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The Allure Podcast: A Dermatologist Dispels the "Black Don't Crack" Myth

Allure Features Director Jessica Cruel and Digital Hair Editor Jihan Forbes sat down with prominent dermatologist Dr. Michelle Henry to break down stigmas and myths about skin and scalp care for brown skin on this episode of The Allure Podcast. (Available on Apple and Spotify.)
Dr. Michelle Henry and The Allure Podcast hosts Jihan Forbes, left, and Jessica Cruel, right (Photo by Cassie Basford)

Jessica Cruel:
So today we're here with Dr. Henry, and why don't you tell us a little bit about yourself?

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Dr. Michelle Henry:
So my name is Dr. Michelle Henry. I'm a dermatologist and dermatologic surgeon based here in Manhattan, New York. I do the full range of dermatology for everything from skin checks to acne to hair loss to things like warts, and I do hair transplant, I do liposuction, I do skin cancer surgery. So I do the full range. I specialize in skin of color and high-risk skin cancers and aesthetic procedures. So I see a ton of patients, and I'm very busy, and I love what I do.

Jessica Cruel:
I think dermatology, Black dermatologists in particular are so rare, and as we all know, if you can't see it, you can't believe it. what was it like for you being one of few Black dermatologists?

Dr. Michelle Henry:
Scary, [laughs] you know? When I initially decided that I was interested in dermatology, it is scary. You know, it's one of the hardest specialties. In getting in, I would joke, it's like the Hunger Games, you know.

Jessica Cruel:
Oh my gosh.

Dr. Michelle Henry:
I choose to be tribute. It's literally like life or death at every stage. My medical school, they tell you quick like full stop, if you don't make this score, we will not write your letter, which means if they don't give you a support letter, you're not getting in. You have to decide early, you have to work hard, you I’m have to compete, you have to have letters. That's what makes it hard, because a lot of it is mentorship. Sometimes, like you said, If you don't see it, you can't do it. Oftentimes, you gravitate towards mentors like ourselves. It is about going outside your comfort level and building those relationships, and going to spaces where, you know, you may not feel welcome, and kind of claw your way in and make it happen. So it's really hard, and I'm sure any Black dermatologist will tell you that it's a fight. It's worth it, but it's a fight.

Jihan Forbes:
So going back to I guess the dearth of Black dermatologists, particularly in the US, because there's been a lot of talk about it. What is that like? You know, is there between all the Black dermatologists. It's obviously a small community is there, like a support there, or is everyone just like, we need to get some more Black folks in this?

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Dr. Michelle Henry:
I will say that I am humbled by the level of support. We are a close-knit group of folks. If I'm busy and someone needs to get in, and they can't get in a month — usually I work someone in — or if they don't live close to me, I'll say, Here's my colleague. Go there. What's most important is that you get the care that you need. We have our own Instagram group where we literally Instagram each other all day, like a pod, talking about what can we do. We share opportunities. We share media opportunities. We have our own Facebook groups, and we have it also with all of our colleagues.

Jihan Forbes:
That's awesome. Let's go into sunscreens.

Jessica Cruel:
Yes! There was that article in the New York Times, "Should Black People Wear Sunscreen?" And I will say, when I grew up, it was just a summertime thing. I didn't even hear about sunscreen until we went to the beach for vacation, and then mom was like, Okay, you've got to put sunscreen on. But other than that, it wasn't a daily thing. I just think maybe two or three years ago, I started wearing sunscreen on a daily basis. But I think there's this myth out there — or maybe it's not a myth — that Black people don't need sunscreen, because we have melanin to protect us.

Dr. Michelle Henry:
[sighs] Yeah, it's a myth. It's a myth. I mean, I'm the same way. The same way I never went to a dermatologist. Sunscreen wasn't a huge thing for me either growing up. Now I think about it, and I'm like, I used to be out in the sun fancy free. We didn't know. We didn't think about it, and culturally it wasn't a thing. I'm Caribbean, and we live on the beach, and that's what we do. We just didn't think about it. Although I shudder at it now, well of course, your habits change. When you know better, you do better.

Dr. Michelle Henry:
So sunscreen is absolutely necessary. We know that UV light is a carcinogen. We know that. Although we have melanin, I always say our melanin is beautiful, but it's not perfect. We still are vulnerable. Even the deepest, darkest, richest, most beautiful skin is just SPF 13, and we know that what we want is SPF 30. We know that protects us. Yes, the rates of skin cancer are lower in skin of color, but it actually hit home for me. My uncle had a basal cell cancer, my type, 5-6, so a little bit darker than me, so dark skin, Black person, uncle just had a basal cell cancer. And so it happens. We say the rates are lower, but it's low until it's you. When you're making decisions for your own life, it's not about the statistics. It's about doing whatever you can do to reduce your risk, your individual risk. I still recommend it.

Sunscreen Ingredients You Should Avoid

Dr. Michelle Henry:
Reasons why people don't want to use it, there are all these conversations about ingredients and toxicity, and especially in skin of color, it's important, because we know that in our products, we are more exposed. Whether it's sunscreen, or whether it's hair dye, or whether it's relaxers, or whether it's just anything that's in the ethnic aisle, we know that our levels of those toxic ingredients are higher. It is a conversation, and we have to be like active consumers and read those labels. The concern is not misguided, but it's just about making good decisions in sunscreen. There are ingredients that we try to avoid, like oxybenzone. Some of those ingredients in the chemical sunscreens, I tell everyone to avoid, including our patients of color.

