← The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show
The TRUTH About Makeup, Sunscreen and Skin Cancer | Teo Soleymani
01:41:31
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- [00:00]
A
Is makeup toxic to the skin?
- [00:02]
B
Short answer is no, I don't think so.
- [00:04]
A
Long answer is 66% of women in the US follow a multi step skincare routine.
- [00:12]
B
The more steps you have, the more products you're probably going to want to buy. So there is a marketing advertising bias based on whichever company is telling you the multi step.
- [00:20]
A
Do we know the exposure from fluorescent lights, regular lights, and the effect on the skin?
- [00:26]
B
Fluorescent light and some halogen light can change the DNA of your skin.
- [00:30]
A
That's terrifying. Does the sun cause skin cancer?
- [00:36]
B
Yes, with an asterisk. Anybody who cares about their skin should do some sort of laser procedure for two reasons. One, we know it improves the appearance and now we know it also cuts your cancer risk.
- [00:50]
A
It does. What about diet?
- [00:53]
B
Diet is medicine. Food is medicine and should be treated as such.
- [00:57]
A
Have you seen any trend that just has really surprised you?
- [01:01]
B
Every day I'm like, what is going on here?
- [01:11]
A
Dr. Teo Solimani, welcome to the show.
- [01:14]
B
Thanks for having me.
- [01:15]
A
You had me at hello with this whole skincare. It's not skin, it's muscle. But before we talk about that, I was up last night googling glass skin.
- [01:24]
B
Yeah.
- [01:25]
A
Is there evidence behind this Korean skincare?
- [01:27]
B
Great question. So Korea, particularly South Korea, has a lot of things that we don't have in the United States and there's many reasons for this. So K beauty is really, really popular right now, partly because of social media, partly because of advertising through different platforms, which we wouldn't be able to see 10 years ago or 20 years ago. There is also a cultural difference in South Korea in terms of how they like their skin to appear that we don't necessarily have in the United States. Part of it is due to old hierarchy in society structures. The fairer you were, it was perceived that you were from royalty. The more tan or darker you were, it was perceived that you were in a different working class. So everybody aspires to have porcelain fair skin without a single flaw. Much more uniformly in South Korea than perhaps the entirety of the United States. Because of that, things are done there that may or may not be approved here as well.
- [02:22]
A
To achieve that. Is that like salmon sperm?
- [02:25]
B
It's a. It's a variety of things. It's things like glutathione IV infusions, which we don't really do here in the United States. Certain lasers that we don't readily have access to here in the States. Certain sunscreens, particularly the big ones, are chemical filters that are available in South Korea that aren't available here. Which is why there's this big hype about Korean sunscreens or Korean beauty. A lot of the formulations in Korea are made to achieve one fair skin, lighten the skin and then have minimal appearance of the product on your face. Whether that's a good thing or a bad thing is each person's own opinion. But the goal of skin care in Korea is a little bit more uniform in achieving fair kind of porcelain, undamaged, unblemished skin. Whereas here in the United States we have a myriad of things we work with. We work with a lot of skin cancer that isn't as prominent in Korea. There are patients who have olive skin, tan skin, ethnic skin, darker skin in which lightning is unrealistic or impossible. Some of our darker skin types can't tolerate the lasers that are being done in Korea for that kind of glass skin. That being said, we can achieve pretty close to near identical results in similar patients as long as you find a good dermatologist.
- [03:44]
A
Is that true? Because I was looking at this statistic in preparation for this and 66% of women in the US now. 66%, that's crazy. Again, this came from a media market statistic, but they now follow a multi step skincare routine. And I will tell you, once I started seeing glass skin, it went from wash and lotion for me or wash and retin a to now wash, then wash again, then tone, then serum, then cream.
- [04:15]
B
Few things to that, few confounding variables to that. The more steps you have, the more products you're probably gonna wanna buy to achieve those steps. So there is a marketing advertising bias based on whichever company is telling you the multi step. In general, the more ingredients that touch your face, the more likely that you are to have some sort of adverse reaction. Either an irritant, contact dermatitis, either some sort of clogging of your pores and acne breakout, some sort of bad reaction, the more steps you have. So in general, less is more what you don't see. Yeah, for sure. And most dermatologists will agree less is more so long as you have really effective products. Now, what you don't see behind the scenes often is what patients are taking orally to keep their skin looking flawless. Blemish, free breakout, free oral supplements ranging from hormone modulating drugs like birth control and spironolactone, antibiotics that prevent breakouts like doxycycline for acne rosacea, or our gold standard Accutane, which there's a whole slew of patients who take low dose Accutane for years. Whether they're in the movie industry, whether they're in entertainment and modeling to keep their skin glowing. That's the stuff you don't see when you watch a 30 second reel on social media saying, hey, follow this nine step routine and you got to buy all nine of these products.
- [05:37]
A
But their skin looks amazing.
- [05:39]
B
Yeah, yeah, for sure. It's very, for sure.
- [05:41]
A
Glassy.
- [05:42]
B
A few important things to that. Glassy skin can absolutely be achieved. It's hard, especially if you are active, especially if you are young, especially if you have, you know, a good healthy hormone milieu, if you're working out a lot, et cetera. But it can absolutely be achieved. One thing I always want to say is, let me see that skin in person. A lot of filtering that's being done. There's a lot of texture that you can't see behind camera that you see in real life. Some of that in real person is perfect. And I'm like, man, this is amazing skin. And some of that is not real in real life.
- [06:15]
A
Well, you bring up makeup.
- [06:18]
B
Yeah.
- [06:19]
A
Is makeup toxic to the skin?
- [06:21]
B
Short answer is no, I don't think so. Long answer is, everybody, unfortunately today can find an article online that will sell your point. Whether it's on the right or right side, the left side, the middle, up, down, what have you. There are chemicals in makeups that at high concentrations can be a problem. Generally, you shouldn't be wearing makeup for a prolonged period of time for a variety of reasons. One, there are some theoretical absorption issues. Usually people aren't putting enough for that to be a problem.
- [06:51]
A
Meaning absorption issues through the skin.
- [06:54]
B
Yeah, exactly, exactly. Usually people aren't putting off enough makeup for that to be a problem. But we did see this in the entertainment industry, particularly in the 60s, 70s, 80s and 90s, where when there were certain cosmetic makeups that were used for filming and things like that that provided a lot of coverage that had heavy metals in there and patients got sick from it. So that's one. Number two, the bigger one is you shouldn't be keeping this stuff on your skin for a long period of time because it doesn't allow your skin to turn over the way it should. So you run into things like overproduction of oil, clogged pores, which can lead to breakouts, which can lead to things like Demodex, which is this common mite that lives on our skin that's a common culprit of rosacea, Especially in women of, you know, age 35 to 45. They persistently get breakouts and they can't figure out why. One of the reasons is this mite called Demodex, and it makes the skin look red with little breakouts.
- [07:48]
A
And how does someone get that?
- [07:50]
B
It's usually a normal, normal organism of our skin, but it overgrows when you provide it its food source, which is dead skin cells and oil. So I tell my wife this all the time and she's really, usually really good about it. But don't sleep with their makeup on for that reason. You don't want to clog your pores. You want to allow your skin to turn over. You don't want to provide extra food for the bacteria and organisms on our skin.
- [08:12]
A
You call them derma mites.
- [08:14]
B
It's Demodex. Demodex is the name. It's a mite. I know this sounds horrible, but it's a parasite. It's one of the most common causes of rosacea in young women. The simplest thing I can do is just ask them, hey, do you sleep with your makeup? They're like, yeah, how do you know? Or when was the last time you washed your brushes? Like, how do you know this? I'm like, because there's, there's.
- [08:31]
A
Because you have demodites on your skin.
- [08:33]
B
And you've tried all the routine things like, you know, benzoyl peroxide washes, retinoids, and your skin's just not getting better. That's a, that's a culprit that's often overlooked.
- [08:42]
A
How would someone treat that?
- [08:43]
B
Usually with topical, certain topical medicine, sometimes some oral medicines. And it's really responsive to medication, but to prevent it, don't sleep with your makeup on.
- [08:52]
A
Easy. That's easy. The Environmental Working Group. Have you heard of that? That group, it lists a toxic 12. Yeah, you're saying. Yeah. I'm curious as to where this is going to go. Many substances that are used in the us they seem to be banned in European countries.
- [09:10]
B
Yeah. I have a love hate relationship with the ewg. I think its intentions are good. I think it's to bring awareness of things that could potentially be a problem to the public in the United States. I think I have a problem when they oversimplify things that are a little bit more complicated in biology and medicine to just being bad versus good. It doesn't work that way. The other thing I have a problem with the EWG is sometimes they have selection bias as to which data set they look at. And there's always a question as to whether there is some lobbying from certain industries swaying EWG reports. You know, the organics industry or certain industries that sway EWG reports. That being said, I think it's, I think it's a source to look at and I think if you're concerned, it's a starting point. The Big 12. The majority of the ingredients in the Big 12 are formaldehyde or preservative releasing compounds. For the majority of the products that we have in the United States, the concentration on the skin is far below anything relevant that we run into. You actually get a similar amount of carcinogen pumping gas at a gas station, breathing the fumes in the environment, but nobody really talks about that as being a problem where lies. The problem is if you are using these products and they sit on your skin for long periods of time, hours, day after day, year after year, decade after decade, then you wonder, is there some biocumulative effect? And nobody knows the answer to that. But it's not unreasonable to think, hey, if I'm really concerned about my health, maybe I avoid a few of these products. It's just, it's really hard because they provide shelf life for, for whatever skincare supplement you're using or makeup or serum or lotion, shampoo, body wash. They provide shelf life so you don't grow fungus in the product, you don't grow mold or bacteria in the product.
- [11:05]
A
If you listen every week and feel like we are in this together, which I believe that we are learning, growing and building strength, then I've created a way for us to get connected even more closely. It's called Forever Strong Insider, a premium community for listeners who want to go deeper. You'll get ad free episodes, which I know you'll love. Bonus Q&As, where your questions shape the conversation behind the scene moments. Because let's face it, I'm hilarious from my daily life and written takeaways to keep at your fingertips. But more than that, you'll be supporting the show so that we can keep creating content that matters. If you've ever wanted to feel part of the inner circle, this is your invitation. Join us at foreverstrong.supercast.com or through the link in the show notes. Does regular makeup use like that actually, does it accelerate aging? Or would it? On the flip side, you're putting formaldehyde on your skin. Does it reduce aging?
- [12:01]
B
Yeah, unfortunately our skin is not like cadaver skin. So formaldehyde is not a formaldehyde for those of you first year of medicine?
- [12:09]
A
Yes, I was. As you're talking, I'm thinking about that formaldehyde smell and these preserved bodies.
- [12:14]
B
Yeah. In Anatomy lab. Yeah.
- [12:16]
A
So gross.
- [12:17]
B
It preserves the skin after we've passed. So I don't think it'll preserve us while we are living. There's some data to suggest that if you routinely use makeup that has some sun protection in it, although the amount that you use is not what you think and it's not enough sun protection SPF in your makeup, at the very least, that can be anti aging to a certain extent.
- [12:36]
A
Can you define what do you mean anti aging?
