Speaker 1 0:15
What's up, everyone? Not what's up, Hadar, today because I'm flying solo. But nevertheless, I'm gonna tell all of you what I'm thinking about because that's usually what Hadar asks me, and one of the things that's on my mind is longevity. Whether we're talking about it from full body or we're looking at different kind of clocks that we're trying to understand, I think facial longevity takes front and center for a lot of us in the dermatology, plastic surgery, esthetics, and just thinking about general wellness space. So today we have a real treat. We have an expert. I have Dr. Kay Durairaj. She is a board-certified facial plastic surgeon, head and neck surgeon, educator, and founder of Beauty by Dr. Kay. And she's in Pasadena, California. And you know what's really cool is that not only does she do all this clinical work, she really knows how to engage with all of us, and she knows how to engage with the public too. So she's got her own podcast. I love the name, by the way. She's the host of Beauty Bites with Dr. Kay Secrets of a Plastic Surgeon, where she really talks about patients, providers on beauty, wellness, evidence-informed esthetic care. So, when you get a chance, check out our podcast. But Kay, we are so excited to have you on the Learn Skin podcast, and welcome.

Dr. Kay Durairaj 1:33
Thank you. I'm very excited to be here, and I love all the things you were talking about. I love the idea of longevity, anti-aging, biologic clocks-it's really an incredible time that we're in in esthetics.

Speaker 1 1:46
Yeah, and maybe that's a good starting point to start off our conversation. Gosh, it is such an incredible time. I think you totally nailed it. And I want to-I want to talk to you a bit more about how you got into the space. I mean, you're a plastic surgeon, and you're probably looking at various aspects of aging and obviously facial aging and esthetics. But you know, tell me what got you into facial or skin longevity or longevity in general, and how is that different from the quote regular practice of medicine?

Dr. Kay Durairaj 2:18
Well, I think it's a kind of a selfish need for me to understand the aging process and what things do I need to do right now at this age in order to make my trajectory of aging better. I see that you know I see some patients in my practice that are healing; they're aging really well. They exercise; they're like you know aging like a fine wine. And I see other people just falling apart, so I'm trying to find those tips and clues and habits for the the healthy and healthy patients who have great skin, great resilience, and they have a great attitude. And I think there's so many different things that we can do at this age. So I I started down this wellness longevity journey as a quest to self-diagnose, I've neglected myself for many years because I have four kids, and until they were fully grown, that was like for every woman, it's the focus of their life. And you don't go to the doctor, and you don't do the things you're supposed to do. So this past two years, I started with full panels of biologic testing, testing my genomics, my proteomics, my metabolomics, my GI tract, everything.

Speaker 2 3:25
Wow!

Dr. Kay Durairaj 3:25
Finding out where my deficiencies, of which there were some surprising ones, and then also trying to get metabolically more active and correct deficiencies, and then realizing too that the things we do for patients are not going to work until we supplement and fix their deficiencies. You know, I can give a collagen stimulator injection, or I can take a patient surgery or do a laser on them, but they will not heal as beautifully as they should heal if we don't have all those correct levels and they have deficiencies if they have metabolic pathway problems. So that's been a really enjoyable journey. I studied molecular biology in college, and I was an MD/PhD candidate, so done a lot of research in the past. And then I'm kind of coming full circle into doing more research, understanding cellular mechanisms of beauty, and looking at how we can reverse age our fibroblasts in our cells with a bunch of brand new things that are hitting the market.

Speaker 1 4:24
Well, wow, that is a full circle, actually, for someone that was looking at you know the study of cells and the molecular aspects of things to now go back to that after becoming a clinician and plastic surgeon and gosh, you know, a mother of four kids too. You have definitely been very busy. Well, I do want to step into this aging conversation a bit more and have you give us a take on what is it that you think defines aging? Like, what what are the changes that happen? What can kind of creep up on all of us? And what are the shifts that you're noticing that. Happens when you go from young to maybe not so young.

