← Skin Anarchy
Loading summary
Transcript75 lines
- [00:00]
A
You guys, welcome back to Skin Anarchy. This is a very special episode because we're going to be talking about a topic that I think we definitely don't talk about enough and a lot of the surrounding science and just getting a true expert opinion from the dermatology side. So without further ado, I want to introduce you guys to Dr. Sabrina Fabi who is a double board certified dermatologist. She is truly brilliant and really knows her field, but she knows so much more and can educate us on things surrounding perimenopause, menopause, how the skin reacts, what we should be knowing. She's also the co founder of a brilliant brand called XOMD. I interviewed Dr. Dayan earlier on last year and he kind of briefly introduced us to xomd. But I can't wait to dive in further. So welcome Dr. Fabi. I'm so excited to introduce you again to our listeners and interview.
- [00:47]
B
Thank you so much for having me. It's truly an honor.
- [00:50]
A
Yeah, no, the honor is mine. I mean, I am such a fan of your work and the science you're bringing forward. I mean, I think there's just not enough information. Right, right. And for consumers there's just so much that we don't know and that we need to know. And so I'm really, really excited to dive into that. But first I want to really talk about you. I mean, you have such an impressive background in medicine and you know, I just want to learn more about you. Can you walk us down memory lane, maybe tell us about your career and what really got you into medicine to begin with?
- [01:19]
B
So you know, you as a doctor as well. I think medicine is more of a calling than anything else. I knew I wanted to help and heal others at the age of seven. It was like the empathic streak in me where it like hurt me when I saw others hurting. So I wanted to heal, I wanted to care for others. And it wasn't until I was about 12 that I realized that I wanted to be a dermatologist. Mainly because you'll get from most dermatologists that they suffered from their own skin ailments when they were a kid. So I, I probably saw dermatologists more than I saw, you know, I was never the kid that was having my bones broken or earaches or you know, ish like that. I was the kid that was at the dermatologist because she had her eczema or her acne, you know, her fungal infection. So I realized quickly how, especially as a child, you don't even, you're so self conscious, you know, you can probably be a little bit more prone to be insecure, and you. You're trying to hide things because you don't want to get made fun of. So I realized early the impact that our outward appearance has on the way that others perceive. Unfortunately, it's just the truth and judge us and then interact with us. Right. Whether it's good or bad. Right. And so I guess first I wanted to at least minimize whatever that condition is for someone navigating the world so that they can be more confident in their own skin. So that's really what made me want to be a dermatologist. And it was in residency. So I did my training from outside suburb of Chicago and did my training in Chicago, and then I went on to do a cosmetic dermatology fellowship. And this is at the time, if you think of esthetics, Esthetic medicine is a relatively new field really, you know, anchored in maybe some laser work that was done in the late 90s, but Botox Cosmetic didn't even come out until 2002. And that really is what created an entire field with my mentor, Jean Carruthers. So if you think of it like I was in training in 2007, so it was relatively new field. There weren't a lot of fellowships, and I wanted to excel in this space. I wanted to become a laser expert, mainly because I found that a lot of derm conditions are things that are just managed, not cured.
- [03:40]
A
Yeah.
- [03:41]
B
So seeing patients for the length of their life, you know, just trying to manage whatever it might be. And I found that lasers usually got you to a much faster outcome. That brought greater satisfaction for me. Is the. Is the doctor and to the patient as well.
- [03:57]
A
Right.
- [03:58]
B
So that's kind of what made me go into aesthetic medicine, is the ability to control the outcome a little bit more, you know, whatever sense of control we think we have, I guess.
- [04:06]
A
Yeah. No, I love that, though. I love that you bring that up, because I've tried to have this conversation actually before where I've. Because I'm just, you know, out of curiosity. Is like aesthetics, Right. Because it's exactly. It's blown up. Right. Recently, in the recent years. Now everybody talks about aesthetic medicine, but it's like even a few years ago, I remember being young and learning about Botox, and no one could even educate on Botox. You know, it was like, hard to find information, like, just to educate yourself, you know, and to understand, like, what does it even do? What are the benefits? What are the, like, all of that. And so now it's like we went from that to like, hyper saturation, you know what I mean, in terms of education. So it's a very interesting growth that the field has seen. But, I mean, I want to come back to your point. You made about, you know, a lot of these. Like, I think the procedures that take place in a static medicine and, you know, really speak to us about this because I think a lot of our listeners, I know a lot of you that tune in, like, we are all at that age where we're opting in for more, you know, just. I'm not, I don't want to say aggressive, but just, I guess, more efficacious options, you know. And so when we're trying to get that glow, I mean, what have you seen, women or men, like, for us to jump into, like, what have you seen us jump into doing where you're like, well, I wish you would dial it back a little bit. Maybe you could give us like, you know, an example or something.
- [05:21]
B
I probably say that what people need to dial back on is doing the wrong thing just because it's the easiest, quickest thing to recover from. Yeah, that's like, most cost effective. Sometimes, you know, doing a more aggressive laser, even if there's five days of downtime, might be what's appropriate, not necessarily a filler, right. Or sometimes what you need is a filler, not necessarily a neuromodulator to relax the issue that you have. So I think sometimes people, you know, go for what's most convenient, maybe because in some parts of the country, it's more accessible. If you go to the mall, you know, you're there, you can do whatever it is that you need to do. But this is still the practice of medicine. And so being assessed properly, being treated like medicine, right? Like being assessed, diagnosed properly, and then getting the right treatment for you, not like, well, I don't want to really do that because it's just gonna. It's too much downtime and it's not convenient for me. Like, we would never do that with, like, the medications that we take or the chemo agents that we take. Right. You're going to go with as most appropriate for the diagnosis. And, you know, you're not like, you know, of course you have to be cost sensitive, but you're definitely not going to go for the bargain either. Right? So I think that we're seeing it being treated too casually. Like, it's not like. Like it's not a aesthetic. I mean, not. It's like, it's not a medical procedure, and it's still the practice of medicine. And this is still your face, and there's still anatomy to consider, and there's still like, anthropometric issues that need to be considered based on your skull shape, based on your ethnicity. And those things only will happen with someone who has the intellect, experience, and knowledge to be able to assess you properly and then diagnose you properly, to give you the most effective treatment.
