The Menopause Show With Sue Moxley – Dr Sabrina Shah Desai, Dry Eye In Menopause

Hi, this is Sue Moxley. This is Women's Radio Station. This is The Menopause Show. You can follow us on Instagram, Facebook, and YouTube, Women's Radio Station, STN abbreviated. Today I have a really lovely guest, Dr. Sabrina. Are you there, doctor? Yes, how are you, Sue? Oh, very well, thank you. Thanks for coming on the show. It's a pleasure. Thank you for having me. Okay, lovely. Can you tell everyone what it is you do or what you have done and what moved into? Okay, so I'm Dr. Sabrina Shah Desai. I'm an oculoplastic surgeon and aesthetic practitioner based on Harley Street in London. I've been oculoplastic, or that means an ophthalmologist and eye plastic surgeon, for more than 25 years, and I left the NHS 8 years ago and concentrate solely on private practice now. And I have, you know, a practice that involves surgery, minimally invasive non-surgical treatments, slightly invasive non-surgical treatments, and a clinic dedicated to skin health, introducing some wellness into the space too. So there's a lot of stuff I do, and I'm also a founder of product for periorbital skincare, which I just launched a year ago. Oh, how's that going? Yeah, it's going well. We're getting, you know, I'm education. I'm— my prime passion is education. And so I'm getting it out there and educating, you know, consumers because that's what will make them realize why they need to be using product for their eye and what the active ingredients do to protect and prevent and treat conditions that bother them. Oh, so it's an eye cream? It's an eye serum and an SPF. Ah, what's it called? So it's called the Perfect 360 Eye Illuminate. That's the eye serum. And then I have the Dark Circle Corrector System, which combines the eye serum and the SPF PF30, which is anti-pollution and also protects against high-energy visible light, formulated for the under-eye skin. So, um, just, just going off this, the subject a little bit, do you think that eye creams can stop puffiness? I know that there's ones that can, you know, help with, with reduce— juicing the lines and the dark circles, but Um, how does it help with puffiness? So when there's caffeine in the product, then the caffeine acts like a vasoconstrictor and it basically shrinks the blood vessels. And oftentimes you will notice that if you've had alcohol or you've had a lot of salt, your eyes look puffy, your eye bags are bigger. And certainly linking it back to the menopause, One of the things we see scientifically that happens is you become more aware of eyes that are, you know, you get these pouches or puffiness under the eye because of the laxity of the skin and the tissues. The eye bags that lie inside the eye socket become visible. So caffeine is extremely powerful for this and also for patients who suffer or consumers who suffer with allergies, hay fever, because basically you have leaky vessels and then you just have these puffy eyes. And so caffeine can work to shrink. But I also have an ingredient called marine exopolysaccharide, SeaFill, which fills and lifts some of the tissue around the eye. So you can improve things. It's never gonna give surgical results, but it's all about, you know, preventing and maintaining the under-eye area so that you don't go into accelerated aging around that eye area. I think I need some of your eye cream, Dr. Sabrina. Oh, it's a pleasure to send you some. Thank you. Yes, I've noticed the puffiness more recently than a few years ago, but yeah, that's fantastic. So tell us how you got into, you know, becoming an eye surgeon in the first place. So I was always interested in eyes and, you know, I come from a family of doctors and of Southeast Asian Indian origin. So I think the generation I grew up with, you know, or in, this is quite normal to be a doctor. My father was a surgeon and I wanted to be a surgeon and I just followed his footsteps and I did ophthalmology because I just liked the minutiae of ophthalmology. And what I loved always was plastic surgery. So I, you know, I was, I was very focused from a very young age in my early 20s, and I wanted to do microscopic surgery, and ophthalmology and plastic surgery interested me. And then lo and behold, I discovered there is a whole subspecialty called ophthalmic plastic reconstructive surgery, which allowed me to marry these two key passions of mine and allowed me to, um, embrace the subspecialty. So that's, you know, what I chose. I just went down that path very easily. Wow, that, that's, uh, that's impressive. So what, um, so just going back to the menopause for a minute, what are your thoughts and personal opinions about navigating menopause? So, so I'm 56. I hit the menopause at, uh, 49. And honestly, uh, even though I came from a medical background, uh, nowhere in my growing years was the menopause discussed because I came from a generation where, you know, either people were ignorant, um, and certainly menopause was not discussed. It was not part of a school curriculum, although sex education was. You know, what happens in the perimenopause and menopause was never discussed, you know. And to be honest, there were changes occurring to me emotionally, mentally, physically that I just didn't know about. And one fine day I just woke up and I looked at my face and I couldn't recognize who was looking back at me in the mirror because the aging changes almost sort of hit you overnight. Although it's a very gradual slope that you're going down, it's a slippery slope downhill from the perimenopause. But because it had never been discussed, or simply, you know, we were unaware of it, it hit me really hard. And, you know, I also realized that during that journey, the last 3 years before my periods had completely stopped, you know, I'd been seeing gynecologist, I'd had, you know, the Mirena coil put in to stabilize my hormones, but nobody actually prepared me for all the other changes that were gonna take place or were taking place. So as a result, I almost felt like I had been dropped into a swamp one fine morning. And I think from my own personal journey came the realization of, oh my God, you know, this is what is required, this is what is happening to my skin, this is what is happening to my body. And, um, it sort of mirrored the kind of patients I was looking after in my clinic. I was