Hormonal Harmony or Havoc: Estrogen Cream on Trial with Dr. Emily Sikking OBGYN

[Intro] Hey, everyone. Welcome to Facially Conscious. I'm Trina Renea, a medically trained master esthetician here in Los Angeles, and I'm sitting with my rock star co-host, Dr. Vicki Rapaport, a board-certified dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry, our resident skincare scientists and regulatory and marketing expert, and Julie Falls, our educated consumer who is here to represent you. 

We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers, and ever-changing trends. With our expert interviews with chemists, doctors, laser reps, and estheticians, you'll be equipped to make informative decisions before investing in potentially expensive treatments. 

It's the Wild West out there, so let's make it easier for you, one episode at a time. Are you ready to discover the latest and greatest skin care secrets? Tune in and let us be your go-to girls for all things facially conscious. Let's dive in.

01:22 Trina Renea: Hey, hey, hey. I don't know why I'm saying it three times today. 

01:26 Dr. Vicki Rapaport: Because you're fat, Albert. Hey, hey, hey. I'm fat. Good morning. 

01:32 Julie Falls: Silly, silly hosts. 

01:34 Dr. Vicki Rapaport: I know. It's been a fun day. We have recorded some episodes, but I think this is going to be the most exciting. 

01:41 Julie Falls: I think so, too. 

01:42 Trina Renea: This is so impromptu and exciting. I can't believe it's happening. 

01:45 Dr. Vicki Rapaport: It came together overnight.

01:46 Trina Renea: Dinner last night. 

01:48 Julie Falls: I've sent her the subject matter 14 times. 

01:51 Trina Renea: You have? 

01:52 Julie Falls: Yeah. I was like, “We have to cover this.”

01:53 Trina Renea: I'm like, “Is it really a thing?”

01:55 Dr. Vicki Rapaport: And only that it's on TikTok, do you not think that it's a thing? 

01:59 Trina Renea: Well, no.

01:59 Julie Falls: No. I don't look at TikTok, but I see a lot of dermatologists talk about it on Instagram. 

02:04 Dr. Vicki Rapaport: Speak about estrogen, okay. Well, today we're going to talk about dermatology trends for 2025, and this first and hottest trend is topical estrogen. It's topical estrogen for females, for facial and for body skin. 

02:17 Trina Renea: Oh, not boys? 

02:18 Dr. Vicki Rapaport: Not boys. No. I don't think boys can use estrogen. 

And just a few highlights about how estrogen actually does protect our skin. It builds collagen, it retains moisture, it helps the skin thickness, basically everything you ever want in a product estrogen can give you. But there are some downsides and we're going to be talking about that. 

02:38 Trina Renea: I want to hear it all.

02:39 Dr. Vicki Rapaport: Estrogen has everything. It also helps with it wound healing. Estrogen, elasticity, it's kind of incredible. And we're super stoked because we have an esteemed OB-GYN, Dr. Emily Sikking on the show today. She's going to help us understand topical estrogen from the OB-GYN perspective. I'll help explain it from the derm perspective. Julie, you can talk about it from the consumer perspective. And Trina, we're going to help you tell your clients about it for your esthetician perspective. 

03:06 Trina Renea: Yes, please, yes. 

03:08 Dr. Vicki Rapaport: So can I tell you a little about Dr. Sikking?

03:08 Trina Renea: Please. 

03:09 Julie Falls: Yes, besides her dog having a toothbrush in his mouth. 

03:13 Dr. Vicki Rapaport: Oh, yeah, we saw her with the dog and the toothbrush. 

03:14 Julie Falls: I love it. 

03:15 Trina Renea: Chasing the puppy out of the room with his toothbrush. 

03:19 Dr. Emily Sikking: Yeah, and a pink toothbrush, no less.

03:20 Dr. Vicki Rapaport: So cute. So she has been in practice, Dr. Emily Sikking has been in private practice for 22 years. She's been helping deliver babies and she's also sending women into the menopause sunset for the past, as I said, 22 years, right here in Santa Monica, which sometimes is a different country. That's why sometimes Beverly Hills patients don't go to Santa Monica, Santa Monica patients don't— but I send my patients to Emily. They go over the 405. It's kind of crazy. 

03:47 Dr. Emily Sikking: It's like bridge and tunnel people. 

03:49 Dr. Vicki Rapaport: Yeah, bridge and tunnel people. 