- [07:16]
A
I love that. That is. I love that you're saying that. And, you know, I couldn't agree more because that's actually, for me, I've always been so hesitant. I'll tell you, as a patient myself, I've always been very hesitant for procedures because of that exact reason. Because it's like, I don't know if the person treating me and being in medicine myself, I don't know if they know how to deal with my specific needs, you know, like my ethnicity component. The ethnicity component, like what I'm looking at. You know what I mean? So it's always been scary, actually, for, you know, I don't know how consumers went from like, being hesitant to now, like, everybody is getting filler, everybody's doing laser, everybody. I mean, it's kind of overwhelming when you think about it, you know, like, where did. Where did we go from like, you know, being kind of slow and steady to just like, let's jump in, you know, and get everything at the same time? I mean, I hear a lot. I recently interviewed a few people that told me about, like, a lot of. A lot of people going overseas to Korea, and they do like nine procedures in one sitting. And I'm like, that can't be good, right? Like, that can't be a good thing.
- [08:22]
B
So it's like the ATM withdrawal at 3am it's probably never for a good reason. Yeah, I. It's, again, it's not being treated like medicine. You know, you wouldn't do that. You wouldn't hop around. Oncologists, you know, every treatment, you know, you may get a second opinion. And I think that's always important. And I think when you're to your question of, like, what are you seeing? A lot of that people need to dial back on. It's the hopping around around, too. That's probably the second thing. Like treating this so casually, like you're dating people. I think it's important to stay steady with someone, you know, be a little bit more monogamous, find who you trust, who's credentialed, who, you know, is. Has the intelligence and Capacity to do what they need to treat you holistically and then. And then stick with them because it's not worth the flash sale at the mall, you know, Because I think that when you keep. When you put too many chefs in the kitchen, it does end up maybe distorting, perhaps, the way someone potentially love.
- [09:28]
A
Absolutely. Yeah. And I think that's such a solid point. And I actually want to kind of dive in further here because I think this specific concern is. Is especially prominent in women who are undergoing the. The first few changes of, like, perimenopause or even menopause. And I would love for you to speak on this because I think that's such a vul time in our lives. And it's so easy, I think, to get sucked in. What are your thoughts around that? And, like, what we should be doing and what should we be really planning for, both psychologically, anatomically, like, those kind of things?
- [10:02]
B
I, you know, I love this. I would, I would tell you that this is probably my passion. It's one of the biggest drivers behind xomd, which is a product line that we, we created leveraging, you know, the hormonal, the hormones that are at play when one is going through the transition, which we call perimenopause. And for those that are listening, menopause is, is. Is defined as when you have completely lost your menses or period for 12 consecutive months. So if you just went, you know, your period, you missed or skipped for two or three times, and then it comes back, you're still not in menopause. But if you've skipped 12 consecutive months, that is the definition of menopause now. And that's a day that it happens. And then every day moving forward is post menopause. Okay? The thing is that there is a time leading up to menopause. It's actually the longest time, which is four to eight years. And many women don't necessarily know when they're in it. Hormonally, you can't quite check because your hormones are all over the place. So it's like kind of like a moving target that you're trying to check. And it's maybe high one day and then it's low another day. So if you kind of follow the Menopause Society of North America, they don't even recommend using hormones to inform whether you're going through something. It's more symptoms. And there's the Menopause Transition Scale, which a lot of integrative medicine doctors or other hormone health specialists will use. And so during this phase, generally, one of the first hormones that declines is progesterone. Estrogen always gets a lot of attention. You know, it's like the hero hormone that, you know, that gets a lot of, you know, a lot of. A lot of attention. But I'd say that there are other hormones, and this is kind of what has inspired me. Progesterone is a hormone that we start to see decline first. It's responsible for your sebum production, your oil production, probably the reason why some of us might have a little bit more acne earlier in life. And so this starts to decline. So most women in perimenopause, the first symptom is dryness. Not lines or wrinkles like you see in menopause, but dryness. And so I started noticing in my patients that have now I've been blessed that are following me and with me and loyal for the last 16 years that, like, they'd been with me in their 20s, 30s, and all of a sudden now they're 42, and their skin just looks a little duller. They're coming in more to get the same outcome. That would require maybe just two laser treatments when they were in their early 30s. Or we have to go heavier and get more aggressive with our laser treatment to kind of restore that glow, that dewiness, that's a hallmark of youth. And it's partly because of that hormone progesterone. And there are other hormones. There's also a decline in testosterone in some women around the same time. This is important because it's responsible for our muscle mass. So if you read more and more into the menopause literature with testosterone, it supports our muscle mass retention and creation. And in your 40s, you're already prone to start losing muscle, which we call sarcopenia. And so what starts to happen is that your muscle mass is responsible for your basic metabolic rate. So basically your metabolism. Right. And so as that starts to decline, then you start to see that you can't hold the muscle that you used to have. And now you're holding onto more fat than you've ever seen when you eat the same amount of stuff you've always eaten. So there's so many shifts happening, not just at the level of the skin, but the body. And so, you know, the thing is that most women, because they haven't lost their periods or they're not having hot flashes, they think that they're not having a hormonal shift.