predominantly looking after women who were peri- and postmenopausal because that's when they come in, because they lose a sense of identity and they come to have treatment. So it was almost mirroring what I was going through. And, uh, that's, uh, I think that was what the start of my journey, particularly into skin health, occurred. Yes, it's amazing though, isn't it, that even you as a doctor didn't really— I know you specialized in the eye area, but you didn't really know what was going on. Because is it true that doctors only get like a few hours tuition on the menopause? Yes, yes. Yeah, so how's anyone supposed to know about it? But also, you know, so much has happened in these last 5 years in terms of menopause awareness, and you only have to look and realize that actually, you know, even the general practitioners would just give you antidepressants or would give you a standardized protocol, you know, just a standard dose, and it was always very dismissive. Um, I mean in my own family, you know, discussing the menopause. Like, everybody was— I remember, you know, my husband would look at me shocked, and he's a surgeon, like, why is she talking about the menopause? And my son would roll his eyes up, and I was like, no, no, no, you men need to know how to support your women. So, you know, I mean, my father, you, you couldn't mention the word period in front of my father. He would be— he would go bright red and leave the room. Yes, exactly. So I think it was a journey collectively for, uh, the, you know, the two men in my life. And I also wanted to empower my daughter, you know, because it was almost simultaneous with, you know, my menopause onset and her puberty onset was almost like simultaneous. And I just felt so strongly about it because, you know, I was literally trying to make sure that everybody would be able to support better support each other and me, and I would be able to better support, you know, my patients in the long run. Yeah, so it's a good thing, isn't it, that this is, um, kind of all coming out now and, uh, people are talking about it a lot more, doctors like yourself becoming passionate about it. So it's a good thing, but I think we still have a way to go, don't you? Yes, 100%, because I think, uh, you know, HRT has received so much publicity, and I see now it's completely different. When I ask my patients what they're on, they tell me HRT, and it's just, you know, it's, it's had almost, um, a 180-degree swing. Yeah. Where, you know, it's like a pendulum that went, and everybody's taking HRT. However, there's still so much lack of knowledge on how you can, um, you know, not HRT is not the panacea for everything. So, and certainly whilst it helps skin, um, it's not, it's not the only thing that's going to help your skin barrier function. Yeah. And so you really need to understand how to optimize your skin health and, um, you know, with other treatments both at home, in clinic, dietary, you know, all of this kind of stuff. And so do you offer that as a package type thing? Yes, yes. Your thoughts are then on, you know, really good skincare in the menopause. Okay, so I mean, the first thing is we all know that you lose about 30% of your collagen within the first 5 years of the menopause. And so you see the visible signs of this as your skin becoming dry and slack and thin dull and sensitive. So you see this happening, but it's already the menopause. And what you really need to start understanding is the perimenopause and what's happening in the run-up to sort of the menopause. So you already beginning to see dry skin, but because of the hormonal imbalance, you can have acne, you can have hyperpigmentation, and you can have sensitivity, and particularly as the skin becomes thinner and the skin barrier function is lost and it gets increasingly inflamed, you can have eczema. And so what I found, and you know, this is again very personal, is I entered skincare quite late. I entered skincare around my perimenopause in my 40s. Yeah. So I came to active skincare quite late. And because I used a very prescriptive method and my skin was highly sensitive, which I was unaware of and the dermatologist looking after me was unaware of, I reacted to something as simple as high doses of vitamin C and retinol, which was— which is like your holy grail. Yeah. And you know what that did is I Sorry, what did that do to you? Oh, you had welts all over my face. So I would go off it. They would tell me, go off it and try to use something else. And then I would move to a slightly, you know, encapsulated form, a weaker form. But essentially my skin was eczematous and inflamed, and I had to stop every active, every fragrance. And I basically for 2 years just had to try and stabilize my skin barrier function. But nobody discussed it with me. And so here's the interesting thing. We do genetic skin testing now for skin health. Okay. And it's, you know, amazing because basically DNA genetic testing offers insights into key areas that influence sort of your skin aging. It offers a more personalized approach. And in my genetic test, I have an extremely sensitive skin. And had I had that, you know, we now know with genetic tests are now freely available. They weren't available when I was making my journey in 16 years ago. Basically, I would have known, right, that is not the correct protocol to start with on this skin because this skin is highly sensitive and was going to get inflamed. I need to stabilize skin barrier function. I need to use, you know, humectants. I need to use hyaluronic acid. First. I need to use ceramides, I need to use niacinamide, you know. So that would have been my entry product into my skincare regime. And then gradually, as the skin barrier function was restored, as the skin was not sensitive, introduced more antioxidants and being very, very careful with, you know, high concentrations of vitamin C and retinol coming in very, very late once you've stabilized the skin barrier function. So for me, that was my entry into skin health, was just buying things over the counter, seeing a dermatologist who just gave me standard protocol based on the visible signs of aging and not really on— not a personalized approach. That was based on, you know, my skin and how genetically I am hardwired to age and how genetically I'm hardwired to respond to certain things or have