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Dr. Michelle Henry:
So if we're using ingredients, like zinc or titanium dioxide, that we know are mineral sunscreens, we live in a great era now that we can have cosmetically elegant sunscreens that are minerals. We have powders. There are some great brands making micronized sunscreens. Using those natural ingredients, micronizing them, and that you can still use them on deep, rich skin tones. We have a lot of options, so it’s not about Should I use sunscreen? You absolutely should. You just have to use a sunscreen that you feel comfortable with. Something that you feel comfortable with the ingredients. And now we have more options and we can do that.

Jessica Cruel:
Something that isn't going to make you look ashy. I think that's the perception, right? That sunscreen is oily and ashy, and it makes me look just pale, and I think that's the perception that people don't want to use it, but like you said, technology is getting better. There are also a lot of Black entrepreneurs coming out with sunscreen specifically targeted for us.

Dr. Michelle Henry:
It's fantastic. You know, it's like, we should lead that charge in terms of like...we are large consumers, so we spend 80% more than our Caucasian counterparts on beauty. So much more! I love all the Black female entrepreneurs that are doing it, but I think all beauty companies are listening that America is browning. The world is browning. There are more of us, and we have to meet those needs. I think I'm starting to see a lot of amazing Black entrepreneurs are doing amazing things and have tested a lot of products from some good things that are on the horizon, and that excites me. But also just even a lot of mainstream brands are investing in making products that are A - safe, and cosmetically elegant, and will not leave you ashy. I always tell all of them, I was like, get it off of my desk if it makes you ashy.

Jessica Cruel:
I don't want to see it.

Dr. Michelle Henry:
I can't do it, because it's blasphemy. You can't come to a Black dermatologist and leave looking like a ghost, you know? Anything that I recommend is going to be cosmetically elegant for everyone's skin. It's a good time for sunscreen.

Jihan Forbes:
So we're talking about SPF 30, and so first I heard that SPF 30 is the most you need, and then everything above that is frivolous.

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Dr. Michelle Henry:
Yeah.

Jihan Forbes:
But I also heard that that's not necessarily true because of how they test SPFs and 30s, how they slather a bunch on.

Dr. Michelle Henry:
Yeah.

Jihan Forbes:
Is it better to go higher with the SPF, or does it not matter as long as you put on a bunch of sunscreen?

Dr. Michelle Henry:
Right now, the belief and like the FDA stance is that above SPF 50 is... the improvement you get above that is negligible, because the truth is it kind of gives you a false sense of security. If you're wearing SPF 100, you feel like, You know what? I could walk right into the sun, right? I'm so protected, I could do whatever I want. That's not true, because you sweat, you perspire, you're outside, you rub it off. And we think that patients feel so protected by it, then they make poor sun choices. The difference between SPF 50 and SPF 100, it's like a percentage point, you know? So it's not significant enough to then give you that false sense of security.

Dr. Michelle Henry:
Some companies are doing their own studies saying that SPF 100 is better, but it's negligible. So right now, we say the difference between 50 and 30 is significant. That's why we recommend 50 when you're outside for more than an hour, but above that... might just be more marketing. Please no one attack me. [laughs] I'm sure I'm going to get a million from 100s and above, and if I see the research, I will recant that statement, but right now, the stance is that 50 is about what you need.

Jessica Cruel:
I know that Black people are less likely to get skin cancer than others, but I know also that we get different types. We're more likely to get it on our palms and the bottom of our feet, correct?

Common Types of Skin Cancer in the Black Community

Dr. Michelle Henry:
Yeah, so in terms of melanoma, all folks of color are more likely to get acral melanoma, and that's when we see it on the hands and feet, on the fingernails. You get these little streaks on our nails. Some of the streaks are benign. That's called melanonychia. Most Black folks will have it by the age of 50. We've all seen it. Our parents have it. When they become thick and dark and disturb the texture of the nail, that could be melanoma. I always remind everyone that it's real. Bob Marley died of acral melanoma, and so we talk about that. Every Black History Month, it's always out there, but it is important to know. It makes it real and tangible, and I've seen it, and it's the worst thing to see. I saw a young 26-year-old woman whose nail was completely destroyed by this Black growth. We biopsied it. Awful melanoma. We know that for many reasons, because of low public knowledge about this. And maybe even a lower index of suspicion for skin cancer with healthcare providers as well, because we just don't think of skin cancer when we think of skin of color that are outcomes are worse.

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Dr. Michelle Henry:
We know that in five years, our survival rates are somewhere like 65-70, and in five years in Caucasian skin, it's 90 or a little bit above 90, and that's because of those two factors. It is really important to talk about melanoma, because again we talk about numbers, we talk about statistics, but when it's you, it's 100%. And so what you're working on is making sure you do whatever you can do to protect yourself from this risk.

Jessica Cruel:
I think it's interesting what you said about not every medical provider knows what to look for in darker skin tones, because I think that's why it's so important for us to have agency and to know what to look for.

Dr. Michelle Henry:
And that's why I tell all my patients, and that comes in, so I have some patients come in angry and have a list. My first thing is I say, I'm here all day. We can answer all of your questions. Because it's important that everyone knows that they have agency and that they should be their own advocate. Don't be afraid to ask your questions and advocate for yourself because it's important. And you’re right, if you go to your primary care doctor and you show them, they say, Oh, that's not a cancer. Oh, you have this. Say, You know what, I want a referral to a dermatologist. I want to go to someone, and I'll ask them. Because a dermatologist will have a higher level of suspicion, and a higher technical expertise in using things like a dermatoscope to look at it. Being able to watch it and measure it and know all the signs. So yeah, ask for a specialist to come in, let us see it, and if your dermatologist doesn't think it, it’s always okay to get a second opinion. Don't be afraid to push. That's why you pay Cigna and all these places our money every month is to make sure that we can have access.

