transcript

Speaker 1:
[00:00] If you've spent hundreds, maybe even thousands of dollars cumulatively over the years on skincare and haircare and wondered why you are not getting the results that you want, today, we are gonna change that. We're talking through every common skincare concern. We're talking acne, skin barrier damage, dark spots, pores, aging, hair loss, and we are finding out what the real root cause is, what actually works, what's a waste of money, what you're probably doing wrong, and the one thing that you can do tonight that will make your skin and your hair look better by tomorrow morning. My guest is Dr. Samantha Ellis, a board certified dermatologist who teaches at UC Davis. She has her own skincare line that is carried at Target. She's become one of the most trusted voices in dermatology online with hundreds of thousands of followers who rely on her deeply science grounded advice. Her private practice has a six month wait list. She works with top celebrities. I am lucky enough to call her my personal dermatologist and my friend, and today she's gonna help all of us get the skin and hair that we deserve. Welcome to The Liz Moody Podcast where we're not gonna add a million things to your life in the name of biohacking or being healthy or doing what you should do. No, we're gonna help you figure out the exact levers to pull that are gonna make you feel how you want to feel. They're gonna get you the results that you want to have. And no matter what you are going through, no matter what you're dealing with, we always, always believe that there is a lever. Dr. Sam Ellis, welcome to the podcast.

Speaker 2:
[01:23] Thank you for having me.

Speaker 1:
[01:24] Welcome back to the podcast.

Speaker 2:
[01:26] It's true.

Speaker 1:
[01:26] In person, I know, it's been so long and like we've become friends since then.

Speaker 2:
[01:31] I know, we've come a long way.

Speaker 1:
[01:32] We've come a long way. Okay, so today we're gonna go through a bunch of different skincare concerns, common things, and we're gonna kind of say, what are the do's and don'ts? What are people getting wrong here? I would love to start with, what is the number one most common skincare mistake that you see people making?

Speaker 2:
[01:46] The number one thing people are getting wrong is how much sunscreen they're applying. I feel like the average person vastly under applies their sunscreen. So they're not really getting the protection that they think they should be.

Speaker 1:
[01:57] What is the right amount to apply?

Speaker 2:
[01:59] So it's a little bit of an estimate, but we want people using about a quarter teaspoon for their face and ears. So for a lot of people, that's going to be about two finger lengths on their hand, because when they're assessing the SPF or the sun protection factor of a sunscreen, they're really counting on you using the correct amount. And if you're under applying it, you're not getting that SPF 50 or that SPF 30 that's stated on the bottle.

Speaker 1:
[02:19] So I don't reapply my sunscreen. I use a physical sunscreen and I don't get burnt. And I'm kind of like, I know it gets patchier throughout the day, but I'm sort of like, is that bad?

Speaker 2:
[02:34] No, it's not. It's a little bit of a nuanced answer. But the reality is most people, including dermatologists, do not reapply throughout the day. And if you are mostly indoors and you're not having tons of sun exposure, reapplication becomes truly less important. But if you are out with lots of UV exposure and you're not wearing a hat, I would prefer you to reapply every couple of hours because exactly as you said, the sunscreen breaks up on your face, you get patchy coverage. That doesn't mean it becomes completely ineffective, but it becomes less protective over time.

Speaker 1:
[03:03] I don't want to dwell on the sunscreen thing too long because I feel like we all know we should be using sunscreen at this point. But the thing that I always say is if you are using actives, that you're trying to clear up dark spots or make your skin look younger or anything like that, and you're not using sunscreen, what are you doing? Because sunscreen is the best thing for all of those things.

Speaker 2:
[03:20] For all of those things. And I always tell my patients, protect your investment. If you're getting laser procedures, if you're using actives, there are even studies that show that if you just wear sunscreen and use no actives, it actually reduces your photoage. So it reduces...

Speaker 1:
[03:32] Wait, it doesn't just prevent it, it reduces...

Speaker 2:
[03:34] No, there's reversal.

Speaker 1:
[03:35] How? Wait, why?

