Shadowing Practice: What Actually Works for Your Skin? A Stanford-Trained Plastic Surgeon Explains - Learn English Speaking with Video
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What is one beauty trend on TikTok that makes you want to scream?
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Over using LED masks.
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Oh, this is a hot take.
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Like if we're staying indoors all day and I'm like, I have no plans to go outside, I'm just working from home.
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Do I still have to wear sunscreen?
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Yeah.
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Is it because of the sun getting into the house or like the fluorescent lights?
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No, it's the lights themselves.
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Are you kidding?
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Yeah.
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That's horrible.
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I'm going to work in the dark.
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Fact or fiction, collagen supplements actually work and noticeably improve your skin.
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Fiction.
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What?
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Yeah.
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I take it every day.
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No. What is your high maintenance to be low maintenance routine?
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Okay, she's already dropping facts.
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This is already so helpful.
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Yeah, I had no idea.
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Okay, you just saved us $2 ,000.
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I'm Sheree.
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I'm Jean.
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I'm Sharmila.
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And we're the Tiger Sisters.
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We are your Wall Street and Silicon Valley big sisters.
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And we're a top 10 business podcast bringing late night sister talk meets boardroom strategy.
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Hi, Tiger fam.
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Welcome to Skincare and Aesthetics 101.
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Every time I open Instagram, I feel like there's a new hot take on skincare, aesthetic procedures, and aging.
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It can be super overwhelming because it feels like for every single decision, there are hundreds of opinions out there online.
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Luckily, we are joined today by Dr. Sharmila Sunder, who is a double board certified plastic surgeon based in Beverly Hills,
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who studied at Johns Hopkins, Cornell, and Stanford.
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And she is here with us today to separate beauty myths from science.
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Today, we're demystifying it all.
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Skincare, Botox, microneedling, lasers, and more.
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We're going to find out today what actually works, what is marketing, and what is right for you.
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We are so excited for this episode
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because Dr. Sunder's philosophy is all about helping people feel more informed and feel like the best version of themselves, not like a different person.
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So quick note before we get into it, this episode is educational.
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We are not saying and would never say that anyone needs Botox, surgery, or any sort of aesthetic treatment to look beautiful or age well.
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We are here to help you understand the options, ask better questions, and make informed decisions for yourself.
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All right, let's get into it.
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Sharmila, welcome to the Tiger Sisters podcast.
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I'm so excited to be here.
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Thank you.
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Yay!
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Dr. Sunder, we have some icebreakers and we wanna get into some hot, juicy topics.
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What's the beauty treatment you think people are overdoing right now?
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I think one of the treatments that people are just overdoing is filler.
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And nicely, I think we're trying to come off of that trend a little bit, but there's still a lot of overdone filler out there.
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Okay, we're gonna get into that later.
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We have a ton of follow -up questions, but I'm glad we're starting there.
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Okay.
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All right.
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She's setting the scene.
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She's setting the scene.
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Okay.
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Filler.
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The other thing that I'm seeing a lot of is on the opposite end, there are people that are doing surgery too prematurely.
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So I think that's the flip side of the coin.
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And I think a lot of that has to do with messaging on social media.
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So on one end, you hear a lot of fillers are bad, fillers are bad.
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So people are swinging completely the other direction, going to surgery prematurely
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and then you're seeing the flip side of it as well.
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I'm totally getting all of that content on social media.
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Like everything about mini facelifts and how like that's like the best way to I guess stay looking like yourself.
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And people are saying you should do it as early as in your forties.
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I'm like, what?
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Okay, so we'll get into that too.
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And so we also want to ask like, since you brought up social media, we can be quite influenced by the things
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that we see as we're scrolling like what are some I guess guardrails
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or things that we can tell ourselves as we're scrolling
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and we're seeing people talking about these topics yeah I think
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it's really easy to get stuck in this like echo chamber of information
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because you went once you engage with one video even
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if you don't necessarily agree with the information in there you're going to be fed similar information
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and then you hear it over and over again
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and then your mind kind of starts playing tricks on itself and you think, well, maybe I do need this surgery or this procedure.
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And I think it's really important to level set every once in a while and say,
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okay, this is just information for me to process and perhaps research and think about whether it's a good fit for me.
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Yeah.
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And really break it apart in that way rather than just taking it at face value.
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Yeah.
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I need to stop the doom scroll at like 11 PM before bed.
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And I'm like seeing all these cosmetics procedures and I'm like, oh, no, I'm spiraling.
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So it's good to get out of that.
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What is one beauty trend on TikTok that makes you want to scream?
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I would say overusing LED masks.
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Oh, what?
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I was not expecting this.
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This is a hot take.
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Yeah.
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So LED masks, I mean, there's so much I can say about that,
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but LED technology, a lot of the masks are just a waste of money.
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They're not effective.
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And for it to be effective, usually you need a certain number of lights, you need them spaced a certain way, and they need to pulse.
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And there's all this metrics that goes into it.
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So a lot of the at -home devices really aren't effective.
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Secondarily, even if you had one that's effective, it's not safe on all skin types.
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So most of these devices aren't tested on skin types five and six.
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So I'm five and six or I'm five.
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So I don't think a lot of people who are skin of color should be using these devices
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because not only are they helpful, but sometimes they could be harmful if you're not the target population.
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then people that have are
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that are prone to hyperpigmentation people with melasma should not be should not be using led mass
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so i see a lot of oh my god yeah i've seen a lot of patients who have melasma
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and they come in they're like oh my melasma has just gotten worse
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this year i'm doing the sunscreen i'm trying to stay away from heat
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and then we'll kind of go down the list of things
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that they're using and the led mass will pop up so
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that is you know i think a lot of people use it thinking it's going to help them.
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And in a lot of scenarios, it's not only not helping, it's actually hurting you.
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Oh my gosh.
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Okay.
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So my journey with the LED mask is that a few years ago,
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I bought one from the Nordstrom anniversary sale and I tried it on one time,
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but it was too heavy and it was like pulling my face down.
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So then I returned it.
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Yeah.
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So I never ended up using it but what about the panels
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so the panel so for example in our office
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and a lot of medical offices medical spas they have these panels
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that are appropriately calibrated
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and those are what a lot of the the fda trials were performed on
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and so those are effective
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but the at -home ones especially the really small ones
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there just aren't enough led lights on there to affect the change so i see yeah I have a really, really tiny one.