The "Black Don't Crack" Myth

Jessica Cruel:
Well, I know for me, what finally convinced me to wear sunscreen is that some protection, even though they say “Black don't crack” [laughter] ... I mean that's debatable. Sunscreen is also a way to protect against the signs of aging, like dark spots and fine lines and things like that. I think me being a little bit vain, I'm not going to lie, that was one of the things that got me wearing sunscreen every day.

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Jihan Forbes:
Oh! My main thing was vanity. I started wearing sunscreen when I was 25. because I found like one smile line. I was like, Oh no, no, no, no. We're doing sunscreen from now on.

Dr. Michelle Henry:
That's what I tell my patients. They're like, Black don't crack. I'm like, Black fades. It sags. It will eventually crack. Oftentimes, my bait to get everyone to use sunscreen is: I want to keep you from skin cancer, but it's often beauty, you know, because that's how we age. You're right. We don't photo age as readily, so we don't get those lines and wrinkles. But we get, like you said, hyperpigmentation is part of how we age. Sunspots, that uneven pigment is how we age, just becoming dull is how we age. And so protecting ourselves from the sun will keep us beautiful and protected also.

Jessica Cruel:
Just because we age at like...50, doesn't mean we don't age at all. You know what I'm saying? My mother is still looking good, 55, but you know, once you get upwards in age, it's going to show. Not everybody's Angela Bassett. She’s lovely.

Dr. Michelle Henry:
I always say, you know what? So what if we don't age until we're 50? Why not age until you're 70, right? We started the race. We have a little advantage in the race, but why not take full benefit of the genes, right? Why stop there?

Jessica Cruel:
I also want to know — now we're getting to the personal questions — are the sisters coming in to get the Botox, fillers, things like that? Because I do think there's a perception that we “Black don't crack,” don't age, but...it's almost like you want to live up to that, or if you see a little something, you want to correct it, but there's like this stigma that we shouldn't be worried about aging, we shouldn't be worried about wrinkles, because black is gorgeous, black don't crack. But I've got a little couple things I'm a little ready to address.

Jihan Forbes:
A little Rastaman eyes is what I call it.

Dr. Michelle Henry:
[laughing] You're so cute!

Jihan Forbes:
I've got the deep circles underneath.

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Dr. Michelle Henry:
No, you know, that's a lie. I injected probably...15 black women today, right?

Jessica Cruel:
Awesome! Make that 16, cause I'm coming.

Jihan Forbes:
17! I've been talking about it!

Why the areas black women get injectables in are different

Dr. Michelle Henry:
It's out! Black women are coming, and it's really becoming normalized. It's like...people are proud that they're coming. Once upon a time, my non-black patients would get injected, they post right after, “I was just here with Dr. Henry.” But now, the black women are posting too, so I know it's really getting normalized. People aren't ashamed, and we're thinking of it as maintenance just like anything else, you know? You're not ashamed that you go to the hair salon, and we sit there for three hours, because we want to look beautiful, right? That's not something we're ashamed of. We shouldn't be ashamed to do the things that everyone else has access to, to also feel and look our best. I have a lot of black women coming in. The areas that I'm injecting are different, so that's a pattern that I see differently. Some black women do come in for lips, but not as much as my white patients. I do a lot of tear troughs. God! I do that all day long.

Jessica Cruel:
That's the one I want.

Jihan Forbes:
That's the one I want too.

Dr. Michelle Henry:
That's where we age first. For many reasons, we age there first. Our cheeks tend to be a little flatter here, and so because of that, we sink early. The lighter skinned folks are wrinklers, and we're saggers and sinkers. We sag and sink here, so I'm injecting tear troughs all day long. I do some cheeks. I do a lot of noses.

Jihan Forbes:
Is it like the injectable nose job?

Dr. Michelle Henry:
Yeah, a lot of noses. Some people come for vanity. Some people just come cause they don't want their glasses to slide anymore.

Jessica Cruel:
Oh my goodness! Y’all can do that?!

Dr. Michelle Henry:
Yeah, they're like, You know what? I'm tired of this life. I don't want my glasses to slide.

Jessica Cruel:
Oh! Put that on my list too. I want that. I'm like making a to-do list.

Dr. Michelle Henry:
Yeah, women are coming in. They're well read on all the procedures. They're like, I want the Restylane for this. I want the Juvederm for that. A lot of black women may not wrinkle on the brow as much, but I have women that come in because their smiles are too gummy, so they want to drop their smile a little bit. They don't like that they flare their nostrils at rest, you know? They're like, I'm always flaring at meetings. I can't control my face. Everyone knows I'm angry [laughs], so we'll do that. They want their eyes to be a little bit wider, so I'll do a little drop right under the eyelid just to make their eyes pop. There's all sorts of things we can do to just give you that pop, make you feel more confident, but most importantly, keep you looking like you.

Jihan Forbes:
I'm stunned. I'm literally here with my mouth open. You can do that? All of these things? Full disclosure, I've been thinking about getting my own little fillers, but I wonder is there anything black women in particular need to know about them because, I mean, is it just like ... obviously our skin is a little bit different in the color, but is there anything in particular that these kinds of procedures do to our skin or how they react with our skin types?