- [13:48]
A
Interesting.
- [13:49]
B
Yeah, because most of us, you know, there was an interesting survey that was conducted by Galderma just last year that I was involved in, we just published. We just presented it at this world's congress in Paris in January. And they surveyed 4,300 women over nine countries. Okay. And they were between the ages of 45 and 60. And they were basically trying to understand their level of knowledge around menopause and perimenopause, what symptoms they experienced or thought were contributing to being, you know, going through this hormonal shift. And the majority of women, actually over 54%, were perimenopausal. Okay. So we're talking about a group primarily in their 40s, because menopause usually hits average age US for 51. And what we found was that the number one thing the perimenopause patient complained of was dryness. The number one thing the menopause patient compared complained of was fine lines and wrinkles. And then both kind of complained about loss of firmness and elasticity. But what was even more like what I see in my patients and what you were alluding to when we started is the impact this has on mind and mood. Right. These hormones don't live in a vacuum, just affecting our skin.
- [15:12]
A
Right.
- [15:12]
B
Also, they affect our brain too, Right. Because they live everywhere. Right? Yeah. Systemic. There's receptors everywhere. Right. And so the number one thing that these women reported out of, you know, of various questions that they were asked was that they felt that they looked less attractive. This was like the most. The number one thing. And then the number two thing that they complained about was, as a result, they felt low in their mood and a little bit more anxious. Okay. And this is a global survey, so this is not just one demographic. And then the third thing they complained about as a result of all of this just not feeling themselves anymore or recognizing what they're seeing in the mirror was feeling less confident. Those were the top three kind of social. Social metrics that we saw. And so this really, you know, it's. It's what I see in practice. And I'm glad that they did this survey because it just reiterates information that there's a gap to fill with women, because if you're not having a hot flash, women don't think that there's a hormonal issue happening. And women go through hot flashes.
- [16:30]
A
Right.
- [16:31]
B
Show up on your skin first. It can show up in your mood first. It can show up at 3am when you wake up and you don't know why you're waking up when you used to sleep so well first. And a lot of those women complained about not feeling well educated. Like, when we were in school, you know, we all went through, like, you know, the birds and the bees and that kind of, you know.
- [16:56]
A
Right. There was some education. Yeah, yeah.
- [16:59]
B
But you don't go through the menopause conversation.
- [17:02]
A
No, right. Not at all.
- [17:03]
B
And so women and men, because menopause go through. Now what's being coined, Menopause. Right. As a decline in testosterone. So people aren't prepared, and it's just kind of like we'll just live with it. Yeah. Transition, you're just supposed to live with.
- [17:16]
A
Yeah, exactly. And not only that, I also feel like it's like, almost it's been shunned for so long. Like, women have been so systemically programmed to not ask questions. Like, literally. I remember being younger, and I don't know if any of you out there can relate to this, but I remember being younger and, like, you know, older women, right, that were like, my. Like, in my circle influencing me. Like, they'd be like, well, don't talk too much about this and don't. And, you know, so this is like a thing. Like, women don't talk about our problems. And so not only do we not have the education, we don't even know what to ask, like, half the time. You know, Dr. Fabi, I literally. I get emails, right, from our listeners, and they're asking like, well, what, Peptide, do I use? Like, everything. Everything you just described, everything you just went through with the dry skin, the issues that we're facing. People are literally chiming in every day and saying, well, what's the best. Peptide, for me, what's the best moisturizer? What's this? It's like, there's no answer that we can give you that's a one and done. And it's like that whole understanding that education component is so lacking, that women are truly. It's like the beauty industry profits off this miseducation of women, and we profit off of, like, not, you know, not educating them in a way that's like, okay, ask better questions instead of asking, what, Peptide? Ask what set of ingredients is actually going to trigger my cells to do what I want them to do? You know, can they still do. Can my fibroblasts still create the collagen that I need them to create? Is that even possible with topical solutions? Like, these are the kind of questions and I. I never see this come up. You know, it never comes. I don't know if your patients have ever approached you with this kind of stuff. I mean, what do you hear in the clinic from from your patients.
- [18:56]
B
That's such a good question. You're right. Like, we're so right. It's the capitalism that we. We live in. I guess it's. The focus is more on the solution. Yeah. Then why is this happening? And what, like. Like a fundamental understanding of the why versus. Okay, I can just. There is this solution that exists. Do I need it?
- [19:17]
A
Right.
- [19:19]
B
You know, you know, we're. And again, this goes back to what I was saying. We treat this like going to the mall and buying shoes. Right. You know, it sounds really good. That doesn't mean that you may need it, you may not need it at all. You know, like topical prescription. Like these topical estrogen creams, for instance.
- [19:35]
A
Yes. Oh, my God. Can we talk about this?
- [19:37]
B
Everybody wants them, but, like, I'll tell you, you know, I'll just be like, maybe a little bit too much information here. But like someone who's, you know, maybe in perimenopause, hard to say, but my estrogen levels are so high, Eka, that it would not. Like, it would do no service to me to add more topical estrogen. My fibroblasts and my keratin, my cell, you know, the. The cells that are in my skin, they're maxed out with the estrogen that they're receiving. Right. Just because it sounds really good on Instagram or an ad that's running doesn't mean that it's a solution for me. In fact, it might even be harmful for me if I even add more estrogen to a person who already is in a high estrogen state, because that can have a side effect where we see a lot more redness with too much estrogen. Right? So, like, it's, you know, so just to, like, self medicate is not, you know, going to someone like, again, right? A trusted professional, a trusted resource that you can run things, these things by is super important.
