Interview with Dr. Azadeh Shirazi, Dermatologist and Laser Specialist

Dr. Thais Aliabadi and Mary Alice Haney sat down with Dr. Azadeh Shirazi—known to many as Dr. Azzi—to get clear, science-forward answers about anti-aging: which lasers actually move the needle, how fillers behave over time, why a skin barrier matters more than buzzwords, and how to use retinoids and vitamin C without turning your face into a flaky mess. This is a practical playbook: no hype, no one-size-fits-all prescriptions, just the guidance we wish everyone had before booking procedures or splurging on the latest serum. 

Table of Contents

• Quick navigation
• FAQ
• Practical protocols we recommend
• Final takeaways

Quick navigation

• Lasers: CO2, BBL, erbium, and resurfacing strategies
• Red light, LED masks, and home devices
• Fillers: hydrophilic vs non-hydrophilic, long-term risks
• Dark circles, eye glow, and under-eye filler choices
• Retinol staging, vitamin C, and building a simple routine
• Teen acne, hair loss, and supportive therapies
• Exotic treatments: salmon sperm, exosomes, and safety
• Practical takeaways and a rapid-fire FAQ  

How did you end up focusing on lasers and aesthetic dermatology?

We started our conversation remembering how unlikely friendships and careers sometimes begin—on vacation. Dr. Azzi trained at Mayo Clinic and UC San Diego, did research fellowships at the Wellman Institute of Photomedicine at Harvard, and then spent years refining what works and what doesn’t in aesthetic practice. That path gave her both technical knowledge about physics and lasers and clinical experience treating a wide range of skin types. We lean on that combination when deciding whether a device or a product is a marketing story or an actual tool for change.

Are resurfacing lasers like CO2 still worth it, or do they ruin the skin barrier?

Lasers are tools. Whether CO2 is “good” or “bad” depends on the settings, the operator, and the patient. We can use CO2 in conservative ways that give one to two days downtime, or we can use higher settings that create two weeks of visible healing. The CO2 family targets water in the skin, vaporizes columns of tissue, and triggers a wound healing cascade that boosts collagen and elastin. That regeneration is powerful and can produce dramatic smoothing, tightening, and texture improvement.

That said, resurfacing lasers do disrupt the skin barrier by design. “Disrupt” is different from “destroy.” A properly performed resurfacing stimulates regeneration without causing long-term damage. Problems arise when the operator chooses settings that are too aggressive for a patient’s skin type, thickness, or underlying conditions. For example, thin or very delicate skin can be harmed by too much heat, which is why choosing a clinician who understands laser-tissue interaction is critical.

How should we think about BBL versus CO2? Which do we pick and why?

We usually think of BBL (broadband light) and CO2 as different categories for different goals. BBL is a light-based treatment that targets chromophores—melanin (pigment) and hemoglobin (redness). It is excellent for “cleaning up” sun damage, brown spots, and redness without removing the surface of the skin. Studies now suggest that repeated BBL can even change cellular aging markers, making treated skin look younger at a genetic expression level.

CO2 and erbium are resurfacing lasers. They remove columns of skin and provoke a regenerative response. If texture, pore size, deeper fine lines, or significant laxity are the priorities, resurfacing will typically deliver superior results. If the priority is minimal downtime and pigment cleanup, BBL is an excellent first option.

We often use both: start with BBL for pigment and vascular concerns, then layer a conservative resurfacing for texture if the downtime is acceptable. Or pick a lighter resurfacing (fractionated erbium, halo, or other non-ablative options) when you want a middle ground.

Are lasers safe for darker skin tones?

We no longer say “lasers are not for darker skin” as a blanket rule. Technology has improved. There are non-ablative resurfacing devices and 1550 nm technologies that can target deeper dermal structures while sparing the superficial melanin-rich layers. But darker skin carries a higher risk of hyperpigmentation and keloid formation because of more robust fibroblasts and more reactive melanocytes. With dark skin, we take extra precautions: pre-treatment bleaching regimens, cooling during treatment, conservative energy settings, staged treatments, and meticulous post-care. The operator’s experience with diverse skin types is the single most important factor.

Does red light therapy at home work, and should we be worried about LED masks?

Low-level light therapy is real, but consistency matters more than gadget hype. LED and red-light devices can stimulate mitochondrial function and improve skin health if used regularly—think three times per week for several weeks. Problems occur when devices are purchased and then never used, or used inconsistently in hopes of a quick fix.

We caution people with melasma or hyperpigmentation: light and heat are triggers. LED masks can exacerbate pigment conditions because they deliver light energy very close to the skin for extended periods. If you have melasma or excess pigmentation, avoid at-home LED until you get professional guidance. For others without pigment sensitivity, red light can be a helpful adjunct, but it is not a miracle.