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Dr. Michelle Henry:
So what I think about whenever I'm injecting women of color is bruising. You really want to prevent against bruising, because sometimes that blood can leak into the skin, and it can leave behind hemosiderin: portions of the blood that can stay as pigment. Now, in light skin, I can just blast out the laser and get rid of it. In brown skin, I can't, and so then it's a problem. Now you look beautiful and contoured, but you have these dark streaks, and you can't get rid of them. Not that we can't. They'll go with time. We can peel them, but it's a big thing. Whenever I'm injecting folks of color, I always make sure I try to use few injection points that reduce your risk of bleeding.

Dr. Michelle Henry:
I try to use cannulas whenever I can. Cannulas are these blunt-tipped objects so we're not damaging as many vessels. I'm really super gentle because we want to make sure we don't cause that problem, because I can't make you beautifully contoured, like I said, and leave streaks behind. Those are some of the big things that I think about. That's the major difference, you know? What we're filling is all about just like bone loss, fat loss, which we all lose bone and fat, and facial structure, but I try to be really gentle.

Jessica Cruel:
Around what age are you finding that black women are coming in to start their injectable regimens?

Jihan Forbes:
And is there an age that's too young, because often you hear, Oh you get that done too early, it's just going to age you anyway, so wait.

Dr. Michelle Henry:
It depends on what I'm doing. There are two reasons why I use filler: for correction and for augmentation, right? For augmentation, there's an age that's too young. I personally, unless there's a 16-year-old that comes in and says, I'm so depressed. My lip is deformed. But if it's deformed, then it's correction. I'm not going to augment someone's lips at 16, right? I'm not going to give them high cheekbones at 16. Come back in 10 years or 4 more. But if someone says, “Her lip is uneven. She had a dog bite, and she is being teased,” then I will do that. It depends on what we're doing it for.

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Dr. Michelle Henry:
For standard aging, everyone ages differently. Some people just by their family or what they've inherited, they may have sunken eyes at 25. If it’s there and I see it and it's troubling, I fix it. I think the problem comes in when people are like, an 18-year-old has been looking at Kylie Jenner, and she wants “Kylie lips.” I mean, you’re 18. You're an adult. That's not my aesthetic, and I always try to push against it. If I see it and it's there, then I treat it. It's hard to say what age, because everyone's so different. I have a patient today that has never had filler, and she is now 56 and looks amazing. We did two drops of Botox and half a syringe of filler. That's all she needed. Then I have 29 year olds where I'm like...bring in more syringes. [laughs] Everyone's different.

Jessica Cruel:
[laughs] That's going to be me.

Jihan Forbes:
Bring in reinforcements!

Dr. Michelle Henry:
Yeah, and it's not the sort of thing when done well that it's not going to ruin your appearance. The fillers, hyaluronic acid is what we use primarily. Your body gets rid of it with time. Some people hold it longer than others, so before I treat you, I always reassess. Some get rid of it in a year. Some get rid of it in six months. Some hold it for two and a half years. Before I re-treat, I always reassess and see if we can see any more product. What we don't want to do is keep building and building and building, and then you start to look odd, right? You want to know how you metabolize the product. It's all about what we see.

Dr. Michelle Henry:
Every time we introduce a needle into the skin, there's some studies that show that we actually stimulate some collagen. So a big question I get is after I do it, am I going to look worse, and actually you're either going to go back to your baseline, and if you truly believe you're stimulating some collagen, then you may even look a little better. It’s not going to stretch out our skin, and then when it goes away, your skin just collapses, and then you're ruined for life. That's not going to happen. Either you go back to baseline, or maybe you will look a little bit better.

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Jessica Cruel:
I'm more worried about getting it and loving it so much ...

Jihan Forbes:
That I can't stop? [laughs]

Jessica Cruel:
Yes, and then you know the way my savings account is set up, like, what if i like it too much? Then I have to have a regular six-month appointment with Dr. Henry. [laughs]

Dr. Michelle Henry:
Well you know what? We don't not buy fashion because we're scared we're going to look too good, and then we're just going to be stuck buying fabulous clothes, right?

Jessica Cruel:
That's true.

Dr. Michelle Henry:
It's with all things. You do things that make you feel good, and if it becomes a part of your maintenance, then you figure it out, you know?

Jessica Cruel:
So I'm going to set up a special savings fund for my fillers. It's a priority. You've got to prioritize.

Jihan Forbes:
Oh God, yes.

Dr. Michelle Henry:
It’s important. A lot of my older patients, they always say — the thing that touches me the most — they always say, Thank you for making me look as good as I feel. We should all look as good as we feel. If you feel powerful and fabulous, you should look that way. We all do better when we know that those things aren't incongruent.

Jihan Forbes:
Do you get a lot of black men sometimes that come in wanting ...

Dr. Michelle Henry:
I am very proud to say I'm getting more and more black men. A lot of black men used to come in, men in general, come in on the sneak. They come in, and they're like, I want a skin check, but there's this thing here. What is that? I’m like, You know it’s a wrinkle, right? And they're not. They're coming in, and they're saying, You know, I have these wrinkles, and I run a company, and I don't want to look tired. I'm at meetings all day, and I'm up at 5 a.m. Or I want to look fit. I'm working out. I'm a marathon runner. My body looks fantastic, but now my face looks haggard, and this is not what I want to project. Men are coming in and just asking for things by name, and they're smart. And they're on Instagram, and they're looking at photos. And they're girlfriend isn't dragging them in. Yeah, I'm seeing more and more. The numbers are growing and growing.

