When we talk about cosmeceuticals, cosmetics, skincare, many times people focus on, and it's so popular right now, on the superficial aspect and how it can make them look more beautiful, how the social media amplifies it to a more filtered look.

getting rid of the wrinkles, getting rid of the spots, having that perfect, clear, glowy skin. The issue with focusing so much on the superficial aspect of it is you're forgetting that the root, the deep aspect of that reflected, beautiful skin has to come from within.

And that means doing the groundwork of taking care of your whole body, your mind, and also working on the health of the skin. And that leads to more resilient, stronger skin that can meet the daily challenges and they are increasing every day.

Welcome to the Double Dumb Podcast with Dr. D. I'm Dr. Paula Daleman, a Triple Board Certified MD with a passion for helping you thrive at every stage of life from your first steps into wellness to navigating menopause like a pro.

Whether you're tackling weight and mastering menopause or leveling up your health, this is your go-to space for transformation. It's time to double down on your health and your life.

Let's get started. Hello and we are here again in another episode of Double Down with Dr. D. Hello everybody and all my listeners. Today we continue talking about skin and beauty from inside out.

I think this is my third episode about it. We love skin. We love feeling good from the inside and then everything reflects in your skin. So for that, I brought you a guest.

She's awesome. She's an integrative dermatologist. This is Dr. Mariana Blumin Karasik. I hope I said it well. She's a board certified dermatologist and a co-founder of Precision Skin and Body Institute.

She specializes in cosmetics, medical and surgical dermatology with a focus on personalized and holistic care. She got me just right there. As the creator for Stamina Cosmetics, she put her brain on it and created the product that she's going to tell you what to use.

She champions skin resilience and wellness. Another two words that I love. Through science-backed, adaptogenics. Hey, you got me there and mindful skincare.

You see, this is why she's my guest. An active researcher, speaker, co-author of more than 40 scientific publications, evidence-based, she brings a compassionate, inclusive approach to helping patients achieve the long-term skin health beauty and well-being.

So as you know, she doesn't stop at the skin and at the surface, she goes deeper. Another physician that sees the person as a whole. Welcome to Double Down with Dr.

D. Mariana. Thank you for saying yes for this interview. Please introduce yourself to my audience. Thank you so much. That was a lovely introduction. It's such an honor to be here, Paula.

And hello, everyone. Thank you so much for listening. We're so looking forward to this stimulating conversation. Awesome. So we're going to make it fun.

Obviously, we already spoke, I have other episodes on aesthetics and how the changes, but I would love to make the connection between lifestyle medicine and your skin health.

So for that, many of your words that you are always your motto, almost like your mantras, have a lot to do with the resilience and the radiance of the skin.

And even your products, they call stamina, which I love that as well. Can you please just enlighten us about why those words are your drive, those are the words that drive you and also inspire you to create your cosmetic line?

Well, thank you so much for that introduction. And yes, I think since I was a little girl, I always been fascinated with human psychology because I thought it was really interesting growing up in former Soviet Union and seeing how adults behave and respond to different things in their lives.

So I grew up in a communist era and it was very challenging. to see certain individuals succumb to significant amount of stress and others thrive and meet the challenge.

So for longest time, I had that fascination of figuring out what is that grit? What is that resilience? What is that stamina that allows us to endure?

And then over time, as I grew up and I became a physician and eventually a dermatologist, I translated that fascination to my skincare practice, to my dermatological practice in an integrative way with my patients, but also with further on, with infused that into my skincare line, Stamina Cosmetics, because I wanted to be able to deliver stamina to any user, not just my patient, but anyone out there that wants to have more resilient, more enduring skin throughout their lifetime.

And what does that mean to me and to everyone who considers that aspect is just changing their mindset about what really skin beauty is. Because when we talk about cosmeceuticals, cosmetics, skincare, many times people focus on, and it's so popular right now, on the superficial aspect and how it can make them look more beautiful, how the social media amplifies it to more filtered look, getting rid of the wrinkles, getting rid of the spots, having that perfect, clear, glowy skin.

The issue with focusing so much on the superficial aspect of it is you're forgetting that the root, the deep aspect of that reflected, beautiful skin has to come from within.

And I'll be more than happy to dive deeper about that. But various stressors are deteriorating the quality of our skin, those exposomes that's causing our skin to flare up with more skin problems and also accelerate the aging process.

And we just need to focus more in seeking that health and beauty of the skin on the resilience and being able to have more enduring skin span. So lifespan, I know that you're passionate about, that's just a branch of medicine that's focusing on how to give more lasting, youthful and healthy and beautiful skin that reads resilience radiance.

So a skin span is something that is admirable pursuit because it approaches the skin in a more holistic way. And the way that I teach most of my patients and students is there's not a complicated way to pursue this.

You can make it very simple and smart. and strategic. And there's a simple formula that I've created. It's called SkinSpan 3×3. And it's basically having three skincare habits that you can fuse together with three optimal skincare products that you integrate into skincare.

and anchor those with three most influential skincare lifestyle modifications into your daily life that are most impactful for extending that skin span.

So what does that mean? That usually means starting on the path of just doing three steps of skincare application every day. So in the morning, using a sunscreen.

That's essential. I know that a lot of the dermatologists have been working significantly in educating everyone around about how important sunscreen is.

So now I think that majority of the public has embraced us. But if someone is still questioning the aspect of sunscreen and being a key in reducing the health and aging of the skin, this is an absolute must.

You can't skip on this stuff. The reason why is the sun damage, the UV rays, the visible light, the heat that's coming from the sun is causing the skin to break down in various aspects from skin barrier, increases the inflammation of the skin, which leads to inflammation, and also DNA changes that can lead to sunburn and skin cancer.

So it's very detrimental to the resilience of the skin. So sunscreen in the morning, and then at nine, which is very protective, and at night balancing the skin by cleansing the skin.

So to cleanse the skin, you've got to find the right cleanser, and it could be very different for every individual. So again, strategic and smart skincare, but the cleansing could be salicylic acid or benzoyl peroxide for someone oily skin and acne prone.

or it could be a gentle, creamy lotion type of cleanser for somebody with mature, dehydrated or sensitive skin so it doesn't agitate the skin. We've got to remove the grime, we've got to remove the oil, the sweat, the various environmental pathogens and irritants that we accumulate throughout the day in order to balance it.

And then finally, moisturizing the skin. In the end, the important to seal the hydration to repair the skin overnight and moisturize is very important to that.