Dr. Kay Durairaj 5:05
Wow, what a great question and what a big question! And I think it all, you know, if we look at the major landmark article that was written on hallmarks of aging, there were 12 hallmarks of aging, and now I think we're up to 15 or 16. That these are the many forms of different pathways that can break down as we age. And for me, the more I look at these pathways of biologic aging, the more I think that it all begins when we our cells lose the supplements and ingredients that they need to fix inborn errors of mutations and metabolic errors and toxin exposure. When we start out with young cells, their their regenerative repair capacities are through the roof, and then we start to get so much mutational damage from ultraviolet, from all the exogenous things that are happening around us, from toxins in the environment, from just normal DNA mutations that we start to lack the amount of energy that it takes and the ATP that it takes to drive the cell cycle to to repair repeat injury over and over and over and I think you know past the age of 20 is where things start to just slowly break down until you have you know lower levels of NAD less DNA repair mechanisms, less mitochondrial power, and thus you know a lot of oxidative damage starts happening. And for me, that's the breakdown process. and And I think that well, we will soon discover like much more clearly what the exact pathways are. But I feel that mitochondrial aging is one of the biggest things. Changes in energy levels of cells that you know you can no longer fix mutations fast enough. Decreasing NAD levels. The human body makes the amount of ATP we generate in in a day is the size of your adult volume. So like your 60 kilos of ATP is generated in a day to power all the reactions in your body, so I think that that is where the breaking point starts. There's not enough fuel to power the repairs. Well, I

Speaker 1 7:09
mean, there's a lot to really consider there, and I I love that you touched upon multiple different things. Obviously, there are changes in the skin that happens, but maybe we should dig into a little bit more what you talked about the energy that we have to make to be able to repair, but before we get into that, I mean, gosh, you went to residency. I'm guessing they didn't teach you a lot of this stuff in residency. I'd like to, I'd like to know, you know, how did you get into this space, and how did you learn about this space? Where did you turn to? And I want to preface just for everyone by saying that Dr. Durairaj is going to be speaking at the Integrative Esthetic Symposium that is coming up. That is also adjoining the Integrative Dermatology Symposium, and this is all coming up in August. We're in Palm Springs. Come check it. Check it out. The Integrative Esthetic Symposium. But to return to my question to you, where did you learn about all these things that I know you didn't learn in residency, unless you did, which in which case I'll be mind blown. But I just want to I want to get a sense of how'd you pick this stuff up.

Dr. Kay Durairaj 8:13
It's so difficult. Like in modern medicine, like the things we're being taught are the things that we've known for the last 50 years that end up in our textbooks, and the new knowledge is like very challenging and difficult to read and get published, and like to keep up with what's being published. So surgery training is definitely all about like the you know the manual labor of doing operations, learning anatomy and learning post-op care and learning how to optimize surgical results, and then all of this wound healing kind of knowledge was the beginning of my journey there. I studied fibroblasts. I did a residency at UCLA. It was like a six-year program in head and neck surgery, and a year of that as research. So I did a year of research related to fibroblast and looking at transforming growth factor beta. And that was back in the day when collagen was the main injection that we had, and we did biopsies to harvest people's skin and grow up their fibroblasts, and then develop you know autologous collagen that we could then inject into patients for use like in their vocal cord or for a line or a wrinkle. So it's kind of very interesting now what's out there and available, but the actual you you actually have to do the reading, and I think I read a lot. Like four or five hours every week is devoted to journal articles that come out, and I I think this interest just was born of curiosity and wanting to know like why do things break down in our bodies, and I listen to a ton of podcasts. I love the STEM talk type of podcasts, and I think once you start to want to learn was how your own body is breaking down, how can you prevent that? That's critical. There's so much molecular biology now that's going on, and if you don't keep up at this. Stage, you're gonna not understand the next 10 years of what's gonna happen in esthetics, wound healing, plastic surgery, longevity. So it really is about investing. I had a couple of companies approach me to like come on board and learn and join their technology and become an investor. Even so, I did a huge deep dive into understanding these molecular mechanisms, and that just split my fire. So I think every person out there should take some time to like invest in future you learning about this stuff now: exosomes, polynucleotides, growth factors, stem cells, regeneration. Like if you don't learn it now, when are you going to find the time? And the by the way, the industry is going to go by leaps and bounds with AI and all the new things that are supporting the research. You will never keep up. So you bring