- [12:38]
B
Yeah. So when we look at aging, there's normal aging that is based on your genetics and your family tree and what normal processes look like over the decades. There's accelerated or premature aging, either due to excess UV or sun exposure, some genetic syndromes, certain medical conditions, your underlying immune system health. And when we look at accelerated aging, we look at things that cause that. Right. Whether you are doing it to yourself from environmental insults, smoking, laying out on the beach, etc, not sleeping long enough, having a poor diet, etc, or your accelerated aging is due to metabolic dysfunction due to immunosuppression, what have you. So if you're using makeup as a tool, at the very least makeup that has some sun protection in it will be slightly anti aging. Now I put an asterisk to that because usually people look at a bottle of, I don't know, let's say liquid foundation and they say, oh, SPF 15 in there, you are putting probably a third of the amount needed on your skin to provide that SPF 1515. So you're really getting like a 5 to 8. So you can't rely on that alone for sun protection.
- [13:46]
A
Truly, I did not know that.
- [13:48]
B
Now you need a, for lack of a better definition, a shot glass worth. And most people are either putting on very little foundation or definitely not a shot glass worth of foundation. So you're not getting the SPF that your makeup says. But at the very least there's something there. I don't think it accelerates aging unless you're doing stuff that really hurts your skin, like leaving it on overnight all the time, not letting your skin turn over, clogging your pores, then trying to scrub things off, being abrasive with your skin, then probably don't do that, but I don't think it's accelerates aging.
- [14:19]
A
Are there any ingredients that you think are really damaging to the skin that we use routinely that we don't think about?
- [14:25]
B
It's a good question because you blew.
- [14:28]
A
My mind when you talked about testosterone and skin.
- [14:31]
B
Yeah, yeah, I'll touch on that. So there's a Few things I think that are surprisingly a problem if not used right in my realm. I'm a fellowship trained skin cancer surgeon, so I see this as a problem. Throughout the United States is what people commonly call black salve. And I see this especially in the Midwest. People use this to try to treat non healing bumps and growths. It's this homemade remedy that's readily available in the United States.
- [14:55]
A
What's in that?
- [14:56]
B
It's a myriad of stuff depending on state to state. But it's supposed to kill cancer and usually people.
- [15:01]
A
Skin cancer?
- [15:02]
B
Yeah. And usually people who use this end up with very aggressive or advanced tumors because they hit it. Black salve is a big problem. More common things that people use that they may not realize is topical retinoids. I love them, but if you use them without sun protection, you're going to burn, you're going to cause some premature aging. Because topical retinoids like tretinoin, retinol over the counter, tazarotene, adapalene, et cetera, turn your skin over. They bring out kind of baby skin to the surface. So that skin is vulnerable to UV exposure. If you put on retin a all the time and you go out without sun protection, you're probably going to hurt your skin more than improve it. Topical steroids, you get a rash, you put a little hydrocortisone on. Long term use without control is a problem. It thins your skin out, it brings out broken blood vessels called telangiectasias. So topical steroids, we are very careful about. What else? Vitamin C serums. Love them in the, in the right context. But they are a common culprit for perioral dermatitis, which is this like acne like eruption around the mouth. So these are common things that people use all the time, but when not used correctly, it's a problem. You brought up testosterone.
- [16:14]
A
Yeah.
- [16:14]
B
Yes, it's, it's making a renaissance right now in, in medicine, and rightfully so. It was ostracized in like the 80s and 90s and now they're like, wait a second, people need to feel better, they need to be fit. You know, being fit reduces your insulin resistance, et cetera. Testosterone, however kind of hur your skin hurts it in the sense that usually increases sebaceous gland thickness. Oil glands, your oil glands get bigger, your skin gets oilier, you actually produce more collagen and elastin. So skin sometimes gets thicker and then there's this ruddiness that people see usually as a result of maybe too high of testosterone, where you're producing Too much blood, your blood count is high, Patients faces look red. So testosterone actually makes our skin a little, a little uglier. You know, people who are very sensitive to testosterone, even at normal levels, will get acne. Steroid acne is a very common thing. We used to use the term steroid acne for prednisone, but now you see, you know, you see it in testosterone. And so long as you're supplementing or, you know, taking it as medically necessary, those breakouts are hard to control. Also, if you're undergoing surgery, any sort of surgery, whether it's cosmetic, whether it's, you know, reconstructive, what have you, testosterone tends to make the scar a little bit more visible.
- [17:36]
A
I need to just stop you here.
- [17:39]
B
Yes, but the question, you know, every single person should ask themselves, okay, what is my goal? Because I hate this cookie cutter approach where you got to, everybody has to do this for your skin. Everybody has to do this for your skin. I personally, and this may not be the same for every dermatologist, I would rather be lean and jacked and jacked and have a six pack than have a dad bod and glassy skin. But that's my perspective.
- [18:01]
A
I think it just depends on what state you live in. But it's.
- [18:04]
B
Okay, fair enough.
- [18:07]
A
We have to pause here. Testosterone and skin. I love that you said that testosterone is having a renaissance moment. It absolutely is. Do you know it was first prescribed? They started using it in the 1930s.
- [18:19]
B
I didn't know that.
- [18:20]
A
Incredible. And it actually was a very commonly used treatment now.
- [18:25]
B
No wonder the greatest generation was World War II. Right?
- [18:28]
A
But it's amazing. And then all of a sudden there was a study that came out that linked testosterone to prostate cancer and they stopped using testosterone and they started castrating guys. That was based on one study with one patient on a blood lab that they no longer use.
- [18:49]
B
That's, that's like the same thing with Accutane and the discussion about, you know, depression and mental health and suicidality. It was one flawed incident in the 70s and 80s that got that label forever. I think testosterone is a great thing. I think over utilization or super therapeutic amounts for a long period of time can be a problem. Just like too low of an amount for a long period of time can be a problem. You know, like everything has its sweet spot. Whether you're talking about testosterone, whether you're talking about sunlight, whether you're talking about a prescription medication, everything has this balance.
- [19:21]
A
Yes.
- [19:22]
B
And if you fall out of the window, you're probably going to be in trouble over a long period of time, not for the first year and not for the first month. But if you're consistently out of the window, like anything in life, you're probably going to run into trouble.
- [19:32]
A
And I have never heard, and I've thought about this, but I've never heard a dermatologist talk about testosterone, skin other than acne. Yeah, yeah, but what you're also saying is beyond acne, it creates this thickening of the skin. And consciously now, everyone could look around and see individuals that probably overuse testosterone, maybe even anabolics. On the flip side, and to be clear, you're not talking about keeping things in a therapeutic range. How can we think about it? Because I don't want people listening to go, oh, my gosh, that's it, I'm stopping it.
- [20:07]
B
No, no, no. And. And every single person has a different response to the same medicine. You know, I have many patients and colleagues who have been on it for a long period of time. It hasn't affected their skin. So one thing you can't measure in a test tube is sensitivity to a hormone. You can try, but everybody responds differently. I have some patients who start it and in the first month they're breaking out, they're oily, they're like, I hate this stuff. So you should be a judge of your own, you know, health, skin health, and your well being. If you're using and you feel great, who am I to tell you to stop? But if you're noticing things with your skin that you didn't have before, take a look and say, hey, maybe this exogenous source is my culprit. And the flip side is true in that we use estrogen to, to protect your skin in a variety of ways. Not just skin, but hair. And that's been, you know, since antiquity. We use estrogen for acne. We use estrogen to help the revitalize postmenopausal skin that's really dry, erotic, kind of dull. We use estrogen to help protect hair. And testosterone accelerates the most common type of hair loss, which is androgenic alopecia, or male pattern hair loss. So we use either estrogen or something that blocks testosterone from binding to its receptor, which is a medication called spironolactone that's very commonly used, especially in young, young girls with hormonal acne. So the flip side is true.
- [21:32]
A
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- [23:06]
B
I personally haven't found topical estrogen to be any better than the vehicle in which the estrogen is in. So if you smeared one half of the face with let's say Aquaphor, not that no specific brand, but let's say 1/2 is Aquaphor and the other half is estrogen cream, over a month there isn't much of an appreciable difference. I think the vehicle is doing more than the estrogen itself and there's a few reasons for that. One is absorption. Two is concentration of estrogen. Our skin on the face is very different than the genital region which women use this for. You know, different reasons. You know, vaginal dryness, atrophy, you know, what have you there. You have a mucosal membrane. The absorption of estrogen is much higher. It's like same thing as putting something under your tongue. The absorption is much higher in mucosal membranes than keratinized skin. So if you want the benefits, oral is the way to go. The way I tend to prescribe it is in the form of birth control and estrogen dominant birth control at low, lowest doses possible does really well to control things that are a result of low estrogen or high testosterone. And this can be pcos, this can be hormonal acne, this can be postmenopausal skin changes. This can be hair loss. That's pattern hair loss. So estrogen does a lot of good things and we use it clinically all the time.
- [24:32]
A
Have you ever considered using the patch, estrogen patch as opposed to oral?
- [24:36]
B
I haven't, I haven't, I don't know. I don't know enough on its effects on skin. I presume the patch has a more steady state release than the pill. I don't know if the patch is purely estrogen based. I know like Depot and the, the implantable like Implanont are progesterone based and they tend to make your skin worse. And you're like what the heck are you talking about?
- [24:56]
A
Worse in what way?
- [24:58]
B
Generally it'll break you out. So a lot of young women come in and they have hormonal acne, which we usually call in the beard distribution. And it's pretty predictable, it's cyclic in the days leading up to their periods. And that tends to be progesterone driven. So as good as estrogen is for your skin, progesterone tends to break you out. So patches, injectables, even the iud, like the Mirena iud, that is progesterone based. A lot of patients are sensitive to that progesterone spike. So I tend to like estrogen dominant forms of supplementation.
- [25:28]
A
It's really fascinating that estrogen plays a role on the skin.
- [25:33]
B
Huge.
- [25:34]
A
What would someone expect to see aside from the acne piece? And what I'm really getting is at elasticity, wrinkles, what do they expect to see and over what period of time with the use of estrogen, say for a post menopausal woman or a woman that is going through menopause and all of a sudden her skin is changing.
- [25:53]
B
So the same thing that happens in your skin is the same thing that happens in your muscle, by the way. And we'll talk about that just briefly because it's your area of expertise. But the most common complaint that we get postmenopausal women in their skin is their skin is dry and, and it lacks luster, that shine is gone and that's usually because of the drop in estrogen relative to testosterone. It's not like your testosterone went high, it's just your estrogen went down. So your body senses that there's an imbalance in the level between testosterone and estrogen. So re supplementing if you are the right candidate, meaning you don't have a personal history of hormone sensitive breast cancer or what have you. And that'll be a discussion with you and your doctor but supplementing usually improves skin hydration, skin turbidity, skin volume. It improves fine lines and wrinkles slightly. But wrinkling is a problem over a decade, so it's hard to see that correction fast. But usually what women say when they come in is like, my skin looks better, my hair feels a little thicker. I just. I feel good, I look good. And that is perhaps not directly quantifiable, but if they feel great, then we've done our job.
- [27:03]
A
There has been this big influx of topical use of estrogen for the skin. I'm not going to lie. I have tried it. Does it work? What?
- [27:12]
B
Does it work? Do you feel like it made a difference?
- [27:14]
A
I don't notice a difference. But then again, I'm thinking to myself, well, number one, this is not probably the right dose.
- [27:20]
B
Yeah, yeah.
- [27:21]
A
And I don't know if there's ever been clinical. Are there clinical studies?
- [27:24]
B
I don't know if there's been randomized dose escalation studies. I think it was inferred from literature that's been around for a long time.
- [27:30]
A
I see.
- [27:31]
B
And what we do in medicine often is we reformulate a drug that was used in another specialty or another indication. Some women say it works. If it works, great. I'm not saying it's not going to work in everyone, but if you're going to use estrogen as a source of revitalizing your skin for whatever reason, I tend to find the higher concentration from oral forms tend to be better than the topical.