So again, choosing the right product for a patient has to be done wisely. And this is where dermatologists come in to guide our patients during their dermatological visit.

what is the ideal product for them for those three essential foundational steps for skincare, whether they're acne prone or whether they're sensitive skin type, and then starting on that routine to protect, to balance, and repair the skin on a daily basis.

And then anchoring that, integrating that with the lifestyle modifications and the three most influential aspects that impact the skin health and age.

Again, we already talked about about sun damage, so using sunscreen and other sun protective strategic tools such as seeking shade, trying to minimize sun exposure midday, especially here in Florida.

in the summertime where the UV index is so high, it can really cause significant damage to our skin. If we love outdoors, because I love being outdoors and I'm not anti-sun advocate completely, but being more strategic of when we expose ourselves to the sun.

So if we would like to play pickleball or tennis, if we would like to go boating, let's do it more early in the morning, late afternoon when the sun is not so strong, not so damaging.

applying a sunscreen, using UV protective clothing, hats, sunglasses, reapplying sunscreen every hour and a half because that's how long it lasts, and making sure that we keep our skin safer that way.

The number two influential impact on the resilience of our skin is stress. So stress management is critical for the health of our skin. So stress I'm talking about the most is the psychological stress.

The issue with stress is that, you know, many people can contract this statement saying that stress is actually important. It gives us survival. That's absolutely correct when it's an acute and small doses, the cortisol rises, the adrenal cordon rises, it allows that flight of flight type of response in order to escape whatever the danger.

And then, then our body responds, the danger comes down. Sometimes these type of stressors are actually thriving and resiliency building for ourselves, for our mind.

But if we have them too much and too chronic for long periods of time, that what breaks down our system. That's what overloads our system. Absolutely.

It is absolutely right. So the stoxic stretch accumulates and then it overflows and the skin is the most apparent organ of our bodies. It's the biggest organ of our bodies.

It's most apparent. We see the story of the stress on the skin. And that's what I recognize the most during COVID. A lot of people, a lot of us, were experiencing significant amount of stress in our lives.

In general, we are high-functioning individuals, but then you amplify of what was happening in our lives of worry about this infection and what it means for our families, what it means for our country, our community, our country, and all the economic and political things that were happening surrounding that.

And that led to so much anxiety and that was even more amplified by the media and that led to such a stress loop that we were having such hard time breaking down and separating ourselves from.

So that was one of the most important impetus for me to create Stamina Cosmetics because I would just throw my hands up at the end of a clinic and go like, I don't know what to do with this.

Like we need more stamina. We are so stressed out and it shows up as acne, maskne, eczema, rosacea on the skin. My patients are suffering. I feel their stress and an empath.

So I feel it. And I just needed to figure out how to connect the dots of addressing that stress. So stress management is not an easy topic, it's a very broad topic, but what led me on a search of what are the most important tools besides the extreme intervention should be always guided with a professional, like a behavioral therapist or a psychiatrist.

But when it's something that we can think that we can control, something that is intermittent and we can put all our efforts in resolving on our own, then I suggest exploring the evidence-based mind-body interventions and tools like breathwork, mindfulness.

Meditation, and that could be in different expressions. I know you talk about this all the time, but for some people, this looks like doing yoga and Pilates movements, a regular exercise.

For others, it's taking a walk with their pet. Others, it's gardening. Others, it's cooking. But something that I call doses of stamina that we can integrate into our life, little sparks of joy, that gives us a grounding and reset to decrease the stress in our lives.

And that is what I infused into my skincare line, Stamina Cosmetics. Besides having the pillar of adaptogenic type of skincare ingredients that are medical grade, cosmeceutical, I also infused the promotion of wellness through a mindful skincare practice.

And why did I do that? It's because I recognize that skincare is extremely popular nowadays, and it became extremely popular during COVID. Looking at the numbers today, when I looked up, it's about 60 to 75% individuals use some form of skincare product daily.

So that's about 6 billion people a day use a skincare product. So if it's a practice that is so common for so many individuals, And it's into this practice, we can infuse a wellness practice, a mindful practice where there could be breath work, there could be affirmations, gratitude, visualization of immediate gratification, some somatic aspects of sensorial pleasure, aromatherapy.

This is something that can be a pathway toward wellness, pathway toward exploring and reminder. Yeah, connecting, uniting the wellness as well as skincare together to enhance skin span and bringing that stamina that we're seeking so much.

And then the third habit that's very important, I know I'm on this long explanation of stress reduction, but I feel very passionate about it and we can talk more about it in the future.

But the third one is So sleep is critical for the best function of our skin. During our sleep, that's an important stage of our circadian rhythm where we can repair our skin in its best performance.

So when we go to sleep, our skin goes to work and it's doing its best in functions of repairing all the damage, oxidative stress, all the different environmental stress, psychological stress, hormonal factors to repair.

to rehydrate, to protect, that's what's main function is for us, to regenerate whatever the elastin collagen that we lost in order to give that firmness and elasticity to the skin.

So sleep is critical. So adequate sleep is something that we really lack nowadays because we're so multitasking, high functioning, over connected with technology.

So bring it back to realization that we need ideal sleep that's six to eight hours, at least few times a week, is critical for my patients to understand, hey, I do need to realize that good sleep, stress reduction, sun strategies, so minimization of sun exposure strategies, are the most important and influential lifestyle modifications in order to expand the skin span.

It's wonderful that you are practicing lifestyle medicine through dermatology. It's wonderful that you recognize that the education, it is absolutely essential and everything, the foundation of everything is basically in lifestyle choices.

So you talk, this conversation that I'm having with you, I can have it with a cardiologist, but the cardiologist is going to talk about the cardiovascular health.

And it's not that far from the skin health, which are two organs, right? We have the heart and the vessels, endothelium, very important system that everybody wants to tackle.

We are going to sit down here with a cardiologist, talk specifically about the type of food we eat, about how exercise is making an impact, how recovering in your sleep, how you have to tackle that stress.

I agree with you with the whole stress. It can be a totally new podcast on it. A lot of things to talk about it because it's also the perception of stress like you were saying.

There is a small little stresses during the day that you might go under recognized by the human. And then with time, it's just a pile up of little stresses that you don't know how to tackle versus a big trauma that is obvious.

You get help like a behavioral therapist or a psychiatrist, and it's like obvious to you, but stress can show up in different perspectives, which is very important that you brought it up.