- [20:39]
A
I agree. And you know, I love, I love that you brought up estrogen because for so long, I literally have been like, racking my brain trying to figure out why every woman needs an estrogen cream. Please tell me, like, there needs to be some sort of, like, someone needs to come out with an official statement explaining this, because I swear, every person that has ever come to us chimed in, or I've spoken to, right? Like on the consumer side, they're like, well, how do I layer my estrogen in with all these other skincare products? And I'm like, I don't even think you need it.
- [21:11]
B
You may not, because it's about a ratio thing Right. These are about ratios. So like I just said, the perimenopausal woman, her progesterone drops first. Now, you may not necessarily want to go just throw estrogen at your progesterone at yourself. And if, you know, because it might cause too much oil production or it might make you a little bit more bloated or it might, like, you can't just treat yourself like it has to be in the context of the entire environment that you're adding this stuff to. Right. So it's a play on, It's a play on ratios. So if you have already high estrogen levels because you're, you know, it's more that you're having a decline in progesterone, especially if you're perimenopausal. What? Why? Your, your receptors are already maxed with that estrogen intake. Why would you apply topical estrogen and think that's going to add even more benefit? That may not be what you need. You may need something else. You know, So I think, I think that maybe just people see things as trends. Yeah. Jump on the trend without consideration that it may not necessarily be what's necessary for you. And listen, I'm an early adopter most things. I mean, Steve will tell you, like, I'm like, I'll go try this peptide. You know, I mean, of course I did my research with which one might be. There are so many and you should be seeing. I, I mean, as much as I know and as curious as I am, I don't try to pretend that I know about all of them, you know.
- [22:40]
A
Right.
- [22:40]
B
And they're, you're. If you're injecting them, you're messing up with the homeostasis of your body. You have to be helpful about what?
- [22:47]
A
You don't even get me started on the stuff. Yeah, I completely agree. And also, it's like, you know, one of my biggest pet peeves has quickly become this idea that we need to, like, put everything we can systemically into our bodies. Like, it's like, I feel like people like, I am a huge believer in longevity. I'll tell you. Like, I really believe, I believed it my entire life. Life, like, since I started studying medicine. I believed in the concept of longevity. I think any scientist has, you know, we understand, like, there's a real value in understanding human biology on that level. But then when you get into the realm of like, biohacking and all the, all that stuff, like, it has really kind of just cluttered the space and made people think that everything needs to Be injected when it doesn't. Like the. Literally, like the skin is the largest surface area that we have to utilize and to work with, and we're not doing it properly, and it's not. And it just kind of blows my mind how we're so quick to be like, well, what can I put in my body? You know what I mean? Like, it's like, leave your liver alone. It'll thank you, I promise. Like, leave your GI system alone. Like, just, you know, like. And that's why I really. I think this is a good segue. And I really want to dive into XOMD because the whole idea, like, when I first. When Dr. Diane was first telling me about this, I mean, I was blown away, right, that you guys have really brought this entire concept forward. Because again, feeding into what you just explained to us about receptors, there is a such thing. There is such a thing as receptor fatigue. There is such a thing as receptor oversaturation. There are multiple receptors in the body. Why aren't we utilizing multiple pathways, you know, and trying to fix things? So I would love for you to kind of give us like, an intro to exomd and tell us, like, the science, because I think it's phenomenal what you're doing.
- [24:35]
B
Thank you. So I would say that XOMD was born from the idea that, you know, there's definitely a connection. And honestly, if you even think of the history we talked about in the beginning, the history of aesthetic medicine.
- [24:49]
A
Yeah.
- [24:49]
B
Born on the idea of a neuropeptide, right? The most popular neuropeptide that we know, we manipulate every day, which is acetylcholine, with the use of Botox, we block its ability to bind to the receptor, and you no longer have as much muscle movement, and voila, you have a facement of a lot line or a wrinkle. Right? And so that's kind of how, you know, Botox cosmetic works. So that's not the only neuropeptide. So this is not like a foreigner concept, right, with the use of neuropeptides, things that reside in our skin but also, you know, have an effect in the brain. Why? Because our brain and our skin both derive from the same tissue called ectoderm when we were in, you know, in utero. And so you're. There is the thought. And I think Steve may have covered it already, you know, which is, if you potentially rev up something locally at the level of the skin, can you have a benefit? Not because somebody necessarily looks good now, because their skin looks good. Right. That now they feel more confident, more attractive and their moods better. But is there possibly like an upregulation that happens at the level of the skin that then creates an upregulation, you know, feedback loop at the level of the brain? Right. So, Steven, you know, like, if you really understand medicine, you understand physiology and you understand neurohormones and neuropeptides, there's a lot more at play. And I think, you know, what's inspired me is my patients recognize the patients that look the best always now, in 16 years of following them, are the ones that are optimized hormonally. I like, not just in the way they look, but the way they show up. They're more confident, they stand, they sit up straighter, they, they take control and demand of their life. Know their bosses, whether they're 60 or when they, when they were 45 and sitting in my, you know, in my chair. So. And the other women look beautiful, but there's definitely, you know, a difference. If