0:00
Is makeup toxic to the skin? Short answer is no. I don’t think so. Long answer is
0:06
66% of women in the US follow a multi-step skinincare routine.
0:11
The more steps you have, the more products you’re probably going to want to buy. So, there is a marketing advertising bias based on whichever
0:18
company is telling you the multi-step. Do we know the exposure from fluorescent
0:23
lights, regular lights, and the effect on the skin? Fluorescent light and some h hallogen light can change the DNA of
0:29
your skin. That’s terrifying. Does the sun cause skin cancer?
0:35
Yes. With an asterisk. Anybody who cares about their skin
0:41
should do some sort of laser procedure for two reasons. One, we know it improves the appearance. And now we know
0:47
it also cuts your cancer risk. It does. What about diet? Diet is medicine. Food is medicine and
0:55
should be treated as such. Have you seen any trend that just has really surprised you?
1:01
Every day I’m like, what is going on here?
1:08
[Music] Dr. Teao Solommani, welcome to the show.
1:14
Thanks for having me. You had me at hello with this whole skin care. It’s not skin, it’s muscle. But
1:20
before we talk about that, I was up last night googling glass skin. Yeah. Is there evidence behind this Korean
1:26
skincare? Great question. So, Korea, particularly South Korea, has a lot of things that we
1:33
don’t have in the United States. And there’s many reasons for this. So, K beauty is really, really popular right now, partly because of social media,
1:40
partly because of advertising through different platforms, which we wouldn’t be able to see 10 years ago or 20 years ago. There’s also a cultural difference
1:47
in South Korea in terms of how they like their skin to appear that we don’t necessarily have in the United States.
1:53
Part of it is due to old hierarchy in society structures. The fairer you were,
1:59
it was perceived that you were from royalty. The more tan or darker you were, it was perceived that you were in a different working class. So everybody
2:05
aspires to have porcelain fair skin without a single flaw much more
2:11
uniformly in South Korea than perhaps the entirety of the United States. Because of that things are done there um
2:19
that may or may not be approved here as well to achieve that. Is that like salmon sperm?
2:25
It’s a variety of things. It’s things like glutathione IV infusions which we
2:30
don’t really do here in the United States. um certain lasers that we don’t readily have access to here in the
2:36
States, certain sunscreens, particularly the big ones are chemical filters that
2:42
are available in South Korea that aren’t available here, which is why there’s this big hype about uh Korean sunscreens
2:48
or Korean beauty. A lot of the formulations in Korea are made to achieve one, fair skin, lighten the
2:55
skin, and then have minimal appearance of the product on your face. Whether that’s a good thing or a bad thing is
3:02
each person’s own opinion, but the the goal of skin care in Korea is a little bit more uniform in achieving fair kind
3:10
of porcelain, undamaged, um, unblenmished skin. Whereas here in the
3:15
United States, we have a myriad of things we work with. We work with a lot of skin cancer that isn’t as po
3:20
prominent in Korea. There are patients who have olive skin, tan skin, ethnic
3:26
skin, darker skin in which lightening is unrealistic or impossible. Some of our
3:31
darker skin types can’t tolerate the lasers that are being done in Korea for that kind of glass skin. That being
3:37
said, we can achieve pretty close to near identical results in similar patients as long as you find a good
3:43
dermatologist. Is that true? Because I was looking at this statistic in preparation for this and 66% of women in the US now 66% I
3:52
that’s crazy again this came from a media market statistic but they now
3:58
follow a multi-step skin care routine and I will tell you once I started seeing glass skin it went from wash and
4:06
lotion for me or wash and reta to now wash then wash again then tone then
4:12
serum then dream. Few things to that, few uh confounding variables to that. The more steps you
4:20
have, the more products you’re probably going to want to buy to achieve those steps. So, there is a marketing
4:25
advertising bias based on whichever company is telling you the multi-step. In general, the more ingredients that
4:31
touch your face, the more likely that you are to have some sort of adverse reaction, either an irritant contact
4:37
dermatitis, either some sort of clogging of your pores, an acne breakout, some sort of bad reaction. the more steps you
4:44
have. So, in general, less is more. What you don’t see, yeah, for sure. And
4:50
most dermatologists will agree, less is more so long as you have really effective products. Now,
4:55
what you don’t see behind the scenes often is what patients are taking orally
5:01
to keep their skin looking flawless, blemish free, breakout free. Oral
5:06
supplements ranging from hormone modulating drugs like birth control and spironolactone,
5:12
antibiotics that prevent breakouts like doxycycline for acne and rosacea or our gold standard Accutane which there’s a
5:20
whole slew of patients who take lowd dose Accutane for years whether they’re in the movie industry whether they’re in
5:26
entertainment and modeling to keep their skin glowing. That’s the stuff you don’t see when you watch a 30-cond reel on
5:33
social media saying, “Hey, follow this nine-step routine and you got to buy all nine of these products.” But their skin looks amazing.
5:38
Yeah. Yeah. For sure. It’s very for sure glassy. A few important things that glassy skin can absolutely be achieved. It’s hard,
5:45
especially if you are active, especially if you are young, especially if you have, you know, a good healthy uh
5:52
hormone millu if you’re working out a lot, etc. But it can absolutely be achieved. One thing I always want to say
5:57
is let me see that skin in person. a lot of filtering that’s being done. There’s a lot of texture that you can’t see
6:03
behind camera that you see in real life. Some of that in real person is perfect
6:09
and I’m like, man, this is amazing skin and some of that is not real in real life.
The Dangers of Makeup & Environmental Toxins
6:15
Well, you bring up makeup. Yeah. Is makeup toxic to the skin?
6:20
Short answer is no, I don’t think so. Long answer is everybody unfortunately today can find an article online that
6:28
will sell your point whether it’s on the right right side, the left side, the middle, up, down, what have you. There
6:35
are chemicals in makeups that at high concentrations can be a problem. Generally, you you shouldn’t be wearing
6:43
makeup for a prolonged period of time for a variety of reasons. One, there are some theoretical absorption issues.
6:48
Usually people aren’t putting enough for that to be a problem. Meaning absorption issues from the skin.
6:54
Exly. Exactly. Usually people aren’t putting off enough makeup for that to be a problem. But we did see this in the
7:00
entertainment industry, particularly in the ‘ 60s, ‘7s, ‘ 80s, and ‘9s when there were certain cosmetic makeups that
7:06
were used for filming and things like that that provided a lot of coverage that had heavy metals in there and patients got sick from it. So, that’s
7:13
one. Number two, the bigger one is you shouldn’t be keeping this stuff on your skin for a long period of time because
7:19
it it doesn’t allow your skin to turn over the way it should. So you run into things like overprouction of oil,
7:27
clogged pores, which can lead to breakouts, which can lead to things like demadeex, which is this common might
7:33
that lives on our skin. That’s a culprit of rosacea, especially in women of, you know, age 35 to 45. They persistently
7:40
get breakouts and they can’t figure out why. One of the reasons is this might called demadeex and it makes the skin
7:46
look red with little breakouts. And how does someone get that? It’s it’s usually a normal normal
7:51
organism of our skin, but it overgrows when you provide it its food source,
7:57
which is dead skin cells and oil. So, I I tell my wife this all the time, and she’s really usually really good about
8:02
it, but don’t sleep with her makeup on for that reason. You don’t want to clog your pores. You want to allow your skin to turn over. You don’t want to provide
8:09
extra food for the bacteria and organisms on our skin. call them dermmites. It’s demadeex. Demadeex is the name.
8:15
It’s a mightite. I know this sounds horrible, but it’s a parasite. It’s one of the most common causes of rosacea in
8:21
young women. The simplest thing I can do is just ask them, hey, do you sleep with your makeup? They’re like, yeah, how do you know? Or when was the last time you
8:27
br washed your brushes? Like, how do you know this? I’m like, because there’s there’s demonites on your skin and and you’ve
8:33
tried all the routine things like, you know, benzyl peroxide washes, um, retinoids, and your skin’s just not
8:38
getting better. That’s a that’s a culprit that’s often overlooked. How would someone treat that? Usually with topical um certain topical
8:45
medicine, sometimes some oral medicines. Um and it’s really responsive to medication. But to prevent it, don’t
8:51
sleep with your makeup on. Easy. That’s easy. The environmental working group. Have you heard of that?
8:56
That group? No. It lists a toxic 12. Yeah. You’re saying Yeah. I’m curious as to
9:02
where this is going to go. Many substances that are used in the US, they
9:07
seem to be banned in European countries. Yeah,
9:12
I have a lovehate relationship with the EWG. I think its intentions are good. I think it’s to bring awareness of things
9:19
that could potentially be a problem to the public in the United States. I think I have a problem when they oversimplify
9:25
things that are a little bit more complicated in biology and medicine to just being bad versus good. It it
9:31
doesn’t work that way. The other thing I have a problem with the EWG is sometimes they have selection bias as to which
9:36
data set they look at and there’s always a question as to whether there is some
9:42
lobbying from certain industries swaying EWG’s reports. You know the organics
9:48
industry or certain industries that sway EWG’s reports. That being said, I think it’s I think it’s a source to look at
9:54
and I think if you’re concerned it’s a starting point. The Big 12, the majority of the thing ingredients in the Big 12
10:00
are formaldahhide or preservative releasing compounds. For the majority of the products that we have in the United
10:07
States, the concentration on the skin is far below anything relevant that we run
10:13
into. You actually get a similar amount of carcinogen pumping gas at a gas
10:19
station, breathing the fumes in the environment, but nobody really talks about that as being a problem. Where lies of the problem is if you are using
10:26
these products and they sit on your skin for long periods of time, hours, day
10:31
after day, year after year, decade after decade, then you wonder, is there some
10:37
biocumulative effect? And nobody knows the answer to that. But it’s not
10:42
unreasonable to think, hey, if I’m really concerned about my health, maybe I avoid a few of these products. It’s
10:48
just it’s really hard because they provide shelf life for whatever skin
10:53
care supplement you’re using or or makeup or or serum or lotion, shampoo, body wash. They provide shelf life so
11:00
you don’t grow fungus in the product. You don’t grow mold or bacteria in the product. If you listen every week and feel like
11:06
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11:50
Does regular makeup use like that actually does it accelerate aging or
11:55
would it on the flip side you’re putting formaldahhide on your skin. Does it reduce aging? Aging?
12:00
Yeah. Fortunately, our skin is not like cadaavver skin. So formaldihide is not a formaldihide
12:06
for those first year of medicine. Yes. I was as you’re talking I’m thinking about that formaldahhide smell
12:12
in these preserved bodies which anatomy lab so gross yeah it preserves the skin after we’ve
12:18
passed so I don’t think it’ll preserve us while we are living there’s some data to suggest that if you
12:24
routinely use makeup that has some sun protection in it although the amount that you use is not what you think and
12:29
it’s not enough sun protection SPF in your makeup at the very least that can be anti-aging
12:35
to a certain extent can you define what do you mean anti-aging yeah so when we look at aging. There’s normal aging that is based on your
12:42
genetics and your family tree and what normal processes look like over the decades. There’s accelerated or
12:48
premature aging either due to excess UV or sun exposure, some genetic syndromes,
12:55
certain medical conditions, your underlying immune system health. And when we look at accelerated aging, we
13:00
look at things that cause that, right? Whether you are doing it to yourself from environmental insults, smoking,
13:06
laying out on the beach, etc. not sleeping long enough, having a poor diet, etc., or your accelerated aging is
13:13
due to metabolic dysfunction, due to imunosuppression, what have you. So, if you’re using makeup as a tool, at the
13:21
very least, makeup that has some sun protection in it will be slightly anti-aging. Now, I I put an asterisk to
13:26
that because usually people look at a bottle of, I don’t know, let’s say liquid foundation, and they say, “Oh,
13:32
SPF 15 in there.” you are putting probably a third of the amount needed on
13:38
your skin to provide that SPF 15. So, you’re really getting like a 5 to eight. So, you can’t rely on that alone for sun
13:46
protection truly. I did not know that. Now, you need a, for lack of a better definition, a shot glass worth. And most
13:52
people are either putting on very little foundation or definitely not a shot glass worth of foundation. So, you’re not getting the SPF that your makeup
13:58
says. But, at the very least, there’s something there. I don’t think it accelerates aging. Unless you’re doing
14:04
stuff that really hurts your skin, like leaving it on overnight all the time, not letting your skin turn over,
14:10
clogging your pores, then trying to scrub things off, being abrasive with your skin, then probably don’t do that.