But what I love the most is the fact that I can prove to my patients, especially now that I'm really a big advocate of lifestyle medicine, Lifestyle medicine can be applied to any specialist and once all of us get together we speak the same language and we pass on the same message.

Obviously all of us have a different, let's say a different technique or a different type like your three three-on-three type of algorithm that you teach because it's easy to follow.

Each of us has a different one, which at least we are on the same boat and the same narrative, which is super important for the new generations to understand how this is a new medicine.

The medicine, the healing, they just put a bandaid on whatever is already broken. It's a medicine that we are all running away. There is half of the doctors that are still are there.

and they are starting to be going into the surface. Everybody is starting to recognize them. I have patients here to go, my doctor is not into it. My doctor said, how come you don't need that much title hormone anymore?

Who's seeing you? I'm seeing this doctor who does lifestyle medicine. That's such a thing. That's ridiculous. That's what that immunologist say. And I'm like, well, it's not that ridiculous.

Your patient doesn't need title hormone anymore. So it is what it is. So it's. little even education in the same medical community without that. So you are part of the tribe.

We're lifestyle medicine. We don't recognize that all the organs make the whole person. We don't treat any more organs or systems or specialties. We treat the whole person, which is fantastic.

And the next thing is include them. in that treatment, in how you educate them about themselves and then you give them the tools to maintain it. I love what you say, that resilience of the skin, right?

Because resilience, radiance, vitality, health span, you always apply that to your body, your cardiovascular system, your mental system. You know, you're going to be resilient, you can do it.

You don't think about your skin, which is like you were saying, there is like so many million people using skincare products, people put the money there.

So lucky you, because many people put the money on everything that has to do skin, because it is your presentation card. And people like to have a beautiful presentation card.

And that's important. If I tell everybody, I need you to do these three things for your liver, most probably people is just going to go, whatever. But I said, I need you to do these three things for your face and your skin.

they will listen carefully. So it's not until the liver start giving them problems that they will say, okay, I'm ready. So skin is very grateful. It just, when you do, it will show it and it's going to be obvious to you, to your patients.

So it's a good, because we talk a lot about the quick fix. We talk a lot about how people also come to me because this is the problem. I want a quick fix.

This is why medicine, Western medicine based on the pill was so It has been successful to a certain extent because the sustainable, ongoing, being consistent changes doesn't bring fast, quick pleasure, so it is more complex.

The field of dermatology, it's a little bit, I'm not saying easier, I'm just saying it's easy to return that pleasure that the people is looking for in a short period of time.

So people will listen to you more, will get educated more, you can pass on so much lifestyle. changes in their life. And if you teach them, please, I need you to sleep better because your skin is going to be prettier than me saying, hey, I need you to sleep better.

So you're going to have more strength. So I can put you to do some resistance tomorrow for your muscle health. It might be taken in a different way. But my next question to you, although you already respond some of it, which is this Skin stressors, we spoke about those stressors that they're not obvious to us and they sneak into our life and maybe we can control them.

We spoke about sun exposure, we spoke about chronic stress. Is that any other sneaky skin stressors, maybe in the other pillars, I'm talking about food, nutrition, maybe our gut health, something else that people should be aware that they exist.

Beautifully put, I really, really love how you guys holistically emphasize the importance of lifestyle medicine, of integrative medicine. And we are so blessed as physicians who are truly nerds and lean upon evidence-based medicine.

now in order to recommend the best care for our patients. But yes, the paradigm of practicing medicine is changing. We're not seeing the best results.

We're actually seeing more detrimental results with just reactive medicine. So we are seeking more proactive medicine and indicating more different other alternative and complementary medicine approaches in order to get the best results for our patients.

And the reason why now it's so significant is because we're getting more scientific backing that these methods work. You know, Andrew Whale, the father of integrated medicine, advocated for years for breath work.

And now there's clinical studies to show breath work reduces stress, improves skin quality, improves metabolic function and reduces inflammation in our body.

Yes, there are many stressors that are damaging for our skin, and I already alluded to some of them, but I'd like to kind of bring them into four main buckets.

Environmental stress, and that includes the UV damage by itself, so the pollution, the smoke, the smog that's around us, the visible light, the blue light that's around the screen that we're looking at each other through.

And, you know, one of the skincare products that I usually recommend my patients, especially in the most cosmetic area like the face, neck, and chest, is tinted sunscreen.

The reason why a tinted sunscreen would be a better choice at this point is it has an ingredient called zinc oxide, not only zinc, but it has an ingredient called iron oxide.

And iron oxide blocks the visible light, the blue light. And that's an important feature of our skin that we have discovered in the last few years. The other bucket that's important is the psychological stress, and we covered that.

And a little tangent off that that many people don't realize is that the stress loop that happens between our mind and our skin is bidirectional. And what that means is that when we are stressed out psychologically, what happens is that there's a whole slew of neurological peptides as well as hormones and immunological signaling that happens together and they flood to the various organs of our body.

That's why it's so important to see the bodies interconnected, all the organs interconnected, not in isolation. They go to our skin, including our skin, and they will present on our skin.

For some people who are a rosacea prone will flush. Some people will sweat more. Some people will have a reactive bumps and hives on their body when they're stressed out, right?

But based on our genetic background, based on what skin care we have at that point, what environmental factors are milestones like hormonal status, our skin will respond to those signals, genealogical, endocrinological, immunological, because it has its own signals in the skin that will manufacture.

And it will send that signal, the signal back, either in a subdued form, it will say, calm down, this is way too much, I'm just going to Be resilient and with my stronghold, I'm going to counteract this signal and I'm going to calm things down and I'm not going to overreact and come back to equilibrium, homeostasis, right?

And that speaks about the adaptogenic side of my skincare line. The adaptogens that we use in the skincare, mostly botanical derived like curcumin and cordyceps go to cola.

They helped us adapt to stress by subduing these over-amplified signals from the stress signal or our body, our skin could say, otherwise, I'm not resilient enough to accept this stress signal.

I'm going to amplify the stress signal. I'm going to send even more of the same type of, or similar signals back to the brain. And the brain is going to pick up and say, oh my God, I'm so itchy.

I'm so uncomfortable. I'm going to break out even more. And this is just talking about the skin, but what happens in our liver, what happens in our gut.

the bloating, the pain that can happen, the migraines that can happen, the joint pain that can happen with this amplification of this type of signal. So it's bi-directional loop, and that's how that mind-skin stress cycle happens.