- [27:55]
A
And we. And to be clear, we don't have a dose. Your estrogen, for example, if I'm looking at blood work as a physician, and I want the outcome to be obviously subjective. Lusterful skin.
- [28:06]
B
Yeah, yeah. No dose. No dose because it has to be titrated based on titrating, meaning we have to find the dose that fits your skin based on what we see. There are patients who. And I'll use. Testosterone is much more readily measured all the time because people tend to supplement more. There are patients who break out when they are in 6, 700 range, and there are patients who don't break out when they're in a thousand 1100 range. So your sensitivity to it is very important. And that can be impacted by your. Your genetic metabolism, other medications that you're on, other supplements that you're on that can affect the metabolism and absorption of the drug. So there isn't really a level that's correlated to skin the way there is a level correlated to internal organ changes related to hormones.
- [28:56]
A
That makes sense. And Also to be clear, skin is not the largest organ in the body muscle. It is 40% of the body weight. I mean, listen, I've never been able.
- [29:05]
B
To say that maybe square footage wise.
- [29:06]
A
I've never been able to say that to a dermatologist, but I believe it. I, I feel very lucky to, to course correct here that it is not the largest organ in the body. It is the skin or it is, oh my gosh, it is muscle, it is not the skin. Have you seen anything that was really surprising? You've been in practice, you did two fellowships. Have you seen any trend that just has really surprised you?
- [29:30]
B
I don't know if I, I think the rise of social media has taken away the surprise. I think, I think every day I'm like, what is going on here? And I think the, the advent of home, home doctors, like homemade doctors through social media and Google searches is a real big problem that wasn't around when I first started training. I mean I'm not that old, but people weren't chatgpting their symptoms and coming in with predetermined diagnoses. These, this makes practice of medicine really hard. It takes more time for you to course correct somebody in clinic than, than, than anything else. I think. I hate blanket statements. And that's become more and more, I think medicine's become polarized in the US and you either fall in this camp or you fall in this camp. And if you're in this camp, you're the enemy of this camp. And like there used to be a lot more middle ground. I'm a dermatologist who focuses primarily on some of the worst skin cancers in the U.S. it was my area of expertise as a full time professor at the university. It's what I do in my practice now.
- [30:34]
A
And that was the ucl.
- [30:36]
B
Yeah. And my career has been dedicated towards treating melanoma and squamous cell carcinoma and basal cells and, etc. I love the sun. I enjoy it. I go outside and I, I, I get a lot of benefit from it. That is blasphemy in our specialty until now. And that's like something I hated when I, when I realized the majority of my field would say you have to avoid the sun at all costs. You have. I'm a, I don't think you do. I really don't think you do. And that was really infuriating to me for two reasons. One, this binary good bad is never existent in medicine. And number two, dermatology is probably the last specialty in which the physicians in the field tend to Guilt their patients into making them feel like they were the cause of their skin cancer. The last time we did this was with cigarette smoking and lung cancer. Made total sense. You stopped cigarette smoking, squamous cell carcinomas of the lung went down. But guess what? The number one cause of lung cancer and lung cancer death in the US now is adenocarcinomas and non smokers. So that guilting feeling is out. But in dermatology, often what happens is patients come in, they have a skin cancer on their nose and their cheek, and people say, you know, the sun you got in your 20s and 30s, you did this to yourself. And don't get me wrong, blistering sunburns are not good. Constantly getting burned is not good. But there's a lot of factors that we don't have control over that predispose people to skin cancer that I think it sucks to make them feel guilty about this.
- [32:12]
A
You know, I always just wonder, how do newborns get so much energy they wake up, they cry, they go to the bathroom? Well, they get something that we don't. They get Colostrum, the OG energy shot. And I'll tell you what, I'm always looking for ways to improve my energy and gut health, since that's where good health starts. And that's why I've added Amra Colostrum to my iced coffee. Amra is a whole food supplement packed with over 400 bioactive nutrients, things like prebiotics, peptides that help strengthen immunity, support digestion, optimize performance. In case you want another newborn. Omra uses a unique technology to preserve these nutrients in their purest, most bioavailable form, which is why it stands out from nearly everything else that I've seen on the market. We have a special offer just for my audience. You can get 15% off your first order. Go to Tri Amra. That's T R Y A R M RA.comDLION and use the code DOCTRLION at checkout. Does the sun cause skin cancer?
- [33:22]
B
Yes, with an asterisk. So there are a whole slew of skin cancers. We talk about the big three in the US because they're the most common. Basal cell squamous cell melanoma. But there are things like dermatofibrosarcoma protuberans. There are things like Merkel cell carcinoma. There are, you know, there's a ton of skin cancers, a ton of different types of skin cancers. When we say yes, there is a direct correlation with chronic excess sun exposure and the number of blistering Sunburns that you've had with our most common types of squamous cell carcinoma and some basal cell carcinomas and melanomas. However, there was a really interesting randomized study. It was the last randomized study that was ever done on sunscreen. And I'll go into this, I'll go into why this is important. That was published in the Lancet in 1999. This was a study done in Australia that looked at people who used diligent sunscreen versus those who did not. And the incidence of some squamous cell carcinomas came down. But there was no change in the incidence of basal cell carcinomas, which is our most common form of skin cancer in the U.S. one in four Americans.
- [34:37]
A
Will develop this squamous cell, basal cell, basil cell.
- [34:40]
B
So no change in basal cells, a decrease in squamous cell and a slight decrease in melanoma, but no change in survival. So you're scratching your head saying, okay, I don't understand, what are you saying? First, sunscreen is a form of sun protection. It's not the only form. Sunscreen only works if you apply enough of it to every square inch of sun exposed skin. Not everybody does that.
- [35:01]
A
Which should be roughly a shot glass.
- [35:02]
B
Yeah, shot glass worth. Which a lot of times people don't put that much.
- [35:05]
A
That's a ton of it is.
- [35:06]
B
It is. And if you're using a spray, forget about it. You're barely getting anything.
- [35:09]
A
Oh my gosh. That's all I use.
- [35:11]
B
It's all I used as a kid. And yeah, it's all I used as, you know, as a kid growing up and adulthood until we learned better. So sunscreen's not the only form. Importantly, the strongest predisposing factor for you is your genetic and family history coupled with your sun cumulative sun exposure dose. So if you are from northern European descent, mom and dad had basal cells, uncles had basal cells, there's a very high chance that you're going to get it in the future.
- [35:40]
A
And is that only to exposed sun areas?
- [35:42]
B
No, it can be anywhere. It occurs more in sun exposed areas because the sun is like the second hit. Your first insult is your genetic predisposition, the second is the sun.
- [35:52]
A
Do we know the exposure from, for example, lights, fluorescent lights, regular lights, and the effect on the skin?
- [35:59]
B
Yes. Published that study as a fellow at nyu and we showed that visible light, particularly fluorescent light and some halogen light can change the pigment and change the DNA of your skin.
- [36:13]
A
That's terrifying.
- [36:14]
B
Yeah. So there's proximity is important, duration of exposure is important. So LCD LED screens don't do this.
- [36:21]
A
What about this computer screen?
- [36:23]
B
No, that's usually LCD or led, but fluorescent lights do it. Some halogen lights do it. Which is why there's a big movement now towards sunscreens and sun. You know, sunscreens that have visible light shielding and glasses that shield against visible light spectrums in the blue wavelength. So there's a movement to wear stuff or do stuff that'll protect you from indoor light. And this came from, you know, we had a lot of patients at NYU that were on Wall Street. They're like, I'm in these lights all day and night. I'm behind these screens. Or they're in, you know, private equity or what have you. They're like, what is this doing for my skin? Nobody really knew the answer. So we did a study for it and we were pretty shocked. You get some pretty significant changes over time. Well, it's not the same as uv. It's nowhere near the same as uv. If we treat light as a form of a drug or medicine, we can touch base on that in a bit. Then everybody should know their dose, right? Your skin and my skin is very different than my Irish patient's skin. I may be able to be outside or be under fluorescent light for an hour and a half before my skin turns red. That's what we call my minimal erythema dose. So that's how much my skin can tolerate. So if I'm going to enjoy the sun safely, I will go a little bit below that. If you tell me, hey, I'm strawberry blonde, blue eyed, I burn in 10 minutes. Your comfortable dose is five. So everybody should kind of know their dose. One thing we didn't touch upon earlier in terms of sun and skin cancer, Melanoma has historically been our deadliest form of skin cancer cancer. And that's changed in the last five years. It's no longer the case. But for all intents and purposes, melanoma has been our deadliest form of skin cancer because it has the quickest ability to spread. It is the most common cancer in age 25 to 39. Second most common cause of cancer death in women ages 25 to 35.
- [38:14]
A
Melanoma.
- [38:14]
B
Melanoma. The majority of lethal melanomas arise in sun. Naive skin, backs and legs are the most common areas. So you're saying, okay, is the sun causing cancer? Is the sun not, like, what's the message here? A little bit of yes and a little bit of no.
- [38:33]
A
Thanks for clearing that up.
- [38:34]
B
Yeah, I know I Made more confusion than anything. My point in saying that is you don't have to fear the sun. If your sun smart, you can enjoy the outdoors, get all the benefits that the sun provides safely, very effectively, while keeping yourself protected from the risks of skin cancer. Now, what is very, very linearly correlated is aging in sun. So skin cancer has a lot of molecular changes, genetic predispositions, family, you know, heritage, ancestry influences that drive skin cancer formation. Aging is a lot more of a straight line. You get too much sun, you're going to wrinkle like a raisin. So that makes. That makes sense.
- [39:15]
A
People find that so controversial, right?
- [39:17]
B
And they find it controversial because they can't account for their genetics. You know, I hear this all the time. My grandma was Greek. She was in the sun all the time. She didn't have a single wrinkle. Maybe if we look back at her photos, maybe she does have a wrinkle. We forgot about it because we loved her. We also don't know how good her skin genetics was in tolerating UV damage. But the way I describe this analogy is put a grape in the sun, it eventually turns into a raisin. It's pretty predictable.
- [39:44]
A
Is that why upstairs on our fourth floor, I had this beautiful rug and it had green and it had tan, and now it looks totally bleached out.
- [39:54]
B
Yeah, yeah, it's exactly right. And it comes through the windows. You think you have protection through the windows, and you really don't have much UV guarding. It's why you're not supposed to put nice fine art or whatever you're trying to preserve by a window, because the UV will eventually erode it.
- [40:07]
A
And do we know that it's uv?
- [40:08]
B
We do, because there's been good studies, not even in skin, but in, in worlds not related to medicine, like art, art preservation, where you look at what damages the paint and what ages the paper behind it. And it's UV heat also plays an important role. But assuming your house is climate controlled.
- [40:28]
A
You'Re not in Texas, not outside in Texas.
- [40:31]
B
Fair enough. Touche.
- [40:32]
A
At least 150 degrees here.
- [40:33]
B
Yeah, 150 will of wrinkle you faster.
- [40:35]
A
But that's terrible. The if we're talking about aging, premature aging versus skin cancer, wrinkling, the number one cause, you would say, is UV exposure.
- [40:45]
B
Excess.
- [40:46]
A
Excess.
- [40:46]
B
Excess.
- [40:47]
A
We didn't define excess and we didn't define a normal amount. Is there such?