adverse reactions to certain things. Does that make sense? Yes, totally, totally. But say, for example, you know, we, we can— not everyone, you know, can take a DNA test, which is amazing that you offer that. And, uh, incredible. But say for example they can't, or they can't afford it, are there other ways to diagnose? Oh, completely. So first of all, you just need to try and understand, you know, what is your skin concern? Is your skin dry and flaky and, uh, itchy? Then first of all, the pH of your skin is changing. So we know that a pH of approximately, you know, 5.5 is optimum. It keeps your skin, you know, hydrated and moist and glowy. But as we hit 50, the pH is getting higher. And we also know that shampoos and soaps, you know, can strip the skin and because they have a very high pH. So you want to move to gentle cream cleansers. You want to use really gentle cleansers on your skin, use mild products. And as I said, you'll get very very good blanket products that you can start improving your barrier function with rather than just going for, you know, straight off retinol or vitamin C. So you have to know, you know, what your complaints are, what your skin type is, because you may have acne, and so you would need to use, you know, salicylic acid to control that. You want to be careful with not using harsh acne products, particularly if you have breakout that is not a teenage breakout, but it is a, you know, perimenopausal, menopausal breakout. So, you know, the visible signs need to be married into actually how you describe your skin. Does your skin feel dry? What your key concerns are? Introduce a couple of safe treatments initially, safe topical care initially, which is not going to irritate the skin because you don't start running a marathon straight away. You know, you have to train for it. So you You introduce Safe Care and then you gradually watch what's happening to the patient and then increase, um, to retinols or, you know, vitamin C, etc. I get that. So it's like a plan, but it might— it's not, you know, something that we do over time to build up the skin. And then you can, after you've built up the health of the skin, then you can maybe start making some improvements to it, i.e., anti-aging, etc.? Yeah. And, you know, look, I'll tell you, I only got my DNA skin health recently, right? So it was this year because these tests were not available freely, you know, to everyone. And also they hadn't got that sophisticated. But a very important thing with aging and skin health and optimizing skin health is a couple of things. Look at how your parents aged. It's very easy. I looked at how my mom aged and my mother was a beautiful and is a beautiful woman. She's 91, but her primary aging at 91 and from the age of her 50s was lower face sagging, thin, lack skin with a lot of wrinkles, you know. And so this is, you know, I've always been told, oh, you're— because you're Southeast Asian, genetically you're not going to wrinkle. But hey, No, I saw my mother and I knew I was going to sag and wrinkle. So I started having home care treatments and in-office treatments that would mitigate against that. Quite simply, you can have ultrasound skin tightening, so safe for the darker skin types. No, no downtime, you know, and it's just promoting collagen, elastin. And so I could see how my mother was aging. You also want to find out at what age your mother got the menopause, because you sort of mimic that very often, and that's the age that you would hit the menopause. So there are things— you don't need a genetic test, you can look at the genetic blueprint of your family, your siblings, to understand. But, you know, aging is only 20% genetic, 80% is epigenetic, and it's lifestyle. And so you really need to look at your lifestyle, you need to look at what you're eating. And really, my gut started telling me it was, you know, vehemently opposed to lactose. I was so lactose intolerant, and for a long time I couldn't figure it out. You know, remember, I'm talking about 16 years ago because, again, you know, it was very natural the way I've been brought up to think that, you know, I was having dairy and it wasn't an issue. But you also get gluten sensitive because of the way processed food is created and the gluten in it. So as a result, I wanted to own my gut health because there is a huge gut-skin axis at work here. And the lifestyle in terms of your supplementation, exercise, antioxidant-rich diet, fiber is very important to keep your gut healthy. So you want to have a lot of a fiber-rich diet with fruits, vegetables, and roughage, you know, because you want to have that gut cleansing. And then equally, you want to make sure you're supplementing, because even if you eat organic food and you eat, you know, spend a lot of money on organic food, you're not going to get the kind of, you know, supplementation you require from all the ingredients, and particularly from the kind of food we eat in the food chain. If you look at you know, how we get our fruits and vegetables, they're frozen and then they're defrosted, even if they're organic. It's not straight from farm to our table very often, and very often for most ingredients. And so supplementation is important. But these are very simple things people can do, you know, just improve your gut health, eat fiber, introduce fiber, less processed food. Definitely sugar is a no-no. You know, just moving, just simple walking, your 10,000 steps every day is great. And then looking at how your parents age and then starting at-home regime and then coming in into clinic to have these treatments is a very, you know, holistic, balanced way of looking at aging. Yeah, perfect. And menopause. When you say supplements, do you mean Supplements that you take, you mean? Do you mean those kind of supplements? Or— Yeah, so I mean, we now know, you know, hydrolyzed collagen, whether it's marine or bovine, you know, whether you have bone broth or whether you have something off a bottle, you want hydrolyzed collagen. We know vitamin C, when combined with this, is very, very powerful in wound repair and ensuring that it improves the hydration and the elasticity of the skin. So we know that what's up, you know, hydrolyzed collagen with vitamin C, MSM, all these things, you know, fish oils, anti-inflammatory. We know that this kind of supplementation works. We know