Speaker 2:
[03:36] There's just some protective effects that are cumulative over time, and we think it perhaps allows your skin to heal or sort of recover in between those...

Speaker 1:
[03:43] Because it's not like fighting off the sun. Exactly. Oh, that's so interesting.

Speaker 2:
[03:47] Exactly, which is really cool, and that was only with SPF 15 products. Now, I still recommend SPF 30 or higher, but even if someone does nothing else with their skincare, but wears consistent and the right amount of sunscreen, they can do a lot for their skin.

Speaker 1:
[03:59] Wait, that is fascinating. I always thought I'm like, I get it, sunscreen is protecting against this future aging, future damage, but the fact that it is letting your cells essentially regroup, repair, amazing. I love it. Okay, what are the top things that you can do for your skin that are not just skincare?

Speaker 2:
[04:14] Number one is protecting from the sun in other ways. So, wide brim hats, sun protective clothing. I know that it's like skincare adjacent, but I think that's really important. I feel like people lean too much on like, I don't like wearing sunscreen or I don't want to have to reapply. But there's other things you can do to protect your skin from the sun that have a lot of value. And again, I'm not trying to like harp on the sun thing, but it is the number one cause of premature skin aging. So the other thing you can do is exercise. Both cardiovascular training and even better resistance training have both been shown to improve the health of your skin and thicken the dermis, which is the deep layer of your skin that gives it bounce and suppleness and just health overall.

Speaker 1:
[04:50] What?

Speaker 2:
[04:50] Yeah.

Speaker 1:
[04:52] What is the mechanism there?

Speaker 2:
[04:53] We think it's because your skin and when your muscles contract, they produce something called myokines, which are signaling molecules that can trigger your skin to reduce inflammatory markers and produce more collagen.

Speaker 1:
[05:03] Wait, OK, so I have been on a workout journey. I've become a workout girly for the first time in my entire life, regularly, and now I crave it. I think I really tied it to my mental health in a very strong way this year, where I was like, wow, I really sleep better. I really feel less anxious. So now I don't miss a day.

Speaker 2:
[05:19] Yes.

Speaker 1:
[05:20] Do I look glowier?

Speaker 2:
[05:22] Well, actually, I do think your skin does look good. And I feel like you're on like this sort of like upswing journey. But this is also talking about making choices for not just your skin, but for like your whole body, your mental health, anything you're doing to support your entire body is going to be reflected in your skin. And now we just have more data to show that more clearly.

Speaker 1:
[05:40] So this gets us right into the first thing that I wanted to talk about, which is hormonal acne. I have read quite a bit of research about the connection between stress, speaking of mental health and acne. Does stress cause acne?

Speaker 2:
[05:53] It can. So cortisol, which is your stress hormone, can drive oil production in the skin. And oil production is one of the core things that cause acne. We think of oil production, irregular skin cell turnover that sort of clogs the pore. And then that leads to an accumulation of acne causing bacteria. And then you have inflammation with that. So anytime you have a cortisol spike in the body, it can lead to increased oil production, which absolutely can drive that acne process forward. Now, I would not say cortisol is the strongest hormone driver of acne, testosterone, DHT, those are the bigger ones, but it absolutely plays a part.

Speaker 1:
[06:26] Is this the reason potentially, I know a lot of friends where they didn't deal with acne at all in their teens or their early twenties, but now they're in their thirties and they're getting all of this acne all of a sudden. Is it because we're more stressed?

Speaker 2:
[06:37] It's possible. That definitely is one way to think about it. Also, a lot of people in their thirties are becoming sort of perimenopausal as much as we don't want to think about that being something that happens in our thirties, it can. And as you start to get those fluctuations in hormones, you get these sort of like surges and then these sort of regressions of hormones, and that absolutely can be stimulatory towards acne.

Speaker 1:
[06:56] So if you are getting acne all of a sudden and you're in your thirties, where should you start? What should you be looking at?

