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

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

2025/6/30
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The Peter Attia Drive

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Suzan Obagi:作为一名医生,我经常遇到病人抱怨看起来疲惫,却无法具体指出原因。我通过展示20岁和60多岁面部图表,解释面部脂肪隔间的萎缩和骨骼结构的变化。女性在40多岁开始出现衰老迹象,50岁后衰老加速,激素水平下降导致骨骼流失和脂肪萎缩。激素替代疗法可以帮助维持骨骼健康。生活方式压力也会加速衰老,而美容科学的质量参差不齐,行业内的经济动机也使情况更加复杂。面部脂肪隔间的作用是让肌肉滑动,而从腹部提取的脂肪移植到面部后,会表现出腹部脂肪的特性。 Tanuj Nakra:关于衰老过程有很多科学研究,骨骼结构随着年龄增长而衰退,骨骼是面部的基础。韧带将皮肤连接到骨骼,随着脂肪萎缩和骨骼后移,韧带拉扯皮肤,导致深层皱纹出现。面部脂肪与身体其他部位的脂肪不同,其代谢和对压力的反应也不同。慢性皮质醇升高可能对脸部的脂肪具有分解代谢作用。人类天生就对美丽有欣赏力,普遍欣赏面部的对称性、比例和性别二态性。社交媒体上的图片经过滤镜处理,是对美的夸张和不真实的表达。过度填充是一个严重的问题,不仅因为它看起来夸张和扭曲,而且还会扰乱正常的解剖结构,使以后的手术更加困难。

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Tanuj Nakra and Suzan Obagi, two leading experts in aesthetic medicine, join Peter to explore the science of facial aging and skin health as well as the responsibilities physicians face in the world of cosmetic procedures. In this episode, they examine the biological and hormonal drivers of facial aging, the evolutionary and psychological foundations of attractiveness, and the impact of modern media on beauty standards. They discuss the rise in cosmetic procedures among adolescents and the ethical responsibilities of physicians in these cases. The conversation then shifts to a practical, evidence-based guide to skin health—covering the use of mineral sunscreens, retinoids, vitamin C, and tailored skincare routines, as well as the management of acne and the psychology behind aesthetic consultations. The episode culminates in a candid, personal assessment of Peter’s own face, offering a revealing look at what aesthetic medicine can achieve and how to think critically about pursuing it.

We discuss:

  • Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00];
  • The biology of the aging face [10:45];
  • Why facial fat atrophies with age while body fat tends to accumulate [17:00];
  • How chronic stress accelerates facial aging [20:30];
  • The evolutionary biology of beauty, and how modern lifestyle, culture, and medicine interact with these ancient aesthetic instincts [25:30];
  • How social media and influencers have rapidly shifted aesthetic trends toward exaggerated features and unrealistic beauty standards [36:45];
  • The ethical challenges, financial incentives, and social pressures shaping modern aesthetic medicine [42:00];
  • The concerning trend of teenagers seeking cosmetic enhancements: the ethical and cultural impact of early beauty pressure [51:45];
  • Protecting the skin: UV damage and sunscreen recommendations [58:15];
  • Strategies for minimizing skin aging: retinoids, vitamin C, and evidence-based application methods [1:09:00];
  • Effective daily skincare routine: cleansing, antioxidants, retinoids, moisturization, and more [1:18:45];
  • The playbook for managing acne [1:31:00];
  • The 4 changes of aging and the complexities of aesthetic consultations including the anatomical, psychological, and ethical factors physicians must navigate [1:39:00];
  • The 5 R’s of rejuvenation [1:50:15];
  • A facial aging analysis and cosmetic strategy using Peter’s face as a real-time case study [1:53:00];
  • The decision-making process between fat grafting and dermal fillers for facial rejuvenation [1:56:30];
  • How self-image, eye aesthetics, and fleeting photos drive the desire for cosmetic enhancement [2:01:45];
  • Advice for wrinkles, causes of dark circles under the eyes, and the importance of facial symmetry [2:05:45];
  • Considerations that shape clinical decision making around fat grafting and other procedures to address the eye area [2:11:00];
  • The evolution of facial cosmetic surgery techniques, the serious risks involved, and how physician skill and procedure selection greatly impact outcomes [2:21:30];
  • How patients can make informed and safe choices when selecting a cosmetic surgeon [2:27:15];
  • A comparison of ablative versus non-ablative skin resurfacing treatments, laser vs. peels, and more [2:38:45];
  • How treatments are chosen and customized based on patient-specific factors [2:48:00];
  • The lifelong human desire to align physical appearance with self-identity [2:52:45]; and
  • More.

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