How do we make sense of fillers: hydrophilic versus non-hydrophilic, and can they cause long-term problems?

Fillers are volume replacement tools. They do not “lift” the face in the surgical sense; they replace lost volume to restore youthful contours. A crucial point we emphasize: different fillers have different behaviors.

Hydrophilic fillers (those that attract water) can cause puffiness over time, especially in areas like the under-eye zone, where skin is thin. Juvederm, for example, is great in lips because of its hydrating character, but it is not our top choice for the under-eye area. Fillers that draw water can make hollows look worse if they were not the right solution in the first place.

Non-hydrophilic options or blends designed for the under-eye area reduce the risk of post-injection puffiness. EyeGlow, as an example, is a patented white opaque filler designed to sit deep and not demonstrate the blue-gray scattering you can see with clear fillers under thin eyelid skin. That opacity avoids the Tyndall effect, when clear gel scatters blue light and creates a bruise-like appearance.

Another long-term risk is fibrosis from repeated, aggressive filler injections. Early marketing and practice encouraged many syringes into faces with limited anatomy training. Repeated injections can produce chronic inflammation and scarring, making tissue rock hard and affecting lymphatic drainage. If filler is overdone repeatedly over a decade, it can create fibrosis, lymphatic changes, and aesthetic distortion. The responsible approach is individualized treatment, conservative dosing, and periodic reassessment rather than automatic repeat injections.

Can fillers cause vascular occlusion or blindness, and what do we do if that happens?

Yes, filler injection carries real vascular risks. If filler is accidentally injected into an artery, it can block blood flow and cause tissue ischemia. In rare cases near the eye, intravascular filler can compromise the retinal circulation. For hyaluronic acid fillers, there is an antidote: hyaluronidase. It breaks down HA rapidly and is a critical emergency tool. The key is early recognition and immediate treatment—timely intervention often prevents permanent damage.

Meticulous technique, knowledge of anatomy, and conservative volumes reduce risk. We also stress choosing an experienced injector rather than the cheapest or fastest option.

What causes dark circles, and which treatments actually help?

Dark circles have many causes. When the root cause is anatomical hollowness, volume replacement works beautifully because hollowness casts a shadow. But if the dark circle comes from superficial pigment, vascular congestion, or thin translucent skin, fillers can worsen the appearance by creating puffiness or light scattering.

We prefer deep, structural fillers for the tear trough when indicated. EyeGlow, which blends hyaluronic acid with calcium hydroxyapatite and is placed from the cheek deep into the preperiosteal plane, replaces volume and gives structural support without the translucency issues of clear gels. But candidacy matters. The best results come from the right product in the right patient, not from one-size-fits-all injection patterns.

What about Sculptra and biostimulators? Are they safe long-term?

Sculptra is a poly-L-lactic acid biostimulator. It triggers collagen formation and can thicken skin and restore contour. Used appropriately, it gives a glowy, youthful look and improves skin quality. But too much stimulation can cause nodules or palpable hardness. Another consideration: if a patient later wants surgical correction, heavy biostimulation can complicate dissection. The rule we follow is “it’s not the product, it’s the dose.” Thoughtful, conservative placement and appropriate patient selection are the priorities.

How do we use retinol and vitamin C without irritation? What routines actually work?

Sunscreen is the non-negotiable. After that, retinoids are the most evidence-backed anti-aging topical we have. They stimulate collagen, increase epidermal turnover, and can raise skin hyaluronic acid content substantially. But retinoids cause irritation in many people.

We teach “retinol staging” as a practical method to minimize irritation. Start the evening routine by cleansing and immediately applying a moisturizer while the skin is still damp. That strengthens the skin barrier. Wait until bedtime, then apply the retinol to clean, hydrated skin. Using retinol at night on top of an already moisturized base helps reduce the drying, flaking, and redness that makes people stop using it. Some people can tolerate applying retinol right after cleansing; others need staging. The key is gradual introduction and consistent use.

Vitamin C serums are powerful antioxidants and brighteners, but good formulations are harder to make. Pure L-ascorbic acid is unstable and can be irritating. We recommend investing in a stable vitamin C formulation from a reputable brand and applying it in the morning. Wait three to five minutes after application before layering on sunscreen and other products to let it absorb. For cleansers, most drugstore gentle brands are fine—save the budget for effective vitamin C and retinoid products.

How many steps should a skincare routine have? Are multi-step routines better?