Speaker 2:
[07:02] I think you've got to look at your skincare. Like, what are you using? Are you using any new products that could be clogging your pores? So sometimes that can be a little bit hard to discern, but I usually say go back three months in your skincare and look at what you've been using. What's new? What's changed? Has anything changed in your diet as well? So although the link between diet and acne is not fully elucidated, there are certain things that can be triggering for some people, whether that's nonfat dairy, whether that's higher glycemic index foods. Even sometimes when people incorporate things like extreme intermittent fasting, it can spike your cortisol and that on its own can cause acne. So I look at your diet, I look at what you're using in your skin care, but for a lot of people, there is just a new hormonal surge that's going on or an increased hormonal sensitivity of the oil glands in your skin. At that point, I would start thinking about seeing a dermatologist just to understand if there's things you can be doing to improve it.

Speaker 1:
[07:49] How can we know if hormones are the underlying cause? Is it just ruling out everything else or they're like hormones that we're testing?

Speaker 2:
[07:56] We don't typically test the hormones because for the vast majority of people who get acne, if you test a hormone panel for them, it will be totally normal. That's because they don't have irregular hormones, but they've increased sensitivity to their hormones. So the oil glands in their skin just respond more actively or bind more strongly. And the other thing is this is not true across the board, but a lot of people when they have quote unquote hormonal acne, which most acne is driven by hormones to be honest, but they get a lot of lower facial acne. So it can be on the jawline, the chin, even the neck area can be more indicative of a stronger hormonal trigger.

Speaker 1:
[08:27] PCOS, that's a big thing with acne, right?

Speaker 2:
[08:29] Yes, definitely.

Speaker 1:
[08:30] So is the idea that kind of until you treat your PCOS, you can't just treat the acne, you need to treat the PCOS.

Speaker 2:
[08:36] Yes, and with people who have polycystic ovarian syndrome PCOS, they have higher circulating levels of androgens. So they do actually have those increased hormones in their body. But when you're getting treated for PCOS, a lot of that will help your skin, for example, going on birth control or spironolactone. These are medications that can be leveraged not just by dermatologists, but by endocrinologists who are helping with PCOS overall.

Speaker 1:
[08:55] If somebody comes to you and they have hormonal breakouts, let's say they're breaking out right before when they're on their period, what would be your Dr. Sam plan for them?

Speaker 2:
[09:03] It might be slightly different from person to person depending on what medications they might be on or what other medical problems they have. But for most people, I will make sure they are on tretinoin, which is a topical medication that helps regulate their skin cell turnover. So it helps unclog their pores. It's anti-inflammatory. It's also anti-aging, so most people aren't mad about that. And then I will also often talk to them about the medication spironolactone. It's a really effective medication at reducing how your androgens interact with your oil glands. And for most women, like over 85% of women who go on that medication, they will see a reduction in their hormonal acne.

Speaker 1:
[09:38] Oh, wow.

Speaker 2:
[09:39] Yeah, so it's very effective. And of course, like I say, for every medication, it's not for everyone and not everyone can tolerate it, but it tends to be quite well tolerated.

Speaker 1:
[09:46] Yeah, what are the downsides?

Speaker 2:
[09:48] Number one, it is a diuretic, meaning that it makes you pee out more fluid.

Speaker 1:
[09:51] When people be like, oh, yeah, I'm not bloated.

Speaker 2:
[09:53] So this is the thing. So it was initially used for blood pressure, to reduce your blood pressure by peeing out extra fluid. It also can be part of some birth control pills, but yes, it can make you lose some water weight, which is great. But also if you tend to have low blood pressure.

Speaker 1:
[10:05] Like if you could feel fainty when you say that.

Speaker 2:
[10:07] Exactly, you have to make sure you're staying really hydrated on the medication. So if you easily get dehydrated or you're not good about staying up on your water intake, that can be really important. And then some people will get breast tenderness, some people can get headaches, but it's really uncommon. I would say for every hundred people that I prescribe spironolactone to, there's just a handful that might have an issue with it. And sometimes we just reduce the dose or we adjust how they're taking their medication and they are able to tolerate it. And that makes a world of difference in terms of how confident they are in their skin on a day to day basis.