Her patients love her, and I think you will as well. She is no-nonsense and she's full of practical information. I just had dinner with her last night and that is why this is impromptu, because I told her I wanted to talk about estrogen. She just rattled off a bunch of really important information from her perspective. 

I said, "Would you like to be on my podcast? It's Saturday. Can you do it?”

04:12 Trina Renea: Tomorrow morning. 

04:13 Dr. Vicki Rapaport: And she said, "Hells, yeah?" And here she is. Welcome, Emily. 

04:15 Trina Renea: Yay. Thank you for joining us so last minute. I appreciate that. 

04:17 Julie Falls: Welcome.

04:19 Dr. Emily Sikking: Thank you for having me. It's so much fun. It's fun to talk about places where we can use gynecologic resources in other places other than my general down-under area. So, it's good. 

04:34 Trina Renea: On the face, no less. 

04:36 Dr. Emily Sikking: On the face, no less. 

04:38 Dr. Vicki Rapaport: I remember 25, 30 years ago, I was at an AAD meeting. I think it was that long ago. And there was somebody who was talking about topical estrogen for the face. I was so impressed and I thought, “Okay, this is the next big thing.”

Then there was nothing else ever mentioned about it. And then I, of course, also forgot about it because I was young, 30-something. As I have matured and my friends have matured, and of course as you see on social media, it's now all the rage. I know menopause is really hot, I know topical estrogen is really hot, and I understand the benefits that we see in the skin, but I am so impressed that we're finally coming back around to using it.

I know there are some downsides to it and I'd like to know what you know about it and what you warn your patients about.

05:26 Dr. Emily Sikking: It's an interesting thing. Estrogen is one of those— the dogs go climbing into the room. 

Estrogen has one of those really interesting aspects that it can really be used kind of ubiquitously for the whole body, because it is. It's general for the whole body. The best way to absorb estrogen is through the skin. Actually, estrogen is generally given transdermally these days, especially the bio-identical formats. But it's given in different ways. When it's given transdermally, it's given either in a patch or a cream. It can be a gel. 

The topical can be either in a cream or a gel form, depending upon whether you get it compounded or whether you pick it up from the pharmacy. But those are generally used for hormone replacement. Those are much higher dosages and much higher concentrations that are being used to help with hot flashes and brain fog and other such kind of menopausal symptoms that women have. 

When you do them in those higher concentrations, you're actually absorbing enough that the recommendations are you need to counterbalance that with progesterone, if you have a uterus, because the estrogen can affect the lining of the uterus, put you at risk for what we call endometrial hyperplasia, which is like thickening of the lining of the uterus. And when that happens, it puts you at risk for endometrial hyperplasia, down the line, endometrial cancer, which is obviously the fear. 

Now, there is estrogen that's being used pretty frequently and fairly across the board for women who have vaginal dryness, who have what we call a post-menopausal vaginal atrophy. That's been used for a much longer period of time because it's in a lower concentration. A much smaller amount is being used. 

That comes in multiple different forms and people have tried to kind of re-engineer various different things. But one of the ways that it's done is through a cream. It's become this interesting thing. I have these patients walk in the door and they say, "Well, can I put my cream on my face?” I'm like, “Which cream?” 

Because if you're putting the cream that's the higher concentration, you're actually increasing the amount of estrogen that you're absorbing in your body. And if you have a uterus, you need to make sure you're taking your progesterone to protect the lining of the uterus. Whereas if you're using the really small concentrations that are for the vagina, it's probably okay because it's not as extensively absorbed.

That said, it should be done under circumstances where someone is actually taking history and actually knows, does this person have a uterus or not? What other medications are they taking? What other hormones are they taking? To just kind of like willy-nilly be slathering estrogen of any concentration all over your face, or any place else for that matter, trying to keep the skin not crepe-y under your arms, which we all would love to do, and neck and all those lovely places. 

It can make for a higher concentration that you're absorbing because your skin, as Vicki, Dr. Rapaport will well say, the skin is the largest organ in the body. So if you're going to put it all over the place, you're going to be absorbing a lot more of it. That's where the wrinkle comes in trying to make sure that you're doing it medically appropriately and that it's being done with at least some conscience involved and that there's someone who's paying attention medically. 

But the concentration that's put in the vagina, I will say, let me just give you this, it comes in multiple different formats. It comes as a little stick that has a little pill at the end of it that can be popped into the vagina. That's called Vagifem or Yuvafem. It's generic and it's covered by most insurances, even Medicare.

