← Mayo Clinic On Human Optimization
Mayo Clinic On Human Optimization
E52 Daily Skin Care Routines We Should Be Doing for Life Long Skin Health
00:56:23
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- [00:00]
A
Foreign. Mayo Clinic Human Optimization Project where we're creating the blueprint to help you become the best human you can be so you can give your gifts back to the world. I'm your guide and fellow optimizer, Christopher Camp. Your skin is the largest organ in your body and it does a lot more than just make you look good. It's our primary defense against the outside world and it regulates many of our body's internal functions as well. Given the major role it plays in our health and overall performance, it's important that we take care of our skin to keep it healthy for as long as possible and it would be nice if we could make it look good while we're at it. To do that, we need to start taking better care of our skin now rather than waiting until it ages to help us learn how. The title of our session today is Daily Skincare Routines we should be Doing for Lifelong Skin Health. Our expert guest today is Dr. Saranya Wiles. She's a dermatologist and director of the NIH funded Mayo Clinic Regenerative Dermatology and Skin Longevity Laboratory. She pursued a research fellowship at the Harvard Stem Cell Institute and received her MD PhD from Mayo Clinic. Dr. Wiles holds two US patents on methods and materials to reduce scar formation and four US patent pending technologies for 3D skin bioprinting. She also serves as Research Chair for Mayo Clinic center for Aesthetic Medicine and Surgery. Her work has been featured in Harper's Bazaar, the Wall Street Journal, National Geographic and Dermatology Times and was highlighted on NBC's Today Show. Today we have three big questions that we're going to work through with Dr. Wiles. The first big question we're going to tackle with her is what does our skin actually do for us and why is skincare so important? In our second section, the big question is how do we make sense of the most common skin care options out there and sort fact from fiction? And then our third section, we're going to have her give us all the answers. What are the regular skincare practices we should all be doing to help us have healthy, vibrant skin lifelong? Well Sabrina, thank you so much for joining us here on the Human Optimization project. Really thankful that you're able to come on and let us learn from your expertise.
- [02:38]
B
Great to be here Chris.
- [02:40]
A
Alright, so let's dive into our first section. So in this section we're going to be talking about what the skin actually does for us and why skin care is so important. So can you first help us understand what exactly is skin and what is its Function?
- [02:54]
B
Absolutely. So your skin is your largest organ. It's your largest regenerative organ. So every 30 days we have a new skin barrier. And it's more than just structure or appearance. It actually has a lot of very important function. So you can think about the skin first and foremost as a barrier. So it serves as a barrier to keep all of the external toxins or pollutants out. So it's protecting you. It serves as this layer that keeps out infection, keeps out the bad. Second, it also helps us with absorption. So it helps absorb the right types of topicals that you're putting on or moisturizers. And in response, it secretes. So if you're a young teenager, you're secreting oils for acne and other types of toxins that can be secreted out through sweat if you're exercising. So it's this active organ that can absorb and secrete. It has this dynamic ability to regulate your body's temperature. So it's a thermoregulator. It allows you to fluctuate between heat and cold. And the right way to achieve homeostasis or balance. It can also help you with different ways of making new components for immunity. So vitamin D is a hormone that is predominantly made in the skin. So actually UV here absorbs and helps make that vitamin D production. So the skin is the only organ that makes vitamin D. And it's so vastly important for so many different things. So it's a great producer of that. And then finally, sensation. This is how we sense the world. This is how we feel, external touch and even whether it's danger or harmful, whether it's heat or pain, and we're sensing a lot through the skin. So it's this incredible external facing organ. But the skin is an incredibly reflective organ of our systemic health. So there's a lot that we can learn from it.
- [04:52]
A
And I would argue one of the most diverse organs in terms of its function. Like, it's. It's interesting to me how people think the skin is so simple, yet it's actually one of the most complex organs that we have in our body. It's really astounding.
- [05:04]
B
Absolutely.
- [05:05]
A
So what are some of the common issues we see with skin as we start to age and get older? Other than wrinkles, we all know about that one. But what are some of the other problems that we see?
- [05:16]
B
Yeah, Chris. So all of the functions that I mentioned earlier, they start to decline. And that decline in function affects how we are able to utilize the skin's ability to protect us. Right. So if we start from the top. So the skin, I think about it as cake layers. So the top layer of the skin is called a stratum corneum. And so there's a lot of natural moisturizing factors and lipids and factors that live there that basically helps protect the skin. And this, like you were alluding to earlier, really can be variable. So the palms and soles of our skin are very thick. So this is important because you're using our hands and our feet, and evolutionarily they served a purpose. So thinking about the different textures of the skin is so important. And then we move down to the second layer of the cake, which is the epidermis. So this is where our regenerative cells live. The cells are called epidermal stem cells. They turn over every 30 days. And that regenerative component is so important to keep the water in. It's so important for your skin to function in that, like barrier surveillance and immunity by keeping its hydration locked in. As we get older, we lose this moisture and we lose consistently that water. This then allows us to be more itchy or more dry. So you're seeing a lot of these changes that are functionally evident in adults, where it's more itchy skin, dry skin, and like you alluded to earlier, the structural wrinkle changes. But there's a lot of functional decline that goes with it too. Like you're not thermoregic, regulating adequately, so you get colder easily, your sensations go down. For patients with diabetic foot ulcers, it's not optimal for peripheral neuropathy. And all of those things are very intertwined in how the skin ages.
- [06:59]
A
Interesting. So is it fair to say? This is probably an oversimplification, so call me out if it is. Okay. But as it ages and we start to see changes, certain things, we can see discoloration, pigmentation, wrinkles and things like that. As we start to see those physical changes, does that probably also correlate with a functional decrease as well? So even though, yeah, maybe you don't like the wrinkles, you don't like the way that that looks, there is some incentive to improve that. Not just because you're trying to fix how you look, but also the actual function of the skin.