Speaker 1 10:51
up such a really good point. There are so many changes. It's rapidly shifting, and you're right. I mean, learning this stuff is not only important for how we treat patients, but yeah, it's for ourselves too. You know, we can live more healthy and whatnot. Maybe on that note, can you give us what are the key things that you think are leading to accelerated aging, especially from a skin perspective? Is is it is it the lack of repair? Are we all just going to get exposed to things that are going to create damage. Do you think that's what drive? I mean, what what are the aspects that you think drive this at the molecular level?

Dr. Kay Durairaj 11:27
It's very much our the exogenous factors that hit us every day. The ultraviolet is a huge one. You know, toxins and microplastics in the environment. It's advanced glycolytion products where our body's own oxidative reactions cause these really dangerous molecules that that can cause distortions in DNA and prevent normal molecular folding. And I think oxidative damage is a huge one. There's so many pathways to help reverse and protect the body from all of this damage that's ongoing, but for the most part, we live in a world of wear and tear. And to some extent, like a human being is subject to the wear and tear of daily life, like repetitive movement of joints and folds from wrinkles, from chewing, from the way we sleep, from all these head positional things that put weight on the face. So, like esthetically, our skin is pounded every day, and the products that we're using-antioxidants, growth factors, and moisturizers of sunscreen-this is just part of the way that we can help the skin. But I think we have to invest in the skin with treatments that build skin dermal thickness, like the resilience of the skin. So I'm a huge fan of microneedling. I love the idea of periodic laser to take away sun damage. Now we've seen an amazing study published in Nature that showed that three sessions of fraxel type of laser cause DNA methylation changes, DNA damage signals to reverse and revert back to non-damaged DNA. So, so much of what we see on the skin surface-that senescence of brown spots, fine lines, and wrinkles-is truly, actually, senescent cells. And we have intuitively, in esthetics, wanted to go and treat those spots. We want to stick Botox in it. We want to put filler in it to take away the wrinkle. We want to like you know use a laser or a peel to blast the brown spots, and that's such a good instinct because when we do biopsies and studies that look within a wrinkle, the fibroblast within a wrinkle has a senescent secretory protein excretion and senescent behavior that's different from a fibroblast that's half a centimeter away from it, not in a wrinkle. So, like these visible external features of skin are actually signifying internal senescent changes. And the more we do to stimulate the cell's repair mechanisms, like lasers, etc. I think we're going to see that these DNA methylation patterns and the epigenetic change that is inflicted on our skin can actually be reversed, and that's super fascinating. That article just got published like a month ago in Nature. I think it's a landmark article for esthetics and, in general, the concept of skin resilience and how we can reverse it, damage and improve

Speaker 1 14:22
it. Yeah, I mean, you know, I, I, I think it's pretty interesting how a lot of these studies now are starting to move into the molecular space. Like you even mentioned with the three CO two laser therapies and looking at how that shifts methylation. There's been a lot looking at methylation more and more. I've noticed, you know, the telomeres unfortunately didn't really work out when they try to look at before and afters, but the methylations did. Doesn't mean it's the end all be all, but you're absolutely right in that you know understanding this space and dipping into it more is going to be essential. Now maybe I can talk to you a little bit about more about how you approach esthetic treatments. So. So when you see a patient for an esthetic treatment, how do you decide which one you're going to do? And then, what are some of the other, you know, coming at it from an integrative perspective? How do you optimize tissue quality, or how do you optimize their ability to make collagen? Do you do you do things like supplements along with it, or any topicals that are meant to accelerate some of the pathways that are induced by some of the procedures that you do.