And that's why when I see someone like a typical teenager that breaks out and has pimples, some of them go, huh, it doesn't bother us. But I have others who are picking at their skin.

And their parents report that they are free to go hang out with their friends because it's impacting their quality of life because they're so ashamed of how their skin looks, right?

So there's different perceptions around the stress. So psychological stressor is number two bucket that's very important to address and it's damaging for the skin.

Lifestyle. So lifestyle is what you already brought up. And yes, that includes not only just sleep, good sleep, but also good diet, nutrition. You know, inflammatory foods like high glycemic index, like high, highly processed food, fast foods, that so many of us high performance individuals could want to just grab that, you know, easy cheeseburger or that french fries on the go or whatever that's around.

Some of our busy moms as we're running around trying to live our lives, we're like. call ourselves garbage bins, right? For like during the toddler years, I'm just going to grab that chicken nugget.

I'm going to take this and that. I mean, don't realize how all of this compounds eventually to reflect on our whole body, our mind and our skin. And then we look in the mirror and it was like, what happened?

I look so dull. I lost my luck luster, right? So all of that is connecting. And we have to understand that lifestyle plays an important role. Are we exercising?

Are we stuck to our Zoom meetings for most of the day? Are we taking breaks, taking walks, doing a little bit of weight strengthening exercise? It's so important for longevity of our whole body.

All of that is part of lifestyle influence. Or we live a sedentary lifestyle, we live more stressful, inflammatory stuff. So these are the choices we make every day.

And each little habit is something that we need to understand adds up to the final result, our longevity, our life, our lifespan. And then finally, we also need to look at the biological.

So biological bucket is one that I call milestone bucket. So what we found over the last few years through studies in Stanford and several other universities globally is that our skin doesn't age cumulatively of various exposomal stresses and aggressors.

It has various leaps. at certain times of our lives. So these intense type of change in molecular epigenetic changes happen during the various stages of our lives.

Like if there's a trauma or for women, it's hormonal changes like puberty. Having a baby, hearing menopause. So often I see women who have kids and then they come a year later and they're like, I don't know what just happened, but I feel like I aged 10 years.

Do you hear this also? Like I suddenly have all these wrinkles and dark circles and my skin is so dry. What's happening or perimenopause? I don't recognize it.

Like I pulled my skin is so crappy and lags. It's not me anymore. What's happening to my skin? These are biological milestones that have significant impact on our skin and that has to do with hormonal shifts.

and various things that we're still discovering, various other neurological and exposomal factors that we will figure out through precision medicine in the future.

But these are the main four buckets that we should be concerned about when we are trying our best to fine tune our habits in the direction of more lifespan, including skin span.

Is there any counter-intuitive methods that people might overlook that actually might help to skin repair or stay radiant and they are easy just to put as a habit?

So it's, of course, because I think most people think that more is better, especially the advocation of the social media and push of marketing. Oh, you got to have this anti-aging serum.

This is the solution for your wrinkles and black skin or this, this is the perfect skin cream for your droopy eyelids and whatever, whatever. So the point is, is that we go in, unfortunately, we go into this deep dive of trying to pursue what again, you said, abandoned as superficial approach to keep our skin beauty relevant and to stay youthful and important for ourselves and other people around us to think and feel the best and have they have that confidence.

But unfortunately, we overdo it because then we don't know how to utilize the skincare and some of these aesthetic procedures and infuse along with a holistic approach of interventions in order to get the utmost result of skin resilience and radiance, right?

So we slap on 50 different steps of serums and gua sha tools and all of that, and we think that is going to be the solution or we inject multiple fillers and do these aggressive lasers.

And all of a sudden we don't look all like ourselves. And I say we, because even myself, I sometimes went in a little bit of an extreme mode and that made me realize, whoa, what just happened?

I'm really happy how my eyebrows look a little heavy and I did a little too much with the both of them. So we, through the experience over many years, I've learned that sometimes the best outcome is less is more.

is the best outcome is to be simple, smart, strategic, not overdoing with the skincare, not overdoing with procedures, living a more holistically healthy lifestyle, really reflecting about the choices we're making every day and fine tuning them to unload the ones that are too much burden for us as much as we can and to load the ones that are going to be serving us for the best.

Yeah, I like that. The less is more, the simple can be better. I agree with you speaking about the world of cosmetics, right? And we get all lost because we don't know.

It requires someone with a lot of knowledge like you to tell us these ingredients are right. These ingredients are not right. It doesn't mean the more expensive is the better for your skin.

I know people that I go, what do you do with your skin? I say, old fashioned heavy ponds cream from grandma. I'm like, okay, wow, this is, or coconut oil and it's done.

So it is incredible how the simpler it's the better. The more preventive is the better. The two liters of water a day will help my moisturizer to get, to really work on it.

So it is, I just, yes, exactly. Two, I have it. I have my moisturizer from Stamina. It is, I'm learning that, right? There is another market too and I'm seeing it because I have a teenager at home, right?

So it's the market of the cosmetic for them. So cheaper, full of extra things. I smell everything that she puts on herself. The package is, it's flamboyant and everybody talks in TikTok and I'm like, I don't know, I'm not sure.

Obviously, this is a 17, 19, 20-year-old skin, which is not going to react unless you're allergic to all these things. But I'm unsure that this is the way, even if they are young and we said, okay, like when we let them eat fast food, they are young, they would learn, let's let them eat fast food.

By 28, they start changing their mind. No, it should be a habit right from the beginning. Yes, get your fast food once a week. It should not be the way you nourish your body.

So same thing, take care of yourself, take care of your skin. And like you were saying, the most cosmetic, which is the face, the neck and the chest, but the rest, you know, I had this podcast with an aesthetician that I like a lot and she's a PA, but she's telling me, my arms, talking about the arms being very, she goes, I forgot about my arms.

I don't want to. I want to pamper them as much as I'm pampering my cheeks. And I take my time and I exfoliate my arms and I moisturize them. And I'm like, wow, what a concept.

I didn't think about it, but you're right. It's not until we start seeing changes that we start doing something. Again, we forgot about prevention. So our young looking women, our young-looking generation, which is they're used to this gorgeous plump skin, which all of them, they have it.

The worst that can happen to a teenager is just the acne, which is treatable. And yes, it has a psychological impact. I treated it too as an adolescent medicine doctor.