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It's like a handheld.
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It's like about this small.
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Yeah.
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And I'm figuring out that probably is in that category where it's
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so tiny that it's not really doing anything except for maybe gua sha -ing my face a little bit.
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Exactly.
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But I want to get one of those like larger panels that, okay, this is me also influenced by social media.
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But I'm like, I should wake up
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and sit in front of my large LED light panel for like 10 minutes when I get up in the morning.
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But it sounds like that might be closer to, you know, the effectiveness that we're looking for rather than the face one.
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Yeah.
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Yeah.
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But then you have to know your own skin.
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If you're likely to get melasma or hyperpigmentation, it could do more harm than good.
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Okay.
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Yeah.
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Well, I think you just saved me $500 or however many.
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Yeah.
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No, they're like $800.
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The bowels are expensive.
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Well, the face masks are a little bit more affordable, but if they're not working.
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Yeah.
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And, you know, all the studies on these masks
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or all the studies on LED light really has to do with inflammation and healing.
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So if you're trying to heal from something, sure.
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Or if if there's inflammation, sure, it'll help.
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But everyday life, we're not walking around inflamed, right?
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Or at least our skin isn't walking around inflamed.
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And so I don't really know if there's really
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that much value in it for that the amount of money you're spending on it.
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Yeah.
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Okay.
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She's already dropping facts.
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This is already so helpful.
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Yeah.
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I had no idea.
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Okay.
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You just saved us $2 ,000.
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Let's back up a little bit and start from the foundations.
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We want to talk about Botox.
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So the first question is what is preventative Botox?
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Should people in their twenties be considering it or is it just marketing?
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So preventative Botox in its purest form,
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what it means is if you are intended to get a line in a certain area,
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doing Botox to that muscle could prevent that line from developing sooner than it would have originally developed.
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And so that has more to do with your anatomy than age.
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So for some people, that line can form in their 20s
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and for other people it's not going to form until their 50s
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so if you were supposed to get that line in your 20s
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and you start the preventive Botox maybe you're going to push it to your 30s
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if you were supposed to get in your 50s starting Botox
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in your 20s really isn't going to do anything right you know whenever people ask me
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when should I start Botox a good example is I tell people you know
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if it's if you're worried about your forehead go ahead
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and raise your forehead keep it there for about a minute and then relax.
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If you have a line in your forehead after you relax it, even for, you know, for five seconds, that means you're eventually going to develop.
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a permanent crease there.
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And so now is this time to start doing Botox to prevent that line from becoming permanent.
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But if you do that and there's no line, you know, even for a few seconds
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and you don't have to treat it just yet and try again six months later or a year later.
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And at some point there will be a line that shows up.
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So then you can do it to start preventing that line from setting it.
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Yeah.
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So for some people, I mean, I've definitely seen patients where they're in their mid -20s
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and they have creases in their skin and
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that could be age related it could be lifestyle related it could be history of smoking vaping whatever it is
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and so for those patients starting in their 20s makes sense
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but for the vast majority of people I think you want to start probably in your 30s
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and then I've had patients who I mean
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I saw someone last month who had never done Botox She was in her late 40s.
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And I was like, I don't think you really need to start it now.
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Give it another year or so.
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So it just really depends on the patient.
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Yeah.
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I feel like the other thing that I've been hearing a lot is the term baby Botox.
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And that gets conflated with preventative Botox a lot, right?
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But baby Botox is kind of just, I'm thinking it's kind of just a marketing term for people to be like, I just got baby Botox.
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Exactly.
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What is baby Botox?
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Baby Botox is one amount.
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Exactly.
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It's just a smaller dose.
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And I think for a lot of people, it makes them feel better that they don't have to do large amounts of Botox.
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Or it seems like it's an entry dose as opposed to a full on dose.
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But I think you should do the dose that that's going to work the best for you.
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You know, there are people who need 48, 50 units to the upper face.
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And then there are people that need 50 units for their entire like neck and face.
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And if you undertreat, you're actually not helping things because you're not really treating the muscle to its fullest extent.
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So long term, you might actually be hurting things.
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So I would say don't don't get fixated on the number too much.
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Just allow your as long as you trust your injector, allow your injector to dose you appropriately appropriately.
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OK, so you just touched upon the other topic that I wanted to bring up,
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which is that I feel like historically Botox used to be really focused on sort of spot treatment.
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And everyone was like, oh, getting Botox in your forehead to prevent the forehead lines or like the 11s.
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But now there's a whole new kind of philosophy of treating the whole face right
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and getting botox is not just for one area it's to kind of there's the term facial balancing i guess
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and then there's also it's not just wrinkles either exactly a holistic application
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so can you tell us a little bit more about
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that yeah so exactly
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when botox first came out it was actually it came out for medical indication not cosmetic indications
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but for when it first came out for cosmetic indications it was just targeting lines right crow's feet lines
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and glabellar lines which are the Angry 11s.
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And now we use it much more artistically, I would say, so you can actually shape the face using Botox
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so people get it in their masseter to slim the face or to make it look a little bit softer.
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You can also use Botox to impact other muscles that aren't being injected.
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For example, you can inject this area and this area,
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So you can inject in between the brows and around the eyes to allow the forehead muscle to relax.
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Or you can treat the DAO to keep your lower face
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from turning into like a more of a pulled look or like pre -jowling, things like that.
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So you can actually weaken a muscle to allow the lifting muscles to get stronger.
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So you can use it a lot more artistically than we were 20, 30 years ago.
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I don't know if you've seen this, but recently a podcast host, comedian, Hannah Berner from Giggly Squad was injected, I think, in her jawline somewhere.
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And it like froze her face and she couldn't smile all the way.
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So there's been like a ton of clips of her like
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kind of like this where she's like trying to smile or when she's like laughing, she's like.
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And like it's become this whole thing.
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Yes.
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So that's been sent to me a few times.
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And I think I might not have the facts completely right, but I think she got masseter Botox.
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And what sounds like happened is there's a muscle called the rasorious muscle, which pulls your lip corners to the side when we smile.
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And that sits right in front of the masseter.
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Sometimes there could be a little bit of overlap, but it sits right adjacent to the masseter. So.
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And Botox that's injected into the masseter could drift into the rosorius and then that could impact that muscle from moving.