14:15
But I I I don’t think it’s accelerates aging. Are there any ingredients that you think
14:21
are really damaging to the skin that we use routinely that we don’t think about? It’s a good question
14:26
because you blew my mind when you talked about testosterone. Yeah. and skin. Yeah. Yeah. Well, I’ll touch on that.
14:32
So, there’s a few things I think that are surprisingly a problem if not used right. In my realm, I I’m a fellowship
14:38
trained skin cancer surgeon, so I see this as a problem throughout the United States is a is what people commonly call
14:44
black salve. And I see this especially in the Midwest. People use this to try to treat non-healing bumps and growths.
14:51
It’s this homemade remedy that’s readily available in the United States. What’s in that? It’s a myriad of stuff
14:57
um depending on stateto state, but it’s supposed to kill cancer and usually people Yeah. And usually people who use
15:03
this end up with very aggressive or advanced tumors because they hit it. Black salva is a big problem. More
15:10
common things that people use that they may not realize is topical retinoids. I
15:15
love them, but if you use them without sun protection, you’re going to burn. you’re going to cause some premature
15:21
aging because topical retinoids like tininoan, retinol, over-the-counter, tesarotene, adapylene, etc. turn your
15:29
skin over. They bring out kind of baby skin to the surface. So that skin is vulnerable to UV exposure. If you put on
15:36
retina all the time and you go out without sun protection, you’re probably going to hurt your skin more than improve it. Topical steroids, you get a
15:43
rash, you put a little hydrocortisone on. Long-term use without control is a
15:50
problem. It thins your skin out. It brings out broken blood vessels called telangctas. So topical steroids we are
15:56
very careful about. What else? Vitamin C serums. Love them in the in the right context, but they are a common culprit
16:03
for peroral dermatitis, which is this like acne like eruption around the mouth. So these are common things that
16:09
people use all the time, but when not used correctly, it’s a problem. You brought up testosterone. Yeah. Yes. It’s it’s making a renaissance
16:15
right now in medicine and rightfully so. It was ostracized in like the 80s and 90s and now they’re like, “Wait a
16:21
second. People need to feel better. They need to be fit. You know, being fit reduces your insulin resistance, etc.”
16:27
Testosterone, however, kind of hurts your skin. Hurts it in the sense that usually increases sebaceous gland uh
16:35
thickness, oil glands. Your oil glands get bigger, your skin gets oilier, you
16:41
actually produce more collagen and elastin. So skin sometimes gets thicker. Um, and then there’s this ruddiness that
16:47
people see usually as a result of maybe too high of testosterone where you’re producing too much blood. Your blood
16:53
count is high. Patients faces look red. So testosterone actually makes our skin
16:59
a little a little uglier. You know, people who are very sensitive to
17:04
testosterone even at normal levels will get acne. Steroid acne is a very common thing. Um we used to use the term
17:10
steroid acne for for predinazone but now you see you know you see it in testosterone and so long as you’re
17:17
supplementing or you know taking it as medically necessary you those breakouts are hard to control. Also if you’re
17:24
undergoing surgery any sort of surgery whether it’s cosmetic whether it’s you know reconstructive what have you
17:30
testosterone tends to make the scar a little bit more visible. H
17:36
I need to just stop you here. Yes. But the question, you know, every single
17:41
person should ask themselves, okay, what is my goal? Because I hate this cookie cutter approach where
17:46
you got to everybody has to do this for your skin. Everybody has to do this for your skin. I personally, and this may
17:51
not be the same for every dermatologist, I would rather be lean and have and jacked and have a have a
17:57
six-pack then have a dad bod and glassy skin, but that’s my perspective. I think it just depends on what state
18:02
you live in, but it’s okay. Fair enough. Um, we have to we have to pause here. testosterone and skin.
18:09
Yeah, I love that you said that testosterone is having a renaissance moment. It absolutely is. Do you know it was first
18:16
prescribed, they started using in the 1930s. I didn’t know that. Incredible. And actually, it was a very
18:22
commonly used treatment. Now, no wonder the greatest generation. It was World War II, right?
18:28
But it’s amazing. And then all of a sudden there was a study that came out that linked testosterone to prostate
18:34
cancer and they stopped using testosterone and they started castrating guys.
18:41
Yeah. Yeah. That was based on one study with one patient on a blood lab that they no
18:47
longer use. That’s that’s like the same thing with Accutane and the discussion about, you know, depression and mental health and
18:53
suicidality. It was one flawed incident in the 70s and 80s that got that label
18:59
forever. I think testosterone is a great thing. I think overutilization or super therapeutic
19:04
amounts for a long period of time can be a problem just like too low of an amount for a long period of time can be a
19:10
problem. You know, like everything has its sweet spot. You know, whether you’re talking about
19:15
testosterone, whether you’re talking about sunlight, whether you’re talking about a prescription medication, everything has like this this balance.
19:21
Yes. And if you fall out of the window, you’re probably going to be in trouble. If over over a long period of time, not for the first year and not for the first
19:27
month, but if you’re consistently out of the window, like anything in life, you’re probably going to run into trouble.
19:32
And I have never heard and I’ I’ve thought about this, but I’ve never heard a dermatologist talk about testosterone
19:38
skin other than acne. Yeah. Yeah. But what you’re also saying is beyond acne, it creates this thickening of the
19:44
skin. And consciously now, everyone could look around and see individuals that probably overuse
19:51
Yeah. Testosterone, maybe even anabolics. Yeah. On the flip side, and and to be clear, you’re not talking about keeping things
19:59
in a therapeutic range. How can we think about it? Because I don’t want people listening to go, “Oh my gosh, that’s it.
20:05
I’m stopping it.” No, no, no. And and every single person has a different response to the same medicine. You know, I have many patients
20:13
and colleagues who have been on it for a long period of time. It hasn’t affected their skin. So, one thing you can’t measure in a test tube is sensitivity to
20:20
a hormone. You can try, but everybody responds differently. I have some patients who start it and in the first
20:27
month they’re breaking out, they’re oily, they’re like, I hate this stuff. So, you should be a judge of your own,
20:32
you know, health, skin health, and and your well-being. If if you’re using and you feel great, who am I to tell you to
20:38
stop? But if you’re noticing things with your skin that you didn’t have before, take a look and say, “Hey, maybe this
20:44
exogenous source is my culprit.” And the flip side is true in that we use estrogen to to protect your skin in a
20:52
variety of ways, not just skin, but hair. And that’s been, you know, since
20:57
antiquity. We use estrogen um for acne. We use estrogen to help the revitalized
21:04
post-menopausal skin that’s really dry, zerotic, kind of, you know, dull. We use
21:09
estrogen to help protect hair. Testosterone accelerates the most common
21:14
type of hair loss which is androgenic alopecia or male pattern hair loss. So we use either estrogen or something that
21:21
blocks testosterone from binding to its receptor which is a medication called spironolactone. That’s very commonly
21:27
used especially in young young girls with hormonal acne. So the flip side is true. People ask me all the time what kind of protein powder
21:34
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21:41
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22:02
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22:09
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lion and use the code drl for 20% off. Do you use estrogen topically, orally?
22:59
How do you see it affecting the skin? Which is the best pathway? Yeah. And what are the most positive outcomes?
23:06
I personally haven’t found topical estrogen to be any better than the
23:12
vehicle in which the estrogen is in. So if you smeared one half of the face with
23:17
let’s say Aquafor not that you know no specific brand but let’s say one half is Aquaor and the other half is um estrogen
23:25
cream over a month there isn’t much of an appreciable difference I think the vehicle is doing more than the estrogen
23:32
itself and there’s a few reasons for that one is absorption two is concentration of estrogen our skin on
23:38
the face is very different than the genital region which women use this for
23:43
you know different reasons and you know vaginal dryness, atrophy, um you know,
23:48
what have you. There you have a mucosal membrane. The absorption of estrogen is much higher. It’s like same thing as
23:54
putting something under your tongue. The absorption is much higher in mucosal membranes than keratinized skin. So if
24:00
you want the benefits, oral is the way to go. The way I tend to prescribe it is in the form of birth control. And
24:05
estrogen dominant birth control at low lowest doses possible does really well
24:11
to control things that are a result of low estrogen or high testosterone. And this is this can be PCOS. This can be
24:19
hormonal acne. This can be post-menopausal skin changes. This can be hair loss. That’s pattern hair loss.
24:27
So estrogen does a lot of good things. Um and we use it clinically all the time. Have you ever considered using the
24:33
patch, estrogen patch, as opposed to oral? I haven’t. I haven’t. I don’t know. I
24:39
don’t know enough um on its effects on skin. I presume the patch has a more steady state release than the pill.
24:46
I don’t know if the patch is purely estrogen based. I know like Depot and the the implantable like implanant are
24:52
progesterone based and they tend to make your skin worse. And you’re like, “What the heck are you talking about?” Worse in what way?
24:57
Generally, it’ll break you out. So, um, a lot of young women come in and they have hormonal acne, which we usually
25:03
call in the beard distribution, and it’s pretty predictable. It’s cyclic in the days leading up to their periods, and
25:09
that tends to be pro progesterone driven. So, as good as estrogen is for your skin, progesterone tends to break
25:15
you out. So, patches, injectables, even the IUD, like the marina IUD that is
25:20
progesterone based, a lot of patients are sensitive to that progesterone spike. So, I tend to like estrogen
25:26
dominant forms of supplementation. It’s really fascinating that estrogen plays a role
25:31
on the skin. Huge. What would someone expect to see aside from the acne piece? And what I’m really
25:38
getting is at elasticity and wrinkles. Yeah. What do they expect to see in over what
25:43
period of time with the use of estrogen? Say for a post-menopausal woman or a woman that is going through menopause
25:50
and all of a sudden her skin is changing. So the same thing that happens in your skin is the same thing that happens in your muscle by the way. And we’ll talk
25:56
about that just briefly because it’s your area of expertise. But the most common complaint that we get post-menopausal women in their skin is
26:03
their skin is dry and it lacks luster. That shine is gone. And that’s usually
26:10
because of the drop in estrogen relative to testosterone. It’s not like your testosterone went high. It’s just your
26:15
estrogen went down. So your body senses that there’s an imbalance in the level between testosterone and estrogen. So
26:21
re- supplementing if you are the right candidate meaning you don’t have a personal history of hormone sensitive
26:27
breast cancer or what have you and that’ll be a discussion with you and your doctor but supplementing usually
26:32
improves skin hydration skin uh turbidity skin volume it improves fine
26:40
lines and wrinkles slightly but wrinkling is a problem over a decade so it’s hard to see that correction fast
26:47
but usually what women say when they come in is like my skin looks looks better. My hair feels a little thicker.
26:52
I just I feel good. I look good. And that is perhaps not directly
26:58
quantifiable, but if they feel great, then we we’ve done our job. There has been this big influx of
27:05
topical use of estrogen for the skin. I’m not going to lie. I have tried it. Uh I
27:11
Does it work? What does it work? Do you feel like it made a difference? I don’t notice a difference. But then again, I’m thinking to myself,
27:16
well, number one, this is not probably the right dose. And I don’t know if
27:21
there’s ever been clinical are there clinical studies? I don’t know if there’s been randomized dose escalation studies. I think it was
27:27
inferred from literature that’s been around for a long time. I see. And and what we do in medicine often is
27:32
we reformulate a drug that was used in another specialty or another indication.