- [40:53]
B
Yeah, except it's person to person dependent. So if we consider light, UV light or sunlight a medicine, then there has to be a dose, right? I give this example all the time. Take a Tylenol or take an Advil. What happens? Your headache goes away. Take 23 of them, see what happens.
- [41:12]
A
You'll be in the ER.
- [41:13]
B
Same thing. Same thing with UV exposure, right? Every person has a dose. The way you kind of know your dose. If you came to clinic and you wanted to test it is called the minimal erythema dose. Where we shine UV light, we find the time in which your skin turns red. That is the dose that you can tolerate. And then anything below that is presumed to be a little safer. The way the average person does this is on a summer day, they're like, hey, 15 minutes later I was burned. Okay, then your tolerance is 10 minutes. The problem in making an umbrella statement as to what's safe is everybody's skin is different. Everybody's skin color is different. Everybody's UV tolerance is different. So you have to find that dose for yourself. But I think there is absolutely nothing wrong with getting 15 to 20 minutes of sun exposure for most people at low UV index times of the day, every single day. I wouldn't recommend 20 minutes in the desert in California. Most people would burn. Not everybody.
- [42:11]
A
If someone can tolerate it, yeah. For example, my dad. My dad lives in Ecuador. 74 is outside all the time. Would you say that there would be a reason to restrict that exposure?
- [42:21]
B
If he hasn't had any skin cancer.
- [42:23]
A
History, which actually, I think that he has had some skin cancer.
- [42:28]
B
You have light colored eyes.
- [42:30]
A
I do.
- [42:30]
B
And ironically, for some reason that we don't understand very well, patients with green or hazel eyes, but with dark skin or dark hair roots tend to have a high incidence of pigmented basal cells. It's the most common skin cancer I see in South Americans. It's the most common skin cancers I see in Southeast Asians. And it's more common in those who have light eyes, but all have features. So if your dad had one, then I would say, okay, I would probably restrict or be careful, because everything in the skin and sun is cumulative effect. Which is why you don't see skin cancers in young kids that frequently. Almost never. Unless they have a genetic syndrome. Most cancers are the same way. It's a cumulative effect. So if your dad's not bothered, if he actually hasn't had a skin cancer, and he doesn't really.
- [43:16]
A
I have to ask him.
- [43:17]
B
Yeah, but find out if he doesn't. If he's not bothered by his aesthetics, then, no, let him have all the fun he wants. If he has and you're worried and it's on a sun exposed area. His his likelihood of having another one is 50%.
- [43:29]
A
Wow, that's high.
- [43:31]
B
Yeah.
- [43:31]
A
And the out to be clear, the outside rays are different. You said that light exposure is cumulative. It's the cumulative UV that we have to be careful with. Are we getting any UV from our lights?
- [43:44]
B
Fluorescent lights have uv? Yeah, that's very well known. You can measure that fluorescent lights have uv. Most of the lights indoors nowadays are not fluorescent. They're either halogen or LED and they do not have UV. They stop sharply. 400.
- [43:59]
A
Was that why they stopped?
- [44:00]
B
And the mercury inside fluorescent tubing was a problem. So when the fluorescent bulbs would break, you were inhaling mercury powder.
- [44:07]
A
Thanks to one of the sponsors of the show, Boncharge man, if you're a mom out there and you've been carrying the whole team, I got a different form of therapy for you and that is red light therapy. And listen good. Light impacts sleep, hormones, mood and even your ability to recover and focus. Bon Charge has created science backed tools to help me live in better alignment with my circadian biology. Artificial light is overloading us. They have blue light blocking glasses that are a staple in our house. They have red light. They have red light light bulbs. They also have infrared PMF mats to help chill my body, relax my muscles and support full body recovery. If you've never tried red light therapy, this is the time to do it. They have some of the best devices that I've ever seen. Great for skin, mitochondrial health and overall resilience. If you care about your skin and if you care about your sleep, if you care about your body and want to try something new, check out boncharge.com DrLion use the code DrLion to get 15% off your entire order. Simple, proven, designed to support your biology. We covered the number one way to prevent wrinkles. Would you say that that's fair? That is expensive?
- [45:28]
B
Yeah. Excess sun protection or excess sun exposure protection.
- [45:31]
A
What about diet? Some people, for example, individuals that are extremely low in protein, animal protein, they seem to age really poorly.
- [45:45]
B
Tell me diet is massive. And I trained at Stanford and this was, it was a really great forward thinking institution in which we incorporated dietary changes to treat skin disease. Diet is medicine. Food is medicine and should be treated as such. Absolutely. The amount of protein that you get correlates to the amount of collagen substrate that you have to build. Collagen is a triple helix, proline, lysine, hydroxyproline or hydroxy lysine. You make that triple helix with some vitamin C. Animal based Proteins are much higher bioavailability, greater density of protein per, you know, plate of food you eat. So protein for certain anti inflammatory diets tend to protect the skin from premature aging and a myriad of skin conditions. Eczema, psoriasis, certain rashes, things like that. I tend to be very pro in the anti inflammatory diet. And generally diet is also correlated with lifestyle habits. If you're eating a shitty diet, you're probably probably not controlling your sleep and exercise and hydration. I don't know anybody who has Cheetos for dinner but is maintaining.
- [46:56]
A
I know my son was doing a pretty good job. Yeah, he's pretty definitely he's not eating Cheetos for dinner.
- [47:01]
B
But you get, you get the point. It's unlikely for you to have a flawless diet and then have everything else out of whack. If you're controlling that, you're concerned about your health, Everything else falls in sync. So diet, absolutely important. I tend not to like foods that spike insulin levels fast or have a high surge in the glycemic load. We see that as a problem in our skin in a myriad of things. The most common complication is just breakouts. Everybody used to think dairy was a culprit until a really good study out of Penn State came out that showed that full fat dairy products caused no acne. Skim and non fat dairy products in the US cause acne. And they looked into this saying, what the heck, where'd this come from? Skim and non fat dairy products in the US tend to have emulsifiers added to them to give them the mouth feel of full fat. Those emulsifiers are sugar substitutes. They spike your insulin. Insulin drives the breakout. So if you're worried about dairy causing breakouts, avoid the skim or non fat stuff. Go full fat. It's really the sugar that's a problem.
- [48:08]
A
And that's well documented.
- [48:09]
B
Yeah, yeah, very well.
- [48:11]
A
Skin is definitely a extremely well studied area. Right. And I want to go back to collagen.
- [48:17]
B
Yeah.
- [48:18]
A
We know that collagen, to the best of our knowledge, has no impact on skeletal muscle because it's the amino acid profile.
- [48:24]
B
Yeah.
- [48:25]
A
What do we know about oral collagen in skin?
- [48:29]
B
So the same reason a lot of people didn't believe in collagen supplementation for muscle is the same reason people didn't believe in collagen supplementation for skin. Because you can make that three amino acid triple helix from other foods that you eat. Doesn't have to be. It's not an essential amino acid. And you know this better than anybody else. What we have found, though, is especially in the US and especially in certain cities, patients have very restrictive dietary habits. Whether that's medically indicated or it's for esthetic purposes. People have a variety of very restrictive diets, vegans, vegetarians, et cetera, in which the amount of overall protein and collagen, you know, content that they're consuming is very low. So we see a benefit overall for two reasons. And several studies have suggested, and these are subjective assessments of skin health, so there's always some bias to it whether your skin looks better after supplementing. But there's two reasons. One, people who have dietary restrictions benefit from supplementation. And number two, when you consume collagen powder, just like whey or any other protein form, you have a measurable spike in the protein comp content of your blood plasma. In your plasma, you can measure, you know, albumin is the common one we measure, but when you consume it, you can see a spike of protein in the plasma component. With that spike draws water, oncotic pressure in your blood increases slightly. That gives that appearance of a little bit more hydrated skin. You can actually measure it in patients who are sensitive to protein supplements and their blood pressure goes up as well. So there's a little bit of a water draw effect with collagen supplements. I think, in my opinion, it's a net neutral to slightly positive. I think at, you know, not high doses. In lower doses, I think it's okay to beneficial, especially for people who are dieting a lot, who have restrictive diets, who aren't, you know, eating everything that they should. It helps for people like yourself who are spot on with their diet, their health. I don't think adding collagen to the mix is gonna make or break your skin.
- [50:39]
A
You know, I use collagen, and I will tell you, I first started using collagen sitting on, you know, we were talking about New York City. I had a practice on fifth Avenue across from Central park, which, it was awesome. And this girl came in and this was before anybody was taking Collagen. It was 10 years ago, and man, this girl came in with glowing skin, I swear to God. And I just said, I need to know. And she goes, well, I don't know if this works, but I've been taking collagen and vitamin C. And after that I was absolutely sold. I don't know if the data is. Because I've looked and it looks like there is.
- [51:18]
B
Yeah, there's some data. The majority of the studies are subjective evaluations, but there is Some improvement. Like you can see it in the photos. It's not, it's. You can see an improvement in the photos. Now the question exists twofold. When they start supplementing, are they also changing things about their daily routine that will improve their skin and overall health? Because now, you know you're part of a study, you're going to be a little bit healthier, you're going to sleep a little bit more, you're going to wash your makeup off, you're going to do all the additional things. These biases, I tend to recommend it in patients who want an additional thing that they can do that's easy and low hanging fruit, or they've noticed a change in the dullness or the volume or the luster in their skin. It's an easy thing to add. I don't think it's a negative. Anecdotally I have one, I found one benefit in my patients and I don't know if this is true across the United States, but a lot of older patients come in complaining about easy bruising on their arms and stuff. We call that Bateman's purpura. We used to call it senile purpura and that's not appropriate anymore.
- [52:16]
A
A little offensive. Senile.
- [52:17]
B
Yeah. But we call it Bateman's purpura. It's basically bruising in the skin. Because of thinning skin and UV changes, sometimes patients are on blood thinners like aspirin and plavics, what have you. Collagen supplementation for those patients reduces their likelihood of bruising as much and that's been really interesting.
- [52:33]
A
I am going to get back to you, I'm going to pick up some studies and I'm going to send them to you and maybe you can tell me again, I'm not a dermatologist.
- [52:38]
B
Yeah.
- [52:39]
A
So maybe there is something out there with benefit. And.
- [52:43]
B
Yeah. And I also, I think you, you, you talked about something important. Vitamin C. Yeah. You can't make the triple helix without vitamin C. So again, if you're not getting a source of vitamin C from your diet and you're not supplementing that collagen you're consuming is less beneficial. Hydrolyzed collagen absorbs better. We found that patients have a better result with hydrolyzed collagen anecdotally than, than just bulk collagen powders. And again, there, there's something that you've looked into. We have, we've looked at. Yeah. For sure. Absolutely. From, from a variety of reasons. One, we want to know where the data lies because patients Ask about it all the time. Two, we're always looking for things that we can do for patient skin besides prescriptions that is easy, safe, won't interact with other medicines that will improve their overall health and their skin health. And in formulating a product ourselves that we have, we added collagen at a low dose for the very reasons that you describe.
- [53:38]
A
We're going to come back to this product because it blew my mind and we're going to spend a little time talking about it because I think you're a genius.
- [53:45]
B
I don't know about that.
- [53:46]
A
Well, let's ask your, let's ask your wife. We'll ask Andrew, our friend Huberman. I think we would all agree you are extremely well trained as a physician.
- [53:55]
B
Thank you.
- [53:55]
A
The better the training of the physician, the more open minded they can be.
- [53:59]
B
I agree with that. And I think the less you know, the more you, the more patients you see, the more questions you have than anything else. I think the Dunning Kruger effect is real.