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So it can limit how much you smile or how wide your smile is.
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So it sounds like that's what happened to her.
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Yeah.
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And she's just waiting for it to fade now, I think.
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Yeah.
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Unfortunately, you know, for fillers, we have a way to reverse it.
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Botox, there's just no way to reverse it yet.
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And so you just kind of have to wait it out.
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There are things you can do to hasten the process, but for the most part, you just have to wait it out.
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Yeah.
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Can you sweat out Botox?
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I've heard.
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Maybe it's like exercise a lot.
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Old wide tail sauna.
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So there is some evidence, and it's not very strong evidence, but heat to the muscle can make the Botox effects go away sooner.
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And sometimes vibration or friction.
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So I've had patients where I've advised them to use like a mechanical,
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like a buzzer or like an electric toothbrush, use the opposite side of it and hold it on to the muscle.
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And sometimes that can speed up the effects of the Botox.
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I never knew that.
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Yeah.
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If there's, you know, if there's ever a time
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when you feel like the Botox is too strong or you want it to come out sooner, those are things you can try.
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Like heat to the area or friction vibration.
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Cool.
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And so going off the topic of like injectors and people who maybe are injecting the Botox,
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are there things that we should look out for?
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Like, for example, if we go to a med spa, like, should there be questions
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that we have ready to ask them to suss out whether the injector is qualified
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or someone that we would trust with our face?
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Yeah.
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So now in the U .S
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and depending on the state there are different types of professionals
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that can inject so in California yeah in California a physician MDDO and
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that could be you know a dermatologist a plastic surgeon
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it doesn't even have to be someone that's trained in aesthetic
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so it can be a gynecologist it could be a medical doctor.
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A dentist?
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A dentist, yes.
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And then nurses, physician associates, really anyone can inject as long as you have one of those degrees.
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And so that means that if someone got their degree on Friday, like their nursing degree on Friday,
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they can theoretically start injecting Monday without having any proper training
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or instruction on the muscles
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and how they're what their interplay is like for example the rosorius masseter thing I bet
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if you asked a lot of injectors they wouldn't know
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that relationship they wouldn't be able to tell you where the rosorius is relative to the masseter
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and so I don't think and that goes for MDs there might be nurses
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that know that relationship and there might be MDs that don't know that relationship, right?
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And so I think it has more to do with experience
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and their level of training within the field more than their degree.
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So there are a lot of great nurse injectors.
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There are a lot of great PA injectors.
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And I think what's more important than anything is who the PAs and nurses are working
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which company they're working as part of.
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So I think the ones that are affiliated with a plastic surgeon, I'm biased, right?
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So I'm a facial plastic surgeon.
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So the nurses in our practice really, really know their anatomy.
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They know the limits.
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And I think that's really important because knowing when to say no is so important in our field.
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And I think that's why you see so many crazy looking faces out there
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because there are a lot of providers that don't know how to say no, are uncomfortable saying no. And so knowing your limits is really important.
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And I think when you work within a plastic surgery practice or you're working within a dermatology practice, I think those standards are established.
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And there are a lot of good med spas, but I would say a lot of the med spas are
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not as critical in the thinking as some of these physician -led practices.
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But that's a generalization, right?
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So there are, like I said, there are some great med spas where they have routine training and continued medical education.
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And so they're great.
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So it's just really hard to tell, you know, as a patient who to go with.
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But I think the experience is really important and seeing who they're affiliated with.
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Hmm.
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That's a good starting point.
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And also like maybe if there's like a consultation or some sort of conversation you can have ahead of time,
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I think the, the point that I'm really latching onto is like, do they know their limits or like when to stop to?
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Exactly.
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Or like if someone comes in like wanting to do a lot of things, like at what point is the,
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is it the provider's responsibility to say no?
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Yeah.
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I see patients all the time where they come in and they say,
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oh, you know, I wasn't happy with this injector because they wouldn't do this.
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And I know you guys do that.
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And I always tell them, that's wonderful that your provider knew their limits and wouldn't do it because they didn't feel comfortable doing it.
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On the flip side, I've seen
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so many patients whose faces have been ruined by someone
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that didn't know that this was inappropriate to do and went ahead
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and did it anyways because they were asked to do that.
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So I think it's always better to have a provider say, I don't know how to do this, or this is not a good idea.
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Go see someone else.
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And here's a referral to someone that's comfortable doing this.
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Yeah.
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And when you see those patients, have they had procedures done to them that are irreversible or what, like, what are some examples?
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Yes.
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So because our practice is both surgical and non -surgical, we see the gamut.
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So we've definitely seen irreversible treatments for example with a lot
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of these devices okay these heat devices these radio frequency devices ultrasound devices we've seen fat loss okay
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and so that's irreversible in the sense
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that your body's not going to produce the fat we there are ways to you know with fat transfer
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or sculpture there are treatments to try to fix it it won't be back to 100%, but there are ways to fix it.
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And then there's reversible treatments, for example, filler scenarios where someone looks crazy or it was placed inappropriately,
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and then we can reverse it and address it.
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Well, I don't know if you remember this, but I used to write for the school newspaper,
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and I actually had an interview column in the Dartmouth, which was our daily newspaper, and I would interview students where every time I interviewed them,
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I would audio record the whole interview and then play it back and manually transcribe the whole interview out for myself.
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Oh my God.
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I feel like that must've taken so much time.
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So much time.
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Honestly, think about all the hours I could have gotten back in my life if I had had granola back then.
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Well, thankfully, 2026, Jean has granola because granola is an AI powered notepad built for the way that people really meet.
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So here's how it works.
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You can take rough notes in the meeting like you normally would, and then Granola runs in the background and it securely transcribes the meeting.
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Then at the end of the meeting, Granola gives you these really clean and structured notes.
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And Granola works through your device's audio, which means it integrates seamlessly into the video conferencing tools you already use.
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And as someone who has literally done the manual version of this dozens, if not hundreds of times,
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Alrighty, now back to the show.
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Okay, so before we get even deeper into aesthetic treatments, we were thinking let's take it back to even more basics.
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So we start with, let's start with like skincare care.
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Yeah.
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So we want to ask you a little bit more about sunscreen because everyone says you have to wear sunscreen, but what does that actually mean?
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Like SPF 30 versus 50, mineral versus chemical, how much should we be putting on our face and reapplying?