- [07:38]
B
Absolutely. So if you were thinking about why a wrinkle's happening in that area, it's photo damage. It's over time, chronic exposure to UV and pollution. And when that photo damage occurs, it affects your next layer of your skin. So we talked about the stratum corneum, your Epidermis and then you have your dermis, which is like your scaffold. So in that dermis lives collagen, elastin, extracellular matrix, proteins, glycosaminoglycans, all the things that are giving the right tools for that skin to function. What are those functions in the dermis? It's wound healing. Wound healing and protecting your blood vessels is huge. So if you get injuries and you're a surgeon, so you can kind of see how pat regenerate and repair after surgeries. Right. So that response to healing is much different in a 50 year old than my 5 year old daughter who heals very quickly. So that is a very important component of the dermis. And when you have loss of collagen, you're seeing it structurally as a wrinkle, but you're also seeing its functional decline as the propensity to rebound or heal is not as optimal.
- [08:39]
A
Wonderful. So what we're talking about here today, it goes beyond just the appearance of our skin. It is also the function which is critical in so many different ways in our body. But the two are really linked.
- [08:49]
B
So.
- [08:50]
A
So the appearance and the function somewhat are related and connected with each other. And I wonder who. We talk about aging and, you know, we're talking about healthy aging and trying not to age and making our skin last. How much of our skin's appearance and function, how much of that deteriorates over time in a natural way that's determined by our age and genetics that we have no control over versus how much of it could we actually control based on behaviors or habits or interventions?
- [09:23]
B
I love this question because I think in this generation we're all looking to control and looking to figure out how we can modify the things that we can. Right. And in that ratio, it's about 25% is genetically fixed. So 25%, it's. Thanks, mom and dad. These are factors that we cannot change. They're inevitable of certain types of skin conditions or benign changes like seborrheic keratosis, which are these stuck on waxy brown papules that patients get over time. So those are like genetic. They're 25%. Right. The other 75% is modifiable. That's a big number. So if you're thinking about it, the skin as this largest external facing organ, it's the only external facing organ that consistently encounters the environment. So how can we modify that 75%? I mean, thinking about factors like UV, which is the biggest driver of breaking down all the different layers of the skin, and then you have pollution, where you have particulate matter from pollution, and people that live, you know, in bigger, crowded urban cities having more exposure compared to rural areas. So definitely those types of pollutions matter. Water, where we live, if you have well water versus city water, those types of exposures, hard water, those are constantly contacting your skin. So there are different things that you could be thinking about for modifying, different risk factors.
- [10:47]
A
Awesome. Okay, and you're going to give us the recipe for that in our third section. You're going to tell us all of the things that we need to be doing. And I think we. You've kind of already set this up when you were defining skin and its function. But can you highlight for us what are some of the benefits of taking better care of our skin?
- [11:04]
B
Yeah, so when you think about the benefits, it really goes beyond the structural ideas. Right. So, sure, you can have improvement in skin tone and texture and the appearance, but there's a lot of benefit that we get from a disease perspective. So the skin has its own set of diseases that you get with age, but you also have the skin to reflect diseases as well. So starting with the reflection, I always talk about skin as this mirror to systemic health. So there are ways that we can see when the body starts declining, whether it's heart failure, even we're learning things like cognitive decline. You will start changes in the appearance of the skin, whether it's the glow going down, people just looking different when they're in the icu. Right. You can see that the change in a person's face compared to when they're out and about and having a healthier lifestyle. So really, that reflective nature of systemic health is something to be talked about. And then the other side of it is the skin conditions itself. So taking care of the skin and looking and understanding it as early signal detection, is it the car engine light that's coming out on and saying, battery needs to be changed? So is it that cues that you're getting that something internally is offsetting, or is it something that's innately present on the skin? Patients that have melasma, which is condition that worsens with UV exposure, but also heat. So different. You know, I have a chef that comes in to see me and his melasma is often exacerbated by being in the kitchen. So it's these things that you wouldn't think about in your natural surrounding environment that you could optimize to help mitigate some of these risks to the skin.
- [12:47]
A
And what about. So that's sort of talking about the Things we're experiencing now, or maybe it's a signal about things that are coming in the future. What about, what does our skin tell us about our past in terms of, you know, the skin that we have now is determined by some of the choices and exposures and those 75% of the modifiable things that we did or didn't do when we were younger. So when you look at somebody's skin, how much information does it give you about their past?
- [13:15]
B
It's a lot. So I actually can tell if a patient has been a lifeguard in the past or if they're a pilot and depending on where they grew up, even for some patients. So there are cues that you can get from the number of blistering sunburns that you've had, if you've had tanning bed exposure in the past, if you have smoking history in the past, and certain things that over time that you have not done well protecting your skin. Different areas, suburban versus urban areas that you've lived in. So a lot of these contributing factors go into how a person ages. So you can tell a lot. It's like a. It's like a map. It's a history. Right. And what is modifiable in that is to look and see where you can take it from that moment forward. A lot of patients worry about where what has happened already. Oh, I was part of the baby oil generation where we used to put baby oil on and reflectors and go out and tan. Is it too late? For me, it's not. You know, I try to say that that modifiable 75% is true regardless of your age. So you could be a 20 year old with that same modification and 75 year old with that same. Your rate of aging is fixed at 25% genetically. And the other 75%, regardless of the past, can be changed.
- [14:32]
A
Wonderful. Okay, so you, you don't have to give up if you've made a lot of poor decisions in the past. Best time to get started is right now.
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B
Right now.
- [14:39]
A
And turn it around. You can still make a difference. All right, that's good to hear. All right, so let's jump into this second section. This is where it gets really confusing for me. There's so many recommendations out there and so many skincare options, and everybody needs to be doing all of these different things. And. And when I look at it, it feels to me like I'm supposed to be spending $500 a day in six hours, you know, in the morning and the evening taking care of my skin. And so I want to get your thoughts. When it comes to skincare, there's so much information. How are we supposed to make sense of that? Do you have sort of a rubric or a thing that you would suggest people think about when they're looking at a new recommendation or new skincare product? What logic do we apply to that to say, is, is this hype or is this fact?