There's Estrace cream, there's Estrace pellets. They're like little bullets. It also can come in something called Imvexxy, which looks like a little vitamin E capsule. And then it also comes as a vaginal ring that can be put inside and changed every three months. These are all, they're like 0.01% of the estrogen that you get.

There's also options of doing things like DHEA, things like that that actually can be converted into estrogen and testosterone intercellularly. We don't really understand how the mechanism of action works, but it does work. 

Those are the ones that I think are pretty comfortable to be used on the skin because they're such a low concentration. They are covered by insurances the vast majority of the time and, which is really fun, women with breast cancer, a vast majority of their oncologists will allow them to use it in the vagina so that they don't have to have a dry vagina, which of course now, Vicki, I've said vagina seven times. So it's a word. It's allowed.

10:22 Dr. Emily Sikking: I give Emily so much credit for using that word so willy-nilly. Now, I'm very comfortable because I hang out with her. I showed her that there was a billboard on La Cienaga and actually had that V word stretched across the billboard. 

10:35 Trina Renea: That V word. 

10:35 Dr. Vicki Rapaport: Because of these V vitamins, and she's like, "Yep, it's pretty mainstream now." 

I said, "It's not just you, Emily, that's saying that word." 

10:41 Trina Renea: Oh, my God, that's so funny. 

10:44 Dr. Vicki Rapaport: So, the over-the-counter products that I get advertised, I'm sure you get advertised, have estrogen in them. There's no doctor's visit. I imagine like it's a 0.03%, or whatever the percentage is. Those are pretty safe, you think, the ones that you can just purposely buy?

10:59 Dr. Emily Sikking: They're pretty safe. It's a really small amount. But at the same time, I just kind of want to like little, not black box warning but like a warning of sorts, that you do have to be responsible with how much you put on, where you're putting it. Obviously, the mucous membrane is going to absorb it more than the topical skin will, because some of it is just not going to get absorbed, especially if your skin is dry to begin with which is a post perimenopausal woman. Their skin is dry so they're not going to absorb as much. 

But you do have to be cognizant of the fact that estrogen doesn't come without some risks. You need to be responsible about that. I'm not in the camp that believes that estrogen causes breast cancer. I think it's a fertilizer, but it's definitely something to keep in mind.

11:50 Trina Renea: I would be afraid to put estrogen cream on my face from a company out there somewhere that's selling estrogen, because I'm on all kinds of different medications. And like how much estrogen can I put in if I'm on an estradiol patch? All these questions, it just seems a little risky to then put it all over your face and then absorb more estrogen…

12:15 Julie Falls: That's why she's saying you have to check with your doctor. 

12:17 Trina Renea: You should check with your doctor. And get it from your doctor, maybe. 

12:22 Dr. Emily Sikking: Yeah, I agree. I think getting it from your doctor is probably the safest way to go. It's just the cavalier of over the counter. They can make the concentration low enough that they can get away without having it go through the rigors of prescription medications. So that's part of the wrinkle, because there's also different kinds of estrogen. There's estradiol, there's estriol, and there's estrone, so there's different kinds of estrogen out there too. 

Some of them are more potent than others. Estradiol is more potent of the estrogens that we know of. And keep in mind, we are like at the tip of the iceberg. We only know a small amount. I'm pretty sure there's probably 10 jillion estrogen-type things that are out there, hormone-type things that we just don't even know about yet. 

But the estradiol, the things that we know we need to be cognizant of. I do say to patients all the time, like, “What other medications are you on? What are you taking?” Oftentimes, they tell me all these crazy supplements that they're on. Not crazy. That's not nice, but lots of supplements that a lot of people are on. And not infrequently, I'll do blood on someone and their testosterone is crazy high. I'm like, “Wow! Why is your testosterone so high? What are the other supplements that you're on? Tell me again.” And one of them has like a massive amount of DHEA. That blocks and causes your testosterone to be really highly elevated. 

I'm like, “All right. Instead of going down the road of doing a full workup on this, let's have you stop the medication, let's recheck your labs and let's see what we got.” And if their testosterone comes down, you know what it is.

But the problem with estrogen is that it's kind of hidden, because the only way you're going to know is if it's affecting the lining of the uterus or if it's amplifying someone's— any estrogen receptor cells in your body, which is a lot, but particularly certain areas like the breast, which is one of the big concerns. 

Women who have breast cancer absolutely should be talking to their gynecologist, their oncologist, whomever it is about the medications that they're taking or the skin products that they're putting on to make sure that if they're getting estrogen, they're not getting too much.