- [54:07]
A
This is absolutely true. I have a couple questions in terms of. You mentioned bruising.
- [54:13]
B
Yeah.
- [54:14]
A
As people age, there is this crepiness that happens. Do you know what I'm talking about, ladies? Do you know what I'm talking about? Tell me there's something to do about that.
- [54:25]
B
I wish I had an easy answer. There are things that you can do that will improve it over time for sure.
- [54:31]
A
What is it?
- [54:32]
B
So the creepiness is usually from a loss of collagen and elastin. When you look under the microscope, if you biopsy the skin, you see a tangled web of broken collagen and elastin fibers. We call it solar elastosis. UV has basically chewed them up and left the epidermis hanging from the fat. And that's the creepiness. You see, there's no, there's no buoyancy in the skin. And that's a result of age. Genetics and some medications accelerate that.
- [55:00]
A
And for everyone knows, Matt, my producer, you know what I'm talking about, right? Where skin is really creepy and you see it and it looks like wet newspaper. It looks like wet newspaper. It looks really thin.
- [55:13]
B
And I operate on those patients all the time. It's really hard to stitch. It's really, really hard to stitch.
- [55:18]
A
What can people do about that?
- [55:20]
B
So first is prevention. What can we do?
- [55:23]
A
But that can't just be sun exposure.
- [55:25]
B
A lot of it is sun, a lot of it is genetic, which is why you see creepier skin on the hands than you do the back or chest. Unless you go to like nudist beaches or beach towns where you see the same creepiness on the just last week. Me too. But you see the creepiness on the arms the most because they're the most sun exposed. Also, the amount of oil glands are an important factor in skin elasticity, skin thickness. So you don't see it as much on the face. Because we have oil glands on our face where we don't.
- [55:55]
A
That's actually true.
- [55:56]
B
When we don't. On the hands and arms. Things that you can do to prevent that. Number one, sun protection. Obviously we talk about this all the.
- [56:02]
A
Time, but a lot of sun protection and we're going to come back to again, we're talking about two things. Talking about vanity wrinkles and then we're also talking about skin cancer from the vanity standpoint. Mitigate sun exposure, sun protection for sure.
- [56:16]
B
Number two, there are laser resurfacing devices that we use all the time to stimulate collagen synthesis in elastin synthesis that 100%. Anybody who cares about their skin should do some sort of laser procedure for two reasons. One, we know it improves the appearance and now we know it also cuts your cancer risk.
- [56:40]
A
It does.
- [56:41]
B
Our new Harvard study came out last year like a 20 year study that showed that it reduces keratinocyte carcinomas.
- [56:46]
A
What kind of laser?
- [56:49]
B
The laser that we studied the most, the brand name is called the Fraxel laser. It's the workhorse in my practice and many derms practices. But any fractionated non ablative resurfacing device.
- [57:01]
A
The Fraxel Fraxel.
- [57:02]
B
Love it. Love it.
- [57:03]
A
I love it too. And I did it to my face and I looked like the mask. Do you remember that movie? Or was it the Elephant man where his ma. Where his face was completely blown?
- [57:14]
B
That happened to my wife. Happened to my nurse practitioners. Happened to everybody.
- [57:17]
A
Ladies, you should. Guys, you should definitely do this.
- [57:20]
B
But you want to know something? If you do it again, it'll be less. If you do it again, it'll be less. Because there's less of a damage target to hit. There's less things that the laser is targeting to erase. So the first time anybody does it.
- [57:33]
A
Terrible.
- [57:34]
B
Yeah. Yeah, for sure. But that's a good thing.
- [57:36]
A
How the Fraxel. I'm so glad that we're talking about this.
- [57:39]
B
I love this device.
- [57:40]
A
This episode is brought to you by something sweet. And it's not me, it's Manicora. Let's talk carbs. Specifically honey. And no, it's not another nickname for my husband. I usually call him something else. People have this idea that carbs are bad and that is simply not true. I use Manakura honey daily. Well positioned carbs like Manakura Honey, they have been amazing for my personal training. I think of Manuka honey, which is what it is, is a functional carbohydrate, not just the sugar. It's serving a purpose. It's not just adding empty carbs. Honestly, we use it anytime we need a natural sweeteners. The bees collect the nectar from the Manuka tea tree in New Zealand. It's very complicated. The nectar is then packed with bioactive ingredients and the honey that is produced has three times more antioxidants than your average honey. If you are looking for good honey and you are looking for something sweet, you can check out their website. To learn more, head to manicora.comdrlion for $25 off your starter kit. We're talking about it in the domain of prevention as well, not just treatment.
- [58:41]
B
No, no prevention for sure.
- [58:43]
A
When should somebody start, start doing it and should they do it on their body?
- [58:47]
B
Yeah, we do. So when you should start is when you start to worry about the way you look. If you ask my dad, he would never do it. If you ask my patients.
- [58:56]
A
19 years old.
- [58:57]
B
No, because your skin hasn't matured yet. You're still in the, your, your hormone milieu is peaking. You're still probably breaking out things like that. But I think starting in your late 20s, early 30s is not unreasonable as prevention in terms of treatment. We start to treat creepiness, volume loss, collagen loss, elastin loss somewhere in our mid-30s, because that's when we first start to notice it. Usually and unfortunately, social media has accelerated perceived aging faster now than ever before. People are coming in, asking for it younger and younger, but in reality, when we look at faces, the first decade that we start to notice appreciable changes is in our 30s. So that's where I start to convert from prevention to treatment. But honestly, you can do it at any age and it's very safe.
- [59:43]
A
How often should someone do it?
- [59:45]
B
If you're treating then.
- [59:47]
A
And what are we treating? Wrinkles, elasticity.
- [59:49]
B
Wrinkles elasticity, sun damage, sunspots. If we are using it as treatment, then it'll be based on how much of that thing we're treating is left. So every six months.
- [59:58]
A
But I'm not gonna, for example, for me, and I use the fraxel laser. I had my girlfriend, Christy Hamilton, she's a plastic surgeon and amazing. I trust her with a lase. I had her do it the first time I did it, my face looked terrible. I did it six months later, it looked better. And then I got really busy and all this other stuff happened. But I'm never gonna erase the wrinkles on my face.
- [60:22]
B
No. And that's. It's not. It's not meant to reverse decades of aging. It's to slow down that natural progression. Everybody will age. We're not going to make it out of this race alive. Right. So if your slope is like Johnson might.
- [60:37]
A
You never know. But.
- [60:38]
B
Or that guy on the boat in Greece.
- [60:40]
A
Yeah.
- [60:40]
B
Loving life. Just that guy's going to be.
- [60:43]
A
Never have any wrinkles. Yeah.
- [60:44]
B
If your slope is like this for aging, the goal of everything we're doing is to make it like this.
- [60:48]
A
I see.
- [60:49]
B
So you, you get there slower. You. You extend the duration of the perceived effect. So it's not like you're going to get a facelift result from a non invasive procedure. And even facelifts don't erase your wrinkles forever. But the goal is to help push that aging process down and help prevent any cancer along that. Fraxel's not the only device that does this. CO2 resurfacing lasers.
- [61:14]
A
So that's actually the one I did. Yeah, I did this.
- [61:16]
B
So you were probably. You were probably pretty messed up.
- [61:18]
A
I was.
- [61:19]
B
But was it Fraxel? Was the brand name Fraxel?
- [61:21]
A
I think so.
- [61:22]
B
These names. So there's an older fraxel that has like a CO2 wavelength component. There's a newer.
- [61:28]
A
Okay.
- [61:28]
B
Fraxel that has a wavelength that's, you know, 1927 or Thuleum tipped. It gets really nuanced in the technicalities. It all depends on what you're targeting.
- [61:36]
A
So CO2 is not necessarily a Fraxel laser.
- [61:39]
B
It's like saying tissue paper and Kleenex.
- [61:42]
A
Okay.
- [61:42]
B
Or petrolatum and Vaseline. So Fraxel is the brand of the Device, and then CO2 is the lasing medium and the wavelength target. There's a lot of companies that make CO2 lasers. And then the more important thing is whether it's fractionated or not, meaning you don't burn the entire square of the skin, but you have little skip areas to allow the skin to heal faster. I love fractionated lasers because it helps patients heal faster.
- [62:08]
A
The kind of laser, the brand. So we hear about Morpheus.
- [62:12]
B
Yeah, yeah, there's a lot. Those are all brands.
- [62:13]
A
Those are all brands of a Fraxel laser.
- [62:17]
B
Those are all brands of different lasers. Morpheus isn't even a laser. It's radio frequency so it gets really.
- [62:23]
A
But this is important.
- [62:24]
B
Yeah. It's really technically nuanced. Yeah.
- [62:26]
A
I want to walk away from this episode knowing what I can take orally to prevent skin cancer, which, you guys. It blew my mind. It really blew my mind. I also want to know as a dermatologist who's done two fellowships and was a professor at ucla, what am I going to do?
- [62:45]
B
Yes.
- [62:46]
A
To age better.
- [62:47]
B
Yeah.
- [62:48]
A
So you gotta, you gotta tell me, you gotta lay it off for me.
- [62:50]
B
If I were to have like my favorite things.
- [62:53]
A
Yeah. I'm all I'm taking.
- [62:55]
B
Let's say you have your perfect regimen for anti aging and essentially skin cancer prevention. Some good form of sun protection.
- [63:05]
A
Do you care?
- [63:05]
B
Doesn't have to be a sunscreen.
- [63:07]
A
Okay, you don't care if it's a sunscreen.
- [63:09]
B
Do you prefer, in fact, in head to head studies.
- [63:12]
A
Yeah.
- [63:12]
B
Sun protection from shade, shelter. You know, covering outperformed any sunscreen on the market because you cannot burn if you're in shade. It's impossible. But you can burn if you don't put on enough sunscreen. That being said, not everybody's going to cover up because life. So some form of sun protection, sunscreen, SPF clothing, shade, shelter, what have you.
- [63:33]
A
Do you care if it's mineral based or non mineral based?
- [63:35]
B
I'm going to get so much heat for this. I tend not to like chemical sunscreen. I treat as a skin cancer surgeon. I treat sunscreen as a drug and it's classified as an over the counter drug by the fda. But I treat it as a mechanism to prevent cancer for my patients. So I don't really give a shit, excuse my French, whether it looks great or not on the skin. Because my job is to prevent something where I have to take a scalpel to it. Not everybody thinks that way, and rightfully so. So for me, I tend to like mineral sunscreens for two reasons. Number one, it tends to have better visible light coverage and broad spectrum coverage than chemical sunscreens. More importantly, there's a lot of smoldering talk in the literature suggesting that chemical sunscreens are not as innocent as they may be played out to seem. Meaning some of the chemicals and their breakdown products can be questionably carcinogenic, can be questionably hormone disrupting. We didn't know this stuff when it came out. Chemical sunscreens came out in the cosmeceutical industry as a way to allow women and men to put on makeup without the chalky white residue of minerals. Because what would bother people is they would Put. Put on sunscreen and then makeup, and you got this white cast or you got this grainy, sandy texture. So minerals started becoming annoying to people who were wearing makeup. So cosmoce industry say, hey, can we find a chemical that will shield us from the sun? That goes on elegantly, goes on nicely. You don't have a white cast, and you don't have that chalky feel. The way chemical sunscreens and mineral sunscreens work are a little bit different. Mineral sunscreens tend to absorb and deflect or refract the light. They sit on the surface of your skin. Chemical sunscreens tend to absorb, undergo a chemical reaction in the skin, release that energy as heat, and then get a breakdown product. So there's a chemical reaction going on on your skin when you apply chemical sunscreens. That's how it protects you from uv, a chemical reaction. There's been enough data in animal studies and an interesting paper that was in JAMA that showed that even with a single application of a chemical sunscreen, we could detect that product in our plasma, meaning in a blood draw at levels that were above what we considered safe and normal. Now, a lot of people are going to come after me, especially those who are in the cosmeceutical industry right now.