And I always saw that difference in between I don't care to all the way to this is destroying my life. But a part of that, obviously, young-looking radiant skin that they can keep it.

It's like the muscle. When I tell the women at 45, keep that muscle. Don't lose it because you're going to start losing percentage of muscle. Keep it as much muscle as you want.

Keep as much of your beautiful collagen as possible and be very knowledgeable about what you're putting in your skin. It's not the smell, it's not the 120 ingredients.

Is there some resources where people can go and say these ingredients, because I know, for example, my shampoo. I'm always looking for my shampoo being sulfite-free.

Is there specific top five ingredients that our listeners should be always reading in the bottle and they should avoid? There are a couple of resources that patients who want to be more savvy about what type of actives that are going on their skin to be more healthy for themselves, for their families, and environmentally.

There is E, American Academy of Dermatology, has some resources and information, as well as EWG, the environmental working group. although their views are very extreme.

And Yuka is also a very common app for more organic and holistic type of skincare, more clean skincare, which is a very broad term and has come to some controversial reviews recently.

But when it comes to You know, what are some of the more cleaner actives is that trying to avoid actives that potentially can be harmful for irritation or allergenicity of the skin.

And that includes synthetic fragrances, certain type of preservatives like phthalates or parabens, formaldehydes. Those are very allergenic and irritating for the skin.

So when reading the labels and there are a lot of synthetic fragrances at the bottom, that's when they usually include it, try to avoid those. Then there's ingredients like oxybenzone and octinoxate, which are found in very rare type of sunscreen because there have been rigorous review in the last few years to remove them from sunscreens, especially in America, in U. S.

Those can be actual hormone disruptors. And hormone disruptors means potentially leading to early puberty and other type of hormonal regulation in humans.

It's definitely been found in mice. So those should be avoided in skincare for sure. So being mindful of looking to avoid those ingredients would be helpful to keep the skin more healthy, especially in young individuals.

Okay. Yeah. Thank you for that, Mariana, because as much as I was treating mild, moderate eczema, after moderate, I sent it to the dermatologist, and I was always looking.

Look at the ingredients, and the simplest, the better. The less ingredients, the better, and always make sure there is no fragging. So for me, fragrance and the moisturizer on the laundry detergent, all these things being always, or even colors, right?

And I was telling the mothers, as simple as no fragrance, no colors, minimum ingredients that you can use to protect the skin from irritants. So that's important.

Obviously, the whole cause, yes, go ahead. Yeah, I'd love to add on a little bit about the fragrance. So when we're reading labels, just a little tip, fragrance free means there's no fragrance in the product.

But when we read on any personal care product that we're using on our bodies, including the clothing that we do, like detergent fabric softener that you mentioned, if it says unscented, doesn't mean it's fragrance free.

It means there was a fragrance that was appalling and then they put another fragrance there to block it. So it's neutral smooth. neutralized. So unscented doesn't mean it doesn't have fragrance, so be careful with that.

Number two, I'm not in complete agreement to always recommend fragrance-free products. It's one of the reasons that two of my products have very subtle but naturally-divided fragrances.

And those naturally-divided fragrances have to be screened by the creators of the skincare, by the formulas to make sure they're hypoallergenic, they're not going to be.

reactive to most individuals with sensitive skin types except the hyper hyper reactive ones and they're usually the lowest on the ingredient list which means they have the smallest concentration in the formula and that's why the fragrance is very subtle and not overwhelming.

Now if you're talking about those very you know teenager gen z and alpha type of skincare products that you know have that embellishment of Synthetic fragrances that smell so strong, that is the problem.

Those synthetic fragrances can irritate and cause allergies and a skin breakout with rashes and exits. So those need to be really reduced in the usage, especially for younger generation.

Okay. Yeah, thank you for the clarification. Absolutely. And I was going to that. That for me, a skin line made by a dermatologist, I already trust you as my doctor.

So of course you're going to know every detail in what cream I'm going to put on my skin. It's the organ that you're a specialist on. I know you're going to treat my organ of the skin the best.

So whatever ingredients are there, I know you're going to have them. You know, it's like if I would create my own, I have some of my friend doctors who create their own supplements, their own protein or their own collagen.

I do trust them that they went through the whole process to the point that they say this is for my patients. my patient trust their health on me, I need them also to trust that what they're going to consume, it is right for their body.

So absolutely, I wanted to go there. For sure, some things have to smell good. And if you're telling me, I don't know, I don't have my own cosmetic, But I do like some fragrance that feels like fresh or if it's, I don't know, the rose petals that has been indeed, the smell of the rose petals came directly from a petal.

So I'm sure that unless my skin really, it is allergic to rose petals in general. it's going to be a nice addition, part of the lifestyle and the whole holistic approach of taking care of your skin, because it's part of the well-being, a good smell, a good feeling, the cooling feeling, the moisturizing feeling, absolutely.

Thank you for that clarification and those tips that we can give to our audience. And let's go back a little bit into that hormonal and skin appearance.

I'm doing a lot of podcasts on midlife and perimenopause, menopause transition. I'm really part of the group, big on it. I want to be revolutionary about it.

And aging with grace, because that concept of anti-aging, I haven't been able to digest that. I don't think anti-aging, it is a word. because we all age, everything that is alive ages is how you do it.

So aging with grace as much vitality as possible and health span more than long life span, right? So going into the hormonal changes, when we're going through perimenopause, those huge changes in our skin, And because we are in an age that we are able now to afford everything that is required from the best cosmetics, makeup cosmetics, all the way to the best skincare, all the way to cosmetic procedures.

So I would like just first to teach us a little bit about the whole estrogen, progesterone, testosterone effect on our skin. What's your take on putting some estriol in our skin, what do you think about that addition to it, that those estrogen creams marketed as a rejuvenation?

And what is the magic bullet? Or if there is a smarter, more holistic way to approach our skin now that we are in more maturity, more in the process of aging our skin.

Thank you. It's a wonderful question. Like yourself, I'm truly really fascinated in this topic too, because I'm going through the change myself. So it's almost like on a selfish aspect and explorative.

And at the same time, a lot of my patients in the community that I'm serving are matrix. So women there are taking care of themselves, but they're also charge of their family health system.

So they're bringing their kids and their husbands and their elderly parents to take care of the skin. So I'm blessed to see the whole family, but the mother is the center that always has to kind of guide the family in the best approach in their health and their skincare and all these important habits.