Speaker 1:
[10:33] So for PCOS, we know like, okay, you need to figure out a way to manage your PCOS to help this acne go away. Is that true for other hormones? Like, do you need to get your perimenopause under control? Do you need to get your other hormonal fluctuations under control from an internal standpoint almost, if you want the acne to go away?

Speaker 2:
[10:49] To some degree, but I would say that PCOS is a little bit different because it directly impacts the hormones that are most triggering to acne. So whether you have like other hormone issues, whether it's thyroid, things like that, those are less important or less well associated with acne. So it wouldn't be something that I would necessarily do as a dermatologist. But sure, it helps to have all aspects of your health aligned when you're trying to treat any skin disorder, including acne.

Speaker 1:
[11:14] What do you think about blue light therapy?

Speaker 2:
[11:16] I'm okay with blue light therapy. I think the devices you use in an office are usually more powerful or potent than what you could do at home. But blue light kills acne causing bacteria. So anytime you're reducing at least one arm of sort of the acne causing quad, that's going to be helpful.

Speaker 1:
[11:31] What do you think people get wrong when treating their acne?

Speaker 2:
[11:34] I think people assume that just one intervention or one modality will be completely curative. And typically the goal with acne is to reduce the intensity and frequency of breakouts. But we can't always get someone to never break out again. And I also think that there's not always an alternative. Sometimes people come in and they say, I don't want to do antibiotics, I don't want to do birth control, I don't want to use high strength retinoids topically. And there's only so much we can do when we have certain restrictions on how we can treat it.

Speaker 1:
[12:00] Yeah, I don't know what the right way to say this is. But I came across the stat that 62% of women have some sort of breakout around their period. And then I was like, is this something we should be treating? Like, is this a problem or is this just like a normal part of life and we need to normalize having some acne, looking at some acne, not having acne mean anything about you as a person or how you're perceived? You know what I mean?

Speaker 2:
[12:24] Absolutely. It's kind of a deeply stigmatizing skin condition. And I think that's why people feel so strongly that they shouldn't have it. We associate it with being a teenager. Some people associate it with poor hygiene, which it has nothing to do with hygiene. I totally understand that. But also I understand being a grown adult and being like, hey, I'm out of my acne phase. There's no reason I should have pimples on my chin. And just being confident in your skin and what you're putting forward to the world every day, I understand why people are bothered by it.

Speaker 1:
[12:47] What's the Dr. Sam protocol for acne scarring?

Speaker 2:
[12:50] I would say it really depends on how intense someone's acne scarring is. If it's just discoloration, like redness and brown spots, a lot of people will call acne scarring. But to me, a scar is something more permanent. That pigment is transient. It will fade no matter what you do, but wearing consistent sunscreen is going to be really helpful.

Speaker 1:
[13:07] Because then our cells have the time and energy to repair the... This is my fun fact of the day. I love it.

Speaker 2:
[13:13] So yes, you want to protect your skin from the sun. You also can do things to help speed up cell turnover, whether that's using your Tretinoin, which we use as an acne treatment, but also an acne scar treatment. Or even ingredients like Azelaic Acid that speed up that skin cell turnover, that help with brown spots, that can be really helpful. But when you have true textural scarring, which is what I think of as true scarring, where you get in bad lighting and you think, not my best angle, that typically involves in-office treatments. And depending on what someone's budget is, how many sessions they want to do, it kind of depends. But we usually do some combination of either micro-needling or more aggressive laser resurfacing. And the thing with acne scars is it can take many, many sessions to reduce them. And the goal usually is a 50% reduction in scarring. It's not to have complete clearance, which is why I'm such a proponent of treating acne more aggressively when someone is younger or at a point in their life when their acne is more severe. And we're just starting to see scarring because I cannot tell you how many adults that come in in their 30s and 40s. And they're like, why didn't I just treat my acne when I was younger? A lot of times when someone comes in and they have a lot of active breakouts, we're thinking about aggressive treatment in the beginning and then we can taper off things. So it's sort of like a kitchen sink approach in the beginning to get the inflammation down and to just stop new breakouts. And then we can start tapering off things. So just because someone starts with maybe a more intense routine, they don't have to stay there, but it really helps just quiet everything down so that they don't get this permanent scarring that can be so stigmatizing as they get older and causes a lot of people to be unnecessarily self-conscious.