- [15:23]
B
Yeah, great question. And I think right now we're in an environment where social media has really dictated a lot of how consumers receive messages on skincare and hair care and nail care. And when you're going through that, it's really hard to do that. Right? Cause there's so much, is it a ten step routine that I need or is it consistency and UV exposure avoidance? So in going through that, I mean, there are key things that we talk to patients about and we could talk about things like protection, which is first and foremost making sure that you're getting protection from uv, UV from pollution and any sort of external exposure that you would be putting your skin at risk. So starting with a sunscreen. I talk about sunscreen as the greatest longevity ingredient for skin because it really is this ability to protect your skin using a broad spectrum sunscreen, which means that it's covering UVA and UVB. So most sunscreens, they have the factor SPF. SPF refers to UVB protection. It does not confer UVA protection. So making sure that the label says UV broad spectrum SPF 30 or above. And that's really important. And then just a bit on sunscreen because it's so important is that you don't need a high SPF. I think when you're achieving between above 30, you're hitting the right protection. But what you do need is consistent reapplication. So people often forget when you're outside that you need to reapply every two hours. So setting a timer if you're at the beach, or setting a timer to, you know, if you're golfing and you need to finish your nine holes, I tell my golfers, Reapply once, 18, reapply twice. Right. So making sure you're kind of timing these things is really important. Okay. So protection is number one, repair is number two. So repair is when the skin barrier feels hydrated. So that stratum corneum and epidermis really need to stay like a basket weave that's tightly knit so it's not losing water to do that. A good moisturizer, making sure you're applying moisturizers within five minutes. After getting out of a shower, not taking too hot of a shower, and using a moisturizer that has, you know, ceramides, they talk about lipids and things in there. That's really key because getting a nice moisturizer on your skin twice a day, especially if you're living in Minnesota or other colder climates, very important. 3. I talk about signal. So signals are evidence based actives. And I know we're gonna go through a lot of list of actives here in a minute, but these are evidence based actives that have good peer reviewed science. You know, there are certain actives like vitamin C and retinoids that have shown good activation of sign skin renewal for years. But there are newer actives that are just as promising, if not more, with less irritation.
- [18:16]
A
And when you use the term active, you're saying it activates skin repair, activates
- [18:22]
B
different skin cells for different things like whether it's repair or it's regenerate, whatever
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A
that skin cell's normal function is.
- [18:32]
B
Exactly. Establish itself baseline.
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A
I see, okay, perfect.
- [18:37]
B
Yep.
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A
Okay, so protection, repair, signal.
- [18:40]
B
And lifestyle.
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A
And lifestyle. Okay.
- [18:42]
B
And lifestyles is where your podcast was I guess launched into. Right. With the optimization of all of our behavior and habits. And when it comes to skin, there are definitely habits of daily living. Sleep, diet, stress reduction and movement or exercise are so key, like for other things. And within that lifestyle is also your habit of putting on a topical. And I always go back to that protect and you know, talk about that sunscreen again. Right. So if you incorporate such a small habit of applying sunscreen and remembering to reapply, that means you've taken the first step of something that's modifiable, controllable, and a first step towards achieving something positive for your whole body wellness. And you're more likely to get on that treadmill, more likely to take a healthier optional.
- [19:30]
A
The first win is always the hardest. Yeah. Awesome. Okay, well, I appreciate you reinforcing the lifestyle message here, which you know, we preach all the time, Human optimization project. So thank you, appreciate the support on that. Okay, so I spent some time online searching in preparation for this because I know there's a lot of information, a lot of different products out there and I've heard of a lot of them, but I'm not that familiar. And so I educated myself and it looks like to me, when I look to seesaw, what are the 20 most common skincare products or routines, and I looked at a bunch of different lists and this is kind of what I put together and I broke it and I Don't know if this is a fair way to characterize it, but I broke it down into three groups. Topicals, and then procedures, and then experimental. So that's what I have. And I was wondering if I can run through this list with you.
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B
Love it.
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A
And have you tell me if it's fact or fiction, hype or hope, and maybe even rank them for me here or rate them one to ten. Is that okay?
- [20:29]
B
This is fun.
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A
Let's do it. Let's do it. Okay, so I'm going to say a 10 means everybody should be doing this. A 5 is maybe it's helpful for some people. And a 1 is total waste of time, effort, money. Don't even think about it.
- [20:43]
B
Yeah.
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A
Okay, that's our scale. So 10. Everybody do it. 1. Nobody should do it. So maybe you give me just the numbers first, and then we'll go back and we'll hit them individually.
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B
I love it. Let's do it.
- [20:53]
A
All right, in the topicals, a daily cleanser.
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B
Daily cleanser. That would be a nine.
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A
Nine. Okay. Moisturizer.
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B
That would also be a nine.
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A
Another nine. Sunscreen. I know what you're gonna say on this sunscreen.
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B
Sunscreen's A12.
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A
A12. I love it. Okay, perfect. All right, off the charts. Retinol or retinoids?
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B
Probably an eight.
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A
Okay. And then we come back, you're gonna tell me the difference in those. And then vitamin C. Serum vitamin C
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B
would be a seven.
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A
A seven. Okay. Hyaluronic acid.
- [21:20]
B
I would do a six.
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A
Six for that. Okay. Exfoliants.
- [21:24]
B
Exfoliants. I'd say a five. And it depends.
- [21:27]
A
Five. Okay. Five with an asterisk. All right. How about eye creams?
- [21:31]
B
Eye creams are a six.
- [21:32]
A
A six. And pimple patches?
- [21:34]
B
Pimple patches are five. Because it depends.
- [21:37]
A
Five. All right, perfect. So five with an asterisk. All right, so those are my topicals. Now let's go into procedures. Botox.
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B
Botox is a nine.
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A
Okay. Dermal fillers.
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B
Dermal fillers are a seven.
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A
Seven. Facials?
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B
Facials are a six.
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A
Okay. Chemical peels.
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B
Chemical peels are a six.
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A
Six. Microdermabrasion.
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B
Microdermabrasion, Probably a four.
- [22:01]
A
Okay. Laser skin rejuvenation.
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B
Lasers are a nine.
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A
Nine. All right. Microneedling.
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B
Microneedling would be a seven.
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A
Seven. Okay, now, these are kind of a little more experimental. Maybe that's not a fair characterization. But that's what I'm going to put them in. I got four more for you. Prp.
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B
PRP is a seven. Depends.
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A
Okay, Seven with an asterisk. Then dermaplaning.
