Patients ask me constantly what I actually do for myself — not what I’d recommend in the abstract, but what I’ve chosen, as someone going through this exact transition, with full knowledge of what’s available and what the evidence actually supports. I think that’s a fair question, and I want to answer it honestly here.
Why my own choices are worth listening to
I have the luxury of demoing and trying new technology, sometimes before it’s even widely available in the marketplace. That access makes me genuinely selective about what I bring into my own practice, and truthfully, the reason is a little selfish: whatever I purchase has to be safe, effective, and — because I use it on myself, not just recommend it to patients — it has to actually work. That’s a different standard than a lot of the industry operates under. Plenty of providers sell treatments and devices they’ve never personally used and have no intention of using. I don’t think that’s a defensible way to practice, and it’s not how I choose what goes in my office.
My regular regimen
- Ultherapy, once a year, to the face and neck — my baseline for structural skin tightening
- BBL Moxi, roughly every quarter — addresses pigment, fine lines, and redness in a single, well-tolerated treatment
- Scarlet RF microneedling — works at a more superficial level than Ultherapy, tightening skin and refining pores, roughly 3-4 times/year
- Thermage FLX, specifically for the eye area — this one’s worth calling out because very few energy-based devices carry a safety indication for use this close to the eyes, and it’s one of the only options I trust in that specific location
What I wish I’d prioritized earlier
If I’m honest, there are things I didn’t do enough of when I was younger, mostly because a full-time surgical practice and three daughters didn’t leave much room for it:
- Bimonthly facials with a licensed aesthetician — not for the momentary glow, but because consistent, professional treatment meaningfully reduces the low-grade inflammation that accumulates from ordinary environmental exposure over time. I’d now put this on the list of things worth prioritizing well before your 40s, not after.
- Within that category, patients often ask me to compare HydraFacial and DiamondGlow — both use a similar cleanse-exfoliate-hydrate approach, though DiamondGlow’s diamond-tip exfoliation tends to be a better fit for patients wanting more mechanical exfoliation, while HydraFacial’s vortex extraction is gentler and often better tolerated on more reactive or sensitive skin.
Where microneedling with PRP fits
For patients dealing with textural scarring, enlarged pores, or early collagen loss that hasn’t yet progressed to needing surgical correction, I’ll often combine microneedling with the patient’s own PRP (platelet-rich plasma) rather than microneedling alone — the growth factors in PRP meaningfully improve collagen remodeling compared to the needling alone, and it’s an approach I have real confidence in because it uses the patient’s own biology rather than anything synthetic.
Where I personally draw the line
CO2 laser resurfacing is a very effective tool for a lot of patients, and I recommend it when appropriate — but I don’t do it on my own skin. My skin type carries a higher risk of post-inflammatory pigmentation with aggressive ablative resurfacing, and I’m not willing to take that risk myself, even for a treatment I think is legitimately good. This is exactly the kind of judgment I think matters in this field: knowing a treatment works doesn’t mean it’s right for every skin type, including your own doctor’s.
A treatment I’m increasingly enthusiastic about
Hair thinning is one of the most common complaints I hear from perimenopausal patients, and for a long time, I didn’t feel like I had a great answer to offer. That’s changed with FOLIX laser, which I’ve started combining with PRP for a synergistic result — I think this combination is truly a game-changer for hair loss treatment. Finally a great solution for a concern that’s historically been underserved and, frankly, dismissed.
The foundation underneath all of it: lifestyle
None of the above matters much without the basics, and I hold myself to a fairly strict standard here: a whole-food, plant-based diet, consistent sleep, and a training routine that combines aerobic and resistance exercise — all of which I track using an Oura ring, because I’d rather have data than guesswork about what’s actually working. Beyond day-to-day tracking, I also use the LEA Blueprint (more detail on this is on my website), along with epigenetic testing and AGEs (advanced glycation end-products) testing, to get an actual read on biological aging rather than relying on how I look or feel in the mirror on a given day. I track my own facial aging over time using AI facial analysis as well, for the same reason — a consistent, objective measure is more useful than assuming subjective progress is the same as measurable progress.
This is the layer that supports everything else, and it’s also the layer most people, including me at an earlier stage of life, are tempted to skip in favor of a procedure instead.
Why I don’t think surgery is always the answer
I’ll say something that might seem unexpected coming from someone who genuinely loves performing surgery: I don’t believe a surgical procedure is always the right answer to aging. The best results, in my experience, come from a real combination of surgical and nonsurgical approaches, layered thoughtfully rather than one replacing the other. Timing matters enormously here — a procedure done too early, before a patient has actually developed the structural change it’s meant to correct, isn’t a head start, it’s a mismatch between the tool and the problem. This is part of why I don’t believe in preventative facelifts: lifting tissue that hasn’t yet lost its structural support doesn’t preserve anything, and it can create an outcome that looks unnatural precisely because it was performed ahead of the actual need. Good judgment in this field is as much about knowing when not to operate, and what to do instead in the meantime, as it is about surgical skill itself.
Where I remain genuinely undecided: peptides
I’ve personally tried most of the peptides currently popular in this space, and I remain ambivalent about recommending them. My concern isn’t that they’re inherently ineffective/unsafe — it’s the lack of regulation and the real variability in dosing and sourcing across suppliers, which makes it difficult to know exactly what you’re getting or at what strength. I’ll also say honestly: the more medical training you have, the more you tend to recognize the limits of what’s actually known, which sometimes makes physicians sound less confident than a lot of the “peptide experts” about a trend than someone with far less background, but far more certainty, on social media. I’m following the research closely, and I’ll change my position the moment the evidence genuinely supports it — but right now, there simply isn’t enough of it to justify the confidence with which peptides are often marketed. That’s not a claim that they don’t work; it’s that we don’t yet know enough about the side effects and long-term risks to recommend them with real confidence.
This is part of an ongoing series on the structural and hormonal changes of perimenopause and menopause. If you’d like to talk through what might actually make sense for your own transition