27:38
Some women say it works. If it works, great. I’m not saying it’s not going to work in everyone, but if you’re going to
27:45
use estrogen as a source of revitalizing your skin for whatever reason, I tend to
27:50
find the higher concentration from oral forms tend to be better than the topical. And we and to be clear, we don’t have a
27:56
dose. Your estrogen, for example, if I’m looking at blood work as a physician and I want the outcome to be obviously is
28:03
subjective. Yeah. Lusterful skin. Yeah. Yeah. No dose. No. no dose because it has to be
28:09
titrated based on titrating meaning we have to find the dose that fits your skin based on what we see. There are
28:16
patients who and I’ll use testosterone is much more readily measured all the time because people tend to supplement
28:21
more. There are patients who break out when they are in 600 700 range and there
28:27
are patients who don’t break out when they’re in a,00 range. So your sensitivity to it is very
28:35
important and that can be impacted by your your genetic metabolism, other
28:41
medications that you’re on, other supplements that you’re on that can affect the metabolism and absorption of
28:46
the drug. So there isn’t really a level that’s correlated to skin the way there is a level correlated to internal organ
28:54
changes related to hormones. That makes sense. And also to be clear, skin is not the largest organ in the
29:00
body. muscle. It is 40% of the body weight. I mean, listen, I’ve never been able to say that. Maybe square square footage wise.
29:06
I’ve never been able to say that to a dermatologist, but I I feel very lucky to to just course correct here that it
29:13
is not the largest organ in the body. It is the skin or it is Oh my gosh. It is muscle. It is not the skin.
29:20
Have you seen anything um that was really surprising? You’ve been in practice. You did two fellowships. Have
29:25
you seen any trend that just has really surprised you? I don’t know if I I think
29:31
the rise of social media has taken away the surprise. I think I think every day I’m like what is going on here? And I
29:38
think the the advent of home home doctors like homemade doctors through
29:44
social media and Google searches is a real big problem that wasn’t around when I first started training. I mean I’m not
29:50
that old but people weren’t chat gpting their symptoms and coming in with predetermined diagnoses. These this
29:57
makes practice of medicine really hard. It it takes more time for you to course
30:03
correct somebody in clinic than than than anything else. I think I I hate blanket statements and
30:11
that’s become more and more I think medicine’s become polarized in the US and you either fall in this camp or you
30:17
fall in this camp and if you’re in this camp you’re the enemy of this camp and like there used to be a lot more middle ground. I’m a dermatologist who focuses
30:25
primarily on some of the worst skin cancers in the US. It was my area of expertise as a full-time professor at
30:31
the university. It’s what I do in my practice now. And that was it. The uh you Yeah. And my
30:37
career has been dedicated towards treating melanoma and squamous cell carcinoma and basil cells and etc. I
30:43
love the sun. I enjoy it. I go outside and I I I get a lot of benefit from it. That is
30:49
blasphemy in our specialty until now. And that’s like something I hated when I when I realized the majority of my field
30:57
would say you have to avoid the sun at all cost. You have I mean I don’t think you do. I really don’t think you do. And
31:03
that was really infuriating to me for two reasons. One this binary good bad is
31:10
never existent in medicine. And number two, dermatology is probably the last
31:15
specialty in which the physicians in the field tend to guilt their patients into
31:22
making them feel like they were the cause of their skin cancer. The last
31:27
time we did this was with cigarette smoking and lung cancer. Made total sense. You stopped cigarette smoking.
31:33
Squamos carcinomomas of the lung went down. But guess what? The number one cause of lung cancer and lung cancer
31:39
death in the US now is adenocarcinomomas and non-smokers. So that guilting
31:45
feeling is out. But in dermatology often what happens is patients come in, they have a skin cancer on their nose and
31:51
their cheek and and people say, you know, the sun you got in your 20s and 30s, you did this to yourself. And don’t
31:57
get me wrong, blistering sunburns are not good. Constantly getting burns is not good.
32:04
But there’s a lot of factors that we don’t have control over that predispose people to skin cancer that I think it
32:10
sucks to make them feel guilty about this. You know, I always just wonder, how do newborns get so much energy? They wake
32:15
up, they cry, they go to the bathroom. Well, they get something that we don’t. They get colostrum, the OG energy shot.
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y a r mm r a.com/d dr lion and use the code dr lion at
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checkout. Does the sun cause skin cancer? Yes, with an asterisk.
33:25
So, there are a whole slew of skin cancers. We talk about the big three in the US because they’re the most common.
33:31
Basilc cell, squamas cell, melanoma. But there are things like dermatop fibro saroma pertubins. There are things like
33:37
Merkel cell carcinoma. There are you know there’s a ton of skin cancers, ton of different types of skin cancers. When
33:44
we say yes, there is a direct correlation with
33:49
chronic excess sun exposure and the number of blistering sunburns that you’ve had with our most common types of
33:57
squamas cell carcinoma and some basilc cell carcinomomas and melanomas.
34:03
However, there was a really interesting randomized study. It was the last
34:08
randomized study that was ever done on sunscreen. And I’ll go into this. I I’ll go into why this is important. That was
34:15
published in the Lancet in the n in 1999. This was study done in Australia that looked at people who used diligent
34:20
sunscreen versus those who did not. And the incidence of some squamous cell
34:27
carcinomomas came down, but there was no change in the incidence of basilc cell
34:32
carcinomomas, which is our most common form of skin cancer in the US. One in four Americans will develop this.
34:37
Squam. Basil cell. Basil cell. So no change in basil cells, a decrease in squamma cell and a slight
34:43
decrease in melanoma, but no change in survival. So you’re scratching your head head saying, “Okay, I don’t understand.
34:49
What are you saying?” First, sunscreen is a form of sun protection. It’s not
34:55
the only form. Sunscreen only works if you apply enough of it to every square inch of sun exposed skin. Not everybody
35:00
does that, which should be roughly a shot glass. Yeah. Shock glass worth, which a lot of times people don’t put that much. That’s a ton.
35:05
It is. It is. And if you’re using a spray, forget about it. You’re barely getting anything on Oh my gosh, that’s all I used.
35:10
It’s all It’s all I used as a kid and yeah, it’s all I used as, you know, as a kid growing up and, you know, adulthood
35:16
until we learn better. So, sunscreen’s not the only form. Importantly, the strongest predisposing
35:22
factor for you is your genetic and family history coupled with your sun
35:28
cumulative sun exposure dose. So if you are from northern European descent, mom
35:34
and dad had basil cells, uncles had basil cells, there’s a very high chance that you’re going to get it in the future.
35:39
And is that only to exposed sun areas? No, can be anywhere. It occurs more in
35:44
sunexposed areas because the sun is like the second hit. Your first insult is your genetic predisposition. The second
35:51
is the sun. Do we know the exposure from for example lights,
35:56
fluorescent lights, regular lights, and the effect on the skin? Yes. published that study as a fellow at
36:02
NYU and we showed that visible light particularly fluorescent light and some
36:07
h hallogen light can change the pigment and change the DNA of your skin.
36:12
That’s terrifying. Yeah. So there’s um proximity is important. Duration of exposure is important. So LCD LED screens don’t do
36:20
this. What about this computer screen? No, that’s usually LCD or LED. But fluorescent lights do it. Some H
36:26
hallogen lights do it. which is why there’s a big movement now towards sunscreens and sun, you know, um
36:34
sunscreens that have visible light shielding and glasses that shield
36:40
against uh visible light spectrums in the blue wavelength. So, there’s a movement to wear stuff or do stuff
36:46
that’ll protect you from indoor light. And this came from, you know, we had a lot of patients at NYU that were um on
36:52
Wall Street. They’re like, I’m in these lights all day and night. I’m behind these screens or or they’re in, you know, private equity or what have you.
36:58
They’re like, “What is this doing for my skin?” Nobody really knew the answer. So, we did a study for and we were pretty shocked. You get some pretty
37:04
significant changes over time. It’s not the same as UV. It’s nowhere
37:09
near the same as UV. If we treat light as a form of a drug or medicine, we can
37:14
touch base on that in a bit. Then, everybody should know their dose, right?
37:19
Your skin and my skin is very different than my Irish patients skin. I may be able to be outside or be under, you
37:26
know, fluorescent light for an hour and a half before my skin turns red. That’s what we call my minimal aiththemma dose.
37:33
So that’s that’s how much my skin can tolerate. So if I’m going to enjoy the sunsafely, I will go a little bit below
37:38
that. If you tell me, hey, I’m I’m, you know, strawberry blonde, blue-eyed, I
37:43
burn in 10 minutes, your comfortable dose is five. So everybody should kind of know their dose. One thing we didn’t
37:49
touch upon earlier in terms of sun and skin cancer. Melanoma has historically been our deadliest form of skin cancer
37:55
and that’s changed in the last five years. It’s no longer the case. But for all intents and purposes, melanoma has
38:01
been our deadliest form of skin cancer because it has the quickest ability to spread. It is the most common cancer in
38:07
age 25 to 39. Second most common cause of cancer death in women ages 25 to 35.
38:13
Melanoma. Melanoma. The majority of lethal melanomas arise in sunna skin. Backs and
38:22
legs are the most common areas. So you’re saying, okay, is the sun causing
38:27
cancer? Is the sun not? Like what’s the message here? A little bit of yes and a little bit of no.
38:32
Thanks for clearing that up. Yeah, I know. I I made more confusion than anything. My point in saying that is you don’t have to fear the sun. If
38:39
you’re suns smart, you can enjoy the outdoors, get all the benefits that the sun provides safely, very effectively
38:46
while keeping yourself protected from the risks of skin cancer. Now, what is
38:52
very very linearly correlated is aging in sun. So, skin cancer has a lot of
39:00
molecular changes, genetic predispositions, family, you know, um, heritage, ancestry influences that drive
39:06
skin cancer formation. aging is a lot more of a straight line. You get too much sun, you’re going to wrinkle like a
39:13
raisin. So, that makes that makes sense. People find that still controversial, right? And they find it controversial because
39:18
they can’t account for their genetics. You know, I I hear this all the time. My
39:24
grandma was Greek. She was in the sun all the time. She didn’t have a single wrinkle. Maybe if we look back at her photos,
39:29
maybe she does have a wrinkle. We forgot about it because we loved her. We also don’t know how good her skin genetics was in tolerating UV damage. But the way
39:37
I describe this analogy is put a grape in the sun, it eventually turns into a raisin. It’s pretty predictable.
39:43
Is that why um upstairs on our fourth floor, I had this beautiful rug
39:50
and it had green and it it had tan and now it looks totally bleached out. Yeah. Yeah, it’s exactly right. And it
39:56
comes through the windows. You think you have protection through the windows and you really don’t have much UV guarding. It’s why you’re not supposed to put nice
40:01
fine art or whatever you’re trying to preserve by a window because the UV will eventually erode it. And do we know that
40:07
it’s UV? We do because there’s been good studies, not even in skin, but in in worlds not
40:14
related to medicine, like art, art preservation, where you look at what damages the paint and what ages the
40:21
paper behind it, and it’s UV. Heat also plays an important role, but assuming your house is climate controlled, you’re
40:28
not not in Texas. Not outside in Texas. Fair enough. Touche. At least 150 degrees here. Yeah, 150 will kind of
40:34
wrinkle you faster, but that’s terrible. The if we’re talking about aging, premature aging versus skin cancer,
40:40
wrinkling, the number one cause you would say is UV exposure. Excess.
40:46
Excess. We didn’t define excess and we didn’t define a normal amount.