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Jihan Forbes:
I love that.

What black women should ask before getting laser treatments

Jessica Cruel:
I also think it's interesting what you mention about lasers. For years, I think, my white counterparts have been able to go to the laser appointments and things like that, and I've always been too afraid, because I worry about the technology. Also, you can't trust everybody with a laser on your face...

Dr. Michelle Henry:
Mmm-hmmm (affirmative).

Jessica Cruel:
...but are there technologies coming out that are better for darker skin tones, or are we years away from that?

Dr. Michelle Henry:
We're years away from everyone being able to do it, but we have the technology, and those who know how to use it appropriately get good results. Again, I laser brown skin, the deepest, darkest, richest skin every single day. A lot of people refer those patients to me, because it is advanced laser surgery. You have to know how to read the skin. You have to know how to do the right settings, cause I also see all the disasters. We know that there are laser pop-up shops around every corner. And sometimes I even do like even little sting operations. I'll go in, and I'll pretend that I want to have a treatment.

Jessica Cruel:
I love it!

Dr. Michelle Henry:
I know. Now I can't do it anymore, because they're going to know it's me. [laughs] I'll go in and I’ll say, What settings are you using on me? Just to see what they're doing, and the settings are often wrong. That scares me, because I know that my patients are out there, and they don't know what settings they're doing. Lasers, it's the one place where these lasers are not color blind, not yet. There are some, but they're not yet. So it's really, really important if you're getting lasers, and you are a person of color, you ask all the right questions. How many have you done? Patients ask me all the time. There's a moment where you're like... [gasp]. But the truth is, I want a patient who is an advocate for themselves. So ask me all the questions, I'll tell you how many I've done. I'll tell you if I've had any problems. And every patient should feel comfortable asking any doctor, any person that's touching them, that question, because it's important.

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Jessica Cruel:
Personally, I want to talk a lot about hair. For black women, hair is our crown. I spend eight hours on my hair on the weekends.

Dr. Michelle Henry:
And it looks fabulous.

Jessica Cruel:
Oh, thank you! Time spent. But there's also, I feel, a lot of underlying scalp issues. Hair loss is something that particularly runs in my family. My aunties love a good wig. But what kind of hair issues are you seeing in your office that black women are really concerned about?

The Hair Loss "Epidemic"

Dr. Michelle Henry:
I see there is a tremendous epidemic of hair loss. Tremendous epidemic of hair loss. Partially some of it is genetic. There are some conditions, like what we call CCCA (Central Centrifugal Cicatricial Alopecia), which is seen more in women of color. We believe that a lot of our styling practices play into that as well. A lot of straightening, pulling, tugging, weaves, wigs — all the things that we do that are beautiful, but are kind of harsh on the follicles. I see a lot of hair loss, a lot of hair loss. It's about finding it early. And part of it is that I wish people knew how common... So when the congresswoman came out with her hair loss, I was like, [sings] Thank God! Because there's so much shame around it. We blame ourselves, and we say, I shouldn't have gotten that relaxer in ‘95. It's my fault. I did this.

Dr. Michelle Henry:
It's just so common, and it's not always you. Sometimes it is you with things like traction, but treat it early. The minute you see it, come in, because our treatments are really great at stopping it. They're good at stopping it, but when it's gone too far, it's a little bit hard. Especially with a lot of scarring hair losses that we see in women of color, it is absolutely critical. Sometimes in my office, patients will come in with just the suggestion of hair loss, and I'll biopsy it, and I'll find CCCA, and it makes my day, because I know that I've saved their hair. They may never become bald. A lot of women come into me when they've lost 70% of their hair, and that's really hard. It's about getting that conversation out there, getting rid of the shame around hair loss. Not only black women, white women, Asian women, Hispanic women — everyone has hair loss.

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Dr. Michelle Henry:
I think that so many women come in blaming themselves, or they won't take their wig off in front of the nurse because there's so much shame. I just want to get rid of that. I tell them, I'm a black woman. I've done all the things. I've done the weaves, the wigs, the relaxers. I've been natural. I've done all the things. I've had hair loss. I've not had hair loss. It’s just about it can happen to everyone. It doesn't discriminate.

Jihan Forbes:
How do you know if it's early? Well, I mean obviously you can see with thinning, but I think sometimes, you're just like, Oh was I just really stressed out? Why is all this hair coming out? I think sometimes we tend to dismiss those little things. Is there a point early on where it’s just like, Okay this hair is coming out, but maybe I should go see a doctor.

Dr. Michelle Henry:
With hair and with anything, anything that goes on for more than a month I want to see it. That's with skin lesions, as well. It's just about checking in so that we can stop it. Just like what you said, stress. There's something that we call telogen effluvium. That happens with... it could be emotional stress, it could be with metabolic or physical stress, if you've had a surgery. And you can get this like shedding that usually stops in two to four months, but sometimes it doesn't. Sometimes it could be indicative of other things. It could be that your thyroid is not quite right. It could be that your iron is low, that your vitamin D is low, that you have an autoimmune disease. Anything that's going on for a month or more, it's worthwhile just coming in and making sure you're okay.

Hair Loss Risks with Protective Hairstyles

Jessica Cruel:
So that brings us to the question, if we're wearing protective styles, which is very popular among the naturals, how long is too long?

Dr. Michelle Henry:
I always say, especially if you're someone who's had hair loss before... No one likes this, and I'm going to be the bearer of bad news.

