Tune In: A Top Dermatologists Honest Thoughts On Filler, Botox, Lasers & More

Cosmetic procedures are more common—and more culturally normalized—than ever. From Botox to biostimulators, the menu of in-office options has expanded far beyond what most people realize. But with rapid innovation comes confusion about what’s safe, effective, and truly necessary. 

In this week’s episode of Clean Beauty School, I chat with board-certified dermatologist Shasa Hu, M.D., Cosmetic Director of the Skin of Color Division at the University of Miami, unpacking the science, psychology, and ethics behind aesthetic medicine.

“Non-invasive procedures are not necessities, they are luxuries. They can enhance, but they are not what you must do to feel pretty,” says board-certified dermatologist Shasa Hu, M.D., Cosmetic Director Skin of Color Division at the University of Miami. “This is the one thing I think everyone needs to take a step back and think about: Be critical about the reasons why you are doing these things. Do not do it just because you think it will make you feel better if you look better.”

Sure, she notes “some degree of validation can help you feel like yourself,” however external changes do not replace the inner work. You can not inject yourself with self-esteem. 

“So first you need to figure out what is really bothering you, then determine if that’s something that an in-office procedure will actually make an impact on,” she says. “Ask yourself: Is the end result going to give you what you're actually looking for?”

In the episode we explore the complex topic of aesthetics—from filler fatigue and Botox backlash to treatment transparency and cautions around trending procedures like exosomes. It’s worth a full listen, thanks to Hu’s refreshing candor, if you’re at all interested in getting any work done yourself.

Most folks could benefit from some type of laser. From mild resurfacing and redness from rosacea to severe sun damage or acne scars, lasers are a tremendously powerful aesthetic treatment. 

In fact, certain types of lasers can half your risk of skin cancer.

“If someone has severe sun damage skin and a history of skin cancer, I may suggest something that's a little bit more aggressive at resurfacing, such as a non-ablative fractional laser,” she notes. “Because on this end of spectrum, studies have actually shown just one session of a fractional laser to resurface the skin can reduce a person's skin cancer risk by 50%.”

Of course, lasers should not be thought of as a monolith. 

“A lot of people will come in and say, ‘I want a laser because like my friend got it, she looks great after she looks so glowy,’” says Hu, noting that the option that might work for one skin type may be ineffective (or even cause damage!) for another. “The physical assessment is very important,” she says. 

The field of regenerative aesthetics is the future of skin care and longevity. At The University of Miami, Hu is helping pave the way: “We’re actually developing a Master of Science course on skin aging because interest in skin rejuvenation and longevity has exploded in recent years,” she says. “Our department came together and decided to focus on this area—to pioneer a dedicated program in the science of skin aging.”

So while she’s championing education and academic exploration into the regenerative sciences, she’s equally cautious about experimenting with these treatments before they’ve been vetted. 

Most notably, with stem cells. 

“Stem cells are what we call pluripotent, meaning they can transform into different types of cells,” she explains. “A stem cell can become a keratinocyte or a fibroblast, supporting the skin barrier, influencing pigment, or helping to produce collagen. In essence, stem cells have the potential to regenerate and heal because they can develop into many different cell types.”

Her first warning is that there’s no regulation about stem cell use in cosmetics or aesthetics. 

“You can simply put ‘stem cell’ on a label as a marketing tool, even though if you look closely it's actually a stem cell from a plant or manufactured in a lab setting. So ‘stem cell’ is just a buzzword to get people interested,” she explains.

The second is far more serious: We still don’t know the safety implications for stem cell use in in-office procedures like injectables or microneedling. 

“When it's combined with a microneedling or actually injected under the skin, there is definitely a real theoretical risk of stimulating cancer potential cells. So yes, you're doing something stimulating, but how are we sure that we're only stimulating healthy cells, not the cancer cells?” she asks. 

So as exciting as these breakthroughs may be, Hu emphasizes that safety and evidence must come first—especially in an office setting.