And what I'm hearing from them is many of my patients are going through these perimenopausal changes like I saw, like myself, and I want to give them the most up to date, the most current information in order to support them through this, as I know myself, because I'm going through this too.

And that is why I am so grateful to be able to connect with an expert like yourself and Samantha's functional medicine provider who is an expert in hormonal treatments.

because hormonal changes really changed the game for us as women, especially. Men go through sort of menopause themselves, but it's a much more extended process and it's a much less intensive process with the testosterone decline.

For women, it's more faster, accelerated, and it happens sometime around our early 40s, sometimes even later, and then it really amplifies toward our 50s.

And multi organs, including our skin. And so what do we see in our skin? We see drastically changes in various quality markers of our skin. The tone, it changes.

So we get that dullness, that sullenness, all of a sudden it's like, where's that luminosity? Where'd it go? And blotchiness, more sunspots, melasma, discolorations on the skin.

We also noticed the firming molecules and the elasticity molecules like collagen and elastin deteriorate quickly during the perimenopause and menopause as estrogen declines.

So the same firming generation of these molecules. So then we noticed that the skin becomes more lax. more wrinkle, we see the gravity winning. And so things are descending.

And so majority of the patients that come to see me around paramanopause do this. Can we do this? This is the first question. Can we lift this up? Because, and that's a sign majority of the time for me is like, oh, that woman is going through a paramanopause.

She's seeing the change because that's drastic to the reduction in collagen and elastin and repair. Repair is something that drastically reduces because the strength, the resiliency of the skin barrier also weakens during menopause.

We don't generate those humectants, the lipids that we usually did as the estrogen drops. So what happens is we feel more dry, dehydrated, the skin more rough and scaly and it's like no matter how much moisturiser we put on or the coconut oil, it seems like it's poof gone within a few minutes and we feel so extremely dry.

So that's why it's so important to understand that these changes are normal. They're frustrating and we all hear you. And these are important conversations to have.

How do we address it? because in the past 10 to 20 years, we've been saying, you know, oh, we're just going to have to hydrate really well. And here's, you know, protect with a sunscreen.

There's a gold standard of retinoid to regenerate, to boost the collagen elastin production. But now the conversation is beginning to change and say, was that WHI study too, was that something that was that risky for us as women to lose all the estrogen and not supplement it when we need it, except for symptomatic medical issues?

So the conversation is that what is the risk of estrogen replacement, right? So you are more of an expert in that. But estrogen replacement is something that's super important for various medical conditions that can happen with the menopause, you know, the hot flashes, the moodiness, the sleep problems, the brain fall, the vaginal dryness, all the symptoms.

But what about the quality of the skin? Because many people will say, oh, well, that's vanity. That's just superficial. But the problem is how we look and feel doesn't at that point coincide what we want to, how we age and what we feel.

Because inside, we may feel more vital. And this is a stage of our lives when our kids are getting older. We want to start being more active and intimate with our loved ones.

We want to interact and be more social. But we may not reflect that on our skin. So we want to have our skin truly reflect how we feel vital inside. And that depends on how much estrogen we have.

So is it worthwhile to replace estrogen for the sake of beauty of our skin? And that is a question that's still controversial, right? Because if we just look on estrogen replacement for just a rejuvenation on the skin, what if in certain individuals, very rare ones, it does put them at high risk for clotting disorders or estrogenic kind of cancers?

So this is a conversation I think is in your lane, and that is why I send the patients you when they want to explore the aspect of holistic estrogen replacement for their skin, as well as their muscle, as well as their bone health and everything else, what other things are going on in their lives.

But when it comes to focal replacement of estrogen, There have been a few soft clinical studies. So that means that they were like more anecdotal, you know, patients of anywhere to 12 to 30 mount were studied and they applied a low potency estrogen called Estreo on their skin and certain part of their face, usually around their eyelids.

And to see if it improved the appearance of the skin. And the studies did show after a month or two that it did improve the radiance, the hydration, the plumpness of the skin.

So it did improve the appearance of the skin. That's not surprising. Our skin has estrogen receptors. So we know that estrogen drops, the estrogen receptors have to bleed.

We lose that radiance and smoothness and hydration. So now we are replenishing with the estrogen cream. But what does it mean for general population? Does every woman now who is going through perimenopause and menopause need to get an estrogen cream and apply it all over their face and around their eyelids?

I don't think so. I think there's a niche individuals that truly want to potentially, so this is a controversial type of topic that may benefit from it.

But again, using Estriol that is low-potency, it's not the same cream that's used for vaginal dryness, or it's not the same cream that's used, that's absorbed into the body, into the blast streams, systemically, that's high-potency estrogen replacement.

This is low-potency. formulated through an expert dermatologist, through a compounding pharmacist. So if someone wants to take a risk and go to compounding pharmacies like Alloy or Muesli that have the ability of compounding these low dose esterals, it's up to them.

But the supervision of a provider there is questionable, right? So if you want an expert guidance of a dermatologist that understands the amount and concentration of the estrogen that needs to go into the cream, I would truly recommend to go to someone who has that expertise and knows the right patient qualification for that.

Again, we will talk about what are the contrary indicators. I don't feel comfortable prescribing to anyone with history of any estrogenic cancer or family history, any history of clotting disorders.

It is a conversation to be had. I am still advocated for alternatives and there are wonderful great alternatives for improving radiance and smoothing and hydration of the skin during this phase of our life, perimenopause and menopause.

And that includes peptides, growth factors, certain areas like the eyelids, retinols could be too irritating. So we have adaptogens and there are these all, you know, mimickers of estrogens that have been developed.

in a skincare line called M-Apple. Are you familiar with M-Apple? No, no, I'm not. Bi-Apple is the mother company from Spain, but they have several lines under it and one of them is M-Apple.

So what M-Apple did a few years back is developed a skincare line. They have a night cream, a serum for the morning, and then also an eye cream. that has a synthetic molecule called MEP that mimics the function of estrogen.

So it latches on to this estrogen receptor and it translates into the skin cell all the necessary steps to say, hey, estrogen is here, you need to make enough collagen, elastin, hyaluronic acid, everything that's needed to make your skin bouncy and radiant and smooth and that way someone could be using this alternative and see the wonderful changes that they're trying to see to improve their skin span and quality without having to potentially put their skin at risk of the estrogen.

MAP does not go into the bloodstream. They tested the blood of the individuals in the studies and it doesn't affect the other estrogen receptors throughout the body.