we're talking about longevity, there's definitely no doubt that hormones probably play the most significant role because it's the environment that they're feeding and creating. So if we're looking at hormones, it's not just estrogen. We talked about that. One always gets all the, all the glory and, and praise. But, you know, we talked a little bit about progesterone, but there's one called oxytoci. This one also declines in menopause. Your ability to recognize it and be sensitive to it declines. And this hormone is of interest to me because twofold in 2021, there was a great publication that came out of Journal Drug and Dermatology by a co dermatology colleague of ours that showed she was curious, you know, why do some women also look so much better in their 60s, even if they've had all this sun exposure, than somebody who's 40 and hasn't had as much photo damage as serum levels of oxytocin. And those that were the people that had higher serum levels, in fact, in her trial, the woman that had. Was 57 had much higher oxytocin levels than the woman that was 48. Right. So you can't say it's age related. You can't. I mean, you can't say that it's age related necessarily, and you can't say that it's photo related. Like, okay, if I go out in the sun, it's going to decline. Right. That woman looked on average three years younger. So it's like we've we kind of brush it off. We kind of think of it as second nature. Oh, like, you look so good. You must have had a good night. Or are you in love? Or what's. You know, we say it societally. Everyone knows it. Well, is there science to support it? And so if you, you know, you're. You're knowing Steve and I more and more, we're constantly curious and we're constantly kind of challenging, like, the dogmatic thinking that everyone wants us to adopt and which is why we love you. Because you're like, wait, what. What people? What are people just believing and doing? You know, like, let's question things. Because there's so much learning in the question. Right. And we can be better if we question things. So we. We. We saw that. We're like. It was interesting. Right. And then around that time, we started kind of looking. Historically, you could only really leverage oxytocin through a nasal spray. Yeah. No pills or IV forms or anything like this. And so we coincidentally, you know, we started kind of looking for a neuroscientist to, like, potentially see if there was a way that we could bind to the piezo receptor. This is a receptor that's at the top layer of our skin that if you can bind to it, it intrinsically releases your own oxytocin at the level of the skin. Oxytocin is created in your skin. This is why when you hug, touch, kiss, it's not like you have to, like, just the touch releases it locally. Okay.
- [29:31]
A
Yeah.
- [29:32]
B
And then it has a positive feedback loop to make you feel better. So we found a neurobiologist that had created a peptide that could bind to this piezo receptor, which actually received the Nobel Prize for being found in 2022.
- [29:49]
A
Wow.
- [29:50]
B
And it's a mechanoreceptor on the skin, which is what, for those that are listening, it's when you touch it, like, it's something that is a receptor that's activated by touch that releases oxytocin. What if you could activate it by binding to it? Right. So some things sound really good, as, you know, in medical school, they sound good in vitro, but then they don't translate into something in vivo, in real life, with the human. Right, right. And so as we're onto this, I get pregnant, and I spontaneously get pregnant. At 42, I thought that I was infertile, truthfully. And so it was like, wow, that's one. And then two after getting aesthetic procedures for 18 years. Well, was I 18? No. Like, 13 years. I started when I was 29. I looked younger and better pregnant than I had looked right before getting pregnant. With all these aesthetic procedures, you had the pregnancy glow. The pregnancy glow, yeah. And it's not because I got so overwhelmingly big that my tissue stretched out. Right. Because I didn't gain that much weight, actually, in the first, you know, two trimesters. It was like, I actually had people coming up to me within about three weeks before I even, like, had told anybody. And they're like, are you pregnant? Yeah. Good. So you see, people know what that looks like, but we just haven't been able to measure it or, like, quantify it. Right. So that, like, we were onto something. So we worked on a formulation because, as you also know, right. Like, if you even have an Active, if you have a peptide, it sounds really good. We've learned a lot, actually, from cne. Ascorbic acid is an excellent example. If you put it in the wrong vehicle, it's inactive. If you put it in, like, you know, it has to be, like, in a dark glass, otherwise it gets oxidized. Right. So even if you have an amazing Active, if it's not in the right formulation, it's going to be an activated. Or it may not even be active by the time you apply it on somebody's skin. So there was a lot at play. So we. It took about two years for us to formulate this, and then we put it to the test because Steve and I really don't need. We just did it out of more, like, curiosity, intellectual exercise to prove our thought than to even think that we were ever going to commercialize this. Okay. And we did a randomized placebo controlled trial. So for those that are listening, this is kind of what we use in aesthetic medicine with, you know, the use of devices or drugs. Like, this is the highest level of rigor in that. Half the group was randomized by a randomization calculate calculator to receive the Active in the vehicle that we formulated. And the other group, blinded to the investigator and to the person received the product. Just the vehicle alone, without the ox factor, which. Without that blend of peptides that bind to the receptor.
- [32:56]
A
Right.
- [32:56]
B
And we followed them for four weeks, in as early as four weeks, what we found. Because people want results fast. I mean, that's the reason I'm in a static medicine, because otherwise, you know, I would have done medical derm. Because that. That's one of the hardest things people want, especially now. I mean, that was 20 years ago. Now it's like, people want. They won't wait for an Uber for more than seven minutes. Right, Right, Yeah.
- [33:19]
A
Attention span has gone down.