that, you know, your zinc, selenium, vitamin B, vitamin A, E, all these are crucial and definitely vitamin D. So you, you understand that some, some of us can't actually produce vitamin D. So for instance, the darker-skinned subpopulation like I am, we inherently are going to be vitamin D deficient, and particularly if we live, you know, in this country, in London or England. So you need to supplement, and, you know, this should be a standard. I mean, I'm always surprised at how people brush their teeth twice a day and they understand about flossing and dental health and they understand about maintenance and that you're going to need to go to the dentist to get your cavities fixed or your root canals. But they have a completely different approach to skin health, which I find quite curious that, you know, that part of the education is completely lost and the value of SPF. Is completely lost in this country. Whereas if you go to Australia, they've nailed SPF, but they came to it from a different angle. They came to it from a skin cancer angle and the exposure that ultraviolet causes. But at the end of the day, we're talking about skin health and we know how important, you know, wearing an SPF and topping it up even on cloudy days is so important. I know, yeah. I mean, years ago, I can remember sunbathing when I was 16, and we used to literally put oil on ourselves, and it was like we were frying, you know. We're so uneducated then, wasn't we? I mean, now I'm so good at staying out of the sun and wearing an SPF, but I think people do need to realize, sun worshippers, that it's not going to do their skin any good, is it? Yeah, I mean, it's a happy— it's vitamin it's a, you know, it gives you a— it's a happy vitamin generator being out in the sun. Who doesn't like it? We love it. You know, we love having a bit of sunshine. It just is a mood uplifter. But I think staying safe in the sun is really important. You know, enjoy your sun in a safe way. Don't get it from a sunbed. And just make sure that you are applying your SPF because it is the single most important anti-aging thing you can do for yourself. You know, what's the second and the third? Uh, I think the second is definitely your gut health and diet, and the third is in-clinic-based treatments. Because let's, let's try and, um, sort of look at this holistically, right? Yeah. Even let's just say that you have hit the menopause, your skin barrier function is impaired because that's what happens when you hit the menopause, the skin barrier function. You know, you have shorter ceramides in your skin. And what studies have shown that even if you take HRT, it can minimize this impact, but it can't fully mitigate against it. So, you know, you're doing something, you're just taking the HRT, but you've already got aging changes and you, you know, you're in estrogen decline. And you're going to lose about 75% of your collagen by the time you're 80. So we know that we need to come back into clinic to have some collagen boosting treatments. And we know that if you can have ultrasound, you can have laser, you can have radiofrequency microneedling, and now you can have injectable hydration into the skin, which is, you know, from your polynucleotides to your mesotherapy products, to PRP, to your skin boosters, which include Profhilo, etc. So putting this into your skin, particularly a peri- and postmenopausal skin, just as a maintenance program is so important, you know, to restore your skin health and maintain your skin health. Okay. Talk to me about skin boosters. By the way, I thought they you know, were just kind of like a temporary fix? Is it something that's helping in the long term? Skin boosters, i.e., Profhilo and those kind of— yeah, I mean, so basically, if you, you know, there, there are some treatments that you have to come regularly and have. So what happens to skin? Skin has got 3 important things that are occurring. So collagen is the structure of the skin, okay? And so collagen declines. I told you we'd lose about 75% by the time you are 80. Then you have elastin, which gives your in elasticity, and we've said that that goes down. So you have slackness of skin. Now, this is where your energy-based treatments become so important in regenerating collagen and elastin, because they're— they— when they injure the skin, the skin goes into wound repair and it produces collagen and elastin, right? Yes. But very often your skin is just very dehydrated and it lacks hyaluronic acid. And that's what you're losing too. So in addition to collagen and elastin, you're also losing hyaluronic acid, which is why your glow goes away, your hydration goes away, and you get this dullness of your skin. And so when hyaluronic acid is injected into the skin, it just stabilizes this environment, you know, around the fibroblast with the hyaluronic acid, and it gives you this immediate glow and hydration of the skin. And so if you think about an inside-outside approach of maintenance, you can apply it topically, you can apply hyaluronic acid topically, which is great because it's working on that skin barrier function, the top coat of the skin. You can inject it within the skin, and this is great because then you are giving it back into the deeper layers, which is the dermis of the skin, and you find that after you've done this for a couple of years, you don't need it as frequently as every 6 months or 9 months. You can actually, you realize that you go through an intense period just, you know, in that peri-postmenopausal period of having treatments. And then the maintenance phase is very different and it's very individualized because everybody's need for this hydration is different. And, you know, you probably, you know, like for me, I just have Profhilo once every year and I only need to have it around my neck because that's my key area and the back of my hands because I'm a surgeon. My hands are, you know, I'm scrubbing my hands every day. I'm between patients. I just have to use alcohol wipes, you know, alcohol to clean my hands. So that dehydrates you know, my lifestyle is dehydrating my hands, so I need more on my hands than I do on my face because of my other treatments and skincare. So, you know, it has to be tailored. Yeah, I get that. So you're very, you're very pro— excuse me— you're very pro skin boosters. So I love, I love skin boosters, but