So it's less of that potential risk. So for my estrogen deficient patients, I recommend first to explore other types of skin care, potentially MAPL, And then we can consider going into the compounding of Estrel to very focal areas, fine thin areas like the eyelids, but small amount.

That's what I would recommend. And then of course, lifestyle, coming back to lifestyle, got to live in a more holistic way. As we're going through perimenopause, everything is affected, not just our skin, right?

You were talking about the muscle, the bones, all of that start deteriorating and in a more compounded way in leaps. That's the milestone that things are beginning to leap.

So seeing a functional medicine expert like yourself and addressing all of these lifestyle modifications, that's what's going to translate to most resilient and radiant skin.

But let me just clarify something, Mariana. I don't consider myself as a functional doctor, although I do respect a lot what the functional doctors do.

They studied for a lot of years. And their motto, I love their motto, which is the root cause. I am an allopathic traditional doctor who thinks outside of the box, who believes that lifestyle medicine, which is more into the integrative.

So lifestyle medicine is very integrative because I still do a lot of prescribed medications when it's required. And I do order the labs that are required.

So sometimes functional medicine goes into too much in the molecular. detail to be replaced by a specific supplement, which might not going to have the whole science back.

So this is why I just tried to put myself on the side on I am not functional, but I do absolutely love to practice like a functional doctor. Functional doctor opens the eyes the way how I do open the eye and it's not that bandaid that we're talking about.

But that's just for clarification. But yes, holistic, integrative like you are. And it's like, I'm so happy that you're talking about the whole estrogen and what you were saying that the controversy, right?

Because this is pretty controversial. I educate a lot of women on menopause, I do it based on the menopause society, what's the indications for estrogen, what is the case of hormonal replacement, what's the other probabilities because there is alternatives.

There is pharmaceutical non-hormonal for certain symptoms and there is also non-pharmaceutical available supplements. Nonetheless, the menopause society does not recommend per se the supplements to be part of the treatment of any symptoms.

But when you come back into when the menopause society decided the well recommended use of estrogen and it has to do a lot with the hot flashes and the vasomotor symptoms also for protection of the osteoporosis when women it's in the osteopenic stage.

But I agree with you with those extra symptoms that we are all questioning why not, why they are not available. Yes, the WHI is a very important study and I always start my education with the WHI and I take a good 10 minutes and explain to my patients what relative risk and absolute risk is and why the interpretation was badly done.

Incredibly well-designed study, the interpretation went downwards. So at this point, it was very important that we were 20 years without replacement, and then we saw more damage than good.

And now we're starting to question each place in the body of requires it doesn't require. I have to tell you that I never have anybody asking me for hormonal replacement only based on their skin.

There is always other symptoms that are going to be affecting quality of life way more. because I don't think, or I don't know, I might be wrong, that an aging skin is not going to affect your daily living as much as a severe acne when you were a teenager.

You are just in the process of, okay, what can I do for this? I'm aging, but it's easy to deal with it because it happens to everybody. Nonetheless, once I start hormonal replacement in a woman that is candidate for it, They notice that their skin gets better and rejuvenating.

So they tell me, wow, and everything else, even, even how they respond to exercise because the muscle is packed with estrogen receptors, the way they think, obviously that before the stress or the little things will trigger them.

Now it's less irritability. So those are almost like extra gifts of the hormonal replacement for the main season symptoms why they come back. Eventually, and all of us that we treat women in premenopausal menopause, we're going to see a shift on safety towards hormonal replacement.

I understand we're waiting for more research results, not projects, because they're out there, and to be a little bit more widely used and we're more careful about how it is produced.

The fact that it's streol or estradiol, if it's progesterone, for example, if it's micronized progesterone or not, what we're using it for, what's the protection.

So these details We take in account that they were not taking in account during, or that they came out in the WHI study and made us think about it. Why the risk?

Why increase 0.8 in the breast cancer risk? Because it was 0.8 per 100 that increased. not even one extra patient, but that 0.8 was interpreted as 26%. So when the big newspaper put it up in 2002 was women on hormonal replacement increased 26% of breast cancer.

So obviously that sounds like, oh my God, I don't want that 26%. So, but it's because it was badly interpreted. It was really from three per hundred to 3.8. per 100, not even four.

So that's something that I teach my patients to that extent so they can make a difference. Now, we're going to do a little bit of a naughty little comment here.

And I tell my patients, I mean, once I start vaginal cream, which is the estradiol, it's a stronger type of estrogen. It is more bioavailable. And some people, they use a little bit of their own vaginal estradiol in their skin.

They use it once or twice a week. I believe, obviously, that's very individualized. I'm not telling anybody here that they have to use it. That's off-label.

FDA has not approved that. All the dermatologists have been telling me, oh, no, no, not estradiol, estriol. because estradiol, and the main reason why not estradiol is because it's stronger, it's more bioavailable, and it might increase the levels in blood, and we are very careful about what's your level.

So some of my patients are like, listening, listen, I'm using my vaginal cream twice a week, tiny little bit on my skin, and it really makes a difference.

And I have to tell you, patient by patient, very precision medicine, the same way you practice, I go, it's fine or it's not fine. Now, I have to tell you that there is some side effects too.

I just had some patients that say, then this thing, it's giving me spots. And I'm like, don't use it in your skin. Again, it's a hormone that still is a hormone.

So we have to be careful just to see how you respond. But as much as when I put the patch or you put the gel, It's a hormone. And if I start in thyroid hormone because you're hypothyroid, it's a hormone.

We observe how your body reacts to those levels. So that's all on estrogen. Do you have anything? Yes, go ahead. Yeah, I would add on that, thank you for bringing up the spots aspect and there have been only one, actually now two anecdotal studies of patients who are using topical low dose estrogen on that for rejuvenation of their skin that have developed melasma, blotches.

So, and we know melasma is hormonally regulated, estrogen is an important hormone that can trigger melasma. blotchy, brownish, beige discolorations that are poorly defined, mostly on the face and mostly in women because we have more estrogen.

But is it something that is going to be seen commonly? Again, it's something that we are still discovering because we don't commonly compound and prescribe this medication.

But it is a warning to us to understand that it is a hormone and then certain individuals could be vulnerable to this risk, the side effect. So especially if someone is prone to melasma, I would not recommend prescribing compounding Estriol for those patients for their safety.

Thank you for that. Yes. Yes. I don't want to be a cowboy with my patients, but I don't want to be the paternalistic doctor of no. The question was, I'm doing it.