40:51
Yeah. Is there such? Yeah. Except it’s personto person dependent.
40:57
So if we consider light, UV light or sunlight a medicine, then there has to
41:03
be a dose, right? I give this example all the time. Take a Tylenol or take an Advil. What happens? Your headache goes
41:10
away. Take 23 of them. See what happens. You’ll be in the ER. Same thing same thing with UV exposure,
41:15
right? Every person has a dose. The way you kind of know your dose if you came to clinic and you wanted to test it is
41:22
called the minimal aiththemma dose where we shine UV light. we find the time in which your skin turns red, that is the
41:28
dose that you can tolerate. And then anything below that is presumed to be safer. The way the average person does
41:35
this is on a summer day, they’re like, “Hey, I 15 minutes later I was burned.” Okay, then your tolerance is 10 minutes.
41:42
The problem in making an umbrella statement as to what’s safe is everybody’s skin is different.
41:47
Everybody’s skin color is different. Everybody’s UV tolerance is different. So, you have to find that dose for
41:52
yourself. But I think there is absolutely nothing wrong with getting 15
41:58
to 20 minutes of sun exposure for most people at low UV index times of the day
42:04
every single day. I wouldn’t recommend 20 minutes in the desert in California. Most people would burn. Not everybody.
42:10
If someone can tolerate it, yeah, for example, my dad, my dad lives in Ecuador, 74, is outside all the time.
42:17
Would you say that there would be a reason to restrict that exposure if he hasn’t had any skin cancer history
42:23
which actually I think that he has had some skin cancer something on his nose. You have you have fair you have light
42:29
colored eyes and ironically for some reason that we don’t understand very well. Patients with green or hazel eyes
42:36
but with dark skin or dark hair roots tend to have a high incidence of pigmented basil cells. It’s the most
42:42
common skin cancer I see in South Americans. is the most common skin cancers I see in Southeast Asians and
42:47
it’s more common in those who have light eyes but olive features. So if your dad
42:52
had one then I would say okay if he I would probably restrict or be careful because everything in the skin and sun
42:59
is cumulative effect which is why you don’t see skin cancers in young kids that frequently almost never unless they
43:06
have a genetic syndrome. Most cancers are the same way. It’s a cumulative effect. So, if your dad’s not bothered,
43:13
if he actually hasn’t had a skin cancer and he doesn’t really I’m sure he has. I have to ask him. Yeah, pretty sure. But find out if he doesn’t if he’s not
43:19
bothered by his aesthetics, then no, let him have all the fun he wants. If he has and you’re worried and it’s on a
43:25
sunexposed area, his his likelihood of having another one is 50%. Wow, that’s high. Yeah.
43:31
And the out to be clear, the outside rays are different. You said that light exposure is cumulative. It’s the
43:37
cumulative UV that we have to be careful with. Are we getting any UV from our lights?
43:44
Fluorescent lights have UV. Yeah, that’s very well known. You can you can measure that. Fluorescent lights have UV. Most
43:51
of the lights indoors know nowadays are not fluorescent. They’re either hallogen or LED and they do not have UV. They
43:56
stop sharply around 400. Was that why they stopped? And the mercury inside fluorescent
44:02
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number one way to prevent wrinkles. Would you say that that’s fair? That is Yeah. Excess sun protection or excess
45:30
sun exposure protection. What about diet? Some people Yeah.
45:35
For example, individuals that are extremely low in protein. Yeah.
45:40
Animal protein, they seem to age really poorly. Yeah. Tell me.
45:46
Diet is massive. And I I trained at Stanford and this was it was a really
45:52
great forward-thinking institution in which we incorporated dietary changes to treat skin disease. Diet is medicine.
46:00
Food is medicine and should be treated as such. Absolutely. The amount of protein that you get correlates to the
46:07
amount of collagen substrate that you have to build. Collagen is a triple helix. Proline lysine hydroxyproline or
46:13
hydroxy. You make that triple helix with some vitamin C. Animal-based proteins
46:18
are much higher bioavailability uh greater density of protein per you know plate of food you eat. So protein
46:26
for certain. Anti-inflammatory diets tend to protect the skin from premature aging and a
46:34
myriad of skin conditions. Eczema, psoriasis, certain rashes, things like that. I tend to be very pro in the
46:41
anti-inflammatory diet. And generally diet is also correlated
46:46
with lifestyle habits. If you’re eating a shitty diet, you’re probably not controlling your sleep and exercise and
46:53
hydration. I don’t know anybody who has Cheetos for dinner but is maintain I know my son was doing a pretty good job pretty
46:59
definitely he’s not eating Cheetos for dinner but you get you get the point. It’s unlikely for you to have a flawless diet
47:05
and then have everything else out of whack. If you’re controlling that you’re concerned about your health. Everything else falls in sync. So diet absolutely
47:12
important. I tend not to like foods that spike insulin levels fast or have a high
47:18
surge in the glycemic load. We see that as a problem in our skin in a myriad of
47:23
things. The most common complication is just breakouts. Everybody used to think
47:28
dairy was a culprit until a really good study out of Penn State came out that showed that full fat dairy products
47:36
cause no acne. Skim and non-fat dairy products in the US cause acne. And they looked into this
47:42
saying, “What the heck? Where’ this come from?” Skim and non-fat dairy products in the US tend to have emulsifiers added to
47:49
them to give them the mouth feel of full fat. Those emulsifiers or sugar substitutes. They spike your insulin.
47:56
Insulin drives the breakout. So, if you’re worried about dairy causing
48:01
breakouts, avoid the skim or non-fat stuff. Go full fat. It’s really the sugar that’s a problem.
48:07
And that’s well documented. Yeah. Yeah. Very well. Skin is definitely a extremely wellstudied area,
48:14
right? And I want to go back to collagen. Yeah. We know that collagen to the best of our knowledge has no impact on skeletal
48:21
muscle because it’s the amino acid profile. Yeah. What do we know about oral collagen and
48:27
skin? Yeah. So the same reason a lot of people didn’t believe in collagen supplementation for muscle is the same reason people didn’t believe in collagen
48:34
supplementation for skin because you can make that three amino acid triple helix
48:40
from other foods that you eat. Doesn’t have to be it’s not an essential amino acid and you know this better than
48:46
anybody else. What we have found though is especially in the US and especially in certain cities patients have very
48:52
restrictive dietary habits whether that’s medically indicated or it’s for aesthetic purposes people have a variety
48:59
of very restrictive diets vegans vegetarians etc in which the amount of
49:06
overall protein and collagen sub you know content that they’re consuming is
49:11
very low. So we see a benefit overall for two reasons and several studies have
49:17
suggested and these are subjective assessments of skin health. So there’s
49:22
always some bias to it whether your skin looks better after supplementing. But there’s two reasons. One, people who
49:28
have dietary restrictions benefit from supplementation. And number two, when you consume collagen powder, just like
49:35
whey or any other protein form, you have a measurable spike in the protein content of your blood plasma. In your
49:42
plasma, you can measure, you know, albamin is the common one we measure. But when you consume it, you can see a
49:48
spike of protein in the plasma component. With that spike draws water.
49:54
Encotic pressure in your blood increases slightly. that gives that appearance of
50:00
a little bit more hydrated skin. You can actually measure it in patients who are sensitive to protein supplements and
50:06
their blood pressure goes up as well. So there’s a little bit of a water draw effect with collagen supplements. I
50:13
think in my opinion it’s a net neutral to slightly positive. I think at you
50:19
know not high doses in in lower doses I think it’s okay to beneficial especially
50:24
for people who are dieting a lot who have restricted diets who aren’t you know eating everything that they should
50:30
it helps for people like yourself who are spot-on with their diet their health
50:35
I don’t think adding collagen to the mix is going to make or break your skin you know I use collagen and I I will
50:43
tell you I first started using collagen sitting on you know we’re talking about New York Yeah, I had a practice on Fifth Avenue across
50:49
from Central Park. And this which it was awesome. And this girl came in and this was
50:54
before anybody was taking collagen. It was 10 years ago. Wow.
50:59
And man, this girl came in with glowing skin. I swear to God. And I just said, I
51:05
I need to know. And she goes, “Well, uh, I don’t know if this works, but I’ve been taking collagen and vitamin C.” And
51:11
after that, I was absolutely sold. I don’t know if the data is cuz I’ve looked and it looks like there is some
51:18
there’s some data. The majority of the studies are subjective evaluations but there is some improvement. I
51:24
like you can see it in the photos. It’s not it’s you can see an improvement in the photos. Now the question exists
51:29
twofold. When they start supplementing are they also changing things about their daily routine that will improve
51:36
their skin and overall health? Because now you know you’re part of a study. You’re going to be a little bit healthier. You’re going to sleep a little bit more. You’re going to wash
51:41
your makeup off. If you’re going to do all the additional things, these biases, I tend to recommend it in patients who
51:49
want an additional thing that they can do that’s easy and lowhanging fruit or they’ve noticed a change in the dullness
51:55
or the volume or the luster in their skin. It’s an easy thing to add. I don’t think it’s a negative. Anecdotally, I
52:02
have one I found one benefit in my patients, and I don’t know if this is true across the United States, but a lot
52:07
of older patients come in complaining about easy bruising on their arms and stuff. We call that baitman’s pera. We
52:13
used to call it senile pera and that’s not not appropriate anymore. A little offensive scenile. Yeah. But we call it baitman’s perra.
52:18
It’s basically, you know, bruising in the skin because of thinning skin and UV changes. Sometimes patients are on blood
52:23
thinners like aspirin and plavix, what have you. Collagen supplementation for those patients reduces their likelihood
52:29
of bruising as much. And that’s been really interesting. I am going to get back to you. I’m going to pick up some studies and I’m going to
52:35
send them to you and maybe you can tell me. Again, I’m not a dermatologist. Yeah. So, um, maybe there is something
52:41
out there with benefit. And yeah, and also I think you you talked about something important, vitamin C.
52:46
Yeah, you can’t make the triple helix without vitamin C. So, again, if you’re not getting a source of vitamin C from your
52:52
diet and you’re not supplementing, that collagen you’re consuming is less beneficial. Hydrayzeed collagen absorbs
52:58
better. I we found that patients have a better result with hydrayzeed collagen, anecdotally, than than just bulk
53:04
collagen powders. And again, there is it something that you’ve looked into? We have. We’ve looked. Yeah, for sure.
53:10
Absolutely. For for variety of reasons. Um, one, we want to know where the data lies because patients ask about it all
53:16
the time. Two, we’re always looking for things that we can do for patients skin besides prescriptions that is easy,
53:24
safe, won’t interact with other medicines that will improve their overall health and their skin health.
53:29
And in formulating a a product ourselves that we have, we added collagen at a low
53:35
dose for the very reasons that you describe. We’re going to come back to this product because it it blew my mind and we’re
53:41
going to spend a little time talking about it because I think you’re genius. I don’t know about that. Well, let’s ask your let’s ask your
53:47
wife. We’ll ask Andrew, our friend Huberman. I think we would all agree you are extremely well trained as a
53:54
physician. Thank you. The better the training of the physician, the more open-minded they can be. I I agree with that and I think the
53:59
less you know the more you the more patients you see the more questions you have than anything else. I think the Dunning Krueger effect is real.
54:06
This is absolutely true. I have a couple questions in terms of you mentioned
54:12
bruising. Yeah. As people age there is this crepiness
54:17
that happens. Yeah. Do you know what I’m talking about? Yeah. Ladies, do you know what I’m talking about?