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Jessica Cruel:
I told you! I told you this was going to happen!

Dr. Michelle Henry:
Don't come for me, please! People get upset, but I say two to four weeks.

Jessica Cruel:
Boom!

Jihan Forbes:
On box braids?!

Dr. Michelle Henry:
Yeah. You know, maybe it depends on your hair type too. You'll know your hair type, so if you have coarse hair that can withstand it, it may be four weeks. But a lot of my patients come in, they're using the braids, because they have fine, weak hair. If you have fine, weak hair, you could lose all of your edges in two weeks.

Jihan Forbes:
Yeah.

Dr. Michelle Henry:
We all know that edges are persnickety, you know? You can have full edges on Monday...

Jihan Forbes:
One day they're in and the next day ...

Dr. Michelle Henry:
...and on Friday, your edges are gone, right? You have to be very, very careful. Everyone gets mad at me. Right now, we know it's festival season. Everyone's going and they're getting their braids, and they want to go out. I'm like, Promise me you'll take it out when you get back. Because it really can happen in a blink of an eye. If we think about our follicles, our follicles are made to hold just those hairs, one or two hairs. How many hairs are in that follicle? But it's made to hold that. Now we're adding hair on top of it. Now we're styling that hair on top of it. We're putting the tension on it that it was never made to hold. What happens when we create tension? We get inflammation. What does inflammation cause? It causes a scar.

Dr. Michelle Henry:
In the same way that we cut ourselves, we get inflammation, we get a scar. That's happening on a microscopic level in our follicles. So we have to be really, really careful. Know yourself. If you have fine hair, you just ... sorry, that's not your gift. You can't have those styles. You can't do that. It's not for you.

Jihan Forbes:
I mean, my heart is breaking.

Jessica Cruel:
The truth hurts.

Jihan Forbes:
It hurts! I'm in pain! Physical pain!

Dr. Michelle Henry:
It stinks, but you know, you can do it, but just not long and not many, many months.

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Jihan Forbes:
I always thought the longest you were supposed to keep box braids, in particular, not like cornrows down, a month is top. I wouldn't even keep it a month. But box braids, I always thought the longest it could go was three months, and then you had to get rid of it.

Dr. Michelle Henry:
It's hard. A lot of people do it, but it depends on your hair type.

Jihan Forbes:
But I feel like wouldn't even getting them redone also still contribute to it because you're still having somebody come in, especially some of these ladies… out here... go to 125th Street and some of these ladies will... peel out your hair.

Dr. Michelle Henry:
They have good intentions, but their hands are very strong. [laughs]

Jessica Cruel:
There's a difference between laid...and laid, okay? Almost gone laid.

Jihan Forbes:
Laid to rest. [laughter]

Dr. Michelle Henry:
You guys are so silly. You have to be really careful, and three months, I don't recommend it. I know people who do it, and they'll say that their hair flourishes, but those follicles are not made to hold anything excessive. Imagine if you were holding your purse that long. Your arm would give out. We're causing our little follicles that also have little tiny muscles attached to them to do that for months and months and months. We just can't do it and expect not to have some level of damage and inflammation. I say, if you do it, not more than a month. If you have weak strands, change it in two weeks. If you are someone who likes the braids, change it up. Don't do the same pattern, because it's said that traction is caused by pulling in the same way all of the time. That tension, that constant tension in that direction. Change it up a little bit if you're going to keep doing it.

Jihan Forbes:
Should we take breaks in between braid styles?

Dr. Michelle Henry:
Absolutely. Yeah, always take a break. Treat your scalp. Whether it's braids or weaves or whatever you're doing, I just really ... there's something I always want to coin. I call it weave fatigue, is what I always tell my patients. Those follicles are like, I just need... Please! I just need a break. But it is a real phenomenon. You see people who've been doing it consistently over and over again, and at a certain point, you just need a break.

How to Regrow Your Edges

Jessica Cruel:
So speaking of that, what is the edge revival regime? Once you've maybe tugged a little bit too hard. You're noticing that your baby hairs aren't laying quite the same. What should we be doing to refresh? I think so much of our ethnic hair aisle is focused on hair growth. So many hair growth oils, so many hair growth pills, which I would love your opinion on, if those are actually worth the money. Because I think people market things to us, knowing that we’re just going to follow it. We need to know are these things actually working, and what's the right way to go about giving our edges some love?

Dr. Michelle Henry:
That's really like you said, there's a lot of snake oil salesmen out there. The whole market really isn't regulated in the way that it should, some people can make a lot of false claims on things that are not actually medications. If I had to give just some ground rules for bringing the edges back, a lot of it is, Hands off, hands off. Leave them! I give talks all the time, and I'm like, My edges are never laid. That's why they're there. They're. Never. Laid.

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Jessica Cruel:
I would get that on a shirt!

Dr. Michelle Henry:
And it’s fine, and we should find beauty in that. I have kinky curly hair, and that's how it's going to grow out of my head, and...I like it. If you don't like it, then turn away. I think it's just a culture of knowing that you don't have to be pulled and tucked within an inch of our lives to be beautiful, and it's okay. Some people can do that, and it looks great when it's laid, and there's no judgment, but you have to know yourself. If you can't do that without losing it, then that's just not for you. Then we find beauty in other things. A lot of it is hands off. Moisture, moisture, moisture, because when those little fine hairs do start to grow, if they're super dry, they're just going to break. It's about stimulating growth and then retention. We always talk about moisture, protein balance. I am a fan of using things that are going to give you some proteins for strength, but not too much. Too much protein makes it snap like a branch. Too much moisture makes it just tear apart. Good products, hands off, moisture, reduce heat — all the things you've always been told.