- [33:21]
B
Yeah, yeah. So attention span in patients gone down. So in as earliest four weeks, we saw a significant difference in metrics like redness. Why? Because we know that oxytocin is mother Nature's own anti inflammatory peptide. It decreases inflammation almost to prime you for the inflammatory physiologic. Pregnancy is improved skin dryness significantly. And this is like in the winter of Chicago, which the study was conducted between November and February. And so here we found that they. And why is this happen? Because oxytocin draws in water into the dermis, into the second layer of the skin. So that's the reason why women look so dewy when they're pregnant. This is the reason why I didn't need aesthetic procedures when I was pregnant. Because your skin almost plumps up a little bit even if you haven't gained the weight, right? Yeah. Improvement in dryness, radiance, dewiness, redness, and then skin tone evenness. Because we know that redness contributes to pigment. A hypervascular face is going to feed pigmentation. Right. So if you can minimize the red, you can minimize the brown. And so we saw an improvement in skin tone evenness. And as a sanity check, we also looked at fine lines and wrinkles which we didn't expect would improve yet because we don't expect fibroblasts to still have an improvement or respond in as early as four weeks. We've learned that from the retinol trials. So there was no difference in fine lines and wrinkles as early as four weeks. But in all the other metrics there was improvement at eight weeks. There was even greater improvement in those that continued on the topical. So we know that if you're going to use topical scan skincare, be consistent because yeah, you'll only reap a better benefit. And the people that were on it for eight weeks looked better than those that were just on it for four weeks. Because at four weeks we crossed over the placebo group and we put them on the, on the xomd.
- [35:31]
A
Wow, that's.
- [35:32]
B
Yeah, for quite a long time there. I'm gonna.
- [35:34]
A
No, that's amazing. I'm just listening because I'm just thinking about all the different parameters that are like your kind of targeting here. I mean, I think this is incredibly fascinating because when you look at conventional dermatology like solutions, one of my biggest complaints has always been the amount of inflammation that we're inducing in people, you know, and like the amount and the damage that is actually doing and the real aging that's occurring because of that. And so this really makes you think because you. You touched on so many. So many important parameters. Like, you know, the inflammatory response alone. Right. Like the. Like down. Regulating inflammation is one of the hardest things you can ever do. Do in the body. It's like one of the hardest things to target. It's. I mean, everybody knows this. And for the skin especially, I feel like this conversation recently only has emerged where we've defined what an, you know, the inflamma aging word even means. You know, and so that's really fascinating for me, I think even from that perspective is this idea that if you are using other stuff, like if you are on trep, for example, and I'd love for you to speak on this because there's so many women, you know, and men. I mean, everybody's on Tret these days. You know, we. Everybody who goes to dermatologist. You're getting some sort of prescription. So being on tret, knowing what trep does to the skin, it is going to. It causes inflammation. How do you feel about someone pairing Xomd moisturizer with Tret or like, something like that? I mean, do you think that's where, like, synergy is really, like, happening? I mean, do you feel that there is, like, you know, positive synergy there?
- [37:04]
B
Oh, 100%. I mean, and the reason why is. I couldn't agree with you more. For anyone that wants to understand aging at the most simplistic level. Yeah. Aging is an inflammation, is an inflammatory process.
- [37:17]
A
Yes.
- [37:17]
B
The more inflammation, the more you're aging. That's the reason why, like, if you have too much of your high, have chronically high cortisol levels, you're definitely going to age more. It breaks up your collagen and elastin. No matter what procedure or how much filler you put in, if you're stressed, you're kind of working. You're working against yourself. Right, Right. So. So it's an inflammation. Aging is an inflammatory process. And so then to be able to potentially, you know, in. The reason why oxytocin is used in the plastic surgery space is because it reduces the inflammatory mediator interleukin sex. So you can control, like, you need a little bit of inflammation. There's the concept of. Of hormesis or, you know, a controlled or good stress. Yeah, a little bit of stress, which is like. Then that becomes the hard question to answer. Like, when is too much stress bad? Right. But if you're in a. In a wound, in this case, they were Looking at like lower, you know, ankle ulcers, they used oxytocin and it reduced inflammatory media and lupin 6 which, it reduced inflammation, it reduced rat free radicals which form from again stress from external factors, from eating too much sugar, from a lot of a host of things. And then this promoted wound healing. So it, that just, just shows you the power, you know, oxytocin has. Now our product doesn't have oxytocin. It is a botanical based peptide that binds to a receptor that releases your own intrinsic oxytocin to give you, you an oxytocin like effect that we see. Right, right. And so, so that's the concept on its anti inflammatory properties, which is probably the reason why we saw a decrease in redness. Now my Tret users, right, I, I'd say 50% can really tolerate it every night. I, I, you know, I don't know, maybe they're more sun sensitive. In San Diego I treat 30% of my patients have rosacea and really sensitive skin.
- [39:23]
A
Right.
- [39:24]
B
And even tolerate it. So that's the type of person where I might use the XOMD serum first because the beta glucan in it, the vehicle that it's in, draws in water to make you a little bit more moist and then the ox will help with that decrease in inflammatory response and then you can tolerate that pea sized amount of Tret. You don't need a thin layer to get the effect of your Tret. Right, right. Then you can put your moisturizer, I like aroused because it's a glycerin based moisturizer, it's a sugar based moisturizer. It's not in a dimethicone base, which can sometimes prove occlusive. And if it's too occlusive now you're trapping your tretinoin in your skin and even it's almost counterintuitive. You're like what I'm moisturizing. Yeah, but you're like in an occlusive, an occlusive based product is trapping. Right. It's not moisturizing. So it might trap the drug that you're putting in there. So caution, you know, is probably what I'd say. But yes, it absolutely helps my more sensitive skin.
- [40:31]
A
Folks, that's exactly why I asked you because I feel like this is why to me, I love what you're doing with Xomd like at large in this industry because of this exact question that I had for you about Tret because it's not that that we can't use drugs or like harsher actives.
- [40:52]
B
Right.