- [22:24]
B
Dermaplaning would be a six.
- [22:26]
A
Okay. Red light therapy.
- [22:27]
B
Red light's an eight.
- [22:28]
A
Ooh. Exosome therapy.
- [22:31]
B
Exosomes. It depends, but if you got the right one, it's a nine.
- [22:34]
A
All right. I love it. Okay. That's my list. And so. Okay, there were some surprises on here for me. I'll be honest with you. I don't know what some of these things are, so I'm excited. Let's run back through them and talk about it. Most of them I'm kind of familiar with. Not everything. Okay.
- [22:48]
B
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- [23:18]
A
Daily Cleanser. You gave it a nine. So we should all be doing that every day.
- [23:22]
B
We should all be doing that. Exactly. So it's so important for your skin at nighttime. So your skin does two different activities. It has a circadian rhythm. So let's talk about that real quick because then clues you into why cleansers are important. So at nighttime, your skin is repairing and at daytime your skin is defending. So during the nighttime, you've just finished repairing and you've kind of regenerated your skin and renewing your skin. So there's a lot of excretion that's happening during the nighttime. So washing your face in the morning is important. Even though you haven't done anything, your skin's been active, renewing. And then at the end of the day, it's important to wash your face again because of its activity as a defender. You've just gone out and got a bunch of exposure to different factors. So bringing that back home and getting it cleansed is important.
- [24:09]
A
Okay. And does it need to be a facial specific cleanser? Can I just use my bar of soap?
- [24:13]
B
You can use a bar soap. That's totally fine. Unscented bar of soap.
- [24:16]
A
Something simple. Keep it simple. Okay. Moisturizer. You gave it a nine. All right. I didn't believe in this until I moved to Minnesota. Now I get it. It is important. Tell me about it.
- [24:27]
B
So moisturizers keep your barrier intact. And a lot of patients will say, all of a sudden I started feeling itchy. I started feeling dry. All of A sudden? Well, it's not that it has happened all of a sudden. It's that you're consistently aging and you lose more water with age. And when you lose water, you need that moisture to lock it back in. So it's that barrier protection with moisturizer that really helps to keep that barrier strong.
- [24:52]
A
Perfect. All right. Sunscreen. You already gave us. You gave it a 12. You already kind of told us why, so I know that one's easy. One question for you. Is the sun doing damage to my skin if I don't get a sunburn?
- [25:04]
B
Yes.
- [25:06]
A
Okay. All right. So I shouldn't just use sunburn as the marker of whether or not I've had some skin damage?
- [25:12]
B
Yes. The sunburn is. You've crossed the threshold too far.
- [25:15]
A
Way too far.
- [25:16]
B
Too far. You've burnt it.
- [25:17]
A
All right. More than. Well done. Okay. So even if you're somebody who thinks they're not in areas with a ton of sun, you would still recommend probably regular sunscreen.
- [25:28]
B
Even on a sun. On a cloudy day?
- [25:29]
A
Even on a cloudy day. Okay. All right. And not. Just because you didn't get burned doesn't mean you were successful here. We should protect it regardless.
- [25:38]
B
Exactly. And I always tell my patients, you're getting the most sun exposure in the car. Believe it or not, it's driving to and back from work for most people. We're working indoor jobs, so it's not like we're outside. And people always think of sunscreen as when I'm on vacation, but it's your car drive. So I tell patients to have sunscreen in their car. So put it on to work. And when you're driving home from work.
- [25:59]
A
Okay. Retinol and retinoids. You gave it an eight. Pretty high. Now, this is an activating thing, correct?
- [26:06]
B
Yes. This is an active. Yeah, exactly. So it's an important active. It's evidence based, but it's really important to look at degrees of retinoids. So there's retinols, retinaldehydes, retinoids. So there's over the counter retinoids, and then there's prescription strength tretinoins, which are stronger if you're not. If you're over exfoliating your skin from a retin, a prescription strength, you've gotta knock it down. Because if you're over exfoliating and you're seeing the skin scaling all the time, people think that's a good thing. Oh, I'm turning over my skin. But it's actually creating low levels of inflammaging on your Skin. So I actually encourage patients. I love an over the counter retinol because that can create a very nice renewal effect without over peeling the skin.
- [26:51]
A
Perfect. So we don't have to go super expensive there. Okay, vitamin C serum, you gave it a seven. What does that do?
- [26:59]
B
So vitamin C is an antioxidant. So when we talked about what the skin does during the day, it's going out and kind of defending against all these different exposures and toxins. So vitamin C is an antioxidant. It protects that when you get a free radical damage from UV or other types of exposures and they create those free radicals go in and they damage your DNA, risking you for skin cancer. What an antioxidant does is it goes in and like Pac man, it kind of eats up all the free radicals and it kind of quenches that so you have less oxidative stress, better antioxidants. So vitamin C is kind of high up there. But the caveat here is that some vitamin Cs are not stable and some vitamin Cs can actually be a little bit of irritate, irritant to the skin.
- [27:44]
A
So if you notice some signs of irritation, is that. What is that going to be? Is it going to be redness or sloughing or.
- [27:49]
B
Exactly, all of the above. So redness is the easiest factor you can tell. And then you can kind of feel. People feel irritation too. It kind of is a tingling kind of burning sensation. So those are signs that you may
- [28:00]
A
be irritated, overdoing it. Stay away from it. Okay, good. Hyaluronic acid, you gave it a six. So maybe some people should think about it. Who should think about it?
- [28:08]
B
People that have drier skin should think about it. And I would add that it needs to be low molecular weight. Hyaluronic acid. Most hyaluronic acids are too large to penetrate the skin barrier, so they just stay on top, which is not a bad thing. It's still creating a barrier. But if you truly want that active to get in, it's smaller molecular weights.
- [28:27]
A
Okay, exfoliants was a 5 with an asterisk. Who needs it and who doesn't?
- [28:31]
B
People that have sensitive skin do not need it. And if you're already using a retinol or a retinoid, you don't need it because you're already exfoliating your skin.
- [28:38]
A
Okay, perfect. Pimple patches, I think that one's for. You gave a five asterisk.