Dr. Kay Durairaj 15:27
That's a great question. So, in the past, I didn't really do that. You know, when patient would book an appointment, they'd sit in your chair, and you just treat them right off the street, like, okay, you need some collagen stimulator, you need laser, whatever peel. But now I've sort of changed my approach, right? Like a patient sits in the chair and they have hair loss. Instead of just jumping to do a PRP treatment, we'll do a whole biologic assessment, so blood work to look at all of their immune, you know, all their deficiencies. Are they iron deficient? Do they have enough thyroid stimulating hormone? Do they actually have vitamin D levels that are normal? What's their hormone panel look like, and what's their ferritin stores look like? So, in the process of doing that, it's been so, it's been so earth-shaking, literally, that 50% of the ladies that I see that look like nice, healthy, normal ladies have severe deficiencies. Like, of course, your hair is falling out. You don't have any ferritin. Your ferritin is five. Yes, you're not going to grow hair, you know. So for me, doing that initial diagnostic patients is worth the time and it's worth the effort. Very often, they have an internist who's super busy and only sees them once a year and doesn't really pay attention. If if it's a pass, it's a pass, right? But if your ferritin passes and it's 20 or 30, that's not really like a ferritin of 70 that's required to grow hair. And so I think helping patients and better understand their deficiencies, correcting deficiencies before we do a treatment, and then seeing the treatment really be successful is pretty important, you know, for growing collagen. I would recommend certainly retinoids are going to be great to increase skin turnover and boost collagen production. I believe in collagen peptides, so I get people started on oral supplement with peptides, like a scoop of collagen peptide powder in your coffee or your drink every day is going to be beneficial.

Speaker 1 17:20
Can I jump in on that one actually? Because I think a lot of people have questions. What are the types of peptides, or what are you looking for that says, "Hey, this is a higher quality product" Because there are more and more that are emerging now on collagen peptides, or even you know non-collagen based approaches to try to stimulate collagen. How do you how do you decide which one you like?

Dr. Kay Durairaj 17:44
I am I'm a huge fan of oral collagen peptides. There are multiple randomized controlled trials and meta-analysis that show that these hydrolyzed collagen peptide proteins increase hydration, improve skin elasticity and wrinkle depth, and they improve you know collagen density in the dermis over time. There was one systematic review of like in 2023 26 randomized control trials. It's almost 1700 people, and the typical dose like you do have to have a good sufficient dose per day. I recommend 12.5 grams per serving, and then at least for like three months, two three months, like don't expect results if you try it for two weeks. But there was evidence from that that patients had improved joint pain, osteoarthritis, bone density improvements, especially like at the femoral head, and even improving muscle support. So I think you look for like if you're gonna just go buy vital proteins or some kind of collagen peptides on the market, you're not gonna perhaps see the results that you might see with products that are clinically studied. So look for a peptide that has some clinical studies. So I make my own collagen peptides powder, and we use products, and they're the collagen peptide ingredients that have been clinically studied, so I think that's super important, and quantity is important. More than 12.5 grams per serving crosses the intestinal barrier into the bloodstream, and it acts in two ways. One is a building block to build collagen, and secondly, as when we see these disintegrated peptides splitting around in the system, the body interprets that as sort of like a damage signal, and thus recruits repair generating cells. So beneficial in both ways. So I think that's it encourages the body to grow its own collagen, and I love to pair that with vitamin C. You need vitamin C as a collagen cofactor. You've got to have enough protein in your diet. I think there's plenty of research that supports the idea that these collagen peptides-they work. They're not harm. They're not harmful. They are potentially beneficial not just to skin, but to bone and joint health too.