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That's a great question.
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So the most important thing with sunscreen is consistency.
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Okay.
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And secondarily, more important than the number is the amount.
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So the number is important, but if you're doing SPF 30 and just doing a small smear of it,
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you might as well just not be using anything.
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So the appropriate amount is, I think it's two grams per centimeter squared.
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So what that works out to is about half a teaspoon for your face and extend down to your neck.
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So what this is really fascinating when I learned this is that the protection goes down exponentially if it's less than that.
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So if you're doing SPF 50, which is what I usually recommend, and you're doing half a teaspoon, then you're getting SPF 50.
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But if you're using a quarter of a teaspoon of SPF 50, you go down to like SPF 7.
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Oh, okay.
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So the amount really matters.
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And I think a lot of people just put a little bit on and they are like, okay, I'm good for the day.
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And that's just not cutting it.
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So I prefer SPF 50 because I feel like most people are under treating anyways.
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You need at least SPF 30.
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And SPF 30 gives you 97 % protection.
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SPF 50 gives you 98 % protection.
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So it's just 1%.
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But if you're not using the amount that you really need to of the 30,
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then you're just putting water on your face at that point, right?
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So I feel like if you can bump it up to SPF 50, then you're giving yourself a little bit more protection.
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But then you really want to make sure you're doing that half a teaspoon on your face and neck.
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Is SPF 100 100 % protection?
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No. So that's like 99%.
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Okay.
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Yeah.
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So you're still not a, you don't ever really get to a hundred percent.
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You're never protected.
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You're never protected.
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And then the other thing I, I just thought people knew,
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but I've been understanding that people don't really know is tinted sunscreen is really important for skin of color,
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for melasma, because it offers indoor light protection,
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which can trigger melasma and can trigger hyperpigmentation or worse than hyperpigmentation on skin of color.
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So anyone that's not of Northern European descent or European descent is technically skin of color.
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So we're all skin of color, right?
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And so tinted sunscreen is really important for us.
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Wow.
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I've actually heard, so correct me if this is right or wrong or just, you know, in the ether,
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but I've heard that tinted sunscreen can actually start to help reverse skin damage
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or it can actually improve your skin as opposed to just preventing further damage what's the level of truth
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I don't know if it can improve the skin but
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if you in the sense that
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if you are preventing further damage you're protecting your skin so
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that it has the chance to heal from the previous damage so you know through that mechanism it could be doing that.
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And there are certain sunscreens that have antioxidants built into them.
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So Isden is a brand that I really like and it has what are called DNA repair zones.
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And so there are certain factors in it
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that can help reverse some of the sun damage and it comes in a tinted form.
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Yeah.
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And when you say indoor light, like if we're staying indoors all day and I'm like, I have no plans to go outside.
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I'm just working from home.
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Do I still have to wear sunscreen?
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Yeah.
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Why?
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Tinted sunscreen.
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Tinted sunscreen.
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So skin of color.
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Yeah.
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If you're prone to hyperpigmentation and then if you have melasma.
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Yes.
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Is it because of the sun getting into the house or like the fluorescence?
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No, it's the lights themselves.
441
Are you kidding?
442
Yes.
443
The fluorescence of the lights?
444
Yeah.
445
That's horrible.
446
I'm going to work in the dark.
447
Obviously it's not as strong or as impactful as solar UV, but it still has some sort of effects to it.
448
So my patients who have melasma or the ones that are really trying to work on reversing melasma,
449
that you could be doing all the things, but if you're not wearing that tinted sunscreen, you're just throwing away thousands of dollars, you know?
450
So for people that have pigment concerns, it's really important to wear sunscreen indoors.
451
How do you know if you're prone to melasma?
452
How can you tell?
453
Well, I mean, you don't really know until it shows up.
454
And it shows up more commonly in skin of color.
455
It usually shows up on your cheeks, on the sides of your cheeks.
456
It can show up as like a darkening of your upper lip.
457
So it can look like a shadow almost or like a little mustache, if you will.
458
And then it can show up along the periphery of your forehead also.
459
So is it kind of like freckles for people of color?
460
It can look like freckles, but usually freckles are sun damage.
461
Oh, but it can look like freckles in some people.
462
But it's more it's more coalesced than.
463
Yeah, more splotchy.
464
Exactly.
465
Wow.
466
Exactly.
467
And it's it can correlate with your period.
468
So it's hormonally mediated.
469
So oftentimes it used to be called like the mask of pregnancy because when your hormones are elevated during pregnancy, it really shows up.
470
Wow.
471
Skin of color and pregnant women can't catch a break.
472
Ever.
473
Watch out for those indoor lights.
474
Hey, Tiger fam.
475
Take five seconds to subscribe to the Tiger Sisters podcast.
476
When you subscribe, you are notified every single time a new episode drops.
477
And if you're listening on Spotify or Apple Podcasts, please rate us five stars and leave a comment about this podcast
478
because it really helps people discover our content and it helps us to continue to make the show for you.
479
If you're listening to this on Spotify right now, take this opportunity to turn on the video.
480
Thanks.
481
Now back to the show.
482
So the next thing I want to talk to you about is skincare routine.
483
And I'm going to kind of talk about mine.
484
So I'm really into skincare, but I am not overly specific about my products.
485
So usually I will use some sort of serum, a moisturizer, tinted SPF, and what else?
486
Oh, and then some sort of Korean skin wipes with active ingredients.
487
And my philosophy in general is that I think that Korean skincare
488
and Japanese skincare is generally better than the skincare you can get in the U .S.
489
Because, and this is just my theory, but I think that the competition is higher in those countries.
490
So you have to have better product for cheaper prices to stay in the market.
491
And I also think they have higher like FDA equivalent regulations.
492
So for me, I'll just kind of buy whatever Korean skincare and not be super discriminating.
493
And is that true?
494
Okay, fine.
495
Let's stop there.
496
Is that true?
497
What do you think?
498
I think the logic makes sense because Korean skincare is like 10 years ahead.
499
Yeah.
500
Yeah.
501
So I do think a lot of the skincare there is better than a lot of the skincare here.
502
However, we have some really great products here.
503
So it might be, you know, 5, 10 % of our products are comparable to 90 % of Korean products maybe.
504
The other thing is what is highlighted in Korean skincare products is different than what's highlighted here.