- [28:42]
B
So it just depends if you're having a breakout. If you're a dad of a Teenage daughter, you're gonna put it up higher on the list.
- [28:47]
A
Right, right, right, exactly. All right. If you're having a breakout and that affects you. Okay, so now the procedures, and I know that, you know, there's a lot of different controversy around these, but Botox was rated as a nine. So tell me what it does and who should think about it.
- [28:59]
B
So in my practice in aesthetics, I see a lot of people who come in for confidence. Right. As we age, what happens is that there is a mismatch of our external appearance and our internal mental state. Right. So when, when that mismatch occurs, you're looking at yourself in the mirror and you're like, I feel forever 29, but I look. Not that, you know, and, and, and, or you're, you're somebody who's an executive and you want to go for a promotion and somebody's asking about retirement, right? So there's a mismatch there that's going on where, where we're trying to get patients or people to function at their optimal state and their confidence level really comes into play. So for me, I look at Botox as an instant confidence booster. It does provide results. So in three months, you're seeing changes in patients face, and you're seeing results where their wrinkles earlier on kind of help reduce. So it really helps reset that change for patients. It's not for everybody. We have a deep conversation to talk about what it means because some patients come in every three months for Botox, others come in twice a year, or some people come in before a major event in their life. So it really depends. And I look at it as a tool to help patients get to where they want to be.
- [30:16]
A
Okay, great. Dermal fillers, we've all seen it go well. We've seen it go wrong. You gave it a 7. Give me your thoughts.
- [30:23]
B
So dermal fillers have a place in my practice. I have a very conservative practice, and there's definitely a place for fillers to give people appearance back, whether it's scar related, whether it's facial aging related, volume loss. I think where we see it go wrong and this like pillow face concept that we're seeing now is when you do too much and, or it's injected in the wrong hands. Typically those changes you're seeing with over 10 syringes of injections, you know, we're doing one or two. So conservatively applied over time with a careful injector, you can really see nice results.
- [30:58]
A
Great. And facials, you gave it a six facials and chemical peels Both were sixes here.
- [31:03]
B
Yeah. So facials and chemical peels resurface the superficial layer of the skin, that stratum corneum and the epidermis. You have to be cautious of where you're going and if you're skin of color. So some darker skin types, certain types of peels, and certain types of facials are actually more harmful. And you can get post inflammatory hyperpigmentation or pigment changes from the irritation. So you really have to be careful. And it's for the right patients, it can be helpful.
- [31:31]
A
Okay, microdermabrasion. What is it? And you gave it a four, one of your lower scores.
- [31:36]
B
Yeah. So microdermabrasion, honestly, could probably be a five, but it's an older technology. It's like sandpapering. Right. So it basically goes exfoliating with a device. Exactly.
- [31:47]
A
Okay.
- [31:48]
B
Yeah. And so you can have irritation. People overdo it. That's where it becomes controversial. And now a lot of med spas are offering it. So if you go and they. They bundle deals. So if you go in too quickly for procedures, you can actually be doing
- [32:00]
A
more harm than good, especially if you're combining it with some of the exfoliants or the retinols. And. Yeah, all right, I'm seeing. I'm learning here. I'm learning. Laser skin rejuvenation. That sounds enticing. What, you give it a nine, too. What is that?
- [32:13]
B
I love it. I love lasers. I mean, we could spend a whole podcast on it because there's so many different types of lasers, Right. You can have lasers. Lasers target color. So lasers, in a sense, are microthermal injuries. So they're heat based, and they go into different layers of the skin and they target colors. It could be a tattoo removal that's targeting green or reds or other black inks. It could be a laser for pulsed dye laser, which is for vascular changes. Rosacea patients tend to do really well with that. It could be a high frequency laser, like a picogenesis laser, which is great for melasma patients who can't overheat their skin. So I have to be very cautious with. Could be safe for skin of color patients if you go in the right wavelengths. And my favorite part about lasers is certain types of lasers, like a fraxel laser or even a V beam pulsed dye laser, can reduce skin cancer risk for up to 50%.
- [33:11]
A
Wow.
- [33:11]
B
It's a huge study. We published this in Dermatologic Surgery a few years ago. And so I really recommend it for anybody that's at high risk for skin cancer, whether you grew up in a southern state or you're a golfer or somebody that is a transplant patient that's more predisposed to having skin cancers. A fraxel laser twice a year will really reset your skin.
- [33:33]
A
Wonderful microneedling. You gave it a 7.
- [33:36]
B
Microneedling is really dependent. I love microneedling for my patients with acne scarring. So if you're coming in with acne scarring, it's going to do, I mean, we do a nice microneedling. We sometimes combine it even with prp, which is a blood, you know, your own blood that's spun down and concentrated to have its growth factor activating. So in the right patients it'll be really nice.
- [33:54]
A
Right. And that's. So PRP was next, which was a seven with an asterisk. So as you just said, that's your own blood products, they get spun down. You get the growth factors and anti inflammatory factors and then re inject those. I know some PRP has been used for hair loss and other things too. So what are some of the other skin functions of prp?
- [34:11]
B
Exactly. So PRP is platelet rich plasma. So it's your own blood that is taken out and we concentrate it and we use it for different aesthetic purposes. We actually run a PRP hair clinic, an alopecia clinic, where we inject it for certain types of hair loss. We're also doing that for acne scarring and other facial rejuvenation measures. There's a 40% chance that the patient does not respond. So it's a pretty high chance. And that's because it's patient's own factors influence it. So similar to how you're talking about optimizing, we actually have a PRP optimization protocol two weeks before a patient comes in. So we try to optimize their diet, try to get them to move more, try to get them to sleep better. Because all these factors and hydration, of course, drinking water really affects their platelet concentration. And we're really seeing that helps patients have a better response to these treatments.
- [35:03]
A
Okay, great. Dermaplaning was a six.
- [35:06]
B
Yeah. Dermaplaning, microdermabrasion. I kind of group those similarly. They're in office. Procedures can have the risk of over exfoliating, especially if you're doing some of the other.
- [35:16]
A
So can work, but be careful. Okay. This one's getting a lot of attention recently. Red light therapy.
- [35:21]
B
Yes.