We prefer simplicity and consistency. A three-step approach works for most people: cleanse, treat, protect. Overloading the skin with five to eight actives often backfires and disrupts the skin microbiome and barrier. Identify your skin type and primary concerns, then choose one solid cleanser, one targeted treatment serum (retinoid or vitamin C, depending on the time of day and issue), and a nourishing moisturizer with sunscreen for daytime. For sensitive skin or eczema, prioritize barrier repair ingredients such as ceramides, glycerin, and colloidal oatmeal.

Does hyaluronic acid in everything actually do harm?

Hyaluronic acid is useful but overused. HA needs water to be effective; if you apply it continuously without ensuring water availability, it can draw moisture from the deeper skin, paradoxically causing dehydration. Avoid stacking multiple HA products. Instead, pair a single HA serum with a good moisturizer to lock in hydration.

Which over-the-counter products are worth buying if we cannot invest in clinician-grade options?

For retinoids, brands like ROC have solid, well-tolerated formulations and are budget-friendly. For vitamin C, many French pharmacy brands and La Roche-Posay make stable, well-formulated options. Cleansers can be gentle and affordable—CeraVe and La Roche-Posay are both reliable. Spend where it counts: the actives in serum form, like vitamin C and retinoids, tend to make the biggest difference.

Do eyelash serums really work, and are there risks? 

Yes—prostaglandin analogs such as bimatoprost (the active ingredient in Latisse) are effective for lash growth. They carry side effects: possible periorbital hyperpigmentation, changes in eye color, and, rarely, fat or volume loss around the eyes if drops get into the eye. We recommend careful application and stopping use if you notice unwanted changes. Castor oil is a common folk remedy and may help for some, but prostaglandin analogs are the most clinically effective agents.

How should parents or clinicians approach teen acne when viral social trends push clinical products?

We see the fallout from social media pressure: young kids using retinoids or complex regimens they don’t need. Teen skin is resilient, and often a simple plan works best: a gentle cleanser, a targeted topical (retin-A if indicated, or benzoyl peroxide, azelaic acid, or topical sulfur depending on sensitivity), and a moisturizer. For inflammatory or cystic acne that sits deep, oral therapies—doxycycline or minocycline—are often necessary. For hormonally driven acne, spironolactone or combined hormonal contraception can help in appropriate patients. When first-line topicals and antibiotics fail, isotretinoin (Accutane) remains a safe, life-changing option when monitored appropriately.

Are there lasers that mimic Accutane’s effects for acne?

Yes. Devices like AviClear target sebaceous glands and reduce oil production—conceptually similar to what isotretinoin does pharmacologically. AviClear is a three-session protocol spaced by weeks and can be used across skin types because it targets the sebaceous gland specifically. It’s another option in the clinician’s toolbox for refractory cases or for patients who cannot or do not want systemic therapy.

How do we approach hair loss in women—what actually helps?

We always start with a systemic assessment: labs for vitamin D, iron parameters, thyroid function, and evaluating nutrition. If nutrients or medications like GLP-1s are affecting hair, address those first. Topical minoxidil remains first-line and effective even at lower doses; many women respond to 1.25 mg orally in certain regimens for hair stimulation. Anti-androgens such as spironolactone or low-dose finasteride can be added for androgen-mediated thinning. Platelet-rich plasma (PRP), low-level laser therapy, and combination protocols that pair medical therapy with energy-based treatments can improve outcomes—provided we schedule treatments properly and optimize baseline health and nutrition.

What are collagen drinks, and do they help skin and hair?

Collagen peptides provide amino acids that serve as building blocks for collagen synthesis. They are not magic labels directing molecules to the skin, but they can support overall protein supply. Think of them as supportive nutrition rather than targeted stimulation. Focus first on a balanced diet, protein intake, vitamin D, and iron optimization, and then consider supplements as supportive measures.

Snail mucin and salmon sperm—are these fads or do they have evidence?

Snail mucin is a topical ingredient popular in K-beauty with humectant and soothing properties and some evidence for barrier support. Salmon sperm, referring to preparations rich in ribonucleotides (PRDN), has gained attention in certain international clinics and may stimulate collagen. The emerging data are promising, but many of these treatments are not FDA-regulated in the United States. That means variable impurity profiles, inconsistent formulation standards, and potential infectious complications when injected or when procedures are performed abroad. We caution patients to evaluate risk and to prioritize regulated, evidence-backed options when possible.

What about exosomes? Are they the next big thing?

Exosomes are small vesicles derived from cells that carry signaling molecules. They represent an exciting field and may help tissue communication and regeneration. The problem is standardization and overselling. The biology is powerful but complex. Overstimulation of a specific pathway can have unintended consequences. We watch the science closely but advise cautious use until products are standardized and safety profiles are robustly established.