I just, I know that there's something that, you know, like you have to keep up. But as you said, it's good over time, you need to do it less and less. Which, um, which is, which is really, really good. I mean, so the worry I have is when people just use one modality. So if you just offer Profhilo, for instance, or Skin Boosters, and you only use that for the aging skin, it's not going to address all your skin health concerns. It's not, because you're only giving back hyaluronic acid, right? It's like, it's, it's pain relief. So, you know, when, if we just do the analogy of pain, You can take paracetamol, you can take Nurofen, you can take diclofenac. You know, I mean, there are certain people respond to very well to paracetamol, but certain pain, kinds of pain require different kind of medication. So it's the same way. If you cannot just address everything with just one skin booster. So you have to realize if it's very thin skin, very slack skin, you're going to need to, you know, very heavy jowls, you're going to need some tightening, then you're going to need some hydration. You need to understand what, you know, and titrate the treatment to what the patient's journey is. Yeah, I get that. Of course. Yeah, I understand that, you know, you can't have a miracle overnight. It's a work in progress, as they say. So, um, so that's really good to hear all your top tips there, um, you know, about diet and health. And so your skincare, why have you only got one product? Are you going to bring out some more? Bringing out some more. So my whole thing is around the eyes, right? I want to stick to my area of expertise. I mean, look, there are lots of skincare products out there, and you know, they're all excellent products, some not so excellent, and I don't want to reinvent the wheel. But I just felt very passionately about educating, uh, how periorbital skin ages. Uh, you know, when I was sitting in clinic, I would often find people would come and tell me that they had under-eye concerns, that there was no, you know, sort of one standard thing that was impacting it. And so the first product I came out with is looking at the 3 key areas across all age groups and genders and ethnicities. So I wanted to have a hero product that was a good all-rounder, and so it addresses fine lines and wrinkles, and in addition thickens thin papery skin. It depuffs the eye, and it also treats hyperpigmentation because one of the things that is happening to skin, particularly aging skin, is you get a darkness, you get shadows under the eye, and you get an increase in the dermal melanosis. So the pigment, pigment increases in the skin. So I wanted something that was going to work on the hyperpigmentation. So it's a good all-rounder. And then I have the SPF because again, 70% of people don't use an SPF under the eye. The eyelid skin is extremely unique, very thin, very sensitive. Sometimes formulations on the face can be too harsh for the under-eye area. And also, SPFs, when they're very close to the waterline or the lash line, can really irritate the eye and make the eye water. So I want to have a product and I wanted to, you know, concentrate on education. My next product coming out is actually a very interesting LED mask with a hydrocolloid. So I'm using a synergistic action of the LED, which is going to improve skin elasticity and wrinkles in a very, you know, sort of a short, shorter span. So these are under-eye LEDs that you can just sit with and work on your computer. Or you can watch a movie with. It's just 10 minutes, 3 times a week, along with a hydrocolloid which helps the penetration of these active ingredients deeper into the skin because of the LED. So that's my second product. But basically there are more products coming out. Everything is just related to the periorbital area because I want to focus on and concentrate on my area of passion and expertise. Well, that's, that's good. You're right, stick to the part that you're most passionate about. So talking about eyes, dry eye is a symptom of menopause with some people, isn't it? Yep. And interestingly, it's also a symptom of HRT with some patients. So dry eye impacts definitely occurs more in a mature population, that is in the perimenopausal, postmenopausal population. You get dry dry eyes, but also some patients with HRT, and depending on the combo of HRT, can have worsening dry eyes. Lifestyle plays a huge factor. So again, you know, lots of screen time, computer time, visual multitasking, constantly being on your iPhone and on your computer, which is what has become the norm now, can be very detrimental and can worsen dry eyes. What, what, why do we get dry eyes in the first place? I understand you've just said some of it is lifestyle, but is there something that degenerates over time from when we're younger? Well, it's the simple thing as hormonal balance. It's the same thing, that's what's happening in skin. It's an imbalance. Estrogen does something, progesterone does something, and testosterone does something, right? And that balance is lost There's an imbalance in the perimenopause, postmenopausal time where because estrogen is in decline, that's what starts giving you a reduction in your layers. You know, the, the tear film layer becomes thinner and you can have either an oil gland depletion or just the water layer itself itself goes down and the contents of the tear film change. So the actual contents of the tear film change, and that's why you start getting different symptoms. Some people get a blepharitis where the eyelid is also inflamed, and some people just get a dry eye where the water content is down. So again, you need different types of drops. Okay, and that's the only way to treat it really, with drops? Well, yes, so you can treat it with drops, but people who have blepharitis need to have like warm compresses. There are things you can do to improve how your oil glands drain. Simple things like taking a break from your computer for, you know, every 20 minutes for 20 seconds, look far away outside your window. Then you can do these little forced blinks every 20 minutes to allow the oil glands to pump. Try not to sit directly under an air condition or a fan. Be very careful with the heaters. Heaters can really dry out not only your skin but your eyes. So simple things like computer etiquette is very important. You could