Speaker 1 19:56
So I'm curious with collagen peptides. You know, one of the thoughts. Is that the collagen peptide itself? Once it degrades, it'll have the amino acids that were supposed to actually make up collagen, thereby being able to support that more directly. I'm curious, you know, what are your thoughts on that? And what about if people just took those individual amino acids and took that as a supplement, or even high-quality protein that contains those amino acids. What what is your opinion on all those three? Because I get questions about it all the time, and I'm curious, you know, how you think about

Dr. Kay Durairaj 20:31
it. I think it's challenging to find high quality peptides by themselves. Like the collagen molecule itself has some main peptides that we look for like hydroxyproline, proline, and glycine, hydroxyglycine. So the average person out there is not going to know the dose, not going to know which is a good brand, not going to know the ratio or combinations of what to take. Like certainly you could do the research and you could provide yourself with those building blocks, but as you know, like just because you put everything in the grocery cart and it's all in one spot, it doesn't mean it's going to go home and get assembled into a gourmet meal correctly. So your body's going to have different reactions, I think, to those individual peptides than it does to a you know fully formed collagen peptide. So I think for simplicity, and also in my own life, I'm all about that. So it's much more efficient to just take a combination collagen peptide product.

Speaker 1 21:29
No, that makes sense. And what about proteins? You know, there's also a lot of people saying, well, if you take protein supplements, you'll get those peptides that come along with it. What what is your approach on that? You know, there's various people saying you should take, you know, whether it's whey or pea or egg white, or there's a lot of protein supplements out there.

Dr. Kay Durairaj 21:46
Yeah, you can definitely take protein supplement, but that doesn't necessarily translate into more collagen building blocks. So yes, you'll get the, you know, it depends. Like, are you eating lean red meat? And when we're trying to get more collagen in our diets, we're going to actually want more of the fatty tissue and the gristle and the cartilaginous stuff that we boil down into the gelatinous. Right, gelatin is where those collagen peptides reside. So, like the people who eat this really lean meat, I think that eventually, like the protein that spills over is definitely beneficial and certainly required. Like I usually ask my patients to take at least one to 1.5 grams protein per kilogram of body weight, and I think it's a good strategy. But even that is tricky to do. If you've ever tried to eat 100 grams of protein in a day or 120 grams, it's work, and you have to have like every meal has to have a 20 gram component. Every snack has to have that. So like, I feel that that's a bit challenging for patients to do. It's necessary, but it doesn't all turn into collagen derivatives. And then, so my my strategy would be to try to do both. Try to get the adequate amount of protein, and then supplement with a collagen peptide.

Speaker 1 23:03
Love it. So you build this into your treatment approach. Then, when you're doing, say, hypercutaneous stimulating collagen treatment, you have them take collagen peptides for a certain amount of time, or how do you approach that?

Dr. Kay Durairaj 23:16
I definitely do. If someone comes into the office and we're doing like a hyperdilute radius, or regular radius, or a sculptra, or a treatment that's you know collagen biostimulator. I will definitely recommend that they get on some vitamin C as well as collagen peptides every day, and increase protein intake. Those three things I drill into all the patients, and like you know how it is. If you advise a patient to take 100 grams, maybe they get 50. You know, they tell them to do three things, maybe they do one. So you're just trying to give them all the ammunition to get the best results because we're all at fault for that, including myself. So right, no,

Speaker 1 23:54
I I like this because this really is the the the synthesis of bringing together integrative approaches, right? At the end of the day, again, just to remind everyone that's listening, the integrative esthetic symposium. We're going to get content like this where it's not just about an outside approach or just an inside approach. It's really bridging the two together with an expert that can really walk us through it. So, you know, again, I wanna I want to just emphasize. Like this is so cool that you're taking the inside out approach. Now, how do you personalize? I think that becomes the the next frontier, and you obviously have some approaches now that can be supplementation based. You're clearly, you know, trying to find the right procedure for the person based on what their needs are. How do you personalize that all together, and what what's the approach that you take?