How do we treat excessive sweating?

Botox injections under the arms, into the scalp for a sweaty scalp, or into the breast crease for focal sweating are effective and reversible every three to six months. For a more permanent solution, devices such as MiraDry use thermal energy to reduce sweat glands with a long-lasting effect after a session or two. Oral anticholinergic drugs such as glycopyrrolate can help systemic or multiple-area sweating but come with side effects. Treatment choice depends on the distribution and severity of sweating and the patient’s tolerance for repeat sessions versus procedures.

How about eczema—what’s the practical daily approach?

We always begin with avoidance and barrier support. Identify sensitizers in the environment—scented candles, essential oils, and fragranced personal care products are frequent triggers. Use fragrance-free, gentle cleansers and build a regimen centered on emollients containing ceramides, glycerin, and colloidal oatmeal. For flares, topical anti-inflammatories—prescription steroids or non-steroidal anti-inflammatories—should be used early to control the outbreak. Consistency in moisturizing and minimizing irritants is the foundation of long-term control.

Are there treatments you would never recommend?

We avoid unregulated “needling” devices marketed aggressively with little evidence and procedures that create polka-dot scarring, such as some plasma pen applications done by inexperienced operators. The more extreme and novel a treatment sounds, the more cautious we are—especially when devices are not FDA cleared or when products are imported without regulation.

FAQs

What is the single most important product you should never skip?

Sunscreen. Preventing UV damage is the best investment for slowing visible aging, reducing pore enlargement, and preventing pigmentation.

Can Botox actually prevent wrinkles?

Yes. Preventive or “baby” Botox can minimize repetitive muscle movement that leads to creases and deep lines. Done early and conservatively, it can delay the formation of static wrinkles over time.

Can we use retinol if we have sensitive skin?

Yes, with the right formulation and a staging technique. Start with lower-strength retinoids or delayed-release versions and adopt retinol staging—hydrate first, apply retinol later at night—to reduce irritation.

Do fillers lift the face?

Not in the surgical sense. Fillers replace lost volume and can create the visual effect of lift when used strategically, but they do not surgically reposition tissues.

Can pores be shrunk?

Pore size is partly genetic but can be improved with UV protection, retinoids, and lasers that stimulate collagen. Keeping pores clean with salicylic acid and using retinoids will make them less noticeable.

Are collagen supplements worth it?

They are supportive. Collagen peptides provide amino acids that can aid the body’s synthesis of collagen, but they are not a targeted delivery system to the skin. Nutrition, protein intake, and vitamin sufficiency remain fundamentals.

What should someone do if they experience an adverse reaction to filler?

If hyaluronic acid was used and vascular compromise is suspected, seek immediate medical attention; hyaluronidase can dissolve HA and restore blood flow if given promptly. For other complications, an experienced injector or oculoplastic surgeon should evaluate and manage the situation.

Practical protocols we recommend

• Daily maintenance: gentle cleanser, targeted serum (vitamin C in the morning), moisturizer with SPF during the day, retinoid at night, and using staging if needed.
• Quarterly refresh: schedule non-ablative treatments such as BBL or milder resurfacing a few times a year to maintain skin health without big downtime.
• If you want a dramatic result: discuss resurfacing options (erbium, CO2) with a clinician who tailors settings for your skin type and plans recovery and aftercare.
• For under-eye hollows: evaluate hollowness first. If present, consider deep, less hydrophilic fillers placed by an expert to avoid puffiness and Tyndall effect.
• For teenage acne: keep routines simple, use one or two targeted products, and escalate to oral agents or isotretinoin when topicals are insufficient to prevent scarring.

Final takeaways

We heard one recurring theme: context matters. Laser choice depends on the skin type and concern. Filler choice depends on anatomy and long-term planning. Skincare works best when it is consistent and simple. New and exotic treatments are exciting, but regulation and rigorous evidence are essential before widespread adoption. When in doubt, prioritize education, pick experienced clinicians, and think long term rather than chasing quick fixes.

We are grateful to Dr. Azzi for sharing practical, science-driven guidance that helps us separate noise from signal in an industry full of fads. If you decide to pursue any aesthetic procedure, choose providers who explain risks, alternatives, and a long-term plan. Your skin and your health will thank you.

For more on Dr. Azadeh Shirazi, find her at Skin by Dr. Azzi on Instagram and TikTok, and explore Ozzi MD Skincare for clinician-formulated products.

This article was created from the video The Anti-Aging Playbook: The Newest Fillers, Lasers, & What Really Works w/ Dr. Azi | SHE MD for Dr. Thais Aliabadi’s website.