just put a little bowl of water if you're sitting next to a radiator or aircon, just so that you have a bit of humidity in the air around you. This can help. You can have— you can use lubricant drops. And certainly if you have different kinds of dry eye, you can have punctal plugs, which is you can put a little plug into the outlet pipe of the eye so that you retain tears much more than, you know, because you're plugging up the outlet pipe. You can also have— Yeah, you could have treatments like LipiFlow, like, you know, laser treatments. You can have Tixel around the eyes just so to allow the oil glands to drain. So there's a lot of in-clinic treatments that can also be done for dry eyes, but we reserve this for moderate to severe dry eyes. Most of it is actually lifestyle modification of managing it at home. Yeah, okay. I like that computer etiquette. I've never heard of that before. I need to write a page about computer etiquette. I like that. Good. Did you make that up? Actually, I just used the word because it is etiquette. It's what you do, you know, with your computers and your smartphones, and you should have an etiquette in using it so that you don't have adverse reactions to your eyes. Yeah, no, that's excellent. I'm definitely going to write a page and call it that. Thank you. Um, so you've got a new product coming out, but they're always going to be around the eye area. And so you're— you work in Harley Street in, in London. Do you ever go anywhere else? So, um, I have two clinics on Harley Street. My primary clinic is called Perfect Eyes Limited. This is predominantly, you know, around, uh, the work I do, the surgical work and the non-surgical work around the eyes. And then I have my sister clinic up in the same building on the second floor called Perfect Skin Studio, where my team is based and where we do the genetic skin testing for skin health. We have, you know, fancy cameras that actually look at your skin, not just the naked appearance of your skin, but what's going on underneath the skin so that we can give you, um, targeted skin advice. And we can also monitor, uh, your skin health. Um, we have a plethora of treatments that we offer to promote collagen. And all these work at different layers of the skin, different skin types, and treat different skin conditions and anti-aging concerns. We do lots of, you know, fillers and toxin, etc., upstairs. We also have lymphatic drainage to help, you know, improve skin health very naturally because that can improve skin elasticity. And so that's the two things. And then I operate offsite at the Hospital of St. John and St. Elizabeth. So, but I see all my patients at these centers and then I go and they come to see me for surgery at Hospital of St. John and St. Elizabeth. Where is that? That's at St. John's Wood. Oh, in St. John's Wood. Yeah. So it's all Central London. It's only 1.5 miles from my clinic on Harley Street. And so, Just whilst we're here, what— you have a website, I presume? Yes. What is that called? It's called, uh, Perfect Eyes Limited Ltd. So perfecteyesltd.com. Yes. And then within it is the link to my sister clinic. But of course, we're just setting up the website, etc., for the sister clinic, which, which should be up and running in the new year. But I have Instagram handles, and so You know, I have a lot of— my Instagram handle is @dr_sabrinashahdesai_official. That's just me talking about things. And then I also have a website for my eye products, which is completely separate, and that's dr_sabrina.com. Okay, that's fantastic. When you said you called it official, have you got someone pretending to be you? Yes, there are lots of Dr. Sabrina, so I have had to call it official. Is that true though? People try to pretend they're you? Well, I think, you know, in this day and age there's so much fraud, and I've seen on social media, you know, they would— they very happily have been, you know, paid— my patients' before-afters have just been— my name has been— my watermark has been taken off it, and, you know, yeah, yeah, the genetic stamp. And they— I— and luckily I have very vigilant or vigilante patients who will tell me so-and-so is using your before and after because they're my followers. So yes, we see a lot of, you know, this on, on social media. So I think I just kept it official and I have a blue tick just so that you know it is me. Yeah, it's so hard to police it, isn't it? Because it's so active, you know, social media. Um, but, um, so what do you think about social media taking over the world, really? Because, you know, things are just not simple anymore, are they, the way used to be? No, I think, you know, and I think it's a reflection of society, you know, the, the, uh, that's, you know, how society consumes, um, its information. And I think that as long as you are, uh, putting the right thing out there and the right energy and it's educational, it's phenomenal. I think that for a— as a consumer or somebody who just lands on a social media site The mistake to make is to think that everything you hear and see on Instagram or certainly on TikTok, which is extremely worrying, is, you know, it may be fake news, it may be fake stuff. And it's just because it's trending and just because the person talking about it has 100 million followers, it does not make it real. And I think that for me is the bugbear, is separating the science from the marketing hype and the influence. And I think that's, that's my concern within what I do. But, you know, I can't control it and I can't police it. The only thing I can do is put out what I believe is, you know, carefully researched scientifically sound, uh, advice and education and information. And that's how I use my platform. Yeah, yeah, that's a good thing. Yeah, I get that. So, um, so do you live in London as well? Yes, I do, I do. And, and how long have you lived there? For a long time? Um, no, I mean, I, I have a place outside London and the commute just got to me. So a lot of things change, you know, around the menopause, and I think I just sort of threw my towel and I quit the NHS, and I also started renting very close to my clinic, given, you know, the impact. And I didn't realize at that time this was all driven by what was— what my body and my mental health was, was having to cope with around the menopause. For me, I only realize it now in