Dr. Michelle Henry:
I am a fan of things like Minoxidil. In traction alopecia people always say, If you do it, you don't have to use it forever? It’s different than female pattern hair loss where your hormones never change. Unless we're doing something to quiet your hormones, you're going to continue to lose that hair, and so yes, you have to use the Minoxidil forever. With traction alopecia, what's causing the hair loss is you and that insult to your follicles. If you can stop that behavior, then you don't have to use it forever. You can use that Minoxidil to help you regrow the hair, and you can stop it as long as you behave and you keep your hands off, and you don't reintroduce that trauma.

Jihan Forbes:
I was watching YouTube, and one of these women, she had just had a baby, and she was like, Where did my edges go? Somewhere with the child. Would Minoxidil work in that kind of situation?

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Dr. Michelle Henry:
Yes, it works with that as well. All my patients say, My baby took my body and my edges. [laughs] That's a comment.

Jihan Forbes:
Literally snatched the edges.

Dr. Michelle Henry:
It's really common. We see that postpartum shedding often in everyone — women of color, everyone has it. It's just a human phenomenon. I sometimes tell women a big problem is that I don't want you using the Minoxidil while you're breastfeeding, so I try to recommend some more natural things. Rosemary oil, actually there's some studies head to head showing that rosemary oil can work as 2% Minoxidil. It's not like the full strength that we see if we go to CVS, but 2% is still something. I do recommend rosemary oil for those that don't want to use or can't because they're breastfeeding, use Minoxidil, so there are some concoctions like rosemary oil that could be effective.

Is Hair Oil Actually Moisturizing?

Jessica Cruel:
That's awesome! I grew up getting my scalp greased with the hair jam and the Blue Magic. You know, all of that.

Dr. Michelle Henry:
Murray’s?

Jessica Cruel:
Exactly! Murray's. There is, I think, this conversation out there like is oil moisturizing? Should we be oiling our scalp the same way? You mentioned rosemary oil for hair growth. Should I be putting oil on my scalp on a regular?

Dr. Michelle Henry:
You know, your scalp doesn't really need the oil. The hair needs the oil. You don't have to oil the scalp really, unless you are really, really dry, a little bit of oil may help. But I think that idea of just slapping oil, like we used to do on the scalp, is not necessary. What you want to do, again, is about retention, so making sure the strands are appropriately hydrated. For some people, if they create a little bit more natural moisture, oil might be sufficient, so I have everyone using a ton of castor oil. Everyone's coming in, But I've used castor oil, and my hair is still dry. That's because, for some, you need to add moisture with something that's more of a cream base, and then lock that moisture in with something that's oil based.

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Dr. Michelle Henry:
Again it depends on your hair type. If you are someone who is using oil and you're fine, by all means continue. But if you're using an oil and you realize that I'm just still dry, I'm still getting breakage, my hair feels like an oily branch, it's still snapping, then you may need to add some more moisture to it in the form of a cream or water-based something to give you that moisture.

Are scalp scrubs damaging?

Jihan Forbes:
Speaking about scalp issues, so everyone is coming out with a scalp scrub, and I'm like, Great! Let's clean our scalps. However, I know sometimes when I'm testing them out, I'm using them, I'm just like, Am I...damaging my scalp? Because I feel like sometimes, especially with the physical exfoliants, it's like salt and super chunky, and then they want to put in glycolic acid and all of this other stuff. Is there something that, especially black women need to... certain things to avoid with scalp scrubs?

Dr. Michelle Henry:
Yeah, I agree that we need to get rid of dirt and debris, mainly because we don't want irritation and inflammation of the scalp, because irritation and inflammation cause hair loss. But conversely, inflammation and irritation from harsh products cause hair loss. It's all about just being gentle on the scalp, so if you like a scalp scrub, I would say maybe once every few months when you're noticing that, maybe I'm having some buildup. Maybe when I scratch my scalp, I see that I have more residue, even after I wash. It's not something that I routinely recommend, and it's not something that feel yet is completely necessary, but if it's something that you're inclined to, I would say use it in the same way that when we talk about using like a clarifying shampoo. Use it when you feel like you have excess buildup. Use it when you feel like your scalp is just not quite as clean as it should be. And when you do use it, be careful, and just make sure you're not scrubbing too hard. Your scalp should not feel tender afterwards. Just be really gentle.

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Dr. Michelle Henry (Photo by Cassie Basford)

Dr. Michelle Henry's Skin-Care Routine

Jessica Cruel:
Sooo now we want to know... What do you have in your bathroom?

Jihan Forbes:
Drop the skin care tea, sis.

Dr. Michelle Henry:
I use all sorts of things. I will say this: I know everyone wants to hear, These are my three magic products. But I think part of the magic of my routine is I listen to my skin every day. Every day, if my skin is dry, then I say, You know what? Today feels like a rich cream day. Today feels like ... I need to add a little more vitamin C to my regimen. The mainstay treatments that I absolutely believe in is retinol. Retinol, retinol, retinol, retinol, retinoid. I used a very strong retinoid. Everyone always thinks it's blasphemy, but I always say I use it twice a day.

Jessica Cruel:
Wow!