54:22
Tell me there’s something to do about that. I wish I had an easy answer. There are things that you can do that will improve
54:28
it over time for sure. And what is it? So the creepiness is usually from a loss of collagen and elastin. When you look
54:35
under the microscope, if you biopsy the skin, you see a tangled web of broken
54:41
collagen and elastin fibers. We call it solar elastosis. UV has basically chewed
54:46
them up and left the epidermis hanging from the fat. And that that’s the
54:51
creepiness you see. There’s no there’s no buoyancy in the skin. And that’s a result of age, genetics, and some
54:58
medications accelerate that. And for everyone knows what Matt, my producer, you know what I’m talking
55:04
about, right? Where skin is really crepey and you see it and it looks like wet newspaper. It looks like wet newspaper.
55:10
It looks really thin. And I operate on those those patients all the time. It’s really hard to
55:16
stitch. It’s really really hard to stitch. What can people do about that? So, first is prevention. But is it? But
55:23
that can’t just be sun exposure. A lot of it is sun. A lot of it is genetic, which is why you see creepier
55:28
skin on the hands than you do the back or chest. Unless you go to like nudest beaches or, you know, beach towns where
55:35
you see the same creepiness on there just last week. Me, too. Um, but you see the creepiness
55:40
on the arms the most because they’re the most sunexposed. Also, the the amount of oil glands are an important factor in
55:47
skin elasticity, skin thickness. So you don’t see it as much on the face because
55:52
we have oil glands on our face where we don’t that’s actually true where we don’t on the hands and arms. Things that you can do to prevent that.
55:59
Number one, sun protection. Obviously, we talk about this all the time, but a lot of sun protection. And we’re going to come back to again, we’re
56:05
talking about two things. Talking about vanity, wrinkles, and then we’re also talking about skin cancer. From the vanity
56:11
standpoint, mitigate sun exposure, sun protection for sure. Number two,
56:17
there are laser resurfacing devices that we use all the time to stimulate collagen
56:25
synthesis and elastin synthesis that 100% anybody who cares about their skin
56:31
should do some sort of laser procedure for two reasons. One, we know it improves the appearance and now we know
56:38
it also cuts your cancer risk. It does. Yes, our new Harvard study came out last year, like a 20-year study that
56:44
showed that it reduces keratin carcinoma. What kind of um laser us the the the laser that we studied the
56:50
most, the brand name is called the Fraal laser. It’s the workhorse in my practice and many derms practices, but any
56:56
fractionated non-ablative resurfacing device. The Fraal. Fraal. Love it. Love it.
57:03
I love it, too. And I did it to my face and I look like the mask. Do you remember that movie? Or was it the
57:08
elephant man where his m where his face was completely blown up?
57:13
How that happened to my wife, happened to my nurse practitioners, happened to everybody I ladies, you should guys, you should
57:18
definitely do this. But you want to know something? If you do it again, it’ll be less. If you do it again, it’ll be less because there’s
57:25
less of a damaged target to hit. There’s less things that the laser is targeting
57:31
to erase. So the first time anybody does it. Terrible. Yeah. Yeah, for sure. But that’s a good thing. how the fraal. I’m so glad that
57:38
we’re talking about this. I love this device. This episode is brought to you by Something Sweet and it’s not me. It’s
57:43
Manakora. Let’s talk carbs, specifically honey. And no, it’s not another nickname for my husband. I usually call him
57:49
something else. People have this idea that carbs are bad, and that is simply not true. I use Manakora honey daily.
57:55
Well carbs like Monora honey, they have been amazing for my personal training. I
58:01
think of manuka honey, which is what it is, is a functional carbohydrate, not just a sugar. It’s serving a purpose.
58:07
It’s not just adding empty carbs. Honestly, we use it anytime we need a natural sweeteners. The bees collect the
58:13
nectar from the Manuka tea tree in New Zealand. It’s very complicated. The nectar is then packed with bioactive
58:20
ingredients. And the honey that is produced has three times more antioxidants than your average honey. If
58:26
you are looking for a good honey and you are looking for something sweet, you can check out their website to learn more. Head to manicura.com/dallion
58:34
for $25 off your starter kit. We’re talking about it in the domain of prevention as well, not just treatment.
58:41
No, no, prevention for sure. When should somebody start doing it? And should they do it on their body?
58:47
Yeah, we do. So, when you should start is when you start to worry about the way you look. If you ask my dad, he would
58:54
never do it. If you ask my patient 19 years old, no, because your skin hasn’t matured yet. You’re still in the your your
59:00
hormone millu is peaking. You’re still probably breaking out, things like that. But I think starting in your late 20s,
59:05
early 30s is not unreasonable as prevention. In terms of treatment,
59:11
we we start to treat creepiness, volume loss, collagen loss, elastin loss
59:16
somewhere in our mid30s because that’s when we first start to notice it usually. And unfortunately, social media
59:22
has accelerated perceived aging faster now than ever before. People are coming in asking for it younger and younger.
59:29
But in reality, when we look at faces, the first decade that we start to notice
59:35
appreciable changes is in our 30s. So that’s where I start to convert from prevention to treatment. But honestly,
59:41
you can do it at any age. And it’s very safe. How often should someone do it? If you’re treating then
59:46
and what are we treating? elasticity, wrinkles, elasticity, sun damage, sunspots. If we are using it as
59:53
treatment, then it’ll be based on how much of that thing we’re treating is left. So, every
59:58
but I’m not going to, for example, for me, and I use the Fraal laser. Um, I had
1:00:03
um my girlfriend Christy Hamilton, she’s a plastic surgeon, and amazing. I I trust her with a laser.
1:00:09
I had her do it. The first time I did it, my face looked terrible. I did it six months later, it looked better. And
1:00:15
then I got really busy and all this other stuff happened. But I’m never going to erase
1:00:20
the wrinkles on my face. No. And that’s it’s not it’s not meant to to reverse decades of aging. It’s to
1:00:28
slow down that natural progression. Everybody will age. We’re not going to make it out of this race alive, right?
1:00:34
So if your slope is like Johnson might, you never know. But or that guy on the boat in Greece, you
1:00:40
know, loving life, just that guy’s going to be 100%. If your slope is like this for aging,
1:00:46
the goal of everything we’re doing is to make it like this. I see. So you you get there slower. You you
1:00:51
extend the duration of the perceived effect. So it’s not like you’re going to get a facelift result from a non-invasive procedure. And even
1:00:58
facelifts don’t erase your wrinkles forever. But the goal is to help push that aging process down and help prevent
1:01:07
any cancer along that. Fraal is not the only device that does this. Um CO2
1:01:13
resurfacing laser. So that’s actually the one I did. I did this. So you were pro you were probably pretty messed up. I was.
1:01:18
But was it Fraal? Was the brand name Fraal? I think so. These names. So there’s an older Fraal
1:01:24
that has a like a CO2 wavelength component. There’s a newer fraal that has a wavelength that’s, you
1:01:30
know, 1927 or thulium tipped. It gets really nuanced in the technicalities. It all depends on what you’re targeting.
1:01:36
So CO2 is not necessarily a fraal laser. It’s like saying tissue paper and Kleenex,
1:01:41
okay? Or petrolottom and baseline. So frail is the brand of the device and then CO2 is
1:01:48
the lasing medium and the wavelength target. There’s a lot of companies that
1:01:53
make CO2 lasers. And then the more important thing is whether it’s fractionated or not. Meaning you don’t
1:01:58
burn the entire square of the skin, but you have little skip areas to allow the skin to heal faster. I love fractionated
1:02:05
lasers because help helps patients heal faster. The kind of laser the brand. So we hear
1:02:10
about Morpheus. Yeah. Yeah. There’s a lot. Those are all brands. Those are all brands. Those are all brands of a fraal laser.
1:02:16
Those are all brands of different lasers. Morpheus isn’t even a laser. It’s radio frequency. So, it gets
1:02:22
really, but this is important for someone who’s listening nuanced. Yeah. I want to walk away from this episode
1:02:28
knowing what I can take orally to prevent skin cancer, which you guys, it
1:02:35
blew my mind. It really blew my mind. I also want to know as a dermatologist
1:02:41
who’s done two fellowships and was a professor at UCLA, what am I going to do? Yes. To age better.
1:02:47
Yeah. So, you got to you got to tell me. You got to lay it out for me. If I were to have like my favorite things.
1:02:53
Yeah, I’m all I’m taking. Let’s let’s say you have your perfect regimen for anti-aging and and
1:03:00
essentially skin cancer pre prevention. Some good form of sun protection. Do you care?
1:03:05
Doesn’t have to be a sunscreen. Okay. You don’t care if it’s a sunscreen. Do you prefer? In fact, in head-to-head studies,
1:03:11
yeah, sun protection from shade, shelter, you know, covering outperformed any
1:03:17
sunscreen on the market. Makes sense. You cannot burn if you’re in shade. It’s impossible. But you can burn if you
1:03:22
don’t put on enough sunscreen. That being said, not everybody’s going to cover up because life. So, some form of
1:03:28
sun protection, sunscreen, SPF, clothing, shade, shelter, h what have you. Do you care if it’s mineral-based or
1:03:34
non-mineral based? I’m going to get so much heat for this. I tend not to like chemical sunscreens.
1:03:41
I treat, as a skin cancer surgeon, I treat sunscreen as a drug. I and and it’s classified as an over-the-c counter
1:03:47
drug by the FDA, but I treat it as a mechanism to prevent cancer for my
1:03:53
patients. So, I don’t really give a excuse my French, whether it looks great or not on the skin because my job
1:03:59
is to prevent something where I have to take a scalpel to it. Not everybody thinks that way and rightfully so. So,
1:04:07
for me, I tend to like mineral sunscreens for two reasons. Number one, it tends to have better visible light
1:04:13
coverage and broadspectctrum coverage than chemical sunscreens. More importantly, there’s a lot of smoldering
1:04:20
talk in the literature suggesting that chemical sunscreens are not as innocent as they may be played out to seem.
1:04:28
Meaning, some of the chemicals and their breakdown products can be questionably
1:04:33
carcinogenic, can be questionably hormone disrupting. We didn’t know this stuff when it came out. Chemical
1:04:39
sunscreens came out in the cosmaceutical industry as a way to allow women to and
1:04:46
men to put on makeup without the chalky white residue of minerals because what
1:04:52
would bother people is they would put put on sunscreen and then makeup and you got this white cast or you got this
1:04:58
grainy sandy texture. So minerals started becoming annoying to people who were wearing makeup. So cosmaceutical
1:05:04
industries say, “Hey, can we find a chemical that will shield us from the sun, that goes on elegantly, goes on
1:05:11
nicely, you don’t have a white cast, and you don’t have that chalky feel.” The way chemical sunscreens and mineral sunscreens work are a little bit
1:05:17
different. Mineral sunscreens tend to absorb and deflect or refract the light.
1:05:24
They sit on the surface of your skin. Chemical sunscreens tend to absorb
1:05:29
undergo a chemical reaction in the skin. release that energy as heat and then get a breakdown product. So there’s a
1:05:36
chemical reaction going on on your skin when you apply chemical sunscreens. That’s how it protects you from UV. A chemical reaction.
1:05:42
There’s been enough data in animal studies and an interesting paper that was in JAMAMA that showed that even with
1:05:49
a single application of a chemical sunscreen, we could detect that product in our plasma, meaning in a blood draw
1:05:56
at levels that were above what we considered safe and normal. Now, a lot of people are going to come after me, especially those who are in the
1:06:03
cosmaceutical industry right now. And would that be zinc oxide? What is a mineral? Is zinc and titanium. I see.