14:24 Julie Falls: Interesting. Have you seen any results, either of you, in patients that have been using it topically? 

14:32 Dr. Emily Sikking: Well, in the vagina, yeah. 

14:34 Dr. Vicki Rapaport: But on the face…

14:36 Julie Falls: She just wanted to say it again.

14:40 Dr. Vicki Rapaport: What do you see? But what changes…

14:40 Dr. Emily Sikking: You knew I was coming. You just opened the door for me.

14:43 Julie Falls: On their faces, Emily.

14:44 Trina Renea: On their face.

14:46 Dr. Emily Sikking: I haven't had a lot of people…

14:47 Dr. Vicki Rapaport: I’ll answer the question about the face after Emily answers the question about how does the vagina change when they use estrogen on it.

14:55 Dr. Emily Sikking: What it does is it actually the skin gets thicker. It gets more pliable. It gets plumper. The mucous membranes actually change. You can actually see— and this is statistical. This is actually written in the literature. You can actually see absolute changes in the tissue, the thicker base membrane, the amount of mucous that you see, the amount of what we all refer to as this lovely word discharge, which nobody likes. Even I don't like that one. 

15:26 Trina Renea: I don't want to discharge on my face. 

15:29 Dr. Emily Sikking: No. It's the mucous membranes. It's inside the vagina and just on the outside. So it does cause changes and you can see improvement. And women who have not been on anything and then suddenly start using estrogen in the vagina, they can be sexually active again without pain. I mean, it's brilliant. 

15:50 Dr. Vicki Rapaport: And part of the reason why I wanted Emily to answer that first is because those changes that you see in the mucous membrane is as a more healthy tissue, like the thickening, the elasticity, more collagen, more lubrication, that's a normal membrane that goes away over time. 

Similar things that the old skin changes. As we get older, the way the skin changes become reversed with estrogen. So a little thickened collagen, definitely more moisture, not the same kind of moisture as the mucous membrane, but you hold on to more moisture, better wound healing. Just a healthier skin that doesn't have the estrogen influence anymore, because we lose our estrogen as we get older. 

I haven't seen a lot of— it is so new. Honestly, it's become only so popular recently that I have not seen a lot of befores and afters, but I know that you're going to be seeing this because it is definitely out there and I think it is very interesting. When done in the right dose and the right directions, it's going to be great. 

16:50 Trina Renea: So are you seeing any of your patients coming in and say, “I've been using estrogen on my face,” yet? 

16:57 Dr. Vicki Rapaport: No, not yet.

16:58 Trina Renea: Not yet. 

16:59 Dr. Vicki Rapaport: But I really think it's coming. 

16:59 Trina Renea: You said like twice a week or something, like it wouldn't be a daily thing. 

17:03 Dr. Vicki Rapaport: Depending on the concentration, Emily.

17:06 Dr. Emily Sikking: Exactly. 

17:07 Dr. Vicki Rapaport: It can be a twice-a-week thing, it can be a daily thing. 

17:10 Dr. Emily Sikking: There are creams. Some women are using bio-identical compounded estrogen creams, and I've had people say to me like, “If I don't use more than what I'm already using, can I use it in other places? Do I have to put it on the inside of my arm?” Which is inside of the arm, inside of the thigh, because you're looking for thin skin where you're going to absorb it.

Kind of my response to that is, “As long as you're not using more than what we're prescribing and we're balancing with progesterone and we're monitoring you, do what you like.”

17:49 Dr. Vicki Rapaport: That's right. So if people are put— no, I thought that was brilliant, Emily. So if people, they don't want the patch, because they want the control or whatever it is that they want, they're using estrogen cream, why put it on your arm and waste the improvement that you're going to get on your face? Just put it on your face.

18:02 Trina Renea: Could you just put it under your eyes? 

18:04 Dr. Vicki Rapaport: Sure. 

18:04 Dr. Emily Sikking: Sure. 

18:05 Trina Renea: But that’s a thin skin. That's a thin skin right there. 

18:07 Dr. Emily Sikking: Actually, the neck, I think, is a good location.

18:08 Trina Renea: Oh, yeah, the neck. That's a good one. 

18:10 Dr. Emily Sikking: I think the neck would be a good spot.

18:13 Trina Renea: But you haven't…

18:14 Dr. Emily Sikking: Little of the creases here.

18:15 Trina Renea: Have you seen any of your patients putting it on their face and neck?