Dr. Michelle Henry:
Mouth on the floor. I don't recommend it for everyone, right, but for me, it works beautifully. I'm very acne prone. No one ever believes me, because I don’t... I hardly have pimples, but it's partly because I do use my retinoid twice a day. But that's not for everyone. Someone else using retinoid twice a day would be dry, they'd have hyperpigmentation. That's why sometimes I hesitate when we give these “10 Tips for Your Best Skin.” Everyone is different. The first tip, I would say, is know your skin type. If you are dry or oily or sensitive, know that and pick your products based on that. After saying all that, then I'll walk you guys through my regimen.

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Dr. Michelle Henry:
So, I cleanse morning and night. I love cleansers that have active ingredients. I am obsessed with glycolic acid — absolutely love glycolic acid. I use some salicylic acid, but I love glycolic acid for two reasons: A) It's a good exfoliant, and B) it's also humectant. Unlike salicylic acid, which is going to dry you out, and for me, the person using retinoid twice a day, I have to be careful not to get too dry. It doesn't dry you out as much as it brings in some moisture while it's exfoliating, so I like that. We know that we age by getting hyperpigmentation, and so that always having something in your regimen that's going to help to exfoliate, helps get rid of my dark spots, helps to stimulate a little bit of collagen in my skin, and helps to keep my pores nice and small. I always have an active ingredient in my cleanser. In the daytime, I use either my retinoid, or I use some sort of vitamin C serum. I do like vitamin C.

Jessica Cruel:
What's the benefit of vitamin C? Because I think that's the question I get from my friends most often. It's like the first thing they always ask me about is vitamin C serums. Can you tell us a little bit about it and why it's something that, especially women of color should have?

Dr. Michelle Henry:
Exactly, so vitamin C is a really potent antioxidant, and so in doing that, it kind of protects your skin from all the bad things the UV light does. And not only UV light, but bad things like pollution. All those free radicals that are created by UV and pollution, and I call it “New York City skin.” Just living in New York and walking out into all of that...

Jessica Cruel:
It's gross.

Dr. Michelle Henry:
...that it's just attacking our skin every day. Vitamin C is kind of like your shield from all that badness. For women of color, it's also important because it also does reduce the creation of pigment. It's a nice gentle way unlike something a little bit more aggressive, like hydroquinone, which is really aggressively lightening skin. It's not really lightening skin. It's breaking up pigment and reducing the production of pigment, so that we're less likely to be uneven, so I like it for that purpose. Those are my top two reasons for vitamin C. If I'm not using vitamin C, let's say that I just had a bunch of pimples, I was stressed out, like last month, and now I have dark spots. I will use other ingredients, so there are a lot of fade creams that contain ingredients, like tranexamic acid, kojic acid, licorice extract. Those are all really great ingredients. Sometimes I'll add a serum like that to help to reduce any pigment.

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Dr. Michelle Henry:
I use my moisturizer and my sunscreen. I usually have a whole bar full of sunscreens, depending on what I feel like. There are some that are primer, some that are powder. I use my sunscreen every day. And then at night, I cleanse, and then I use something at night, especially, I use something to help me exfoliate even more. So, I like the old school Buf-Puf from the ‘90s.

Dr. Michelle Henry:
Sometimes I'll use a spin brush. I like both the Clarisonic. Proactiv also has a good one that's a cheaper price point, but I love them all. Whatever you love for exfoliation, add a little bit more. Especially as we get older, it's important to shed that dead skin so you look nice and luminous and fresh and beautiful. I use my retinoid. I have another bar of rich moisturizers. I love rich moisturizers. I love to look greasy at night.

Jihan Forbes:
Same!

Jessica Cruel:
I think it comes from ... you know how your mom used to be like... Vaseline on your face. I like to look kind of… what the girls call dewy, but is almost borderline greasy. I like to shine.

Dr. Michelle Henry:
Exactly! If you come to my house, the seamless guy that delivers my dinner is like... I'm always greasy. It's important to me. If I don't, I'm dry in the morning, because I'm acne prone. But I'm also kind of… tend towards being dry sometimes, probably with all the things that I do. But yeah, a good rich moisturizer is that time to indulge. That's my regimen. Sometimes I'll throw in a mask, depending on how I'm feeling. If I'm tired, there's some eye serums that I will use.

Jihan Forbes:
Is there anything you'd like to promote?

Dr. Michelle Henry:
Take care of yourself. Seek information. Advocate for yourself. Ask all of the questions. Beauty, skin care, aesthetics is not just for Caucasian skin. It's for everyone. Just because you want to fix something does not mean you don't like yourself, does not mean you don't like being black, does not mean you don't like being a woman. We can have access to all of those things. It does not mean that your self-esteem is damaged. It means that you want access to all the things that Caucasian people have access to. We should have access to all the things, and it doesn't make you less than to seek out that.

Jessica Cruel:
Where can we find you?

Dr. Michelle Henry:
You can find me, you can go to my Instagram. I do a lot of before and afters on Instagram, and so that's @drmichellehenry. I'm also on YouTube. We have a fledgling YouTube page that's growing, but lots of content that we're going to push out over the next few months where I'm just talking about skin care, answering questions. So you can find me on YouTube. And then you can go to my website which is — we're about to have a relaunch — but it's DrMichelleHenry.com. I'm on all of those places. I'm responsive. If you have questions, you can reach out to me, and I would love to see you guys there.

Jessica Cruel:
Awesome.

Jihan Forbes:
You will because...

Jessica Cruel:
Were going to be there next week for our appointments. Thank you so much for coming!

Dr. Michelle Henry:
You're welcome. Thank you guys for having me. This was so fun!