin.

Dr. Joy: And the girls have also been very curious, Dr. Henry, if we could get some insight into your personal skincare routinely. What kinds of things are you loving right now?

Dr. Henry: I use a lot. You know, I'm hard because I get so many products. If I didn't put all the things on the floor here, you would see this is a mountain of products. I get products every single day, five times a day, so I'm always trying something new. Things that I love, I do love my retinoid. I use a prescription retinoid, I actually use it twice a day. We tell patients not to do that, but I'm a little oily on the nose and I'll break out on the nose, so I'll use it twice a day there. So that is something I swear by. Right now for my moisturizer, I'm doing a project with La Mer, so I'm using some La Mer products. Which for the longest time I was like, La Mer is just expensive and it does nothing. But now that I'm learning about the science a little bit more, I am enjoying the products and understanding how they work and the value. I like SkinCeuticals so I use SkinCeuticals Triple Lipid Restore. That's one of my favorite moisturizers as well. I like Kiehl's Moisturizer, it’s the Ultra Facial. It is a really old, faithful great, rich moisturizer.

What else do I use? I like toner, so I will use things like the Biologique P50 lotion, I wear a lot. I do like acids, like glycolic acids, so I will incorporate different acids into my regimen. I like vitamin Cs. I use everything from the L'Oreal vitamin C to the BeautyStat vitamin C, which is a little bit pricier but I like that too. I love a good foaming cleanser. I wear a fair amount of makeup. Not today, but typically I'm wearing a fair amount of makeup. I do a lot of like media stuff, and so I do like a nice foaming cleanser to get rid of that. And if I'm really wearing makeup, I will use a nice balm. I've been using a balm by Relevant. They have a nice makeup balm and they started like a collective called Thirteen Lune which is really great. But they have this great balm that I've been using to remove my makeup too that's been really great. So just lots of things. If you ask me tomorrow, it might be different, but that's what I'm currently using.

Dr. Joy: More from our conversation after the break.

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Dr. Joy: I wanna go back to your comments around sunscreen because I think there are still some misconceptions around like, even if you're somebody who doesn't necessarily spend a lot of time outside, should you still be wearing sunscreen?

Dr. Henry: Like right now, I'm sitting next to a window so I'm getting UVA. And if I have hyperpigmentation, it's just getting worse all day long, all day long. UVA is long wavelength. UVA is UV aging, that's what we say. UVB is UV burning, that's what makes up UV light. There's also UVC, but most of it doesn't make its way into the atmosphere. But UVB is what really contributes to skin cancer, that's what makes us burn when we’re outside. Now, UVB doesn't make its way in through windows very well, just a little bit. But UVA comes right in. We would argue that even if you're sitting next to a big window at work, that we should wear sunscreen to protect us from that UVA as well. Because aging our skin, it's causing hyperpigmentation, especially in darker skin types.

Dr. Joy: Are there any new technologies that you're excited about?

Dr. Henry: For at home or for in the office?

Dr. Joy: Let's say both.

Dr. Henry: At home, what's interesting? I mean we're getting some interesting at home like little delivery systems. Like there's a new product called the Droplette, so it helps them mist and increase the penetration of products. We're seeing more and more tolerable retinoids on the market, so they're like microdosing retinoids that you can use. They're formulated to use twice a day so you can get more exposure but less irritation. I'm excited about all the conversations around barrier protection. I think for a long time, everyone was getting into skincare, especially with COVID, but we were doing everything. Like we were just throwing everything at our skin. We're getting inflamed and angry and getting hyperpigmentation. It’s now we're pulling back and having more like gentle skin care. Thinking about hydration, thinking about the skin barrier, and so there are some really smart products to help to fortify and strengthen the skin barrier.

I like all the technology around clean skin care, you know? Clean is kind of a loosey-goosey title, you know, what does it mean? There's no one regulating it. But I think that desire to be more mindful of the ingredients that we're putting on our skin because it is our largest organ (it is absorbing things from the environment) is important. So I like all the technology and conversations around clean skincare. In the office, there are lots of cool lasers and many, many lasers. I have the pleasure and privilege of caring for many patients of color, and so there are a lot of new lasers that are coming in that are safe for skin of color. So more microneedling lasers, more resurfacing lasers. Which once upon a time, we never said resurfacing in brown skin, and now we're having resurfacing lasers that are made with darker skin types in mind. So yeah, there's a lot on the laser front. I even have a new laser that I can use in the fat pads under the eyes. We all get older, we start suffering with those bags. At a certain point, they're just not going down. So those sorts of lasers are really great for that. So it helps to reduce it without surgery.

I have another new laser, probably the newest device in my toolkit. It helps to increase the absorption of anything you put underneath it. A lot of my patients have a big hair loss practice so I do hair transplant, I have a lot of patients suffering with hair loss and they get tired of needles. Hair loss treatments, it’s just a long road. It could be months and months or years of treatment, oftentimes with needles. And so I have a new laser that I can put these little peptides and growth factors on the scalp and the laser increases the absorption by 184%, which is significant. And so it does that so you can get all those factors that help to stimulate hair growth without having needles.
So that's probably one of the new fun things we have in the office that a lot of patients are enjoying.

Dr. Joy: What is an ethnic rhinoplasty and what are some things that someone should consider before deciding to undergo this procedure?