hindsight that I made a lot of quite significant changes in my life because I just couldn't cope with certain things anymore. And I, in hindsight, I realized it was all to do with the menopause. And so, um, I actually Monday to Friday live in the city and, uh, I live in a, you know, in a lovely place in the city. And then I go home on the weekends, um, and have a bit of countryside on the weekend. So I'm, I'm lucky that my family still loves me and supports me despite me having made those changes. Oh, that's nice. No, I can totally understand that. There's menopause and traffic jams just don't go together, do they? Exactly. You know, the day that you jumped out of the car and screamed at the person behind you because they dared to come a few inches too close, that things are starting to go wrong. Yeah, I realize the road rage. Yeah. Sinking with my depressive mood, and I started swearing like a sailor and getting angrier and angrier when I was driving. And I just realized, no, no, this is not happening to me. And now I love it. I walk, so I get my 10,000 steps, and I don't care rain or shine. It's just wonderful. And I'm in such a good mood, and I've looked after myself, and I've made the lifestyle change. That is actually helping me be a better person and anti-age me. So it's a win-win, you know, you can convert something that was happening to you into something so amazing. It's fabulous, isn't it? Yeah, I mean, people don't realize that, do they, that with just certain lifestyle changes like, like you did— I mean, might probably be quite a big lifestyle change really, where you decided to stay near to work and not have to commute can be really, really beneficial to our health and well-being. And you know, it's just taking that little step sometimes, isn't it? And saying— not everybody is so lucky. And I think, you know, there was a transition period that was very hard for everybody. I had a lot of guilt, and I think it was very hard certainly for my family. Luckily, my kids were much older, but you know, there is a guilt associated with it and there's this kind of like, why are you living separately? You know, you know, you commuted all these years, why can't you commute? So I think I was very lucky. But the pandemic for a lot of people has given them the option of being able to take, you know, working from home, work a little more flexi time. And I just think people need to start understanding and having those conversations. First of all, you need to have it with yourself. Enough. And you need some space to be, you know, some headspace and some physical space to be in a reflective mood to understand what is happening to your life, the impact all these things are having on you and your state of health, your happiness, your mental health. And then be able to be resilient and strong enough to make those decisions. But you can't make them alone. You have to have your family support you and your friends support you through it, you know. Yeah. Oh, it sounds like you've got a very understanding family then. Well, they've had to become. They had no choice. Yeah, they had no choice. Oh, good for you. There's just, you know, women do have it hard these days, don't they? Because most, most, a lot of women now have careers, um, which was what they wanted, and we wanted to be equal and all of those things, and But then they still have to look after the family and, you know, make sure the kids are okay and their elderly parents are okay and organize food. And they have so much to do, whereas men just go to work and come home and think that's it, you know. Women have a lot more on their plate sometimes, I think. I agree. And we are predominantly— although this sounds You know, like, and I know so many men who actually help, who cook and, you know, um, do help their partners. But I think the traditional— traditionally, a lot of women are the caregivers and the care, um, carers. And, you know, it's a layer on layer on layer that— and, and they've got careers. And some of people who don't have careers also feel a sense of loss of identity because the kids have grown up and flown the nest. Menopause has happened. So I think there's a double whammy if you're a career woman, or equally if you've given up your career for your family, and then the menopause and that perimenopausal period when your hormones are in decline can be extremely traumatic. And this is where, um, you know, I think women need to be able to delegate. They need to be able to let go of the guilt, and they need to be able to understand that they need to let go of that perfectionist traits of being everything to everybody and being 100% all the time. And for me, it was very important to learn. I actually took on a coach. I took on a coach which was phenomenal because, you know what, I was like, I think I need some mentorship here. And the first thing the person said to me was, you have to learn to paraphrase no, because you're not saying no to somebody, because I was always scared to say no, so I said yes to everybody, because I wanted to please everybody, and give 100% to everything. And they said, no, just paraphrase your no to actually what you're saying yes to. So when, you know, I say no to something, in my head, what am I saying yes to? It, you know, it just made saying no easy because I was saying yes to more time for myself, more time for my family, more time for my career, more, more, uh, you know, the ability to then grow something else rather than just keep on doing sort of jobs that didn't grow me, uh, or support, uh, the family. And so I think it was really important that ability, even for somebody as driven as me and who is a CEO and has, you know, these 3 different companies, it's never too late to have a coach or a mentor or, you know, somebody who's going to help you through those periods because it was really phenomenal. And I think just being able to paraphrase no for me was a very big one. And I think that's the big one for women because we're so used to doing things and not saying no. Yeah, trying to please everyone but ourselves. Exactly. Yeah, so, oh, that's really good advice. And you know, that's good that you just said that, that you know, even someone as educated and driven as you thought, you know what, I need someone to tell me how to run my life really, because it's got out of control. Yeah, exactly. I