505
So pigmentation is number one priority in Korean skincare, right? and
506
that and and skin texture which is not necessary
507
or until recently was not necessarily a priority for americans
508
or american skin care and and i think for you know you have asian skin
509
so it will play it'll play well with your skin type whereas someone
510
which asian skin tends to be a little bit more sebaceous
511
not as dry in general right whereas caucasian skin is not that right it's not as sebaceous usually.
512
So I think you do need to be a little individual in picking skincare.
513
And so I can see how it would work well for you.
514
And I think that logic completely makes sense, but it doesn't apply to everyone.
515
Okay.
516
But it would apply to Asians.
517
Yeah. And I think...
518
Well, I'll sell my Asians out there.
519
But also for Caucasians that have pigment concerns and textural concerns
520
and they're incorporating a lot of ingredients
521
that we haven't really started thinking about yet so for example pdrn
522
or even snail mucin was or allantoin was i remember like 20 years ago
523
when i was in asia picking up this product like snail mucin
524
and being like it was so popular there and no one had heard of it in the U .S.
525
And then like 10 years later, it worked its way over here.
526
And so there's a lot of like TXA in Asian products.
527
What does that mean?
528
TXA is tranexamic acid, which is a good component for pigmentation.
529
That is just starting to show up in American skincare.
530
Interesting.
531
And I feel like also niacinamide, right?
532
It affects like the pigment pathway.
533
Yeah.
534
Yeah.
535
Yeah.
536
Gina's definitely way more advanced than I am in her skincare routine.
537
I'm really into skincare.
538
I love it.
539
Well, you know, when you were asking about what's a TikTok beauty trend that drives you nuts,
540
that is actually my number one issue is kids who do
541
not need to be using anti -aging products who are using a ton of skincare.
542
I think that is my number one issue.
543
Because it's just too young.
544
It's too young.
545
There's no need for it.
546
And a lot of kids are damaging their skincare barrier by using these products that are way too strong.
547
So I hear that term a lot.
548
What does it actually mean to damage your skin barrier?
549
People are always trying to repair their skin barrier.
550
Yeah.
551
So I think we're going to talk about retinols or retinoids, right?
552
And so that is something that happens commonly with retinoid is when you use too much of it, you're actually breaking down the,
553
so the barrier is basically, you know, like the fabric of the skin and you're breaking down the,
554
the surface layers of it and creating little cracks in the layer, initial layer of the skin.
555
And that, that's what causes redness that that's what causes that stinging sensation.
556
And so your body needs to go through a process of healing all that before you can introduce retinoids again.
557
And so a lot of a lot.
558
It's really funny.
559
I'll see these influencers with super shiny skin and it's meant to be perceived as healthy skin.
560
But oftentimes it's really them like really aggressively weakening their barrier.
561
And so the skin is just trying to heal itself and it looks really shiny and it's not healthy skin.
562
So it's a different type of shine on healthy skin versus damaged skin.
563
How can you tell visually?
564
There's you.
565
I mean, I think it's just gotten because I've gotten used to seeing what that looks like.
566
But it's it's just different it's not like like you've got this glowy skin
567
and it looks plump and glowy
568
which is different than the irritated shiny okay yeah
569
I was an expert eye yeah I was at Sephora um a few months ago
570
and I was buying some makeup there I was online
571
and these two young girls were next to me online
572
and in my head I was like where are your parents number one number two
573
I like engaged with them I was like hi girls they're like one of them's like 10 or 12
574
and I asked him like how old are you guys she's like I'm 12 I'm 9 wait no I'm 10
575
and I'm like what are you buying and they're like lotions
576
and stuff and they had like drunk elephant
577
and I was like how are you affording this right
578
and also I'm like in my mind I was just like wow
579
they're really young I'm like 20 years older than them
580
and we're like in the same line at Sephora yeah
581
so I thought that was pretty insane
582
and I wasn't gonna be like where's your parents
583
but I was just like she was about to though I was engaging with them
584
i was like hey girls dang it was
585
so crazy yeah i mean at that age you really just need spf
586
and then maybe a moisturizer but that's you don't really need much more than
587
that at 10 and you know 10 11 12.
588
yeah
589
and in our practice we've definitely seen young patients where they've
590
i had a patient um who basically burned her skin with using a retinoid and the salicylic acid cleanser,
591
which she then usually that would be our recommendation for someone that has acne.
592
She never had acne.
593
She just saw someone doing it.
594
Yeah.
595
And so really traumatized her skin and basically gave herself a chemical peel.
596
Oh, doing that combination.
597
Yeah.
598
Yeah.
599
Because there are definitely some things you should never you shouldn't combine.
600
Yeah.
601
Like I know if you're doing a retinol like at night, like you probably shouldn't do vitamin C in the morning or no,
602
you can do vitamin c in the morning
603
but you don't want to do too many acids all together
604
okay yeah okay back to me okay my other question is
605
that i well so both sheree and i recently started doing facials
606
so we started getting facials monthly and i really think it makes a difference
607
and i love it but i guess what is the the science behind it is it just
608
that it's helping to like cleanse your skin and then is there,
609
it just seems funny in my mind because you're putting on just lots of layers of things to treat the skin.
610
So is it scientifically helpful?
611
So facial is like a very broad term, right?
612
It's an umbrella term.
613
So it depends on the type of facial that you're getting.
614
So if it's just a basic facial, I think the only way
615
that it's helping is it's probably just cleansing your skin to a deeper level
616
but as part of the facial you can also incorporate certain ingredients
617
so if someone's not using vitamin c routinely incorporating the vitamin c as part of the facial may help
618
or a lot of facials have certain enzymes that exfoliate your skin
619
and a lot of people don't exfoliate regularly and
620
so this is an opportunity to have that exfoliation
621
but then there are more advanced facials also like there's hydrofacial
622
there are facials where you're using different types of AHA BHA acids
623
that are really improving or increasing cell turnover
624
so that's more of a true treatment and
625
so it depends on what kind of facials you're getting and
626
so I can definitely see it being impactful if it's one of the ones that are incorporating these acids and higher
627
active ingredients.
628
Okay, Dr. Sunder, let's talk lasers.
629
I feel like lasers are such a broad category and I'm not sure if they include all of these things.
630
So radiofrequency, ultrasound, all therapy, Morpheus, Zerf, SoftWave, Thermage, CO2, Pico laser.