18:19 Julie Falls: I just asked her that. 

18:21 Dr. Emily Sikking: Where were you? Yes, both of them. No, I only have patients asking, “Can I? Do you know about this?” And my response is, “Give it a go. See what happens. You're not increasing the amount that you're absorbing, so you're not taking more than what I'm prescribing. Sure, let's see what happens.” I mean, why not? 

18:42 Julie Falls: There's so much on social media, it's unbelievable. Before and afters…

18:45 Dr. Emily Sikking: Crazy. 

18:48 Trina Renea: It's because people go, “What?” Estrogen on the face is such a shocking thing to talk about on social media.

18:53 Dr. Vicki Rapaport: It's not sexy. It's not sexy like a growth factor or exosomes or hyaluronic or peptides. It's not sexy, but I really think that it's going to be incredible. It's going to be an ingredient that people will add. 

19:08 Dr. Emily Sikking: But, come on, estrogen is so sexy.

19:11 Julie Falls: I think so too. 

19:13 Dr. Emily Sikking: Come on. It's so sexy.

19:14 Julie Falls: Definitely. 

19:15 Dr. Vicki Rapaport: Estrogen is sexy in OB-GYN land, but in skincare land, it's not there yet, but maybe it will get there. 

19:20 Julie Falls: Not there yet, yeah.

19:22 Dr. Emily Sikking: No, I mean, you just have to call it E2.

19:26 Trina Renea: Okay. So here's a thought that I have. I started the estrogen patch at the lowest and then she moved me up just a notch because I was still having some issues or whatever. So then after a few months go by, maybe my estrogen dropped out completely and it was too much now. Something happened because, all of a sudden, I put a patch on one day and I got like five cysts on my chin. I have never got a cyst on my chin in my life. Never. 

And so I was like, "Oh, my God, I'm taking too much estrogen. This is an estrogen situation. This is hormones on my chin right now." 

So I asked her to lower my dose back down, and we did and it never happened again. But I was like, "That was crazy." So I'm afraid if I put estrogen on my face, would I get cystic acne? 

20:23 Dr. Vicki Rapaport: It's a great question. Generally speaking, it's the testosterone, the DHE, and the progesterone that can cause acne, not typically estrogen. But what do you think, Emily? 

20:33 Dr. Emily Sikking: It's true. More of what it is, is it's the conversion of estrogen to other things, because it's like anything else. It's like you take DHEA, it converts into all sorts of different things. It's like increasing your cortisol. You're going to convert any of those things to other hormones just because your body's normal mechanism of action of breakdown in ourselves is going to do that. 

I will tell you, it doesn't make sense why that happened if you look at sort of basic science, but the fact is, is that it happens. So there's a lot, like I said, we don't know. We assume that cystic acne and things like that that happen that we, that Vicki refers to as hormonal acne, which we see all the time. Hormonal acne is definitely something that occurs. The assumption is that it's related to androgens or progesterone.

But could it be related to estrogen? Certainly possible. Could it be related to the way that your body is responding to the elevated amount of estrogen that your body is using it in another way? It's certainly possible, but it's something to keep in mind. 

And maybe that's your body's way of saying, “Whoa, whoa, whoa, you don't need that much. You may think you need that much, but you don't.”

21:49 Trina Renea: That's what I was thinking, because it was weird. 

21:53 Dr. Emily Sikking: Sometimes, it's listening to that inner voice of what your body is telling you and being a little bit more cognizant, a little bit more intuitive to your own body, because we're each individuals. What happens for one is not the same as what happens to another.

22:05 Julie Falls: Exactly. 

22:05 Trina Renea: Right. Isn't that weird, though? It happened in one day.

22:10 Dr. Emily Sikking: Yeah. 

22:10 Dr. Vicki Rapaport: I mean, it's powerful. 

Emily, this was so incredible. 

22:15 Trina Renea: Oh, my God, that was fun.

22:16 Julie Falls: Thank you so much. 

22:18 Trina Renea: So we're on the cutting edge of this. We're not there quite yet, because neither of you are seeing it yet.

22:26 Dr. Vicki Rapaport: Correct. 

22:26 Dr. Emily Sikking: Yeah, it's coming. 

22:28 Julie Falls: It's coming. 

22:28 Dr. Vicki Rapaport: It's coming.

22:29 Trina Renea: It's coming.

22:29 Julie Falls: We'll be ready for it. 

22:30 Trina Renea: Come 2025. 