Dr. Kay Durairaj 24:44
Well, it's a really important step because we in our in my office I start with full face scanning, so we do 3d analysis of the face, and then looking at mapping facial laxity, lines and wrinkles, pore size. We do an A. Measurement that you know in 710 seconds can scan 14 different parameters of skin health. So I like to get some data just from the photography and that 3d analysis and the skin quality analysis. We even have a cutometer, so if we have time, we might go ahead and measure like skin elasticity or skin turgor. And I think that's a luxury to have all those tools, but if you are really interested to change how people age, that's a very beneficial tool to have. We use hair metrics, which is a hair AI that can look at hair follicle thickness and interfolicular distance, and also just like the number of follicles per centimeter squared. So all of these measures are a great starting point. And if you couple that then with a few lab tests, your patient feels very well cared for, like they've had a full Star Trek body scan analysis, right? You you want to know? No, it

Speaker 1 25:56
is the stuff of Star Trek, isn't it? All these things that are now emerging. Yes, it is,

Dr. Kay Durairaj 26:01
and there will be one day the scanner that just is able to like fully scan you and generate all your data and read your sensors. You'll walk into a door, all your biologic sensors will download. You put your hand on a plate, and then you know upload all your wearable data, your CG at your continuous glucose monitor, your your Whoop and Aura ring and your sleep pattern. It's like that's that's kind of the dream. Like right, we can get their DEXA scan as they walk through my built-in MRI doorway, full body scan. If I was to imagine what the future should look like, it's that. And then I'm able to tell them like your skin hydration level is lower. I'm going to recommend these products for you, or your skin oxidative damage. Your DNA methylation test shows that you're aging more rapidly than you should be, and so like that's the Star Trek high you know version of the future that was coming. But I have to tell you, in my office, we're doing DNA methylation tape strips for patients, and we're tracking skin quality change. Admittedly, it's for a study, but I feel like it's really the next level of what will happen when it becomes commercially available for patients to do themselves or for clinics to do, where we can before and after an intervention track did that actually do something to reverse age the skin in these cells. So that's very cool time that's coming.

Speaker 1 27:20
Wow, I love it. You clearly are the Star Trek doctor here. I mean, not only are you doing this in the clinic, you've got research activities going on, pushing the frontier. Well, you know, I could talk to you on and on about this, just because I think this area is so cool and developing at such a rapid pace. That being said, if all of you want to learn more, remember the Integrative Esthetic Symposium, Palm Springs. Come and join us. It's in August. You can look us up. Integrative Dermatology Symposium and also Integrative Esthetic Symposium. Well, Kay, how can people find you? And you know, while you say that, I also like to have everyone tell us like, what is your goal in what you're doing? Like, what would you want medicine to? How would you want medicine to shift, or what is your overall goal with all the work that you've been doing?

Dr. Kay Durairaj 28:10
Great questions. If people want to reach out or find me and my content, it's my Instagram is beauty by Dr. K. That's D R K A Y, and that's the same for Instagram, TikTok, YouTube. Our podcast is Beauty Bites with Dr. K, Secrets of a Plastic Surgeon. That's on all the podcast channels. And yeah, send me a DM. That's how I think people should reach out. My goal, and I think I've always wanted this goal, is to never to to allow a human to not be trapped in a decaying body that's breaking down, like the beautiful soul and the intellect, and the warmth and brilliance of a human being should not be allowed to perish in a body that breaks down slowly around it. And if I could fix one thing, it would be that: is to reverse that disease and aging process, and keep us maintained at our optimal prime, so that we can do so many things that we have planned for our lives.

Speaker 1 29:09
Well, there you have it. I really appreciate your time with us on the podcast, and look forward to hearing more from you in you know future podcasts, future lectures. Keep fighting the good fight for us. I love it.

Dr. Kay Durairaj 29:22
Thank you, Raja. That was so fun chatting about that. I feel like the Star Trek Star Trek Doctor.

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