- [35:21]
A
So maybe tell us what it is. You gave it an 8 too, which is a fairly positive score. Maybe tell us what it is. What it does and if you're going to use it, how you should do it.
- [35:30]
B
Absolutely. So red light's gotten quite popular and red light is on a spectrum. So red light and infrared are visible light spectrums and low levels of heat that actually can activate mitochondria. So at the skin level, that's how it's working. It's kind of resetting and rebooting skin mitochondria, giving you the right energy so you can turn over cells better, faster. We've seen a lot of evidence around wound healing. So actually I've started to recommend my patients who have lasers, full face facial rejuvenation, facial ablative lasers. They go under red light for a week or two after their procedures, if they're able to have that and afford it. And we could do that two or three times a day. And as short exposures, that activates mitochondrial rejuvenation and helps your skin turnover for better wound healing. There's, you know, people are using it often. You'll see a lot of social media posts of dermatologists walking around with red light masks and other, other people. And I think the idea is that it's doing more consistent use is red light is creating collagen, regeneration, et cetera. I think the evidence is still arising around that.
- [36:38]
A
And I know that there are red light beds out there, a whole bed, and there's some people talking about red light therapy actually helping some of the deeper tissues with musc and connective tissue and things. I don't think we quite have the evidence for that yet, but people are definitely looking at it. So. So who knows? But seems like there is very good evidence for wound healing in skin and then probably increased collagen production in healthy skin.
- [37:02]
B
Exactly. And I would just caution for certain types of patients, you should not use red light. And those are patients with melasma, because it can make your melasma potentially worse.
- [37:10]
A
Great, thank you. All right, Last 1. Exosome therapy 9 with an is what you gave it. So what is it and who should think about it?
- [37:19]
B
So let's define exosomes first. Exosomes are cell talk. They're like text messages that cells send to each other. And these can be beneficial signals or harmful signals. And it all depends on the source that it's coming from. So if it's coming from a harmful cell, like a cancer cell, an inflammatory cell, they could be sending signals of metastasize or inflammation. But if it's coming from a regenerative cell, like a stem cell or A platelet, then it's sending signals of renewal and repair. There's a lot of variability right now in the market around exosomes and we could talk about that, but I think the platelet source for exosomes has been really promising. We've done a lot of studies around that here, and we're finding that that's helpful for a lot of different things. Even beyond the skin for osteoarthritis, people are using it for heart failure now. Everything is under clinical trials for medical indications, but from an aesthetic point for topical application on intact skin, it's shown some benefits.
- [38:19]
A
Okay, great. And a lot of these things, you know, especially some of the procedures, some of the experimental things are injections and they are procedure based. And so I would tell our audience after listening to this and getting this information, be careful. Like any. Anything you're applying to your skin or injecting into your body, make sure you're doing it in the right way, a reputable way, going to. To, you know, a reasonable person or professional. There are complications reported with some of this stuff too, if you're going to shady places and having untrained folks do it. So just, just be smart and be careful. Okay? So that was excellent. Thank you for running through that with us. Well, let's jump into our third section. So now, you know, we have that laundry list of different options available to us now. I want to try to make it practical for people. So I think, you know, there's a lot of time and money that could be spent on this. And, you know, we just went through that whole list and I'm thinking, well, there's a lot of this stuff I probably should be doing. But I'll be honest, I don't have a lot of time. I don't want to spend a lot of money. So how much time and money are people currently spending out there? Because it seems like it can get out of hand really quickly. And what's a, what's a reasonable expectation for how much time and money we should be investing in our skin?
- [39:34]
B
Absolutely. So the average consumer spends about $500 on skincare. And I'm not talking about teenagers right now because who have whole shelves of skincare, which is probably a lot. That's probably a monthly basis.
- [39:47]
A
500 a year.
- [39:48]
B
500 a year is the average consumer. And if we were to take it back to highlighting what are the key actives and key ingredients, most of those are actually found in a drugstore. So you don't need to be spending huge amounts of products to achieve the same results. And I would highlight that consistency is king here because being consistent in your habits is where you're gonna see the highest results or the highest ROI from investing in your skin.
- [40:23]
A
All right, perfect. So consistency is king. I love that. Tell me though, if I have a. And I know this is gonna vary, but if I am consistent, I'm doing these things every day or some of them twice a day, how much time do I need to be dedicating? I mean, with some of this stuff, Is it gonna take me an hour to do this every day, or can I do it faster than that?
- [40:43]
B
You could do it a lot faster. I think that's where it's become so overwhelming, in what we're seeing and learning in social media and other ways we're educating ourselves. A three step skincare regimen in the morning and at night should really just take you 15 minutes, if not less. And I talk to my patients about incorporating skincare as brushing your teeth. You don't think twice about. Okay, how long do I need to set my timer to brush my teeth? You're brushing your teeth twice a day. It's a regimen, it's a habit. That's how we should incorporate these skin care habits that it should be accessible. Washing your face, putting on a serum, and putting on a moisturizer or a sunscreen. So there's a lot we can achieve in, in a small amount of time.
- [41:25]
A
Okay, wonderful. So let's do that. And you kind of alluded earlier to sort of a structure framework where you talked about protection, repair, signaling, and lifestyle. I'd kind of like to take a minute to go through that. And maybe if you don't mind, give us like the minimum. Like, here's the bare bones basic. Everybody, you got to do this every single day. And then tell us, okay, now if you care a little bit more and you have the, what are the first few things you should be adding on to that routine? So let's start with the minimum everybody needs to do this every single day. All right, what's that regimen?
- [41:59]
B
So minimum, the bare bones minimum. In the morning, wash your face and put a sunscreen with a moisturizer.
- [42:07]
A
Okay. Wash, sunscreen, moisturizer. And you mentioned earlier for the moisturizer, you mentioned serums. Is that the same thing or is that different?
- [42:19]
B
No, that's different. So that's the bare bones minimum. Now we're going to graduate you to a little bit more advanced beginner.
- [42:25]
A
Wait, before I do, you said in the morning, wash, sunscreen, moisturizer in the evening. What I need to do, you're gonna
- [42:32]
B
wash your face, and then you can put a moisturizer on if you're able to. I'd put a retinoid on first.