22:33 Dr. Vicki Rapaport: There you go, trends of 2025.

22:35 Dr. Emily Sikking: Yeah, I like it.

22:36 Dr. Vicki Rapaport: Emily, I thought this was your day off. Why are you working? 

22:39 Dr. Emily Sikking: I always work. I'm an OB-GYN. I'm the nutty doctor. I'm the one who always works. No shifts.

22:46 Dr. Vicki Rapaport: And I think you're also going in on Sundays. 

22:48 Dr. Emily Sikking: Always. 

22:49 Trina Renea: Oh no. 

22:50 Dr. Vicki Rapaport: She goes in on Sundays. 

22:51 Julie Falls: Wow.

22:51 Trina Renea: Why? 

22:53 Dr. Emily Sikking: Yeah. Well, it started in COVID, because my OB patients, I was concerned about them being exposed to COVID, being in an office building that had other doctors working and seeing patients, and so I started having them come in on Sundays. They liked it and I liked it. It's nice and they can bring their family and everybody can hang out. So, I started doing that.

Then my patients who come in for other things that are routine, like they're coming in for their hormones or they're coming in for other purposes, it just seemed nice to have those days where they're coming in frequently to be days where office is quiet, it's relaxed. 

23:32 Julie Falls: That’s smart.

23:33 Dr. Emily Sikking: It's just me. They text me when they get there. They're like, "I'm at the door." I go to open the door and bring them in and it's relaxed, it's mellow. It's nice. 

23:41 Trina Renea: Then you take a weekday off and you get to see what the world looks like on week days. 

23:46 Dr. Emily Sikking: No. 

23:47 Trina Renea: No? Oh no. 

23:49 Dr. Vicki Rapaport: She works six days a week. She's insane. 

23:50 Julie Falls: Oh, my God. 

23:52 Trina Renea: Oh, my God. Well, she loves her work. She's passionate about it, so it's fun.

23:54 Dr. Emily Sikking: I do. I love what I do. I also still have a kid in college, so it's a lot. 

23:59 Trina Renea: Lucky kid. Knows his mom is working six days a week to pay that college. 

24:05 Dr. Emily Sikking: That's right. 

24:07 Dr. Vicki Rapaport: Emily, thank you so much. You elucidated all our questions. I'm feeling like I'm going to go start prescribing some estrogen to patients, but I have a lot more information about warning them about the potential downsides. So, thank you. 

24:18 Julie Falls: Yes. Thank you so much.

24:19 Dr. Emily Sikking: I agree. And thank you for inviting me. This was fun.

24:23 Trina Renea: Can I ask you guys one more question, sorry, before we go? Have either of you been approached by people in the skincare industry who are making these estrogen creams that are like, “Hey, we have this now,”? Has that happened yet? 

24:36 Dr. Emily Sikking: No.

24:37 Dr. Vicki Rapaport: They don't need doctors to do that stuff. Remember, they just put them, they market it themselves on TikTok with influencers. 

24:43 Trina Renea: But they could have doctors selling it inside their offices. 

24:47 Dr. Vicki Rapaport: Yeah, well, we just prescribe it and we just send it to the pharmacy. But will there be skincare lines? Sure, there will be. Maybe there will be some really fabulous one by Allergan or SkinMedica or another line or some OB-GYN company, but no, nobody's approached me.

25:03 Dr. Emily Sikking: It's going to be the new filler. 

25:06 Julie Falls: Yeah. Yep.

25:07 Trina Renea: Oh, my God. Don't say that. That would be so weird. Estrogen fillers in the face.

25:13 Dr. Vicki Rapaport: You never know. 

25:14 Trina Renea: Yeah, it could happen. 

25:15 Dr. Emily Sikking: Why not? I mean, it could be the new filler and it's just slowly absorbed and you're not going to need to wear your patch all the time. 

25:20 Julie Falls: And you can plump up your vagina. I had to get another vagina in there. Plump it, plump your vagina. 

25:25 Dr. Emily Sikking: Yeah, pump up that vagina. That's right. 

25:28 Dr. Vicki Rapaport: Thank you, Emily. We appreciate you. 

25:29 Julie Falls: Thank you. Nice meeting you. 

25:30 Trina Renea: Thank you. Nice meeting you.

25:31 Dr. Emily Sikking: Bye, guys. Thank you for having me. 

25:32 Dr. Vicki Rapaport: I'll see you later, I'm sure. 

25:33 Trina Renea: Bye. 

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