Is that right or is wrong, especially when it comes to my level? So that's the thing. But I agree with you. Everything, we have to be respectful to what we are doing to us.

Is there any space to progesterone or testosterone in the whole process of aging of the skin? So progesterone is very connected with estrogen, especially with the uterine lining and how we age in the process of perimenopause.

The question becomes often involved when we're thinking about how we're replacing, and this is where I have the controversial dislike of pellets. when as a way to replace hormone in my patients because with the progesterone is also trying to level out the estrogen and help with the female wellness hasn't been linked directly with some of this through research, some of the changes as much as estrogen that we see with the aging process of the skin, but it's critical to balance out the ratios, right?

The ratios of estrogen progesterone for best function of our whole body. When we do pellets to replace estrogen, progesterone, and testosterone, when they go into our body, unfortunately, it's very hard to find to because they create the spike of these hormones in our bodies and that can manifest as a very side effects including on our skin.

And what I'm seeing in my patients is more prone to patients who are a little bit Temporarily overdosed with testosterone, spikes is increased in acne and folliculitis.

So breakouts in pimples and even rosacea, which are more acne-formed lesions due to sensitivity of the skin, as well as body acne we call folliculitis.

So this is important to be mindful if you are undergoing hormonal replacement through pallets, you're more prone to these type of skin problems. And it may be wise for you to reconsider a different approach of hormone replacement and speak to endocrinologists, again, an integrative provider like yourself who could fine tune it better in a more gradual and more holistic way.

And then seek the help of dermatologists for the breakouts because they can leave significant detrimental marks and blemishes and scars that we can intervene early and prevent from having these long-term side effects.

There's various skin care and procedures like chemical peels or gentle lasers like Picaway or V beam laser and LED type of energy devices that we have in our practice in precision.

Yeah, thank you for that, exactly. We were talking about the side effects as well. Testosterone is actually, it's a hormone that many people seek and that I have a lot of respect for, especially in women.

There is a full protocol on how the replacement goes and what labels the FDA have on it or not. So that's important, but mainly on the side effect, right?

Because it is always important just to bring up that and it's absolutely related to dosage. I don't believe in pellets. I don't think it is the right way to go just because it is too difficult to dosage up or down.

And this is a trial and error kind of dosage in all the hormones because everybody responds different. So once it's in, it's impossible to help people just to You know what?

Let's stop it. Let's win you down. Let's because once it's in, it's in for good. So at least there is an option. Suppose that someone was exposed to testosterone pellets and their acne is just flaring up.

The testosterone is going to be in their levels, in their bloodstream for a good three months. So for three months they have to top it up. So better to go and see Dr.

Mariana and get a treatment that is going to smooth out that skin until the levels go down. Well, Mariana, we're slowly about to wrap up this beautiful conversation.

Oh my God, this cannot stop here. We're going to do another podcast together. Thank you. I want to ask you a question. If your skin could talk, what would it want you to do every day to keep it healthy and glowing?

And your skin can ask you one thing, what would be that? That's a tough one for a dermatologist, but I'm just going to answer. To have, to give it more stamina.

Okay. And I know that's a loaded answer, but that's a loaded question. So back to you, but to give it more stamina, it's again, that skin span three times three.

Do you know the consistent habit of protecting, balancing and repairing the skin and getting some protection, stress reduction through mindfulness and then better sleep.

Fantastic. That means skin stamina. That's stamina. I like it because stamina comes from inside. Actually, I'm learning from you. And from outside. From outside in your products with adaptogenics, you're giving stamina to that skin as well to make it resilient.

I love that. All right, we're going to do a rapid fire set of three questions. Ready? Let's go. One food everyone should eat for a radiant skin is? Avocado.

Ooh, like that one. What daily habit that secretly ages your skin and you should ditch? Scrolling forever into two o'clock in the morning on social media.

I like that one. Thank you. Well, the last one was about if your skin can give us a motto for life, what it would be, but I think I know because I think that came from the last question.

Is your skin, your skin has a motto? It does. And it's kind of a life as well as the skin motto that I think for myself and all everybody who I meet, I try to pass on that, you know, life will encounter a lot of challenges and.

and our skin is going to encounter a lot of challenges. And overcoming those challenges is what gives meaning to our health and our skin and to our life.

So it's okay that we face a lot of changes and a lot of challenges throughout our life. And while we thrive through them, it's how we really attain the most happiness and meaning.

Wow. I like that motto. It's beautiful. Thank you. Thank you. Mariana, what a good energy you have. I love it. Thank you. Please, Mariana, tell my audience how they can find you.

Just give us your coordinates. We want to reach out to you. Thank you so much. I love this conversation. Forever grateful to you and I look forward to more.

And thank you for all the listeners. Feel free to reach out to me. You can find me at Derm with Stamina on social media, on Instagram. You can find me at Precision Skin Institute handle also, as well as Stamina Cosmetics handle.

You can find me at StaminaCosmetics.com website with all the products, as well as Precision Skin and Body Institute in South Florida, in Davie, Florida, my practice.

Come see these so we can make your skin more resilient and radiant. And I believe in that 100%. I receive all her products. Her products are here. They're awesome.

They come with instructions. So I don't have to even ask her how they go. They order how we can put all her products. We know they're clean. They come from a researcher, someone who has been producing 40 and plus publications, so you're safe in her hands.

And we are also so lucky to have her with all these tips that she gave to us today, and we can apply to our life for a very resilient and radiant scheme.

So- Thank you so much. Thank you, Mariana. You got this. And we'll do another podcast with Mariana. We're gonna talk about chronic and toxic stress because I think it is important and especially if I'm gonna have this conversation with a dermatologist.

But for now, I say goodbye to my audience. Thank you for staying with me until the end. Remember, I'm bringing all this information to you to educate you free of bias and evidence-based.

Bye, everybody. See you in my next episode. Thank you, be well. Thank you for tuning into Dr. Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

Each day is a new opportunity to make choices that empower your wellbeing. For more insights and strategies, subscribe to our podcast and visit our website, www. DrTalks.com.

Stay connected, stay healthy, and join us next time on Doctor Talks, real talks from real doctors on the issues that matter to you most.

Skin Resilience & The Skin-Span Formula: Inside-Out Beauty with Dr. Marianna BK

Paola D’Aleman Poveda, MD

Marianna Blyumin-Karasik, MD

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