mean, I didn't have enough hours in the day. It was just like snowballing and um, and it was never good enough. And I felt I was not good enough because I was just trying to be everything to everybody. Um, and now it's lovely. So it's about laying those little boundaries. And, you know, and actually one of the boundaries I laid to myself was the time I'm on social media. Tell me about it. So yeah, isn't it? No, no, I just don't. I don't. It's a boundary. It's like, I am not going to go there at after this time in the night or at this point, you know, there's a cutoff period when I look at it and when I don't look at it and that's it. I've started to do that recently because, you know, I'd be looking at it, I have dinner, maybe watch a bit of TV or something and then go to bed and then start looking at it again when I'm in bed and then thinking, wow, it's actually 1:30 in the morning and what have I just done, you know. And then you're all wired and you've got the light and which keeps you awake. It's so bad for you, isn't it? So, yeah, basically your phone is learning. It's AI. It's learning what you're enchanted with. So basically it's, you know, we don't realize that something that you've looked at and followed, like, like that rabbit hole down, like it's a little bit like Alice in Wonderland. And then your phone or your computer, your AI has learned Aha, that's what— and they keep throwing you that again and again, that content again and again and again. So it's, it's sort of, you know, taking you down a rabbit hole, which is why you're that enthralled with it, because that's what it's throwing up for you. Um, but it's horrible for your eyes, it's horrible for your sleep, and, you know, you just need— and it messes with your mental health because you also see you're constantly bombarded with filtered images of people's wonderful lives, highlights, not their lowlights. So, you know, you always think everyone else having a fantastic time, but, um, I'm really not a conspiracy theorist, not at all. I'm far, probably the other end of the scale. But sometimes I say something, I haven't put it into Google, I haven't looked at it, and then whatever it was I said to my husband then starts coming up on the phone. Has that ever happened to you? Yes, and you just make sure you don't have Alexa or somebody around, and you know, but your phones are constantly hearing what you say, you know. It's really weird, actually. Here they can actually hear rather than constantly, you know, we— in terms of, um, you know, algorithms and how it works, uh, it's, it's, it's a computer, it's robotic, it's auto, you know, as I said, it's It's an AI thing that's just managing what you're looking at, how frequently you look at it, how frequently you touch your phone, you know, um, what's in your shopping cart. I remember, I mean, if I go on a— and I try to shop for something, you just watch how all the ads change. I'm just being bombarded. Even when I'm looking at my emails on it, on the side panel of my, you know, account, It's like constant because now they suddenly realized, ah, you know, she wants to shop or she's interested in boots, and then that's what it's being bombarded with. I know, it's absolutely crazy. Funny world we live in now, huh? Yep, yep. But it's a beautiful world, and I think, you know, as long as we are very realistic and practical and we enjoy every single day— for me, it's really important I, you know, I really enjoy every single day. And to have that ability, to have that ability at my age, you know, whatever tough a life and a career I've had, because it's hard being a female plastic surgeon and, and getting to where I am, um, you know, um, and a person of color getting to where I am. So there are lots of nuances to it. I'm just, every single day You know, I cannot believe, and I call them awe walks. When I walk, I'm still awestruck with the things I see around me, and I'm happy. And every day when I see the clinics on Harley Street, I think, oh my God, those are mine. I'm so lucky and blessed. And I think to have, to be able to convert all of that into a positivity, you know, is really important so that you don't feel that your, um, you know, life sucks and it's that somebody has something and you don't have something. I think it's really important because that can be very quickly apparent on social media because you're seeing people's top notes of their life. You may have 4 more and you may think, oh, I don't have this in my life, I need to do better, or I'm not good enough. But that's not the case at all if you can just appreciate what you have. I agree. I totally agree with you. And yes, so well done to you. I mean, you have done really well in your life, and I really admire women that do that. And yeah, all for women, me. But it's been really lovely talking to you, and it's gone really quickly. We've been chatting for an hour, and it's gone really quickly. I know. So thank you for all your tips and advice on skincare and eye care. And yeah, I'd definitely like to try your, your eye care, get rid of these puffy bags. And I'm delighted to send you some, so I will— it's coming out in the post to you. Oh, thank you, Dr. Sabrina. And it's been really lovely to talk to you, and hopefully you'll come on again sometime. I look forward to it, and it's been wonderful chatting with you. Hopefully next time we can do it over a cup of coffee, and that'll be even more fun. Lovely. It would be even better over a martini or two. I agree. Okay, well, it's lovely to talk to you, Dr. Sabrina. Thank you for coming. Thank you. Lots of love. Bye. So this is Women's Radio Station. That was Dr. Sabrina. She was really lovely talk to and very interesting. Hope you've all learned some things about skincare and eye care. And this is Women's Radio Station, The Menopause Show. I'm Sue Moxley, and I'll speak to you in about 2 weeks. Thank you, goodbye. Menopause isn't just about hot flushes and weight gain. It can be so much more than that. It can cause anxiety, depression, and can become really problematic. So on this show, we will be dealing with those kind of issues as well, because they are just as important as, you know, the other, the other issues. So then we're going to be covering lots and lots of things. On The Menopause Show. Look forward to having you listening in, um, on a regular basis.