Dr. Henry: Ethnic rhinoplasty just means that you're going to someone who understands those unique parameters that are with ethnic skin. Things like our skin is thicker, our cartilage is different and can be softer. And just understands how to modify an ethnic nose with those different structures and those different tissues. Also, someone who understands beyond understanding how to manipulate that tissue, that understands the aesthetic. That not everyone that wants an ethnic rhinoplasty wants to have a super western Anglicized nose, you know? So understanding what is a nose of African descent? What is a Hispanic nose? What does it mean if I put the bridge here versus putting it here? You know, what does that mean? Someone who really understands all of the cultural implications of how we structure a nose. Ethnic rhinoplasty in purest definition is rhinoplasty on a person of color, an ethnic person. But on a grander scale, it really is somebody who understands the nuance of an ethnic nose from the outside topography and what that means to the inside internal structures, and how to make them and modify them the best and the safest way.

Dr. Joy: You’ve already talked a little bit about this, but what are the best ways to vet a dermatologist or a surgeon, especially for somebody who is working on darker colored skin?

Dr. Henry: Visit them, talk to them, ask them the question. I think it is our duty to answer those questions. So if someone asks me a question, I answer. Wanna know how many cases I've done – maybe I don't have the number but I'm gonna give you a rough estimate. If you wanna know the kind of negative outcomes that we've had, we're gonna tell you. That’s part of our job, to be honest with you about our comfort level. And I think any dermatologist kind of worth their salt is gonna feel comfortable telling you that. So go in, look for before and afters. When you're looking at before and afters, look for consistency. Especially when you're looking at rhinoplasty. Everyone has one great job, anyone could do it one time, but is it reproducible? Can they show you, you know, five, six, seven of them with similar changes to what you're looking for? So don't be afraid to ask for that. And don't be afraid to go to many doctors, that's why we're here. Even you have to pay for those consultations, it costs you more to fix a disaster than to pay a few hundred dollars to see enough people until you find the person who really resonates with you. So really do your research, ask the right questions, look at the photos. And what's really important – is this reproducible? Again, anyone can do a great job once.

Dr. Joy: What advice would you give to somebody who feels overwhelmed and maybe even a little pressured with all of the products and cosmetic surgery options? Like what kinds of things would you say to them?

Dr. Henry: Don't be. Take your time, take your time. And especially with skincare, you don't have to spend a ton of money. Start with a few things. There are lots of great drugstore products. Start with like the fundamentals, things like your cleanser, it doesn't have to be super expensive. We're literally washing it down the sink so you don't need anything fancy there. Pick your one hero product first. Think about what your major concern is. So if your major concern is hyperpigmentation, let's find one product that works on that. Let's sit with that and try that for the next four to eight weeks. Let's see if that works. We're happy with that, now let's add. Let's add products in kind of a stepwise approach. Everything is not for everyone. You'll see your favorite influencer that's like, let me show you the number one game changer in your skin. And we're just kinda like, well, we love that for you.
It may not be for me, you know. So realize that just because it works for someone else doesn't mean it works for you. Understand your skin type. What do you respond to? Are you sensitive? Are you dry? Are you oily? And try to work with your dermatologist, your esthetician, or whomever to come up with something that's customized and unique for your specific and targeted concerns.

Dr. Joy: Thank you for that. You know, Dr. Henry, we often hear this phrase, black don't crack. Is there some truth behind it? And if so, what is the science behind black not cracking?

Dr. Henry: This is what I say. I say black may not crack, but it does sag and sink and dull. So it's not that we're not aging, we just aged differently. Whereas our bio white patients may need Botox a little earlier because of the lack of melanin, they're not gonna have as much protection from the sun, they may see those fine lines and wrinkles earlier than darker skin. But in darker skin patients, for instance, I do a lot of filler around the eyes. And how did that become one of my specialties? Because I see a lot of women of color. And what happens is that we're a little bit flatter in the midface, just structurally. So because of that, when we start to lose fat, which we all start to lose fat, as we get older, it's more pronounced here. So all of the sunken-ness around the eye becomes more pronounced because we already started with a deficit. So it's not that we're not aging, we're just aging differently. We're not gonna photo age as early, but we're gonna age in the other ways. We're gonna sag, we're gonna lose that fat. Again, we may not crack, but we sink and we sag and we dull.

Dr. Joy: Dr. Henry, where can people stay connected to you and all the incredible work you're doing?
What's your website as well as any social media handles?

Dr. Henry: I practice in Manhattan, New York. My practice's name is Skin & Aesthetic Surgery of Manhattan. Our website is skinaestheticsurgery.com. That's a mouthful, but you can also find me on social media. I do a lot of Instagram and I think a lot of my patients are really finding me from Instagram and booking there or accessing my website through Instagram. And my Instagram handle is @DrMichelleHenry. But I also have a budding TikTok page where I'm @SkinDocToks, so that's growing. We have content that's gonna be coming out over the next few months that's gonna be pretty interesting. But yeah, my Instagram is probably my most popular platform. I'm there, I do a lot there and I engage with you there. It is me. If you go to my Instagram, it is me. It's not someone else managing it. So I will get around to things when I can, but that's where you can learn more about me there.

Dr. Joy: Perfect. Thank you so much for spending some time with us today, Dr. Henry. I appreciate it.

Dr. Henry: You're welcome. Thank you for having me. It was a pleasure and it's so nice to meet you. I've been looking at your platform for a long time, so I'm so glad that we got to do this.

Dr. Joy: Indeed, me too.

I'm so glad Dr. Henry was able to join us for this week's episode. To learn more about her and her work, visit the show notes at TherapyForBlackGirls.com/session311. And don't forget to text two of your girls right now and tell them to check out the episode. If you're looking for a therapist in your area, check out our therapist directory at TherapyForBlackGirls.com/directory. And if you wanna continue digging into this topic or just be in community with other sisters, come on over and join us in the Sister Circle. It's our cozy corner of the internet designed just for black women. You can join us at Community.TherapyForBlackGirls.com. This episode was produced by Fredia Lucas and Ellice Ellis, and editing was done by Dennison Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care.