Interview : Dr Heidi Waldorf, Dermatologist
Dr Heidi A Waldorf, MD is a nationally and internationally respected expert and sought after lecturer in the field of Dermatology and Cosmetic Medicine, including skin rejuvenation, soft tissue augmentation, cosmetic use of botulinum toxin, noninvasive fat reduction, laser and other energy based device technology and cosmeceuticals.
Dr. Waldorf completed her undergraduate and medical education and training at Harvard University and the University of Pennsylvania, after which she completed a fellowship in Mohs Micrographic Surgery, Laser Surgery and Cosmetic Dermatologic Surgery. Former Director of Laser and Cosmetic Dermatology at Mount Sinai Hospital in New York for two decades, Dr Waldorf now sees users exclusively at her private practice Waldorf Dermatology Aesthetics in Nanuet, NY.
1) Tell us a bit about your background. How did you choose dermatology as your speciality?
My dad was not subtle in ‘suggesting’ I be a derm: “pass the potatoes – have I told you that dermatology is a wonderful career”. So if anything, I decided I would be anything but a dermatologist. But it must be genetic – my dad, the derm, + my late mom, an artist before she became a lawyer = me, very visual and spatially oriented and good with my hands. Plus I love seeing customers of all ages and working with the tangible. So despite going to medical school thinking I’d go into public policy (my college major was economics and I wrote my honors thesis on the tobacco industry), I decided on dermatology. My subspecialty evolved as I went through training – first bench work research, then dermatologic surgery, then lasers and so on. What is interesting is that most of what I do in practice today was not available when I came out of fellowship in 1995. But it shows the importance of completing a residency and fellowship and becoming board certified in a core cosmetic field (dermatologic surgery, plastic surgery, facial plastics and oculoplastics). Because of my background in skin pathophysiology and facial anatomy, I was able to grow with the field. Aesthetics is my passion clinically and academically. I spend the time lecturing, training and helping develop new solutions because I believe strongly that it can and should always be done safely, ethically and with a natural appearing outcome.
2) What do you feel are the most commonly made mistakes in skin care? How do you feel these can best be avoided?
Too much – too often is a common mistake in skincare for everything except sunscreen (which people tend to use too little and too infrequently). What I mean is people over use products thinking that more is better. When scaley they exfoliate – they are smooth for a day then scaley again and exfoliate more and so on. If they’d consulted a dermatologist, they’d have learned that exfoliation without moisturization doesn’t give longlasting results. If skin doesn’t turn over normally itself – due to photodamage, use of a retinoid or dermatologic concern – then exfoliating physically or chemically is helpful. But the only way to get at the root of the issue is to hydrate and seal in that moisture after exfoliating. Retinoids are another common example. Every dermatologist will tell you that there is more science on retinoids to reduce aging and photoaging than any other category of ingredient. However, they can irritate. It is important to ease into use – twice a week to three times a week etc , start with lower rather than higher concentrations, and moisturize with it.
3) Your skin’s always so glowy! Could you walk us through your skincare routine?
My skincare routine is simple – because at 54, I still have no sun damage. In the morning, I wash with Neostrata exfoliating foaming cleanser for my face and Dove body wash for my body in the shower. Then I apply Caudalie body butter to my arms, legs and wherever else I feel dry on my body, Dermatopix intensive hand cream to my hands and Caudalie premier cru crème riche, to my face and neck I follow with ISDIN Eryfotona Actinica sunscreen for face, neck, arms – whatever might be exposed. During the summer months when I don’t need as much moisturization and have more of my arms and legs exposed, I often skip the caudalie moisturizers and just use the Eryfotona Actinica for my face and neck and Elta UV Lotion for my arms and legs. At night, I apply Vaseline or bag balm to my lips and Dermatopix to my hands and feet. I do nothing else – at most I will wipe my face with a pre-moistened towelette by Neutrogena, Simple or Garnier and apply some of the crème riche but most nights I don’t even wash my face. I can do that because I don’t wear foundation and have no tendency for acne. I have My Pillow pillows that don’t fight against my face and use Illuminage and Slip pillowcases and eye masks – Illuminage contains copper fibers which are antibacterial and rejenerative and Slip silk fabric keeps your face from sticking to it and forming sleep lines.
4) It’s said that pigmentation’s become the new wrinkle. What are your thoughts on the safety profile?
The limitation of some products is irritation from topical use and the inability to use during pregnancy, a time when many women develop hyperpigmentation. As a dermatologist, pigmentation has always been a biggie for my practice – it goes hand in hand with wrinkling in photodamage and in users with stubborn discoloration.
5) You recently mentioned Cysteamine’s to be a new product on the market that’s said to be a great option for reducing stubborn discoloration and pigment issues. Could you tell us more about how it works?
Cysteamine is interesting because this main ingredient was actually discovered in the 1960’s. But there were manufacturing issues limiting its use until recently .cysteamine reduces melanin in the epidermis by blocking the process of melanogenesis. That allows customers to use it during a time when pigment is a particular concern. I also find it useful for customers who have used other products. Switching to cysteamine allows them to get further meaningful improvement. They can use it alone or alternate night with a retinoid or alpha hydroxy acid. Note that using cysteamine does not remove the importance of sun protection which is always a critical part of any pigmentation care.
6) What has been the greatest difficulty you have encountered in starting and maintaining your own successful dermatology practice? In the skin care business?
Time. There’s never enough of it. I love improving customers, working with my staff, lecturing at aesthetic dermatology and multispecialty meetings, consulting with industry to help develop new solution protocols, reviewing papers for peer reviewed journals and doing my #heideas videos for the public and editorials for the journals I edit. I love traveling for work and play. And there’s the ‘life scut’ required to administer a practice and live a life, not to mention time with family, friends and myself. Something’s gotta give. After years of feeling overwhelmed I received a present from a friend - a ‘no’ button. And that’s been the key to balance - learning to say ‘no’ to the things/experiences that aren’t necessary, enjoyable and/or that add to my life as a physician or person.
7) Are you loyal to any pro services or solutions/care?
Yes. When someone or something works, I don’t see the need to switch. Beth Minardi has colored my hair for over 20 years - before and after I lost it to chemotherapy (and she helped me get my wig!). Sachiko Fukumoto has cut my hair for that same time. Lysette Drumgold has done my blowouts and makeup for events for a decade. I do my own tox but filler is trickier. There are only 4 or 5 people I’ve let do my filler when I can’t reach - we do it when I see them at meetings. And my staff does my coolsculpting, emsculpt and thermage!
8) Lastly, for someone just starting to think about how to age gracefully, what is the best advice you can offer in terms of maintenance?
I can’t overemphasize my big 3: don’t smoke, don’t pick and DO protect against ultraviolet light!!! And see a board certified cosmetic dermatologist who specializes in noninvasive rejuvenation and at the same time is specialty trained to recognize things that should not be improved aesthetically like malignancies. This isn’t like getting a blow out or massage - avoid the groupon crowd and anti mutagenicdon’t doctor shop based on price. Better to get less done but done well and safely. And develop a relationship with that doctor that allows her to know your needs and what works for you over the long term. Then you can grow old looking young together.