- [66:05]
A
And would that be zinc oxide?
- [66:06]
B
What is a mineral is zinc and titanium. Chemicals are things like oxybenzone, avobenzone, octocrylene, a bunch of. If you can't really pronounce the name, it's probably a chemical sunscreen. And a lot of people are going to come after me for this. But if I have enough data that says maybe this class is not as safe as we think, whereas this class is generally recognized as safe, I'm gonna pick this one, of course, especially for my kids. In fact, the American Academy of Pediatrics and the American Academy of Dermatology do not recommend applying chemical sunscreens to infants 6 months and younger. So if we have that already and now, I'm sure in the comments, people are gonna say, well, no, the amount of mineral, the amount of chemical you need to put on is 500 times what you put on. There's enough data for me to say, you know, if I'm.
- [66:53]
A
I don't think you're going to get pushback.
- [66:55]
B
You know, you'd be surprised. I've gotten some remarkable pushback from a lot of industry. And I get it. Like, skincare is a $200 billion global industry. People have to push product. And they say, oh, my mineral, my chemical sunscreen. Is this. And there's no absorption. I don't know. There's a lot of basic science and some translated translational science that suggests chemicals aren't that safe.
- [67:19]
A
We're taking chemicals. So you would avoid. So you would use mineral.
- [67:22]
B
I recommend mineral sunscreens. It's majority of what we carry in our practice. Mineral sunscreen and a retinoid are the two single best things you can do for your skin.
- [67:32]
A
And this would be Retin A or.
- [67:34]
B
Something like prescription grade is always better than over the counter. The reason for that is the over the counter retinols are not active. They are inactive prodrugs that need to be converted into the active form by your body. The conversion varies person to person based on the enzymes that they have. Which is why somebody will use this product from Sephora and say oh my God, I'm like flaking and dry. I'm having the effects. And the other person will use it. I'm not, I didn't get any of that effect. Prescription strength always better.
- [68:06]
A
And that's generic. Can be generic.
- [68:08]
B
Yeah, generic.
- [68:09]
A
What percent?
- [68:11]
B
Start at the lowest because it'll irritate your skin. Tretinoin 0.025% now there is one prescription that is now available over the counter. It was a prescription up until a few years ago. Adapalene, the brand name is different. That is a prescription strength. Not, not an inactive retinoid. It's called Adapalene. It's 20 bucks at Target.
- [68:31]
A
And do people put it everywhere? If someone. And what is it going to do?
- [68:35]
B
Yeah, so retinoids should go on at night. You put a pea sized amount to the full face. You go 1, 2, 3, 4 and.
- [68:42]
A
Massage it in including under your eyes and above your eyes.
- [68:44]
B
You don't have to go right up to the eyelids because the eyelid skin is thin and it'll get really irritated but it'll diffuse naturally. So if you get it to your cheekbones, you're fine. You start once a week at night and if you're not dry and peely you'll go to two times a week at night. If you're not dry and peely you'll go to three times and the goal is to get to nightly. But if I told you go get retinoids, start them at night and you start peeling, you're going to say this guy's an idiot. So start slowly.
- [69:07]
A
And this is for wrinkles.
- [69:09]
B
It is for wrinkles. It was its indication is acne has been since the 80s. But it is the only medicine that we know Topical or otherwise, that grows new collagen and that's been studied for 30 years. You can biopsy the skin and see changes in collagen density increase and elastin. So it prevents wrinkles, it prevents sunspots, it prevents fine lines, it prevents sun damage, it prevents pre cancers, it prevents acne. It's the best topical medicine you can use.
- [69:41]
A
I'm sold. Why am I just putting it on my face?
- [69:43]
B
You could put it on everywhere. One, you'll probably run out of the tube. And really the area we concern, we're concerned about, if we're thinking aesthetics is face and it responds, it affects and modulates the pilo sebaceous unit, which is the hair follicle and oil gland. So if you don't have that on your like arms, legs, it's not going to be as effective.
- [70:00]
A
But what about for that creepiness of the skin?
- [70:02]
B
It can help. It's not great.
- [70:04]
A
Okay.
- [70:05]
B
It's not great. And it may just irritate your skin a little bit more. But for the face, it does help long term for the creepiness. Okay, so those are the two single topical products that you should. Everybody should be on sunscreen in the morning and any time you have excess sun exposure and a retinoid at night.
- [70:20]
A
Got it.
- [70:21]
B
If you want to ice the cake, you've built your cake. If you want to ice the cake, everybody wants.
- [70:25]
A
And we want a cherry, all of it.
- [70:27]
B
You can add a vitamin C serum. The way vitamin C works, if you think about this, is, you know, cut an apple, put some lemon on one side, leave the other side unexposed, leave the apple out in the sun, the unexposed side will brown, the side with the lemon will not brown. That's the vitamin C preventing oxidative stress and oxidation from the environment. The theory is you put that on your skin in the mornings and you help prevent oxidative stress and changes from the environment. When you're out and about. Now, don't go rubbing lemon on your face or oranges on your face, because that's going to create a whole slew of other problems. But vitamin C is an added thing that you can do once your cake is built. So if you're not using sunscreen, you're not using a retinoid. I don't think spending a lot of money on vitamin C is helpful.
- [71:11]
A
What about the Kojic acid? And there's a whole bunch of other products.
- [71:15]
B
So there's a lot of products depending on what you're targeting. Usually the acids are to help improve Dyspigmentation, melasma, sunspots. Acids are basically abrasive things that burn the top layer of skin off either gently or very aggressively. There's acids that are over the counter, lactic, kojic, glycolic, etc. Then there's acids that we do in the office, like higher strength.
- [71:37]
A
I've done those too.
- [71:38]
B
Tca, you know, trichloroacetic acid, glycolic acid, phenol peels. These chemical peels are acids. I caution people into doing too many things because a lot of what we're putting on are caustic. They burn the skin. Vitamin C is an acid, ascorbic acid. So if you're putting vitamin C acid on, if you're adding kojic acid, if you're having a lactic acid wash and you're putting on a retinoid, your skin's gonna really be irritated. You gotta build into these things slowly. So I bring this cake frame again. But once your cake is built, then you can frost it. Once the frosting set in, then you can put the sprinkles and the cherry on top. But it takes some time for your skin to get used to it or you're gonna have a bad reaction.
- [72:16]
A
What about. And you really are building the foundation of the things that you should.
- [72:20]
B
For 100 wrinkles.
- [72:21]
A
Anti Aging. Sunscreen.
- [72:23]
B
Yes.
- [72:24]
A
Retinol, vitamin C. Yeah. What? And it sounds like it's a give or take vitamin C for you.
- [72:29]
B
Look, I love it. I don't want people to throw everything at their skin right away. If you've been using sunscreen and a retinoid, for sure, add a vitamin C. And if you're at the age where you're starting to see the changes. I like Vitamin C. Late 30s, 40s, 50s. It does help prevent oxidative stress. And it is an antioxidant by definition as well as a vitamin. But you have to be careful with it. It can irritate your skin, it can cause some perioral dermatitis. But I do love it. It does brighten complexion. It does help with dispigmentation and sunspots. It's a great add on.
- [73:02]
A
What about lotions, things of that nature. And red light therapy?
- [73:06]
B
Yes. Everybody should have moisturizer. Everybody should have a good moisturizer. There's three big forms. Ointments, creams, lotions. What are the differences? Ointments are basically oil with some water droplets mixed in. The most classic ointment is Vaseline or petrolatum. Aquaphor is an equivalent creams are much broader. They tend to be white. They can be thick, they can be not so thick. Creams are water emulsions with a little bit of oil mixed in. So creams are lighter than ointments. Lotions are powders mixed with water. They are the least moisturizing. So I generally say, how dry is your skin, how irritated is your skin? The drier, the more irritated, the more moisturizing properties. You want. You want to go towards thicker things given that you're not breaking out. You know, if you're 18 years old, don't put Vaseline on your face, you're going to break out.
- [73:59]
A
But put on your feet, you know, I help your feet.
- [74:02]
B
That actually brings up another point. This whole, like beef tallow.
- [74:05]
A
I was going to ask you that. That's exactly what I was going to ask you.
- [74:07]
B
So my entire, unfortunately, my entire field has put this umbrella term on beef tallow is horrible for your skin.
- [74:16]
A
I cannot believe you bring this up. That is exactly my next.
- [74:19]
B
Because we're talking, you know, ointments, creams, lotion. So I am neither for or against beef tallow. In my culture. I'm ethnically Armenian. There is an equivalent homemade remedy that is like a beef tallow equivalent, that is that everybody in my culture knows about, that we use to treat burns and scrapes and injuries. If you are using beef tallow and you are not having any issues like acne breakouts, clogged pores, by all means use it. Who am I to say otherwise?
- [74:49]
A
Are they saying not to use it because doesn't it have fat soluble vitamins in it as well?
- [74:52]
B
People are saying it does not enough for it to be appreciable in your skin. You're probably not absorbing it enough for it to even make a difference. But it does. It has a lot of bioactives that you don't get from petrolatum. What is a problem with beef tallow is in young individuals, those who are actively getting their medical information from social media and they're 23 years old, they have a lot of acne or they have hormonal acne, or they have congested pores and they're smearing the stuff on their skin. It would be the same as if you smeared Vaseline on your skin. It's not really much different. But I have older patients who have dry skin. They're like, you know, I've been using beef tallow. My skin looks great. Who am I to say anything else, you know, your skin looks great, continue using it. So in the right patient it's fine. The other problem with beef tallow is where you source it from and quality. Like, you know, backyard beef tallow. I probably wouldn't recommend it. I don't know where it's coming from. I don't know if it's sterile. I don't know what else you're getting in there. But you know, good brands, you know, trusted brands that make beef tallow. I'm not against it. Go ahead, by all means. But if you start to notice your skin's reacting to it, back off and let's figure out why.
- [76:02]
A
It's good advice. It makes sense.
- [76:03]
B
Yeah, I hate like being umbrella one or the other way. I think every person responds differently. Now you bring up red light. Actually, before we transition to red light, you asked moisturizer. I think everybody needs a moisturizer if they're using a retinoid or an acid. Your skin is going to be dry. Pick the moisturizer that works with your skin.
- [76:21]
A
Is there one you use?
- [76:22]
B
I don't have any brand affiliations. I tend to like Neutrogena's Hydro boost or CeraVe's PM moisturizer or Vani Cream. You know anyone that is non comedogenic. So you want to look for that label that says non comedogenic, meaning it's been tested. Not to clog your pores, but Neutrogena is great. Anyone that you like that you will use and it won't be a glorified paperweight on your desk use. If you have issues with it, then figure out why. Maybe there's a preservative that your skin doesn't agree with. Maybe there's an ingredient that is breaking you out in terms of red light. A lot of talk about red light. I tend to like it. I have it in my practice. We have one that we use post procedure. We have. We also use it post procedure for hair treatment. I love is not a game changer device. Game changer devices are devices that can completely change your skin's biology. Full face ablative resurfacing. We can. Which is like the CO2 devices that peel your entire skin off and it regrows beautifully. Those are game changer devices. I think red light does a few things that is awesome. It increases blood flow to the skin. It helps promote some wound healing. It helps improve post procedure healing, you know, after laser resurfacing, what have you. I think that's great. I don't think there's a negative to it. I think the only thing people should be aware of Is whether their red light device is powered enough to see a clinical benefit. The way you kind of know is if anything is battery powered, forget about it. Probably is not powered enough to get the joules or the energy output, the fluence to see the effects we see in studies most of the time the ones that are effective are usually clinical grade or medical grade and they plug into a wall and you can see an energy output.