631
They're all, I think they're all totally different modalities, but they all get bucketed under the same.
632
bucket yeah so can you tell us a little bit more about
633
that and how do you figure out what is right for you yeah
634
so those are all what we consider devices lasers are actually very specific
635
so IPL is a laser co2 technically isn't a laser radio frequency ultrasound those aren't really lasers they're all devices
636
and they all tackle different problems so usually ultrasound is for tightening and toning.
637
So all therapy, softwave, those are ultrasound devices.
638
Then there are radio frequency devices.
639
They can also tighten and tone,
640
but they can be combined with microneedling like Morpheus, Viva, Potenza, Vivace.
641
All those are microneedling radiofrequency treatments.
642
So those can help with texture and tone as well as a little bit of tightening.
643
The issue with the radiofrequency and some of the ultrasound devices is that depending on the energy level and depth of penetration,
644
it can lead to fat loss in some cases.
645
And so when we were talking about experience level of the provider and, you know, choosing a med spa versus choosing a physician's practice,
646
I think that's where some of that is really important because when these device companies give you, you know, when you buy the device,
647
they tell you standard settings.
648
And, you know, just between the three of us, your skin depth is different than your skin depth is different than mine.
649
And so it really needs to be a provider
650
that can tell based off of what we look like and based off of examination, how to adjust that setting.
651
Because if you just did standard settings on everyone
652
or you cranked up the settings trying to achieve tightening then you could run into trouble with fat loss
653
and we've seen that a lot with patients
654
that have referred into us who've had fat loss or other complications
655
so in our practice we really understand how the technology works
656
and we know how to adjust it so
657
that you can achieve great results without really cranking the energy
658
so rather than doing one treatment at the highest setting you do three treatments at one -third the setting maybe
659
and ultimately get to the same result okay so there's risk even for
660
radio frequency yes oh yeah yeah now it's not a very high percentage
661
i think this is another scenario where social media is really blown
662
it out of proportion where i have patients come in And if I'm recommending a radiofrequency treatment, they're like, oh, no, no, I can't.
663
I don't want to have fat loss.
664
So it's not that anytime you get radiofrequency, you're going to have fat loss.
665
But if it's used inappropriately or if it's used to lift, there's a chance that you can have fat loss with it.
666
Because the settings required for lifting heat up the tissue so much that you could inadvertently get fat loss.
667
Okay.
668
So radio frequency is not really intended for lifting.
669
It is.
670
Oh, it is.
671
So there are some radio frequency devices that you use for lifting.
672
And what are they called?
673
I mean, all of them.
674
So Morpheus, you can use it for lifting.
675
But if you use it at that setting, you're usually going to get fat loss.
676
So when I have a patient come in and say, I want to have a certain level, you know, a certain result.
677
We have that discussion.
678
And I say, well, if we do it at this setting to give you the level of lifting that you're hoping to achieve,
679
the unintended side effect will be fat loss.
680
And so I don't want you to have, and there are lots of people who say, oh, I feel like I have a full face.
681
I'm fine with losing a little bit of fat.
682
You don't want to lose fat because that's the subcutaneous fat, especially the fat
683
that is right under your skin kind of nourishes your skin it's what gives the skin its plump quality okay
684
so if you lose that fat that will inadvertently age your skin faster
685
I think with all of these technologies
686
and devices for someone like me who is not as advanced
687
in it it can feel really intimidating like with all these names like how do you suggest
688
that someone a consumer go research it?
689
Like what should we be looking up or is it just talking to a provider?
690
It's talking to the provider because there's just so much information
691
and it can get very confusing and it's not very black or white, right?
692
So like I said, radio frequency can cause fat loss.
693
It doesn't most of the time.
694
And in most practice.. practices where they do it in a way that's thoughtful it's not going to happen
695
and so I think the information especially on the internet it's not fact -based right there's always
696
if you're reading it off of someone's website there's some level of subjective anecdotes involved right
697
and so I think it goes back to identifying a provider that you trust that's ethical, that's going to be honest with you,
698
that can help guide you.
699
And really the other thing is I think it's really important for the patient to not push the provider either, because I think in general,
700
most of us want to help our patients achieve whatever their goal is, right?
701
And so if a patient is saying, oh, I really want to do this, I really want to do this,
702
but I don't want to do surgery but i really want lifting
703
and so the provider is going to be tempted to okay let me turn up the energy to give them
704
that lift and they're thinking about short -term benefit which is lifting
705
but long -term loss is the fat loss
706
which over the course of five years ten years is actually going to do the patient a disservice yeah
707
i think maybe a good question to ask as a
708
follow -up to a provider is like what are the
709
long -term effects of this treatment what are the long -term effects
710
but also i think a lot of patients
711
now are open to surgery the question should be asked how will this impact future surgery
712
if i'm thinking about having a facelift in five years how will this impact it okay
713
and i have heard that some of these devices can impact yeah
714
because it so it it can create scar tissue
715
or no okay yeah it creates scar tissue
716
so the dissection planes are not as easy to identify it's not impossible to do
717
but it you know it makes it more challenging
718
so it's definitely something that you want to disclose to your surgeon
719
and i usually have a time frame so
720
if someone has had any of these heat devices within a year of surgery i usually ask the patients to wait
721
And not necessarily because of the scar tissue, but because of the inflammation.
722
So when you have a treatment, it can take a full year for your body to reset and for the full healing process,
723
the collagen stimulation process to complete.
724
And so if you go in three months after a treatment, when there's some low level of inflammation,
725
you're actually going to aggravate the tissues and there could be potential complications from the surgery.
726
So if it's beyond a year, it's not as problematic, but it's good for the surgeon to know there's going to be scar tissue.
727
So the surgery may need to be a little bit longer.
728
We may want to do certain things as part of the surgery to improve healing, whether it's PRP or hyperbaric oxygen or exosome,
729
different modalities to help improve healing.
730
So I think it'll help formulate a game plan better for the surgeon to have that information.
731
And is that a general, I guess, rule of thumb that you have for each of these?
732
What do you call them?
733
Like all therapy and these other...
734
All these heat -based devices.
735
Heat -based devices.
736
Yeah.
737
Is that your rule of thumb that you should wait a year between?
738
Yeah.
739
That's my personal rule.