- [40:53]
A
They're proven. There's data. Okay. You know, we know the benefits, but it's also about, like, educating consumers on. You need to also know how to pair things. Because if you have too much inflammation, and Dr. Fibe, I think you already spoke on this. If you have that much inflammation in your skin, in any tissue, it doesn't matter what you're putting on, on like that, in that inflammatory burden, you know what I mean? That inflammatory burden is going to just completely clog that micro environment and not allow normal receptor binding. It's not going to allow for normal signaling to happen. Like, there's like that physiology won't take place. And so that's why I asked you that, because so many people chime in and ask this question of, well, I'm using Tret. Even if they're using it every night, you know, even if they're using it three times a night. What else can I put with this? And so that. This is your solution. This is the kind of product you need, something that's going to calm down that inflammation and actually let your, the drug work. You know, I can do its job.
- [41:54]
B
So I think without irritating you in the process. 100, 150%. I, you're, you're absolutely right. I mean, and that's the reason why we, you know, it's like a laser is excellent, right? Like, let's say CO2 laser, right? The most aggressive laser that you potentially do to yourself. But this is the very thing. If it, if it's uncontrolled, then that injury is now shifting into too much injury, which can cause scarring. Right? Like, too much injury is not good. Right? So it's a delicate balance when you are playing with stress, when you're stressing your tissue in order to try to get the response of. Because, you know, your tissue gets sleepy. And so the thought here is to kind of wake it up with a controlled stress response, which is a play on hormesis. But the problem is if you create too much stress, then you can actually have a negative consequence, like scarring.
- [42:54]
A
Yeah, no, that's very real. And that's. I'm glad you're saying that because I think that's really, I mean, truthfully, if you ask me, just as someone who's been observing the space of skin care, I think that's what we've been doing. And we've been using 10 products for, like, literally how many of you out there exfoliate five times a week? You know, like, I've Heard this time and time again. People are using.
- [43:18]
B
Unnecessary. Yeah, unnecessary. Right. You see it in the 17 year old teenager that's scrubbing their acne and using salicylic acid on top of an alpha glycolic acid. Yeah. Like what ends up happening. They'll tell you that their acne flared, they look more red, I mean because your see your sebaceous glands go nuts and they're like wait, I need to produce more oil to protect this barrier that's been disrupted. So it's, you have to, it's a controlled manipulation. Right. And so that requires expertise. And if you're going to play with an aggressive laser, let's say just like, because that's a controlled, you know, thing that we know exists, cysts, then it's like you then have to do things to counteract the inflammation so that you get the desired outcome without the potential side effect.
- [44:03]
A
Exactly. And you know, another thing I really want to kind of point out here just for our listeners because I think this is like why I really love your approach with XOMD so much is because I'm a huge believer in like cell biology and molecular biology like before any other like medical sub discipline. Like for me that was my first love in medicine, you know, like cell signaling. And when you think about the amount that you can accomplish with proper signaling and sending the right signal in the right dose in the right amount with consistency to any tissue in the body is profound. The results are profound. I mean all of oncology medicine will show you that. You know what I mean? It's like people need to understand that. And I really feel like consumers will stop spending ridiculous amounts of money if we just, just wrap our heads around this biology concept, you know what I mean? Like, just like, like using a product that is telling you like you use this every day, okay, Every day. You do this every single day. You're training your skin, you're training your organ to respond every day on cue. That's going to go way further along for you than like okay, well two days I'm doing this. Third day I'm going to go get a laser treatment. Fourth day I'm going to exfoliate the crap out of my skin. Like you can't do that, you know, and, and unfortunately that's where we are because there's so much misinformation out there, you know, and there's so much like conflicting information. So what are, I mean I'd love to hear your thoughts on that in terms of like these like multi. I don't know, like multi modal routines people have, I mean, you know, what are your thoughts?
- [45:34]
B
You know, this is the deal, right? And it's like, it's, I love hearing you because, you know, I, I'm like, I am, you know, I'm in the more aggressive camp, you know, but I've been humble, right? And then I have the, I've been humbled by the body and I've been humbled to see, you know what, that's a little too much. And I've also, I, I put it to the test. Like we, we do trials. If we do this on top of this, do I get a better outcome sometimes? No. You know, if I do it alone, it actually in some cases, when we've done studies with one modality versus combining modalities, we find that the singular modality worked just as good as the combination. And in other studies, like we did an ipl, clear and brilliant, let's say half the face. IPL alone on the other half I. Clear and brilliant. Alone on the other half we ran. So I actually, I'm curious about this. Like I, I try my. So it's like test it, right? Like do a study, run it, run it through the irb, you know. Right. And we found in that study that the combination did work. Work. So I think it's the right amount of intermittent stress.
- [46:43]
A
Yeah.
- [46:44]
B
You know, that then creates the adaptive response that you want in the tissue. But if it's severe stress, the tissue may not like it. So it's like, it's like creating chocolate chip cookies, right. It's like a little bit of salt, something times makes them taste good. But if you put too much, then it's like it ruined it. So, you know, but we don't know the, what the effect of these combinations are sometimes because they're studied and they're approved as singular treatments and modalities. Then people sometimes try to layer it or come up with their, you know, proprietary combination for marketing purposes. And there's no doubt that sometimes the combination can absolutely give someone a more desirable, complete, effective response. But sometimes it may not be necessary.
- [47:40]
A
Right.
- [47:41]
B
Because more doesn't always mean better. And so I think it's like asking your doctor or provider, has this been looked at or investigated? Combine it. Is it necessary? What's the right sequence and why are you doing it this way? Try to get an idea of whether they're thinking about what they're doing. Not just doing it because the place down the street is running a special for some competitive other combination, but like there's actually a scientific, medically based reason as to why they're combining something. I think that that just simple question can get insight on whether they're thinking.