- [78:13]
A
Do we know why? What the mechanism for hair growth is from the red light?
- [78:18]
B
Yeah, it's thought so. Hair loss. The most common type of hair loss that everybody seeks, most people seek medical attention for is androgenetic or androgenic alopecia. And that's male or female pattern hair loss. And that's hair miniaturization and dormancy Due to sensitivity to dht, testosterone's byproduct, the hair is not gone. You may look bald, but when you biopsy the scalp, the hair follicles are there. They're miniaturized and they're shrinking. They go into resting phase. The way the red light is thought to work is it increases the blood flow to the dermal papilla cells, basically the stem cell region of the hair follicle to provide more fertilizer. Imagine turning up the hose in your garden and you can now provide more water to your plants. Your plants are going to grow again so long as the plants are there. And most of the time it is, its effect is slow. Person to person. You get a variability depending on how thick your scalp is and how deep the hair follicle sits in the scalp. Those are things you can't really measure. But some people get great response. 10 to 15% increase in hair density. That's a lot with red light alone. Some people don't. I tend to use it post procedure. So if you get hair transplant, microneedling, microneedling with prp, PRP injections alone, we use it immediately post procedure when the skin is already a little bit more inflamed to increase that circulatory flow.
- [79:45]
A
You mentioned prp. We didn't really talk about it, but I do want to talk about PRP exosomes.
- [79:51]
B
Yeah, yeah.
- [79:51]
A
But before we do that, what is the mechanism for the skin, for the red light therapy on the face? Is it just increase blood flow?
- [79:57]
B
It's thought to be increased blood flow. And in doing that, you can get a lot more fibroblast recruitment and a lot more stem cell regeneration from post procedure. And increased blood flow allows us to turn the skin over appropriately. You know, it allows your Your skin has stem cells that go down the hair follicles, and they live in the base, you know, basement membrane. Increasing flow to our pilosebaceous unit allows our skin to be a little bit more vitalized.
- [80:23]
A
You know, this has me thinking, and I've used a red light cap for hair growth. I've used it for years. I actually have kind of fallen off the bandwagon of recent. But if it increases hair growth on the head, would it increase hair growth on the face?
- [80:37]
B
In theory, potentially. But you have to have those types of hairs on the face that respond to that. So generally, terminal hairs, which are the dark, thick, or the thick blonde or thick brown hairs that come out of our head, those are terminal hairs. Whereas the hairs we have on our face, men tend to have terminal hair in their beard area. Women tend to have what's called vellus hairs, which is that peach fuzz hair that is not so responsive to things like red light or even hormones. Unless you shift them from vellus to terminal, you won't be able to do that with the red light.
- [81:11]
A
Okay, that's good.
- [81:12]
B
Good question. So you're not going to grow a beard, but you actually bring up a point. You know, people use Rogaine, Minoxidil topically and now orally to help improve hair vitality. That will grow peach fuzz as well.
- [81:25]
A
So where do you use that in your practice? We do minoxidil.
- [81:27]
B
We use it orally more than topically, mostly because, you know, guys hate putting on topical minoxidil. Women will be a little bit more compliant, but the efficacy of the oral version in, in my opinion, is a lot better than the topical.
- [81:39]
A
We use oral minoxidil as well. What dose do you happen to use just for women?
- [81:43]
B
Usually 1.25. And then we'll go up to 2.5. For men. We start around 2.5. Yeah, as long as they have no issues. No heart.
- [81:51]
A
Yep.
- [81:51]
B
Palpitations.
- [81:52]
A
And you find that they seem to.
- [81:54]
B
Lose hair first, so there's a shedding phase. You know, 30 to 50% of patients will have an initial shedding phase in the first four to six weeks. That's a good thing because it means you're a responder. We see it with the topical and we see it with the oral. So if you don't counsel patients about that, they'll come in, say, I'm losing my hair more. You're crazy. What the heck did you give me? Yeah, it does work. So the only thing is, you will grow peach fuzz. Your, your body Hair may increase a little bit. That's the downside to minoxidil. But it is safe, effective, doesn't modulate hormones the way finasteride or dutasteride do.
- [82:26]
A
Yes. And for the record, we never recommend finasteride. You know, we were talking about big.
- [82:32]
B
Time out of favor.
- [82:33]
A
Thank goodness for those. And that's propecia. If anyone is taking that, I strongly recommend you go and you see your physician and really talk about for sure coming off of that. That was, I think, a medical.
- [82:43]
B
Yeah. Especially in young patients.
- [82:45]
A
Yes.
- [82:45]
B
You know, if you're post the age of deciding to want children, you know, your 40s, 50s, older, maybe it can be a discussion because it'll provide some prostate protection as well in men. But for young guys especially that come in like 18, 19, like, dude, you don't need this.
- [82:59]
A
Like they're, they're the things we do way, way better.
- [83:02]
B
Your hair's probably not even reached its state where we need to treat it anyway.
- [83:06]
A
The circling back to the PRP and exosomes, that's a big, really hot topic. Okay, talk to me about what that is and how effective that is.
- [83:14]
B
PRP is great. Platelet rich plasma. We basically draw all the concentrated growth factors from the plasma portion of your blood, concentrate it, and then re inject it in an area of concern. It was popular in orthopedics, still is popular in orthopedics. And regenerating tendons, ligaments.
- [83:30]
A
I just had it done.
- [83:30]
B
Yeah, it's great. In skin and hair, we use it to reintroduce either growth factors, stimulate hair growth or wound healing post procedure. So let's say you have laser resurfacing done and the skin is injured. You can apply prp. That'll speed up the healing process, theoretically increase the amount of collagen and elastin you'll produce.
- [83:55]
A
Does it work?
- [83:56]
B
I think it works. Yeah. We use it, I use it a lot post microneedling. So we will microneedle the skin. Microneedled skin is basically bloodied. And we take a concentrated form of PRP and apply it to the skin and hope that it absorbs it because those microneedling channels are open. The patients that I've used it, the ones that benefit the most are the ones that tend to have like acne scars or traumatic scars in which we are trying to get rid of the scars. PRP seems to improve the density of collagen and speed up the healing more than if we just did microneedling or laser alone.
- [84:31]
A
And there's various modalities that you're talking about. But could someone skip all that and just go right to laser?
- [84:36]
B
Yeah, for sure. We blend them together. They do different things. We usually use them in synchrony. So laser and PRP at the same time. It depends on all what we're targeting. So if we're targeting like sunspots or melasma or dyspigmentation, the PRP is not going to provide you much benefit.
- [84:53]
A
Wrinkles, we care about wrinkles. And elasticity.
- [84:56]
B
If we're treating wrinkles, elasticity, PRP at the same time, for sure. If you're treating hair loss, prp, you know, PRP injections, red light therapy, things like that are all simpler procedures. There are bigger procedures. You can do hair transplant, facelift, and they're very effective. But most people are not, you know, diving straight into a facelift.
- [85:14]
A
No exosomes. Exosomes, what's that?
- [85:17]
B
These are thought to be messaging signal molecules.
- [85:21]
A
I don't like that you, you just took that big sigh because I just put bought exosome under eye cream and I am afraid I just wasted cash.
- [85:31]
B
You may have.
- [85:32]
A
Oh, come on.
- [85:33]
B
Yeah. Unlike internal organ mechanisms, exosomes and they fall in the category of peptides as well in the skin. Except maybe two or three companies that use exosomes that are shelf stable and verified in terms of having the exosomes they claim they have. The majority of the stuff sold. Hogwash. No hogwash.
- [85:58]
A
But would if I happen to have purchased. Which I'm going to go look and I'm going to find out. Well, I'm definitely using it because it was expensive.
- [86:07]
B
It is very expensive. There are some great brands that have some good exosomes.
- [86:11]
A
Okay. And the exosome itself is a signaling mechanism.
- [86:15]
B
It is. Usually it's a combination of peptides or amino acids. Sometimes there's a metal attached to it like a copper moiety. Those are really popular in the skin. Copper based exosomes. Some are derived from stem cells, either human stem cells or plant based stem cells. The plant ones don't really do much because our body works differently. It's theorized to send signals to increase your fibroblast ability to grow new collagen and elastin.
- [86:42]
A
You're not a fan.
- [86:43]
B
I have yet to see a difference in which the vehicle is used and the vehicle plus the exosome is used and see an appreciable difference. Nobody really likes to do that study. Which is why a lot of times in that realm, like scar healing products, you won't see many companies Do a split scar study where they use standard petrolatum aquaphor for 1/2 of the scar, allantoin for 1/2 of the scar and their scar healing product on the other half because it looks the same. What they will do is show you an untreated scar, no, nothing on it, and then a scar that's treated with their product. Well, of course that product is going to work better because you're doing something to protect it. Okay, well if you're going to spend the money for exosomes, my opinion is hold it and get a procedure that really provides skin health. Some sort of resurfacing, laser microneedling. Something I we touched upon what we can do for anti aging in terms of topicals. There's a lot of things we can do in the office that will help you in terms of anti aging from a procedure standpoint. I love. There's three. If I had three magic devices and those are the only devices I can use, it would be Fraxel or some sort of fractionated non ablative laser. Fraxel's my favorite. Some sort of vascular laser that targets blood vessels. I like the V beam or the pulse dye laser. I like it because it gets rid of all the broken blood vessels, gets rid of rosacea and it helps reduce the likelihood of basal cells. It gives you that really nice even tone.
- [88:20]
A
How often can someone do that and.
- [88:22]
B
Do it every month if they like. Especially for fair skinned patients who have a lot of redness, who flush in the sun or with hot beverages or with spicy foods, or with emotion. You know that rosacea flush, this, this is the gold standard for getting rid of that broken blood vessels around the corners of the nose.
- [88:35]
A
I'm going, signing up.
- [88:36]
B
And then a microneedling device. Simple, effective and stimulating collagen synthesis. You can do it in all skin tones. One of the biggest challenges in the US is we can't use every device on every skin type because of the risk of dispigmentation and consequences with changing their skin tone. So a lot of what we can use in very fair skinned individuals is not safe in very olive or ethnic skin or dark skin.
- [89:01]
A
The laser and the microneedling, do they do different things? The fraxel, the fractionated laser, it depends.
- [89:07]
B
On if you're targeting fractionation for sun damage, then yes, that targets a higher level of the skin, gets rid of freckling, sunspots, etc. If you're targeting fine lines and wrinkles, depending on the depth, they do similar things, but I use them in conjunction all the time. And then probably the third thing that you can do is utilize a daily supplement that will protect your skin from the harmful effects of the sun. Now everybody's like, what the hell are you talking about?
- [89:34]
A
Yeah, say it again.