1:06:08
Chemicals are things like oxyenzone, avoenzone, octacryline, a bunch of if
1:06:15
you can’t really pronounce the name, it’s probably a chemical sunscreen. And a lot of people are going to come after me for this, but if I have enough data
1:06:22
that says maybe this class is not as safe as we think, whereas this class is
1:06:27
generally recognized as safe, I’m going to pick this one, of course, especially for my kids. In fact, the
1:06:33
American Academy of Pediatrics and the American Academy of Dermatology do not recommend applying chemical sunscreens
1:06:39
to infants six months and younger. So, if we have that already and now I’m sure in the comments people are going to say,
1:06:45
“Well, no, the amount of mineral the amount of chemical you need to put on is 500 times what you put on is it there’s
1:06:51
enough data for me to say, you know, if I’m No, I don’t think you’re going to get push back. You know, you’d be surprised. I’ve gotten some remarkable push back from uh
1:06:58
a lot of industry and I get it like skincare is a $200 billion global industry. people have to,
1:07:06
you know, push product and they say, “Oh, my mineral, my chemical sunscreen is is this and there’s no absorption.” I
1:07:12
don’t know. There’s a lot of basic science and some translated translational science that suggests chemicals aren’t that safe.
1:07:19
We’re taking chemicals. So, you would avoid So, you would use minerals. I recommend mineral sunscreens. It’s majority of what we carry in our
1:07:25
practice. Mineral sunscreen and a retinoid are the two single best things you can
1:07:31
do for your skin. And this would be reta or something like that. prescription grade is always better than over-thec counter. The
1:07:37
reason for that is the over-the-counter retinols are not active. They are
1:07:42
inactive prod drugs that need to be converted into the active form by your
1:07:48
body. The conversion varies person to person based on the enzymes that they have. Which is why somebody will use
1:07:55
this product from Sephora and say, “Oh my god, I’m like flaking and dry. I have I’m having the effects.” And the other
1:08:00
person will use it like, “I’m not I didn’t get any of that effect. Prescription strength always better
1:08:06
and that’s generic. Can be generic. Yeah, generic. What uh percent? Um start at the lowest because it’ll
1:08:12
irritate your skin. Tinoan 0025%. Now there is one prescription that is now available over the counter. It was a
1:08:18
prescription up until a few years ago. Adapylene. The brand name is different. That is a prescription strength not not
1:08:26
an inactive retinoid. It’s called adapylene. It’s 20 bucks at Target. And
1:08:31
do people put it everywhere if someone and what is it going to do? Yeah. So retinoid should go on at night.
1:08:37
You put a P-sized amount to the full face. You go one, two, three, four, and massage it in,
1:08:42
including under your eyes and above your eyes. You don’t have to go right up to the eyelids because the eyelid skin is thin. It’ll get really irritated, but it’ll
1:08:48
diffuse naturally. So if you get it to your cheekbones, you’re fine. You start once a week at night. And if you’re not
1:08:54
dry and peely, you’ll go to two times a week at night. If you’re not dry and peely, you’ll go to three times. And the
1:09:00
goal is to get to nightly. But if I told you go get retinoids, start them at night and you start peeling, you’re going to say, “This guy’s an idiot.” So
1:09:06
start slowly. And this is for wrinkles. It is for wrinkles. It was its
1:09:11
indication is acne. Has been since the 80s, but it has the only medicine that
1:09:16
we know, topical or otherwise, that grows new collagen. And that’s been
1:09:22
studied for 30 years. You can biopsy the skin and see changes in collagen density
1:09:28
increase and elastin. So it prevents wrinkles, it prevents sunspots, it
1:09:33
prevents fine lines, it prevents sun damage, it prevents precancers, it prevents acne. It’s the best topical
1:09:39
medicine you can use. I’m sold. Why am I just putting it on my face? You could put it on everywhere. One, you’ll probably run out of the tube. And
1:09:45
really the area we concern we’re concerned about if we’re thinking aesthetics is face. And it responds. It
1:09:50
affects and modulates the pyos sebaceous unit which is the hair follicle and oil gland. So if you don’t have that on your
1:09:56
like arms, legs, it’s not going to be as effective. But what about for that crepiness of the skin?
1:10:02
It can help. It’s not great. It’s not great and it may just irritate your skin a
1:10:07
little bit more, but for the face, it does help long term for the crepiness. Okay. So those are the two single topical
1:10:13
products that you should everybody should be on. Sunscreen in the morning and any time you have excess sun exposure and a retinoid at night. Got
1:10:19
it. If you want to ice the cake, you’ve built your cake. If you want to ice the cake, everybody wants to and we want a cherry
1:10:26
on top of it. You can add a vitamin C serum. The way vitamin C works, if you think about this, is, you know, cut an apple, put
1:10:32
some lemon on one side, leave the other side unexposed, leave the apple out in the sun. The unexposed side will brown.
1:10:38
The side with the lemon will not brown. That’s the vitamin C preventing oxidative stress and oxidation from the
1:10:46
environment. The theory is you put that on your skin in the mornings and you help prevent oxidative stress and
1:10:52
changes from the environment when you’re out and about. Now, don’t go rubbing lemon on your face
1:10:58
or oranges on your face because that’s going to create a whole slew of other problems. But vitamin C is an added thing that you can do once your cake is
1:11:05
built. So, if you’re not using sunscreen, you’re not using a retinoid, I don’t think spending a lot of money on vitamin C is helpful.
1:11:10
What about the kic acid? And there’s a whole bunch of other products. So there’s a lot of products depending on
1:11:16
what you’re targeting. Usually the acids are to help improve dispigmentation, mealasma, sunspots. Acids are basically
1:11:24
abrasive things that burn the top layer of skin off either gently or very aggressively.
1:11:29
There’s acids that are over the counter, lactic, kic, glycolic, etc. Then there’s acids that we do in the office like
1:11:35
higher strength. I’ve done those. TCA, you know, triclor acetic acid, glycolic acid, phenol peels. These, you
1:11:42
know, chemical peels are acids. I caution people into doing too many things because a lot of what we’re
1:11:48
putting on are costic. They burn the skin. Vitamin C is an acid, ascorbic acid. So, if you’re putting vitamin C
1:11:54
acid on, if you’re adding kic acid, if you’re having a lactic acid wash and you’re putting on a retinoid, your
1:12:00
skin’s going to really be irritated. You got to build into these things slowly. So, I I bring this cake frame again, but
1:12:06
once your cake is built, then you can frost it. Once the frosting’s set in, then you can put the sprinkles and the cherry on top. But it takes some time
1:12:13
for your skin to get used to it or you’re gonna have a bad reaction. What about And you’ve really are building the foundation of the things
1:12:19
that you should for wrinkles, anti-aging, sunscreen. Yes. Retinol, vitamin C.
1:12:26
Yeah. What? And it sounds like it’s a give or take vitamin C for you. Look, I love it. I don’t want people to
1:12:31
throw everything at their skin right away. If you’ve been using sunscreen and a retinoid, for sure add a vitamin C.
1:12:37
And if you’re at the age where you’re starting to see the changes, I like vitamin C late 30s, 40s, 50s. It does
1:12:43
help prevent oxidative stress and it is an antioxidant by definition as well as
1:12:48
a vitamin. But you have to be careful with it. It can irritate your skin. It can cause some peroral dermatitis. But I do love
1:12:55
it. It does brighten complexion. It does help with dispigmentation and sunspots. It’s a great add-on.
1:13:02
What about lotions, things of that nature, and red light therapy? Yes, everybody should have a moisturizer.
1:13:08
Everybody should have a good moisturizer. There’s three big forms. Ointments, creams, lotions. What are the
1:13:13
differences? Ointments are basically oil with some water droplets mixed in. The most classic ointment is Vaseline or
1:13:20
petrolotum. Aquaor is an equivalent. Creams are much broader. They tend to be white. They can be thick. They can be
1:13:27
not so thick. Creams are water emulsions with a little bit of oil mixed in. So,
1:13:33
creams are lighter than ointments. Lotions are powders mixed with water.
1:13:39
They are the least moisturizing. So I generally say how dry is your skin?
1:13:45
How irritated is your skin? The drier, the more irritated, the more moisturizing properties you want. You
1:13:52
want to go towards thicker things given that you’re not breaking out. You know, if you’re 18 years old, don’t put
1:13:57
Vaseline on your face. You’re going to break out. But put on your feet. It will definitely help your feet. That actually brings up another point.
1:14:03
This whole like beef tallow. I was going to ask you that next. That’s exactly what I was going to ask you. So my entire unfortunately my entire
1:14:09
field has put this umbrella term on beef tallow is horrible for your skin.
1:14:16
I cannot believe you bring this up to that is exactly my next because we’re talking you know ointments, creams, lotions. So I am
1:14:22
neither for or against beef tallow. In my culture I’m ethically Armenian. There
1:14:27
is an equivalent homemade remedy that is like a beef tallow equivalent that is that everybody in my culture knows about
1:14:34
that we use to treat burns and scrapes and injuries. If you are using beef tallow and you are
1:14:42
not having any issues like acne, breakouts, clogged pores, by all means use it. Who am I to say otherwise?
1:14:48
Are they saying not to use it? Because doesn’t it have fats soluble vitamins in it as well? People are saying it does not enough for
1:14:54
it to be appreciable in your skin. you’re probably not absorbing it enough for it to even make a difference. But it does. It has a lot of bioactives that
1:15:01
you don’t get from prolotum. What is a problem with beef tallow is in
1:15:07
young individuals, those who are actively getting their medical information from social media and
1:15:13
they’re 23 years old, they have a lot of acne or they have hormonal acne or they have congested pores and they’re
1:15:19
smearing the stuff on their skin. It would be the same as if you smeared
1:15:24
Vaseline on your skin. It’s not really much different. But I have older patients who have dry skin. They’re
1:15:30
like, you know, I’ve been using beef tallow. My skin looks great. Who am I to say anything else? You know, your skin
1:15:36
looks great. Continue using it. So, in the right patient, it’s fine. The other
1:15:41
problem with beef tallow is where you source it from and quality. Like, you know, backyard beef tallow, I probably
1:15:46
wouldn’t recommend it. I don’t know where it’s coming from. I don’t know if it’s sterile. I don’t know what else you’re getting in there, but you know,
1:15:52
good brands, you know, trusted brands that make beef tallow. I’m not against it. Go ahead, by all means. But if you
1:15:57
start to notice your skin’s reacting to it, back off and let’s figure out why. It’s good advice. It makes sense.
1:16:03
Yeah. I hate like being umbrella one or the other way. I think every person responds differently. Now, you bring up
1:16:09
red light. Actually, before we transition to red light, you asked moisturizer. I think everybody needs a moisturizer if they’re using a retinoid
1:16:15
or an acid. Your skin’s going to be dry. Pick the moisturizer that works with your skin. Is there one you use?
1:16:21
I don’t have any brand affiliations. I tend to like Neutrogena’s Hydroboost or Cave um PM moisturizer or Vany cream.
1:16:29
You know, anyone that is non-comogenic. So, you want to look for that label that says non-comogenic, meaning it’s been
1:16:35
tested not to clog your pores. But Neutrogena is great. Anyone that you
1:16:40
like that you will use and it won’t be a glorified paper weight on your desk, use. If you have issues with it, then
1:16:46
figure out why. Maybe there’s a preservative that your skin doesn’t agree with. Maybe there’s an ingredient that is breaking you out. In terms of red light, a lot of talk about red
1:16:53
light. I tend to like it. I have it in my practice. We have one that we use
1:16:59
post-procedure. We have we also use it post-procedure for hair treatment. I
1:17:04
love it. It is not a gamecher device. Gamecher devices are devices that can
1:17:13
completely change your skin’s biology. full face a blade of resurfacing we can
1:17:20
like the CO2 like devices that peel your entire skin off and it regrows
1:17:25
beautifully those are gamecher devices I think red light does a few things that
1:17:30
is awesome it increases blood flow to the skin it helps promote some wound
1:17:35
healing it helps improve post-procedure healing you know after laser resurfacing
1:17:42
what have you think that’s great I don’t think there’s a negative to it I think The only thing people should be aware of
1:17:48
is whether their red light device is powered enough to see a clinical benefit. The way you kind of know is if
1:17:53
anything is battery powered, forget about it. Probably is not powered enough to get the jewels or the energy output,
1:18:00
the fluence to to see the effects we see in studies. Most of the time, the ones that are effective are usually clinical
1:18:07
grade or medical grade and they plug into a wall and you can see an energy output. Do we know why what the
1:18:14
mechanism for hair growth is from the red light? Yeah, it’s thought so hair loss the most
1:18:21
common type of hair loss that everybody seeks most people seek medical attention for is androgenetic or androgenic
1:18:27
alopecia. That’s male or female pattern hair loss and that’s hair miniaturization
1:18:34
and dorcy due to sensitivity to DHT testosterone’s
1:18:39
byproduct. The hair is not gone. You may look bald, but when you biopsy the
1:18:45
scalp, the hair follicles are there. They’re miniaturaturized and they’re they’re shrinking. They go into resting
1:18:50
phase. The way the red light is thought to work is it increases the blood flow to the dermal pills, basically the stem
1:18:57
cell region of the hair follicle to provide more fertilizer. Imagine turning up the hose in your garden and you can
1:19:05
now provide more water to your plants. your plants are going to grow again. So long as the plants are there, and most of the time it is. Its effect is slow.