- [42:38]
A
Okay. All right. And then moisturizer. All right. So my bare bones, minimum. Everybody needs to be doing this is in the morning wash, sunscreen, moisturizer, and then in the evening wash, retinoid moisturizer. All right, perfect. That's not. That's not going to take very long. That's a couple minutes.
- [42:58]
B
And there's a lot of products that have them combined. So you can do a sunscreen with
- [43:01]
A
a moisturizer super easy. Okay. All right. I'm feeling convicted. I'm going to make some changes in my life after this. Okay. All right, so tell me, what's the next level? Graduate me up to the next level once we get that going.
- [43:11]
B
All right, so now you're going to wash your face in the morning, and then you're going to put an antioxidant on. Okay. There's a lot of active. So I'm gonna give you two or three that you can go after. So you could do a vitamin C. You wanna look for a vitamin C. That's a THD vitamin C. It's the most stable vitamin C. Okay. You could also add a niacinamide, which is gonna help brighten and protect your skin. That's another active. And then the third active is a platelet exosome. So you could utilize a product like this plated, that can help do a lot of the above with antioxidant protection. So three examples.
- [43:47]
A
Is it okay to do all three of those or do you pick one of those?
- [43:50]
B
I would pick one.
- [43:51]
A
Pick one.
- [43:51]
B
Keep it very simple.
- [43:53]
A
So one active. Okay.
- [43:55]
B
And then you could do a sunscreen with a moisturizer after that. So three steps.
- [44:00]
A
So the wash, sunscreen, and moisturizer, that's going to be for everybody? Always. I'm picking up the pattern here. Okay. All right. And then what are we going to do in the evening?
- [44:09]
B
So in the evening, you're going to wash your face again. And then you're gonna add an active, which is a retinoid that we've already talked about. You can also escalate and do like a plated exosome. There's also a lot of peptides that are absorbed in the skin that are fantastic because we talked about at nighttime your skin is rebuilding, so you need to give it. That building blocks, the building factors. So peptides, like copper peptides, and lots of others, hexapeptide. So we can share some links to the Mayo Clinic store that have these actives, if people are interested, and we can talk about that. But essentially it's a peptide and then a retinoid. You could do both of them and then follow it up with a moisturizer.
- [44:55]
A
Okay. Is there another level beyond that?
- [44:58]
B
There is, but that's where I would add that's if you have a certain type of stuff, skin disease. So if you're introducing a disease, like if you've got rosacea, if you've got melasma, if you've got acne, then we'd be thinking about where in that regimen we would add your medications to that.
- [45:12]
A
So let's run through that real quick. So some of the most common things. So acne, what would you. So for acne, would it be okay for them to use either of those plans you just outlined?
- [45:22]
B
I would start with the basic plan. A lot of patients that have acne have sensitive and irritant skin, so you have to be careful with the actives you're adding. You know, benzoyl peroxide are cleansers that I would switch them into. So instead of using a gentle cleanser, I would have them use a benzoyl peroxide or a salicylic acid cleanser. So it's giving them an extra exfoliation. And then I would have them, you know, use a topical medication, whether it's like benzoyl peroxide with clindamycin or another active that they're interested in, based on, you know, their skin profile. And then top it off with a sunscreen moisturizer.
- [45:59]
A
Okay, great. And then what modifications would you make for somebody with rosacea?
- [46:04]
B
With rosacea, I would bring in factors of antioxidants. So in my rosacea patients, I do encourage them to use the vitamin C serum if they're tolerating it, or niacinamide. There's also topical medications that we can do for rosacea skin because the skin microbiome is shifted in rosacea. So we utilize products like metronidazole topically that can help re stabilize the that microbiome. So they would incorporate that in. Typically, I have them put in the medicated products first on their skin so it gets absorbed quickly. Then you can layer.
- [46:38]
A
Okay, great. And then last, for somebody with melasma, what modifications should they make?
- [46:43]
B
So melasma patients, this is so important that they use a sunscreen with tint in there, because melasma patients are not just looking at UV damage, but there's also visible light damage. So you're gonna see sunscreen labels that have broad spectrum tinted sunscreen. So the tint on there is not necessarily for foundation or skin appearance. It actually the tint has iron oxide that protects from visible light. So that's a really great additive in a sunscreen for melasma patients to add in.
- [47:12]
A
Okay, so let's say I'm somebody who historically was just, just hypothetically washed my face with a bar of soap one time a day and didn't do anything else, just hypothetically. And then let's say I started this sort of minimum protocol, you know, of washing sunscreen, moisturizer in the morning and then washing a retinoid and a moisturizer in the evening. How long would it take for me to start seeing some changes, do you think?
- [47:35]
B
Great question. So I would encourage you to look at it at three different phases so you can start to see barrier changes within two or three weeks. So that's that top layer of the skin. You may be looking more glowy, just more refined, refreshed. And then depending on if you're adding actives that are going to like reboot your skin, like retinoids, that can take up to three months to see changes.
- [47:58]
A
Okay, got it. And then my last question is, how long should we stick with the skincare routine before mixing it up? You know, a lot of things. Your body sort of gets used to it and adjusts and you have to mix it up. Is this the same or you said consistency is king. Does that only apply for three to six months or is that indefinite forever?
- [48:17]
B
Yeah, it depends. Again, and I think part of it is you can tell if a product is irritating your skin or if you're allergic to it or something's not going right pretty quickly within a day or two. So if that's your reasoning, then stop right away and time to switch. Otherwise, if you're new to skincare and you're adding these actives in, add one at a time. You're tolerating it great. Give it about two, three weeks and stick to it up to three months. I would give everything a fair shot. If you're tolerating it up to three months to see if it's improving. And some things it's kind of like you have to just do it consistently for long term benefits. It's not a short term benefit. Right. You brush your teeth to prevent cavities, you use sunscreen to prevent skin cancer.
- [48:58]
A
Right, Right. And my last question for you here is that I Think as we start to look at this, we look at this long list, you've given us a lot of options. Should we ease into some of this? Right, Like I shouldn't probably go do all of these things tonight or I'm going to be blistered tomorrow. Right. And so what's my appropriate cadence for introducing these new skincare things?