740
Different surgeons have different rules about it.
741
But my personal rule is you want to wait a year.
742
Because your skin is still inflamed and still healing over the course of that year.
743
Yeah.
744
And it depends on the depth.
745
So for example, Morpheus, if you're doing it at a superficial setting and you're having a deep plane lift,
746
it doesn't, you don't have to wait a full year,
747
but all therapy, which goes deeper and it can affect healing of the skin that I would wait a year.
748
In between those, even like all therapy to all therapy.
749
No, that depends.
750
Yeah.
751
Sometimes you can do it at six months.
752
Yeah.
753
Depending on, on the settings.
754
I know we talked about filler very early in this episode, but I just want to ask you,
755
do you have any words of wisdom or advice when people are thinking about fillers? So I,
756
going back to the provider and listening to the provider is really important
757
because I see it time and time again with filler.
758
Patients will come in and they're the most conservative patient.
759
They're like, I don't want to do too much.
760
I just So scared of it.
761
I just want to do a little bit.
762
And we do it.
763
And then they're back three to six months later, wanting more in the same area because our minds play tricks on us.
764
So the initial delta is so significant.
765
The change in what you see is so significant that once that change starts going away,
766
you think it's all gone so three months six months later
767
when some of it's going away patients want to come back in
768
and do another full syringe to that area
769
because they don't really forget where they started off and
770
so that's where it's really important to have a provider
771
that says no look at your photos from three months ago
772
or six months ago there's still some filler
773
there you're not ready for more yeah you might be ready for more
774
but chances are you're probably not ready for more especially in the lips right
775
and so I think not overdoing it is important so volume matters
776
and frequency matters and that's when you get a lot of these migration issues,
777
especially with the lip, is when you're doing too much in an area that can't handle that volume.
778
And so it has to go somewhere.
779
So it's following the path of least resistance.
780
So if there's no way for the filler to come forward with the lip, it has to go up into the white,
781
the mustache area of the lip.
782
So I think volume is really important.
783
Frequency is really important.
784
And so to prevent migration, it's just like, don't overfill don't overfill yeah yeah
785
and it sounds like documentation is really important yeah having a clear idea of what you looked like before
786
and after the first treatment yeah
787
that you can refer back to together with your provider exactly hey guys it came to my attention
788
that some of you don't know
789
we have a matcha brand what a matcha brand yes like
790
some of my friends were talking to me like wait you guys have a matcha brand
791
and it's called sisters matcha jean and i started it in October 2024
792
and it's something that means a lot to us because I lived
793
and worked on the farm where we source the matcha from.
794
This matcha brand is our baby and we are
795
so passionate about it and we really love everything that has gone into it.
796
There's just so much love and passion that goes into our company and we want to share it with you guys.
797
We source from a small family farm just an hour
798
and a half outside of Kyoto called Wazuka is the name of the town and it's absolutely incredible.
799
We've visited the farm.
800
We've worked on the farm.
801
And we're so excited to bring it to you.
802
So you can find out more at sistersmatcha .com.
803
That's sistersmatcha .com.
804
All righty, now back to the show.
805
Okay, so one question I've been dying to ask you, Dr. Sunder, is as someone who has unlimited access to every single treatment in the world,
806
what do you do?
807
Like, what is your high -maintenance -to -be -low -maintenance routine?
808
Yeah, that's great.
809
I love, we have a proprietary peel that we customize to patients.
810
And so I try to do that once every two years
811
or once a year just to remove any sun damage that has accrued throughout the year.
812
So I think that has been really helpful.
813
The other thing that I like is fractionated radio frequency.
814
So that helps with skin quality, skin tone.
815
And so I do that actually once a year and that
816
that way I'm not the best when it comes to skin care.
817
And so I feel like that really is a great foundation for me.
818
Botox is the other thing.
819
I think that's and I do it for preventative reasons and I think it's worked really well for me.
820
I was on board to have really, really deep 11 lines and I've really been able to reverse that pretty well.
821
So I think Botox and then Sculptra. So, yeah.
822
So I think Sculptra, especially in like the chin area for me, has been helpful just because I'm postmenopausal.
823
So postmenopausal women or women in general will start losing bone in their jawline.
824
And so that's expedited in the postmenopausal phase.
825
And so that I think has been helpful in supporting my jawline.
826
Oh, and then one quick question about Sculptra.
827
Sculptra is not a filler, right?
828
It's not a filler.
829
No, it's a collagen stimulator.
830
So it's an injection, but it's stimulating your own collagen rather than putting a gel into the face.
831
So it's a different category.
832
It's a different category.
833
Yeah.
834
Cool.
835
I love it.
836
Thank you so much.
837
Thank you for having me.
838
This is great.
839
We have one last section called fact or fiction,
840
which is a rapid fire we give you a statement and you say whether it's fact or fiction or quick clarification.
841
Okay.
842
Number one, filler always migrates.
843
Fiction.
844
Yeah, actually.
845
That one's tough.
846
That one's tough because it can migrate if it's placed improperly
847
or in a different layer or if it's in an area that moves a lot.
848
So around the eyes, it can move, it can migrate a little.
849
But I think the way people think of migration, that's not accurate.
850
So I've had patients who come in where we're wanting to do chin filler
851
and they're worried that it's going to migrate up to their cheek.
852
And that's not how it happens.
853
So from that respect, it's fiction.
854
Okay.
855
Fact or fiction, Botox prevents wrinkles.
856
Fact.
857
Drinking more water automatically gives you glowing hydrated skin.
858
Fiction.
859
I'm horrible about drinking water and I feel like my skin looks pretty good
860
because of the other things that I do to compensate for it.
861
Yeah.
862
That makes me feel better.
863
Okay.
864
Fact or fiction?
865
Everyone needs retinol.
866
Fiction.
867
Fact or fiction?
868
Expensive skincare is always better.
869
Fiction.
870
Okay.
871
Fact or fiction?
872
If a skincare product burns or tingles, that means it's working.
873
Fiction.
874
Fact or fiction, Ozempic ages your face.
875
That needs a clarification.
876
So it can age the face if you lose too much fat or lose too much volume in the face.
877
But I think for a lot of people, or for most people, Ozempic is an anti -inflammatory.
878
And so a lot of people carry inflammation in their face.
879
And so decreasing that inflammation can actually make someone look younger or more importantly, healthier.
