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

**Peter Attia** (0:11)
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My guests this week are Dr. Tanuj Nakra and Dr. Suzan Obagi. Two highly respected physicians in Aesthetic Medicine. Tanuj is triple board certified in Facial and Ophthalmic Plastic Surgery, faculty at the Dell Medical School and the Director of the Cosmetic Surgery Fellowship at the TOCI and FACE Institute in Austin. Suzan is double board certified in Dermatology and Cosmetic Surgery. She is an Associate Professor at the University of Pittsburgh and the Director of the UPMC Cosmetic Surgery and Skin Health Center, where she leads advancements in Cosmetic and Laser Surgery on a global health scale. In this episode, we talk about the biology of facial aging, how hormonal changes impact facial bone structure and skin integrity, and the critical role that hormone replacement therapy plays in preserving a youthful appearance. We talk about what makes a face attractive from an evolutionary perspective and a psychological perspective, and how modern media and social media filters are warping and distorting those standards. Talk about the troubling rise in cosmetic procedures among teenagers and how physicians can navigate ethical decisions around these things. And then we really get to the substance of this podcast, which is we talk through a practical and science-backed approach to skin health, including the essentials, sunscreen, retinoids and vitamin C, and many more things. We talk about mineral sunscreens and why they are likely superior to chemical or organic sunscreens, how to use retinoids correctly based on skin type and sensitivity, what a personalized morning and evening skin care routine should look like, including cleanser type and application order, the medical management of acne, especially cystic acne, the psychology behind aesthetic consultations, and why trust, motivation and emotional readiness are critical before undertaking procedures. And finally, and perhaps most importantly, at the end of this podcast, we turn the tables. I'm the patient. I'm sitting across from them, and I'm asking them to be as brutal as they need to be and offer an assessment of what would be truly possible if someone in my shoes wanted to take all the steps of aesthetic medicine and apply them to their own appearance from the neck up. This was the most illuminating discussion. And while I realized that listening to it, it might sound like they're being overly harsh or critical. You have to understand this is exactly what I wanted. I wanted to understand these things. And honestly, I came away from this realizing there was more quote unquote wrong with my face than I ever imagined. Again, will I do anything about it? Truthfully, beyond the new skin regimen, I have adopted probably nothing. But nevertheless, I was intrigued by this. And I think that many of you who have been thinking about these things as well will come away either deciding maybe there are things you want to do from an aesthetic standpoint or at a minimum, just taking care of your skin might be the right thing to do. And clearly, you'll come away from this with a great regimen for how to do that. So without further delay, please enjoy my conversation with Dr. Tanuj Nakra and Dr. Suzan Obagi.
Tanuj, Suzan, great to have you here both. You're obviously in Austin. You traveled from Pittsburgh, right?

**Suzan Obagi** (4:13)
Yes.

**Peter Attia** (4:13)
Awesome. Well, this is a topic we get asked a lot about. And sometimes when we get asked about topics, I already know quite a bit. And this is absolutely an example of the opposite of that. This is a topic we get asked about a lot. And I would argue that my knowledge is even below that of the general public. I can't think of a time when I've done a discussion on the podcast on something where I know less, than all things related to the health of one's skin and appearance. And so, yeah, thank you very much for both being here. And thank you for helping me even think about how to structure a discussion on this topic. Maybe before we jump into it, just give us each a little bit of your backgrounds. I think it was helpful to have not one, but two experts here because you guys have sort of a different specialty. Obviously, within medicine, you have a different specialty. You overlap in things, but obviously do some things different. So tell us a little bit about your training, your background and what you focus on.