- [89:36]
B
Yeah, the third thing. So topicals, a sunscreen, a retinoid and a vitamin C. And then you can add all the other things that you'd like. You know, Kojic acid, azelaic acid, what have you after the fact, a retinoid at night, laser resurfacing procedures that will stimulate collagen and elastin growth, get rid of sun damage, prevent skin cancer. Those are excellent. And then the third thing, which I recommend to all of my patients, is to take supplements that protect your skin from the sun. There are three, well, four, three really big supplements that I like. One is a plant called Polypodium leucotomas, which is from a fern in the Amazon. It's a fern that when you consume, lets you be out in the sun longer before you burn.
- [90:20]
A
Dale, where did you even. Were you in Peru somewhere?
- [90:24]
B
This is a.
- [90:25]
A
In the jungle, which is, you know, with a machete.
- [90:29]
B
It's well known in a niche of dermatology, this plant.
- [90:32]
A
You mean like five people?
- [90:33]
B
Yeah, like seven. Yeah. And it's a. It's a readily available plant that went. Consumed at the right dose. Lets you be out double the time before your skin burns. It's not a replacement to sunscreen.
- [90:45]
A
That is so cool.
- [90:46]
B
Yeah, it's awesome.
- [90:47]
A
Wait, it's a fern.
- [90:48]
B
It's a fern. It's like a, like a naturally growing fern. Amazon. Polypodium leucotomas, of course.
- [90:53]
A
And where. What. Who is. Were they eating it?
- [90:59]
B
So the way they found out is indigenous people would go out on fishing expeditions on the Amazon and they'd be out for three days. So the way they'd protect themselves is they'd crush up the leaves and eat it.
- [91:08]
A
Wow.
- [91:08]
B
And they wouldn't get a sunburn.
- [91:10]
A
That's really cool.
- [91:11]
B
So this came out, you know, this like, data came out about 10, 15 years ago saying, hey, there's a supplement that you can eat that you can consume that will protect your skin from head to toe from burning. And it helps prevent things like flaring of your melasma, helps prevent sunspots. It's basically an internal shield for your skin against UV and sun damage.
- [91:32]
A
You know, I'm going to have to ask, do they know the mechanism of action?
- [91:35]
B
There is a myriad. It's thought to decrease our skin's dimerization from UV exposure.
- [91:43]
A
Meaning?
- [91:44]
B
Meaning it's thought to prevent our skin cells ability from causing UV mutations from the sun. That's one. The next supplement is a supplement called nicotinamide. Now, not nmn, not nad. These are commonly mistaken or confused. NAD is nicotine, nicotinamide, adenine, dinucleotide. NMN is the mononucleotide. They have different functions in the body. They have no relevance in the skin. But pure nicotinamide, when given at the right dose, has been shown to reduce our skin cancer risk, our non melanoma skin cancer risk by up to 30%. And that data was published in the New England Journal of Medicine, one of our most prestigious medical journals, in a phase three study. So this is great supplement that is over the counter.
- [92:30]
A
Where would you find it in food?
- [92:31]
B
Yes. Nicotinamide you won't find. It's a derivative of niacin. So niacin is vitamin B3. But the amide derivative that has the amide moiety attached to it is nicotinamide, also known as niacinamide. You can find that in supplements. You won't really find it naturally occurring in foods. That is another excellent supplement. And the third is astaxanthin.
- [92:55]
A
I am really big into this.
- [92:57]
B
It's not well known in dermatology, but it is well known in the anti aging, wellness longevity world. It is a powerhouse antioxidant and has been shown now in several studies to prevent premature aging of the skin. Helps prevent fine lines and wrinkles, helps prevent sun damage. You can. These are excellent supplements that everybody should be on.
- [93:20]
A
Where would you find anthocyanins in, in terms of food?
- [93:23]
B
You'll find it in like shrimp, salmon. You'll find it if you eat a lot of marine algae, you'll find in marine algae, the bioavailability in shrimp and salmon and crustaceans that are have that orange hue. That's where the orange hues from is higher bioavailability than the marine form. But if you don't eat, you know.
- [93:41]
A
And it's also difficult to get the dose.
- [93:43]
B
Yeah, yeah.
- [93:44]
A
A precision dose. I've actually am starting to take 12 milligrams which is high. So 2 milligrams I've been reading about is great for eye health.
- [93:54]
B
Yeah. And the skin is around four.
- [93:55]
A
Around four, yeah.
- [93:56]
B
So because of all this, we put together, me and my two partners put together a product called Sunpowder.
- [94:04]
A
It's very cool.
- [94:05]
B
It's the world's first daily drinkable supplement that you can take to protect your skin against sunburns, to Help reduce the likelihood of non melanoma skin cancers and to prevent premature aging from the sun. In my practice, I have a lot of patients who are sun damage heavy, meaning they have skin cancers, they have life threatening skin cancers. I have a lot of patients that come in for, hey, what happened to my skin? Like, why is it all wrinkled? And I lived at the beach, I'm like, okay, let's figure this out. My partner, who's a Harvard trained laser dermatologist, sees a ton of patients every day for laser resurfacing, mostly for aesthetic purposes. And aside from the standard sunscreen, avoid the sun, wear your retinoid. There has to be something. And dermatology never really looked into the supplementation world because in medicine, unfortunately it was taboo for a long time. If it wasn't a prescription, it didn't work.
- [94:54]
A
Remember, remember Perricone back in the day?
- [94:56]
B
Yeah, yeah, I remember that very well.
- [94:58]
A
That must have been the first. And I don't know, is he still alive?
- [95:01]
B
Actually, don't know.
- [95:02]
A
Okay, I don't know. So this guy, Dr. Perricone was the OG. I remember reading this in my grandmother's bathroom while she was, I don't know, watching Jane Fonda and he was talking about food and stuff.
- [95:13]
B
There's a lot that we can do that we don't look at that can improve skin vitality from the inside out.
- [95:20]
A
How did you come up with this and this sunpowder?
- [95:22]
B
So originally like eight years ago or what have you, when I was doing my training at Stanford, we had a high risk clinic, we had a high risk skin cancer clinic. Patients who had a lot of tumors and a lot of burden of disease, those who had a high chance of metastatic disease or death. And we looked for things that we can do to reduce their skin cancer burden. And ironically, oral retinoids are one thing that you can do, and that's a prescription that has to be talked about with your dermatologist. But we found that nicotinamide also helped reduce their skin cancer burden. By what do you mean?
- [95:57]
A
Their burden? Meaning how much you were finding if.
- [95:59]
B
You had a high likelihood of making five of these next year, squamous cell, basal cell, what have you. When you supplemented with nicotinamide, your risk reduced by 30%. And it's a lot because all of the majority of the skin cancers tend to occur on the face. So then we said, okay, if this food supplement or if this oral supplement does this, is there anything else that can improve skin appearance? Resistance to uv? So that's where the dive Began and we did a lot.
- [96:27]
A
Really disappointing. Collagen didn't make it in there.
- [96:29]
B
It's in there. It's in there. Not a lot. Not a lot, but enough for those. And there's vitamin C in there for that reason. How much vitamin C is 250 milligrams. And then we have hyaluronic acid, which is the same thing that, you know, filler, cosmetic fillers are made of. This helps hydrate your skin. We have glutathione in there, which is, I think we're the only oral supplement that has reduced glutathione in there. Really popular product, Korea, really popular in Asia, both as supplement and as infusion to lighten and even out the skin from sun. And then we have astaxanthin, we have nicotinamide polypodium. So we put all of these ingredients into one supplement called sunpowder. And all of my patients, they take a single scoop, mix it into water and drink.
- [97:12]
A
How long till they see. Obviously, there's the cancer prevention.
- [97:17]
B
Good question.
- [97:18]
A
How long till you anticipate a cancer prevention versus how long till they can see it in their skin?
- [97:25]
B
So if you're using it for sunburn protection, if you're using it to reduce the likelihood of you burning within two hours of consumption, we see that change.
- [97:34]
A
That's unbelievable how that doesn't even make sense.
- [97:37]
B
It's awesome. I know. It's really, really cool. The polypodium is amazing. The astaxanthin works together.
- [97:43]
A
But how does it get into the skin that fast?
- [97:45]
B
Well, usually if you consume something, you can measure an uptake in your plasma of whatever you're consuming somewhere around 30 minutes to an hour, depending on gastric emptying and how much food you've eaten, what have you. Ideally, it works better if you know you're gonna go on a trip and you start a week before there's a cumulative, measurable change in your skin. So if you know you're going to Hawaii next week, start a week, have a scoop a day. It preps your skin for uv. So if you know. So if you're using it for sun protection two hours before sun exposure or daily, just as a preventative, if you're using it for skin cancer reduction. Our data point inflection was nine months. You had to be on it for at least nine months to start to see the changes. And not just skin cancer. We saw a reduction in what's called AKs, actinic keratoses. Pre cancers patients who supplemented had a lower number of them. When they would return. This is without any other treatment. So if you're using it for skin cancer, somewhere in nine months or so, if you're using it for primary anti aging prevention, you just want your skin to look good. Think of this as. And I have no brand affiliation, but think of this as like AG1 for your skin. If you're using it for that, it's the time point is hard to see a specific like inflection point. But most of our customers, my patients will come in around three months and say, hey, I'm noticing my skin looks a little bit brighter. I feel a little bit more hydrated. I'm in the sun and I'm not burning. We've had a lot of patients from across the US Message and say, this is the first summer I've been able to go outside.
- [99:13]
A
Unbelievable.
- [99:14]
B
Without either getting a sun allergy, which we call PMLE or polymorphous light eruption, or they've gone to Disneyland, Florida, Hawaii, where have you on vacation and they haven't burned. No, it's not a replacement for sunscreen. I got to make that clear. Sunscreen does a different thing. It works from the outside in. Sun powder works from the inside out.
- [99:30]
A
It is really amazing. I'm going to try it. You brought me four bags?
- [99:33]
B
Yeah.
- [99:34]
A
Two follow up questions. Can kids take it?
- [99:37]
B
Six and older. Six and older. Generally it should be weight based, so six to 12. I say take half a scoop. 12 and older, if they're of normal body weight, they can take a scoop.
- [99:48]
A
Very cool.
- [99:48]
B
Everything is water soluble, doesn't interact with medications. You don't have to worry about it being a drug or a prescription pregnancy. Run it by your ob. Theoretically, every ingredient in there is safe for pregnancy. But every pregnancy is very sacred. Every. Every person is different. I would hate for something that is like this to affect it. So run it by your ob.
- [100:10]
A
This is a random question. And this is because my best friend's sister has, I don't know, she has some polymorphism that every time she goes out into the sun she gets. It's like very painful. What is that called?
- [100:23]
B
It's either PMLE polymorphous lidorexia.
- [100:25]
A
That was right.
- [100:26]
B
Or the more severe version is actinic prurigo. Okay, serious. But they tend to get better with what's called sun hardening. So as the summer goes on, their skin tends to tolerate the UV more and more. There's actually medical indication for our supplement for that.
- [100:43]
A
That's what I was. I'm gonna send her one of my bags.
- [100:45]
B
Yeah. It's used for pmle. It protects your skin from the inside. It's really effective because it's miserable for patients. They get this itchy, blistery rash on their forearms.
- [100:53]
A
Dr. Teo Soleimani, thank you so much. This was such a fun conversation, and we'll have to do it again.
- [101:00]
B
Yeah. There's so many things we haven't even touched upon. We didn't even touch upon Botox, which is the quintessential neuromodulator. So for another episode, I'm a fan of it, but it's been an honor to be here. It's been a pleasure. I've had a lot of fun chatting about all the things I love to do, and hopefully this provided some information for people to find the right direction, how to make their skin look good and stay healthy.
- [101:21]
A
Thank you so much.