1:19:14
Person, you get a variability depending on how thick your scalp is and how deep the hair follicle sits in the scalp.
1:19:20
Those are things you can’t really measure, but some people get great response. 10 to 15% increase in hair
1:19:25
density. That’s a lot with red light alone. Some people don’t. I tend to use it post-procedure. So if
1:19:32
you get hair transplant, micro needling, micro needling with PRP, uh PRP
1:19:37
injections alone, we use it immediately post procedure when the skin is already a little bit more inflamed to increase
1:19:43
that circulatory flow. You mentioned um PRP, we didn’t really talk about it, but I do want to talk
1:19:48
about PRP exoomes. Yeah. But before we do that, what is the mechanism for the skin for the red light
1:19:54
therapy on the face? Is it just increased blood flow? It’s thought to be increased blood flow and in doing that you can get a lot more fiberblast
1:20:00
recruitment and a lot more stem cell regeneration from post-procedure and increased blood flow allows us to turn
1:20:09
the skin over appropriately. You know it allows your your skin has stem cells
1:20:14
that go down the hair follicles and they live in the base you know basement membrane. Increasing flow to our
1:20:19
pyosbaceous unit allows our skin to be a little bit more vitalized. You know, this has me thinking and I’ve used a red
1:20:25
light cap for hair growth. I’ve used it for years. I actually have kind of fallen off the bandwagon of recent, but
1:20:31
if it increases hair growth on the head, would it increase hair growth on the face?
1:20:36
In theory, potentially, but you have to have those types of hairs on the face
1:20:42
that respond to that. So generally terminal hairs which are the dark thick or the you know thick blonde or thick
1:20:49
brown hairs that come out of our head those are terminal hairs whereas the hairs we have on our face men tend to
1:20:55
have terminal hair in their beard area. Women tend to have what’s called vevelis hairs which is that peach fuzz hair that
1:21:02
is not so responsive to things like red light or even hormones unless you shift
1:21:07
them from vevelis to terminal. You won’t be able to do that with the red light. Okay, that’s good. Good question. So, you’re not going to
1:21:13
grow be But you actually bring up a point. You know, people use Rogain Minoxidil topically and now orally to
1:21:20
help improve hair vitality. That will grow peach fuzz as well. So, you use that in your practice?
1:21:26
We do. Minoxidil, we use it orally more than topically, mostly because, you know, guys hate putting on topical minoxidil. Women will
1:21:32
be a little bit more compliant, but the efficacy of the oral version in in my opinion is a lot better than the
1:21:38
topical. We use oral minoxidil as well. What dose do you happen to use? Just for for women, usually 1.25 and then
1:21:44
we’ll go up to 2.5. For men, we start around 2.5. Yeah. As long as they have no issues, you
1:21:49
know, no heart Yep. palpitations. And do you find that they seem to lose hair first?
1:21:55
So there’s a shedding phase. You know, 30 to 50% of patients will have an initial shedding phase in the first four
1:22:01
to six weeks. That’s a good thing because it means you’re a responder. We see it with the topical, we see it with
1:22:07
the oral. So if you don’t counsel patients about that, they’ll come in and say, “I’m losing my hair more. You’re crazy. What the heck you give me?” Yeah,
1:22:14
it does work. So the only thing is you will grow peach fuzz. Your your body hair may increase a little bit. That’s
1:22:19
the downside to minoxidil, but it is safe, effective, doesn’t modulate hormones the way finasteride or dutasteride do.
1:22:25
Yes. And for the record, we never recommend finasteride. Um, you know, we were talking about falling big time out
1:22:32
of favor. Thank goodness for those. And that’s Propeia. If anyone is taking that, I strongly recommend you go and you see
1:22:38
your physician and and really talk about for sure coming off of that. That was a medical
1:22:43
especially in young patients. Yes. You know, if you’re post the age of deciding to want children, you know,
1:22:49
you’re 40s, 50s older maybe can be a discussion because it’ll provide some prostate protection as well in men. But
1:22:55
for young guys especially that come in like 18, 19, I’m like, dude, you don’t need this. Like there there are other things we can do. Way better. your hair
1:23:02
is probably not even reached its state where we need to treat it anyway. The circling back to the PRP and
1:23:08
exoomes, that’s a a really hot topic. Okay. Talk to me about what that is and how effective that is.
1:23:14
PRP is great. Plateletri plasma. We basically draw all the concentrated growth factors from the plasma portion
1:23:20
of your blood, concentrate it, and then reinject it in an area of concern. It was popular in orthopedics, still is
1:23:26
popular in orthopedics in regenerating, you know, tendons, ligaments, what have you. Just had it done. Yeah, it’s great.
1:23:31
um in skin and hair we use it to reintroduce either growth factors
1:23:38
stimulate hair growth or wound healing postprocedure. So let’s say you have laser resurfacing done and the skin is
1:23:44
injured you can apply PRP that’ll speed up the healing process theoretically
1:23:51
increase the amount of collagen and elastin you’ll produce. Does it work? I think it works. Yeah, we use it um I
1:23:58
use it a lot post micro needling. So we will micro needle the skin. Micro needled skin is basically bloodied and
1:24:05
we take a concentrated form of PRP and apply it to the skin and hope that it absorbs it because those micro needling
1:24:11
channels are open. The patients that I’ve used it, the ones that benefit the most are the ones that tend to have like
1:24:17
acne scars or traumatic scars in which we are trying to get rid of the scars. PRP seems to improve the density of
1:24:25
collagen and speed up the healing more than if we just did micro needling or laser alone.
1:24:30
And there’s various modalities that you’re talking about, but could someone skip all that and just go right to laser?
1:24:36
Yeah, for sure. We blend them together. They do different things. Um, we usually use them in synchrony. So laser and PRP at
1:24:43
the same time. Um, it depends on all what we’re targeting. So if we’re targeting like sunspots or melasma or
1:24:50
dispigmentation, the PRP is not going to provide you much benefit. Wrinkles, we care about wrinkles and elasticity.
1:24:55
If we’re treating wrinkles, elasticity, PRP at the same time for sure. If you’re treating hair loss,
1:25:00
PRP at, you know, PRP, injections, red light therapy, things like that are all simpler procedures. There are bigger
1:25:07
procedures you can do. Hair transplant, facelift, and they’re very effective, but most people are not, you know,
1:25:13
diving straight into a facelift. No exoomes. Exoomes. What’s that? These are thought to be messaging signal
1:25:20
molecules. I don’t like that you you just took that big sigh because I just bought
1:25:26
Exoome under eye cream and I am afraid I just wasted cash. You may have.
1:25:31
Oh, come on. Yeah. Unlike internal organ mechanisms,
1:25:37
exoomes and they fall in the category of peptides as well in the skin except
1:25:44
maybe two or three companies that use exoomes that are shelfstable and
1:25:49
verified in terms of having the exoomes they claim they have. The majority of the
1:25:55
stuff sold hogwash. No hogwash. But would if I happen to have purchased,
1:26:01
which I’m going to go look and I’m going to find out. Well, I’m definitely using it because it was expensive.
1:26:06
Yeah, it it is very expensive. There are some great brands that have some good exosomes. Okay. And the exoome itself is a
1:26:13
signaling mechanism. It is usually it’s a combination of peptides or amino acids. Sometimes
1:26:18
there’s an there’s a metal attached to it like a copper moyet. Those are really popular in the skin. Copper based
1:26:24
exoomes. Some are derived from stem cells, either human stem cells or
1:26:30
plant-based stem cells. The plant ones don’t really do much because our body works differently. It’s theorized to
1:26:36
send signals to increase your fiber blast ability to grow new collagen and elastin.
1:26:42
You’re not a fan. I have yet to see a difference in which the vehicle is used and the vehicle plus
1:26:48
the exoome is used and see an appreciable difference. Nobody really likes to do that study.
1:26:53
Darn it. Which is why a lot of times in that realm like scar healing products,
1:26:59
you won’t see many companies do a split scar study where they use standard
1:27:05
petrolotum aquaor for one half of the scar, a lanttoin for one half of the scar and their scar healing product on
1:27:12
the other half because it looks the same. What they will do is show you an untreated scar, no nothing on it, and
1:27:19
then a scar that’s treated with their product. Well, of course that product’s going to work better because you’re doing something to protect it.
1:27:24
Okay. Well, if you’re going to spend the money for exoomes, my opinion is hold it and get a
1:27:31
procedure that really provides skin health, some sort of resurfacing laser,
1:27:36
micro needling, something. I we touched upon what we can do for anti-aging in
1:27:41
terms of topicals. There’s a lot of things we can do in the office that will help you in terms of
1:27:47
anti-aging from a procedure standpoint. I love there’s three if I had three
1:27:53
magic devices and that’s the only devices I can use it would be fraal or
1:27:58
some sort of fractionated non-ablative laser fraal is my favorite some sort of
1:28:04
vascular laser that targets blood vessels I like the V-beam or the pulse die laser I like it because it gets rid
1:28:11
of all the broken blood vessels gets rid of rosacea and it helps reduce the likelihood of basil cells it gives you
1:28:17
that really nice even tone own. How often can someone do that? And do it every month if they’d like.
1:28:23
Especially for fair skin patients who have a lot of redness who flush in the sun or with hot beverages or with spicy
1:28:28
foods or with emotion. You know that rosacea flush. This this is the gold standard for getting rid of that broken blood vessels around the corners of the
1:28:34
nose. I’m going yeah signing up. And then a micro needling device. Simple, effective, and stimulating
1:28:40
collagen synthesis. You can do it in all skin tones. One of the biggest challenges in the US is we can’t use
1:28:48
every device on every skin type because of the risk of dispigmentation and consequences with changing their skin
1:28:54
tone. So a lot of what we can use in very fair skinned individuals is not safe in very olive or ethnic skin or
1:29:00
dark skin. The laser and the micro needling do they do different things? the fraal, the fractioning laser.
1:29:06
It depends on if you’re targeting fractionation for sun damage, then yes, that targets a higher level of the skin,
1:29:12
gets rid of freckling, sunspots, etc. If you’re targeting fine lines and wrinkles, depending on the depth, they
1:29:19
do similar things. Um, but I I use them in conjunction all the time. Okay. And then probably the third thing that
1:29:26
you can do is utilize a daily supplement that will protect your skin from the
1:29:31
harmful effects of the sun. Now everybody’s like, “What the hell are you talking about?” Yeah. Say it again. There are Yeah. The third thing. So
1:29:37
topicals, a sunscreen, a retinoid, and a vitamin C, and then you can add all the other things that you’d like, you know,
1:29:43
kic acid, um, azelleic acid, what have you after the fact, a retinoid at night,
1:29:50
laser resurfacing procedures that will stimulate collagen and elastin growth, get rid of sun damage, prevent skin
1:29:55
cancer. Those are excellent. And then the third thing which I recommend to all of my patients is to
1:30:01
take supplements that protect your skin from the sun. There are three well four
1:30:07
three really big supplements that I like. One is a plant called polypodium lucatus which is from a fern in the
1:30:13
Amazon. It’s a fern that when you consume lets you be out in the sun
1:30:18
longer before you burn. Yeah. Where did you even were you in Peru somewhere and in the jungle which
1:30:26
you know with a machete? I don’t understand. It’s well known in a niche of dermatology this plant.