- [49:22]
B
Yeah, I think, you know, starting with basics of like the three step regimen in the morning.
- [49:27]
A
And then we can all start right away.
- [49:28]
B
We can all start right away.
- [49:29]
A
Go for that. Okay, got it. And then the other sort of when we graduate up to using some of the antioxidants and the actives and the peptides, would you say maybe one at a time for those things?
- [49:40]
B
Exactly, yes, one at a time. Because even certain products, some of these products can be a little bit more cost prohibitive, like peptides or certain platelet exosomes. And if that's the case, you want to slowly introduce them and see which one gives you the best benefit, best bang for your buck, and then move on to adding multiples. There is something else that we didn't talk about here, which is called skin cycling. And skin cycling is this idea that you don't need all actives all the time, that you can actually take pauses and breaks and do some things on Monday, Wednesday, Friday, and others on Tuesday, Thursday, Saturday. So you can kind of stagger these actives too if it gets too much for your skin to introduce new ingredients.
- [50:20]
A
Okay, fantastic. Well, this has been incredibly helpful. I learned a lot and I appreciate it. A lot of the stuff that I needed to know, which is really good. So I'm going to take a minute here and I'm going to run through my notes and summarize those for myself and for the audience. And then I'm going to give you a chance to answer our big three questions again, kind of rapid fire style, if that's okay.
- [50:40]
B
Great.
- [50:40]
A
So my summary, I didn't realize skin turns over every 30 days, which, which is incredible. And then also the function of the skin is much more complex even than I knew in that it is a barrier. So it keeps out bad things. It's important for absorption, so it absorbs good things. Hopefully it secretes bad stuff away and helps us get rid of toxins. It's also a key thermal regulator and helps with internal homeostasis within our bodies. It also helps us with our immunity and some function in terms of it's the only source of vitamin D that we have naturally. And then lastly, it provides sensation, so it's really how we sense the world. So it is a very functionally diverse organ. It's obviously the largest organ in our body. It does decline with age, but only about 25% of our skin status is determined by our genetics. And so only 25% is fixed. 75% of that is modifiable. Even if you've made a lot of bad decisions in the past, you better go ahead and get started now because you can impact 75% of your future. Even if you didn't do it right in the past, there is some natural decline as we age and as our skin starts to shift, show visible changes and the appearance is affected, we know that that also probably correlates with some functional changes. So in doing this, we're not just trying to look good, we're also trying to improve the function and overall skin health. I like how you talked about in the daytime our skin is defending and then in the nighttime it's repairing. The average person spends about $500 a year on skincare, a lot of which I bet is probably wasted if it's not targeted correctly. Consistency is king. And taking care of your skin, you did a great job Running through my 20, my list of 20 different products and techniques and I appreciate that. And then you sort of gave us sort of the minimum skin routine and the advanced skin routine. I'm going to run through the minimum again. So in the morning, wash it, sunscreen, moisturize. In the, in the pm, wash it, apply a retinoid or retinol and then moisturize. So start, start there. And then we talked about some other things you can do as you pop up. So some vitamin C, nicotinamide, some platelet exosomes, antioxidants and other things that you can be doing as you reach later stages. That's my summary. I've got a lot of work to do, so I appreciate that. Now I'm going to give you a chance, answer our three big questions here. You ready? So, number one, what does our skin actually do for us and why is skin care so important?
- [53:05]
B
The skin is your largest external facing organ and it helps keep your whole body healthy. So it's, it functions at multiple different levels and optimizes overall health.
- [53:17]
A
Right. Number two, how do we make sense of the most common skincare options out there and sort fact from fiction?
- [53:24]
B
I would say here being consistent with things that have evidence that's backed them like a good sunscreen, good moisturizer, cleansing your skin and protecting your skin, so making sure you're achieving shade and Seeking shade as well as wearing UPF clothing when you're outdoors for long periods of of time.
- [53:42]
A
Great. And our last one, what are the regular skin care practices we should all be doing to help us have healthy, vibrant skin lifelong?
- [53:49]
B
I think changing mindset here that we're not trying to achieve perfect skin, a perfect appearance, but rather to achieve more resilient skin and a skin that helps you defend and just be strong for the rest of your life. I think keeping that skin protected and clean and hydrated and moisturized and. And protected from the sun are all important things we could do to invest in that resiliency.
- [54:17]
A
Awesome. All right, well, we always like to issue a challenge or a call to action here at the end of the show, and we try to help people get the first big win. And you've made this incredibly easy. So my challenge to everybody is to adopt the minimum skincare regimen if you haven't already. So we talked about that. In the morning, you're going to wash, sunscreen, moisturize. In the evening you're going to wash, use a retinoid and then a moisture moisturizer. So try that. And how long do we think we need to start doing that before we see changes? Some changes you may see as soon as a couple of weeks, but for maximal benefit, maybe up to three months.
- [54:51]
B
Exactly.
- [54:52]
A
So I would encourage you do that for three months and then see and then you can start thinking about moving on to the advanced plan that we outline. Serenity. Thank you so much. It was incredibly helpful. I learned a ton. I'm sure our audience did as well. We really appreciate you taking the time.
- [55:05]
B
My pleasure. Thanks, Chris.
- [55:06]
A
Good to our audience. Remember to live intentionally, consistently Better Keep striving to be the best human you can be so you can give your gifts back to the world and never stop optimizing. Thanks for listening to the Mayo Clinic Human Optimization project. If you like this episode, hit subscribe and leave a review. It helps others find us know someone who might benefit. Share the episode with them to join us in our mission to help as many people as possible become the best humans they can be. Have feedback or a topic idea. Email us at optimizeo. Edu and be sure to look for us on Instagram X and YouTube.
- [55:44]
B
This podcast is for informational and educational purposes only and should not be relied upon for medical, professional or legal advice. Always consult with a qualified professional for any questions. The appearance of any guest does not imply an endorsement of them, their employer, or any entity they represent. The views and opinions expressed by the guests are their own and do not necessarily reflect the views of Mayo Clinic. Reference to any product, service or entity is for informational purposes only and does not constitute an endorsement or recommendation by Mayo Clinic.