Speaker 1:
[14:38] Can we pop our pimples?

Speaker 2:
[14:40] The dermatologist in me wants to say no, but the human in me wants to say yes. I think the key if you're going to release a pimple is to wait until it is very, very white at the top. So a lot of people try to pop pimples when they are red or sort of that deep cystic acne, and that's not going to pop well because you don't actually have a little pocket of pus. But if you have that really superficial white bump with clean hands, warm compress ahead of time, it's not my preferred thing, but I think if you're going to do it, wait until it's at that point because otherwise you're just going to give yourself a world of hurt.

Speaker 1:
[15:15] It is so satisfying, though.

Speaker 2:
[15:16] It's so satisfying, and a lot of us in dermatology will also talk about this sort of like triangle of death around the nose and the mouth area that you really shouldn't pop your pimples because bacteria can travel retrograde into the veins that communicate directly with your brain and people can get deep infections. So anything around the nose, like those deep ones there, we generally say like, please don't touch.

Speaker 1:
[15:36] Wait, how often does that happen?

Speaker 2:
[15:38] Very, very rarely, but enough that I wouldn't pop a pimple there.

Speaker 1:
[15:42] I've heard that for filler too. Like it's quite dangerous to get filler in your nose. Is that because the filler goes to your brain?

Speaker 2:
[15:49] That's almost, so you have vessels throughout your face, but the vessels around your nose area and that run through the center of your face can communicate directly with the blood vessels that supply oxygen to the back of your eye. So if you were to get filler, which can clog a blood vessel and stop blood flow into the vessel that supplies your eye, you could go blind, which is why it's so important that you go to a reputable injector, that they're taking all the right precautions, because these are very rare complications, but obviously completely life altering.

Speaker 1:
[16:19] I had happened to a friend, not the nose, but she had, I forget, you probably know what it's called. It blocked her vein in her chin and it was turning like black and it was the most pain she had ever been in her life. It took them days to figure it out and then to dissolve it. If it had gone much further, it could have been really, really, really bad. Then her dermatologist who ended up treating it, not the person who did it initially, was like unless they can describe in detail what's happening underneath your face, the structure of the muscles and where the veins are and all that, do not have them inject you.

Speaker 2:
[16:50] Absolutely. If they don't have a really sound understanding of that anatomy, there's no reason they should be blindly placing a needle or product into your face. That is the problem here.

Speaker 1:
[17:00] So casual about it.

Speaker 2:
[17:01] So casual. I think because we talk about it casually and in some ways, I'm happy with that, that people are less-

Speaker 1:
[17:07] Like self-conscious?

Speaker 2:
[17:08] Yeah, and they are okay with talking about what they've had done, but I feel like it's also empowered a group of people to inject, that really shouldn't be injecting people.

Speaker 1:
[17:16] Would you go to a non-derm?

Speaker 2:
[17:18] Depends, but yes, there are some that I would go to because they either do a lot of teaching, they've clearly done a lot of training. There are great non-derm injectors, but there's less sort of structured education that happens around it. So for example, in a couple of days, I'm going up to UC Davis to lecture the residents about how to do safe injections. We're going to do hands-on stuff. If you haven't done that in your training, how can you expect to be safe with a patient?

Speaker 1:
[17:41] So how can we know if we're like scrolling on Yelp or Google? How do you know that somebody is reputable and good?

Speaker 2:
[17:47] This is tough because one thing with your injectors, you want them to be safe, but also you want to have a good aesthetic outcome, and those are both important. I would say safety always is going to take the priority, but there's no point in having the procedure if you're not going to be happy with how it looks as well. Number one, I would say look at their credentials to see where they trained, are they an MD, a DO, a nurse practitioner, a physician assistant, because that gives you a little bit of an idea about their training background. You can see if they do education, if they publish in the area of aesthetics, but ultimately I also say go to someone who a friend or family member has gone to because that also can just give you a sense of what the vibe is. I made a whole YouTube video about how to find a good injector because I do think so many people struggle with this.