- [48:25]
A
Well, just also, like, I love that and I, I love that you're saying that because I want to really circle back real quick to that, you know, that conversation we first had about the, you know, perimenopausal menopau years, you know, and the skin changes. I mean, really, I think this is so applicable what you're saying, especially during that time period for women, because we are so quick to jump the gun and we're so quick to be like, well, if it's, hey, if there's any data, I'll do it. You know, I've seen this, like, I've seen so many of our listeners chime in about that, but, like, what are the latest treatments? What are the, you know, and it's like, guys, like, you gotta pause and you gotta really think, like, like, what is going on with my body and why does this matter and how do I actually get to the bottom of this? And so, you know, I guess, like, I, I just want to round out the interview and really get some words of wisdom from you for that demographic of our listeners, right? About like, how should you, like, what should they be pausing on and how should they really be like, I guess, re strategizing when it comes to their skin care, you know, strategy or their skincare approach. Like, what are some things you would suggest, like a good starting place.
- [49:34]
B
Yeah. So, you know, going back to that survey, because I like to kind of lead always with some type of evidence, right. You know, like let, let, let us kind of anchor in that and then we can, I can extrapolate based on my experience when we went back to that survey of like 4300 people and this is the largest menopause survey that I am aware of, you know, globally conducted, when women were asked what they're doing, doing to combat their symptoms, the number one were food supplements. Right? It's like, based on what? Right? Like, how do you know these aren't even approved or even usually have studies to support their claims. And so that was an interesting thing. Some women. The third was dietary change. Okay. Interestingly, HRT only 17% of women even use to try to combat the cutaneous changes that they were seeing. And esthetic treatments only 15% were doing to combat the skin dryness or the lines and wrinkles they complained about. So that was interesting. A lot of women don't even make the association that the changes that they're seeing are caused by hormones and that, that what they need to do to address those skin changes are not found in food supplements. Right. So. So that was like an interesting learning for me. And so when they were asked, took it a step further, what are the things that made their symptoms that they complained about, what did they find the most satisfaction with? The number one thing were specialized aesthetic treatments. So. So the treatments that we do do definitely play a role in this demographic in making them look better and feel better. There is no doubt. Okay. Actually, in fact, it did it more in a short term basis than even HRT in satisfaction. Okay, but what I will tell you then, this is a snapshot of a group of women that don't. They just know they're having these symptoms. They know that this is what they've done and they're happy. Okay. It's not following them out for the long term. What all would all finish with, I guess, is that then in my experience, seeing these women, the trajectory of their, of their hormonal journey is that there is definitely aesthetic treatments play a role. What you apply every single day absolutely plays a role. In fact, if you apply the wrong thing, like an apricot scrub that was super popular when we were probably kids, it can make it worse. Right, right. And that if you're being seen by someone that treats you as, as the holistic human that you are, that you will not only feel better, but look better too, that there's a role for the hormonal environment that can support. You can't just lean on one thing to do all of it, but it needs to be managed and cared for by somebody who's not following the latest trend, but by someone who fundamentally understands the practice of medicine and you as a human being.
- [52:32]
A
I love that. Multidisciplinary.
- [52:34]
B
Yes, it is. You know so much about what you do. I, I know so much about what I do. I don't try to pretend, yeah, I am like a hormonal health specialist, that I should be prescribing that for you, but I sure will find the best person to do it.
- [52:48]
A
Right, Right. No, I love that. I'm so glad you said that. And I, I couldn't agree with you more. I think for anyone listening out there, like, really take this advice to heart, you guys, because honestly, yeah, I mean, I mean, you gotta figure out first of all where you're getting your health care, you know, like real care. Like, that's what it is. Like, medicine isn't just techniques. It's Care, it's somebody who wants to help you and. Yeah, I couldn't agree more. Dr. Fabi, I think you're absolutely spot on and absolutely brilliant insights. I am a huge supporter of xomd and I am because I understand how, how amazing the scientific like, logic that you guys have employed here is. I mean, this is really, really cool to see and I'm really like, hats off to, to you and Dr. Dayon for like coming up with this concept and like bringing it to life because I wish more people would invest in this like deep, deep science, like go deeper, you know what I mean? Like go further.
- [53:45]
B
I think we, I think we will. I think people are. I, I have hope, you know, I think that people are seeking information. That's why, you know, people come to listen to you and you're doing such a great service to so many by, you know, seeking, you know, people that might be experts in whatever field or discipline they're in to try to bring the most credible scientific backed information to an audience. Right. And so this is what we learned from this survey. So many women wanted more information and were disappointed with the information they had, but they wanted it. So people are seeking it. And so I have hope that it's going to become something that's mainstream and understood.
- [54:29]
A
I love that. And I can't wait for the entire category of skin care to evolve in the years to come. Honestly, I feel like this is so cool to watch. Like we're, you know, like, I think I had a conversation a long time ago early on the podcast where we talked about how it's like skin care and skin science is one of the only medical like, like, like special, like disciplines of science that you can see so much being adopted, you know, from like very, very rigorous scientific disciplines, like, like regenerative medicine, oncology, you know, like translational medicine coming to life. Like, it's such a beautiful field and it's so ever evolving that like, it's just, it's wonderful watching, you know, and yeah, so I'm, I'm very excited about the future.
- [55:09]
B
I am too. Thank you so much for having me.
- [55:12]
A
Thank you so much. This has been such an amazing conversation.