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Peter Attia MD#13 – Brett Kotlus, M.D.: How to look younger while we live longer
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At a glance
WHAT IT’S REALLY ABOUT
Natural-looking facial rejuvenation: aging mechanics, smart injectables, and simple skincare
- Dr. Brett Kotlus explains how facial aging results from combined intrinsic changes (bone and fat loss, ligament support degradation) and extrinsic damage like chronic UV exposure that reduces collagen and elastin.
- He describes why some cosmetic work looks unnatural, emphasizing proportion, shadow/contour preservation, and realistic goals rather than trying to look decades younger.
- He outlines nuanced approaches to injectables, including preserving brow function with Botox technique and using a cheek-entry cannula method for under-eye filler to reduce risk and improve natural results.
- He offers a practical skincare foundation centered on broad-spectrum physical sunscreen, nighttime vitamin A (retinol/tretinoin), and morning topical vitamin C, while noting common misconceptions and product limitations.
- He gives a framework for choosing providers and evaluating procedures/devices, warning that FDA approval often signals safety more than proven effectiveness and that some popular treatments (e.g., certain tightening devices and PRP facials) may be oversold.
IDEAS WORTH REMEMBERING
5 ideasFacial aging is multi-layered: skin, fat, muscle, bone, and support structures all change.
He describes intrinsic drivers (genetics, bone loss, fat loss/redistribution, ligament/support degradation) and extrinsic drivers (especially cumulative UV exposure causing collagen/elastin loss, telangiectasias, and brown spots) acting across skin, fat, muscle, and bone.
“Unnatural” cosmetic results usually come from exceeding natural proportions and losing facial shadows/expression.
He notes that overdone results come from enlarging or pulling features beyond natural dimensions, and from chasing an unrealistic “younger self” rather than aiming for a modest, natural refresh; he also argues you don’t notice well-done work because it looks normal.
Good Botox strategy preserves brow movement by avoiding heavy frontalis treatment.
He explains that the common mistake is heavily treating the forehead muscle (frontalis), which is the only muscle that raises the brows; instead, he prefers focusing on frown muscles (corrugator/procerus) and using only light forehead dosing so expression and function remain.
Under-eye filler can look “invisible” when placed with the right tool, product, and restraint.
He describes his under-eye approach using a blunt cannula inserted from the cheek (through a small needle entry) rather than placing needles under the eye, selecting appropriate hyaluronic acid filler properties, and using restraint—sometimes staging treatment—to avoid puffiness/unnatural results.
A basic routine of sunscreen + vitamin A at night + vitamin C in the morning is his core skincare foundation.
He recommends a simple “trifecta” for people who want non-procedural skin improvement: daily broad-spectrum physical sunscreen (zinc/titanium) at least SPF 30, nightly vitamin A (retinol/tretinoin), and topical vitamin C (noting stabilization/oxidation issues and that it may be better for reversing existing sun damage than preventing it).
WORDS WORTH SAVING
5 quotesYou look at your one-year-old son, and it's all downhill from there.
— Dr. Brett Kotlus
Think about all the people that are walking by you on the street that have had work done, and you haven't-- you don't notice it because it's done well.
— Dr. Brett Kotlus
We say, like, you can't have light without dark.
— Dr. Brett Kotlus
The biggest risk is, uh, financial loss and no effect.
— Dr. Brett Kotlus
Just because something's FDA approved doesn't mean that it's effective. It just means that it's safe.
— Dr. Brett Kotlus
High quality AI-generated summary created from speaker-labeled transcript.