1:30:32
You mean like five people? Yeah. Like seven. Yeah. And it’s a it’s a readily available plant that when
1:30:38
consumed at the right dose lets you be out double the time before your skin burns. It’s not a replacement to
1:30:44
sunscreen. That is so cool. Yeah, it’s awesome. Wait, it’s a fern? What is it? It’s a fern. It’s like a like a naturally growing fern in the Amazon.
1:30:51
Polypodium lucatus of course. And where um what who
1:30:56
is were they eating it? Was it So the way they found out is indigenous people would go out on fishing
1:31:02
expeditions on the Amazon and they’d be out for three days. So the way they’d protect themselves is they’d crush up the leaves and eat it.
1:31:08
Wow. And they wouldn’t get a sunburn. It’s really cool. So this came out, you know, this like data came out about 10,
1:31:15
15 years ago saying, hey, there’s a supplement that you can eat that you can consume that will protect
1:31:20
your skin from head to toe from burning and it helps prevent things like flaring of your mealasma, helps prevent
1:31:26
sunspots. It’s basically an internal shield for your skin against UV and sun
1:31:31
damage. You know, I’m going to have to ask, do they know the mechanism of action? There is a myriad. It’s thought to
1:31:37
decrease our skin’s drizzation from UV exposure.
1:31:43
Meaning meaning it’s thought to prevent our skin cells ability from causing UV mutations
1:31:50
from from the sun. That’s one. The next supplement is a supplement called
1:31:56
nicotinomide. Now not NMN, not NAD. These are commonly mistaken or confused.
1:32:02
NAD is nicotine nicotinomide adinine ducleotide. NMN is the monucleotide.
1:32:07
They have different functions in the body. They have no relevance in the skin. But pure nicotenomide
1:32:13
when given at the right dose has been shown to reduce our skin cancer risk, our non-melanoma skin cancer risk by up
1:32:20
to 30%. And that data was published in the New England Journal of Medicine, one of our most prestigious medical journals in a phase three study. So this is great
1:32:27
supplement that is over-thecounter. Where would you find it in food? Yes. Nicotenomide you won’t find. It’s a
1:32:33
derivative of niacin. So niacin is vitamin B3 but the amide derivative that
1:32:40
has the amide moy attached to it is nicotenomide also known as niocinamide can find that in supplements you won’t
1:32:47
really find it naturally occurring in foods that is another excellent supplement and the third is aazanthin
1:32:54
I am really big into this it’s not well known in dermatology but it is well known in the anti-aging
1:33:01
wellness longevity world it is a powerhouse antioxidant and has been
1:33:06
shown now in several studies to prevent premature aging of the skin. Helps
1:33:12
prevent fine lines and wrinkles. Helps prevent sun damage. You can these are excellent supplements that everybody
1:33:18
should be on. Where would you find athyinins? In in terms of food, you’ll find it in like
1:33:25
shrimp, salmon. You’ll find it in if you eat a lot of marine algae, you’ll find it in marine algae. the bioavailability
1:33:31
in shrimp and salmon and crustaceians that are have that orange hue. That’s where the orange hue is from is higher
1:33:37
bioavailability than the marine form. But if you don’t eat, you know, and it’s also difficult to get the dose,
1:33:44
a precision dose. I’ve actually am starting to take 12 milligrams, which which is high. So 2 milligrams I’ve been
1:33:51
reading about is great for eye health. And the skin is around four. Around four.
1:33:56
Yeah. So, because of all this, we put together my me and my two partners put
1:34:01
together a product called sun powder. It’s very cool. It’s the world’s first daily drinkable
1:34:07
supplement that you can take to protect your skin against sunburns, to help reduce the likelihood of non-melanoma
1:34:13
skin cancers, and to prevent premature aging from the sun. In my practice, I have a lot of patients who are sun
1:34:19
damageheavy, meaning they have skin cancers, they have life-threatening skin cancers. Have a lot of patients that come in for, hey, what happened to my
1:34:25
skin? like why is it all wrinkled and you know I lived at the beach. I’m like okay let’s figure this out. My partner
1:34:30
who’s a Harvard trained laser dermatologist sees a ton of patients every day for laser resurfacing mostly
1:34:36
for aesthetic purposes. And aside from the standard sunscreen,
1:34:41
avoid the sun, wear your retinoid, there has to be something. And dermatology
1:34:47
never really looked into the supplementation world because in medicine unfortunately it was taboo for a long time. If it wasn’t a prescription
1:34:53
it didn’t work. remember paracone back in the day. He must have been the first
1:34:59
and I don’t know is he still alive? Actually don’t know. Okay. So this guy Dr. Par is the was the
1:35:04
OG. I remember reading this in my grandmother’s bathroom while she was I don’t know watching Jane Fonda and he
1:35:10
was talking about there’s a lot there’s a lot that we can do that we don’t look at that can
1:35:16
improve skin vitality from the inside out. How did you come up with this and is sun powder? So originally like eight years
1:35:24
ago or what have you when I was doing my training at Stanford we had a high-risisk clinic we had a high-risisk
1:35:30
skin cancer clinic patients who had a lot of tumors and a lot of burden of disease those who had a high chance of
1:35:36
metastatic disease or death and we looked for things that we can do to reduce their skin cancer burden and
1:35:43
ironically oral retinoids are one thing that you can do and that’s a prescription that has to be talked about
1:35:49
with your dermatologist but we found that not nicotinomide also helped reduce
1:35:55
their skin cancer burden by meaning their burden meaning how much you were finding if you had a high likelihood of making
1:36:01
five of these next year squamous cell basil cell what have you when you supplemented with nicotinomide your risk
1:36:07
reduced by 30%. And it’s a lot because all of the majority of the skin cancers tend to
1:36:13
occur on the face. So then we said, okay, if this food supplement or if this oral supplement does this, is there
1:36:19
anything else that can improve skin appearance resistance to UV? So that’s
1:36:25
where the dive began and we did a lot. I’m disappointed collagen didn’t make it in there. It did a little bit. It’s in there. Not a lot. Not a lot, but enough
1:36:32
for those. And there’s vitamin C in there for that reason. How much um vitamin C is 250 milligrams. Okay.
1:36:38
And then we have hyaluronic acid, which is the same thing that you know filler, cosmetic fillers are made of. This helps
1:36:44
hydrate your skin. We have glutathione in there, which is I think we’re the only oral supplement that has reduced
1:36:50
glutathione in there. Really popular product Korea. Really popular in Asia both as supplement and as infusion to
1:36:57
lighten and even out the skin from sun. And then we have aanthin, we have
1:37:02
nicotinomide, polyodium. So we put all of these ingredients into one supplement called sun powder. And all of my
1:37:08
patients, they take a single scoop, mix it into water and drink. How long till they see obviously there’s the
1:37:15
cancer prevention? Good question. How long till you anticipate a cancer
1:37:20
prevention versus how long till they can see it in their skin? So if you’re using it for sunburn
1:37:27
protection, if you’re using it to reduce the likelihood of you burning within two hours of consumption, we see
1:37:33
that change. Unbeliev how I know it’s really really
1:37:38
cool. It the polyodium is amazing. The aazanthin works together into the skin
1:37:44
that fast. Well, usually if you consume something, you can measure an uptake in your plasma
1:37:50
of whatever you’re consuming. Somewhere around 30 minutes to an hour depending on gastric emptying and how much food you’ve eaten, what have you.
1:37:56
Ideally, it works better if you know you’re going to go on a trip and you start a week before. There’s a cumulative measurable change in your
1:38:02
skin. So, if you know you’re going to Hawaii next week, start a week, have a scoop a day. It preps your skin for a
1:38:08
UV. Amazing. So if you know, so if you’re using it for sun protection, two hours before sun exposure or daily just as a preventive.
1:38:14
If you’re using it for skin cancer reduction, our data point inflection was 9 months. You had to be on it for at
1:38:21
least 9 months to start to see the changes. And not just skin cancer. We saw a reduction in what’s called AKs,
1:38:27
actinicossis. Precancers, patients who supplemented had a lower number of them when they would return. This is without
1:38:34
any other treatment. So, if you’re using it for skin cancer somewhere in 9 months or so, if you’re using it for primary
1:38:40
anti-aging prevention, you just want your skin to look good. Think of this as and I have no brand affiliation, but think of this as like AG1 for your skin.
1:38:47
If you’re using it for that, it’s the time point is hard to see a a specific
1:38:52
like inflection point, but most of our customers, my patients will come in around 3 months and say, “Hey, I’m
1:38:59
noticing my skin looks a little bit brighter. I feel a little bit more hydrated. I’m in the sun and I’m not
1:39:05
burning. We’ve had a we’ve had a lot of patients from across the US message and say, “This is the first summer I’ve been
1:39:12
able to go outside.” Unbelievable. Without either getting a sun allergy, which we call PMLE or polymorphis light
1:39:17
eruption, or they’ve gone to Disneyland, Florida, Hawaii, where have you on vacation and
1:39:22
they haven’t burned. Now, it’s not a replacement for sunscreen. Got to make that clear. Sunscreen does a different thing. It works from the outside in. Sun
1:39:28
powder works from the inside out. It is really amazing. I’m going to try it. You brought me four bags. Yeah. Yeah.
1:39:33
Um, two follow-up questions. Can kids take it? Six and older. Six and older. Six and older. Generally, it should be
1:39:40
weight based. So, six to 12, I say take half a scoop. 12 and older, if they’re, you know, of normal body weight, they
1:39:47
can take a scoop. Very cool. Everything is water soluble. It doesn’t interact with medications. You don’t have to worry about it being a drug or a
1:39:53
prescription. Pregnancy, run it by your OB. Theoretically, every
1:39:58
ingredient in there is safe for pregnancy, but every pregnancy is very
1:40:03
sacred. Every every person is different. I would hate for something that is like this to affect it. So, run it by your
1:40:09
OB. This is a random question, and this is because my best friend’s sister
1:40:14
has um I don’t know, she has some polymorphism that every time she goes out into the sun, she gets ex it’s like
1:40:20
very painful. What is that called? It’s either PML, polymorphis. That was right. or the more severe
1:40:26
version is actctinic parigo. Okay. Um serious. But they tend to get better
1:40:32
at with what’s called sun hardening. So as the summer goes on, their skin tends to tolerate the UV more and more.
1:40:39
There’s actually medical indication for our supplement for that. That’s what I was I’m one of my bags.
1:40:45
Yeah. It’s used for PMLA. It protects your skin from the inside. It’s really effective because it’s miserable for
1:40:50
patients. They get this itchy, blistery rash on their forearms. Dr. Teao Solommani, thank you so much. This
Final Thoughts & The Future of Skincare
1:40:56
was such a fun conversation and we’ll have to do it again. Yeah, we we there’s so many things we haven’t even touched upon. We didn’t
1:41:02
even touch upon Botox, like which is the quintessential neurom modulator. So, not for for another episode, but I’m one I’m
1:41:08
I’m a fan of it. But it’s been an honor to be here. It’s been a pleasure. I’ve had a lot of fun chatting about all the
1:41:14
things I love to do and hopefully this provided some information for people to find the right direction how to make their skin look good and stay healthy.
1:41:20
Thank you so much. Welcome.