880
So I think, yeah, yeah.
881
So I think it can do both.
882
Okay.
883
Everything in moderation.
884
Yeah.
885
Depends on the person.
886
Depends on the person and everything in moderation.
887
Okay.
888
Fact or fiction, collagen supplements actually work and noticeably improve your skin.
889
Fiction.
890
What?
891
I take it every day.
892
No. Are you sure?
893
Yes.
894
This is actually, there's like evidence to, yeah.
895
Right now, all the products on the market, there's no way that, so your body breaks down these collagen supplements, right?
896
Into like individual amino acids.
897
It can't target specifically the skin or the hair.
898
So if you're seeing a benefit, it's usually the other products that are,
899
it's usually compounded with certain vitamins and other supplements that have a benefit to skin and hair anyway.
900
So collagen itself, the molecules are just too big right now.
901
There's, they're just, they're just not doing what I think they're doing.
902
But if it's working, I mean, if it's working for you, I wouldn't say to discontinue.
903
I think it's a protein boost for you.
904
It's a protein boost.
905
Yeah, other health benefits.
906
Yeah, exactly.
907
Exactly.
908
Last one.
909
Fact or fiction?
910
It's too late to start taking care of your skin after 50.
911
No. Fiction.
912
Absolute fiction.
913
Awesome.
914
All right.
915
Thank you so much.
916
Thank you so much, Dr. Sunder.
917
This was so informative.
918
I'm so glad.
919
It was so fun.
920
Thank you for having me.
921
Where can people find you online?
922
So I'm on Instagram and on TikTok at Dr. Sharmala Sunder.
923
So it's D -R -S -A -R -M -E -L -A -S -U -N -D -E -R.
924
Awesome.
925
Thanks, Tiger Fam.
926
We'll see you next time.
927
Bye.
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Vocabulary and speaking notes for this lesson
This speaking lesson is built on the video “What Actually Works for Your Skin? A Stanford-Trained Plastic Surgeon Explains”. This video has 927 sentences and 9657 words to shadow. The speech runs for 57:43. The speaker talks at a natural 167 words per minute, close to everyday conversation. 83% of the words are among the 3,000 most common in English; the rest is worth studying before you start.
Key vocabulary in this video
15 words from the video worth learning, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| fiction noun | /ˈfɪkʃən/ | Literary type using invented or imaginative writing, instead of real facts, usually written as prose. |
| provider noun | /pɹəˈvaɪ.də(ɹ)/ | One who, or that which, provides a service, commodity, or the means for subsistence. |
| facial adjective | /ˈfeɪ.ʃəl/ | Of or affecting the face. |
| muscle noun | /ˈmʌs.əl/ | A contractile form of tissue which animals use to effect movement. |
| frequency noun | /ˈfɹiːkwənsi/ | The rate of occurrence of anything; the relationship between incidence and time period. |
| heal verb | /ˈhiːl/ | To make better from a disease, wound, etc.; to revive or cure. |
| mask noun | /mæsk/ | A cover, or partial cover, for the face, used for disguise or protection. |
| laser noun | /ˈleɪzɚ/ | A device that produces a monochromatic, coherent beam of light. |
| helpful adjective | /ˈhɛlp.fl̩/ | Furnishing help; giving aid; useful. |
| surgeon noun | /ˈsɝd͡ʒən/ | One who performs surgery; a doctor who performs operations on people or animals. |
| forehead noun | /ˈfɔɹ.hɛd/ | The part of the face above the eyebrows and below the hairline. |
| acid noun | /ˈæsɪd/ | A sour substance. |
| reverse noun | /ɹɪˈvɝs/ | The opposite of something. |
| inflammation noun | /ɪnfləˈmeɪ̯ʃən/ | The state of being inflamed. |
| ultrasound noun | /ʌl.tɹə.saʊnd/ | Sound with a frequency greater than the upper limit of human hearing, which is approximately 20 kilohertz. |
Phrasal verbs you will hear
| Word | Pronunciation | Meaning |
|---|---|---|
| show up verb | To appear, arrive, or attend, especially suddenly or erratically. | |
| break down verb | To stop functioning. | |
| go away verb | To depart or leave a place. | |
| bring up verb | To mention. | |
| come out verb | /ˌkʌm ˈaʊt/ | To be discovered; to be revealed. |
| figure out verb | To come to understand; to discover or find a solution; to deduce. | |
| find out verb | To discover, as by asking or investigating. | |
| go back to verb | To stem from; to originate in. |
Sentences worth repeating
Short, complete lines from the video that you can reuse in everyday conversation:
- Do I still have to wear sunscreen?
- What's the beauty treatment you think people are overdoing right now?
- How do you know if you're prone to melasma?
- How can you tell visually?
- What do you call them?
Grammar in this video
The structures the speaker uses most, with the exact words from the video:
| Structure | In the video |
|---|---|
| Present perfect continuous have/has been + -ing — an action that started earlier and is still going on | I've been hearing · I've been understanding · I've been dying |
| Conditional sentences if + clause, will/would + verb — a condition and its result | if if there's inflammation, sure, it'll help · if you lose that fat that will inadvertently · if it's working for you, I wouldn't say |
| “Used to” used to + verb — a past habit or state that is no longer true | used to be · used to write |
| Present perfect have/has + past participle — a past action that still matters now | i've seen · has just gotten · I've definitely seen |
Pronunciation to watch
The speaker uses 239 contractions and reduced forms, such as you're, I'm, don't. Say them the short way, as you hear them.
- The “th” sounds: aesthetic /ɛsˈθɛ.tɪk/, thumb /ˈθʌm/
- The “sh” and “zh” sounds: fiction /ˈfɪkʃən/, facial /ˈfeɪ.ʃəl/, inflammation /ɪnfləˈmeɪ̯ʃən/, tissue /ˈtɪʃ.(j)u/, physician /fəˈzɪʃən/
- Long words — get the stress right: inflammation /ɪnfləˈmeɪ̯ʃən/, ingredient /ɪnˈɡɹiːdi.ənt/, necessarily /ˌnɛs.əˈsɛɹ.ə.li/, incorporate /ɪŋˈkɔɹ.pɚ.eɪt/, priority /pɹaɪˈɒɹɪti/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
- Record yourself and compare with the original, paying attention to words like fiction, provider, facial.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.