Speaker 1:
[18:26] The other thing that I hear about all the time with acne is you over treated it and it made it worse. You dried out your skin, you damaged your barrier layer, etc. How often do you see that as playing a part in the equation?

Speaker 2:
[18:37] I used to see it more because I think people would try to start too many actives at one time or they'd be given a big regimen by their dermatologist and no one really explained to them how to use this or how to start incorporating things. I feel like in my practice, I spend a lot of time educating the patient not just on what they should be using, but how to ramp up because a lot of things with acne, especially topicals, cause dryness, cause irritation. And so although they might have three things that they're getting prescribed, I don't always have them start all those things simultaneously so that they can have less irritation because for sure, the number one reason people's acne doesn't get better is not because they weren't prescribed the right things, but the patient wasn't able to be compliant, whether it's because the regimen was too complicated or the regimen was too irritating. So we always try to make sure it's something that the patient can actually find success with if they do it slowly over time.

Speaker 1:
[19:24] Okay, we're going to move in to dryness and skin barrier damage in a second, but just final thoughts on acne. If somebody was dealing with acne, what's the first thing you would have them do? Would it be adding in tretinoin with their sunscreen? What would be the step one?

Speaker 2:
[19:37] The first thing I would have them do is call and make a dermatology appointment because it's going to be months before they can get into most dermatologists. So they can have that appointment on the books. In the meantime, they can go to a drugstore and buy adapalene gel, which is essentially an over-the-counter retinoid that helps regulate your skin cell turnover, helps with oil control, it's anti-inflammatory. And I would have someone start using that because it works for all types of acne two nights a week after washing their face and then slowly working themselves up to every other night and then nightly because even just using that before they see a dermatologist will help start regulating everything. And then by the time you get to a dermatologist, if they want to prescribe something stronger, you've now been sort of like working towards that.

Speaker 1:
[20:17] Actually, I have two more questions. I lied. One, I want to clarify tretinoin because I talk about it online all the time and people are like, wait, what is that? It's kind of like the more fancy version of retinol, right?

Speaker 2:
[20:27] Yes, exactly. Tretinoin, retinol, they're both vitamin A derivatives. Retinol in your skin needs to be converted to retinoic acid, which is tretinoin. So retinol is sort of like a much, much weaker form of tretinoin. And all of the studies when it comes to acne and when it comes to anti-aging are more robust when it comes to tretinoin.

Speaker 1:
[20:47] Okay. I say fancy. It's not really. It comes in like a little medical tube. It doesn't look very fancy. But it's expensive.

Speaker 2:
[20:53] It can be. I mean, with a coupon and buying it generic, it shouldn't be more than 50 bucks for a tube. So that's pretty.

Speaker 1:
[21:00] Which lasts for ever. Because you are using a pea sized amount. So it lasts for a very, very long time. But there's also a million retinol products on the market. What's the difference? How do we know if we should be using one of those versus using tretinoin?

Speaker 2:
[21:13] First of all, retinol, not good for acne. It just doesn't work enough and as potently as we need it to. So you should either be using prescription retinoin or adapalene gel, which used to be prescription, but is also retinoic acid. It's the active molecule. It's just a third generation retinoid instead of tretinoin, which is a first generation retinoid. But they're essentially working on the same receptors and as directly as either one.

Speaker 1:
[21:34] And then retinol, is that good for aging?

Speaker 2:
[21:37] Yes. So retinol can be good for aging. So it's not quite potent enough to have consistent effects on acne, but can help with fine lines, collagen production. But if someone was tolerating retinol really well, there's more data to support that using tretinoin regularly will offer more benefits in the skin.

Speaker 1:
[21:53] Yeah, this is always my question. Like, why would anybody buy, especially there's ones over the counter that are like $200. I'm like, why are we buying this when we could get the prescription tube of the stuff that is actually more potent?

Speaker 2:
[22:03] Yes. So one, not everyone has access to prescriptions. But more so, I would say there are a subset of people who just can't tolerate tretinoin, like no matter how they layer it or how slowly they try to introduce it, it will just always cause irritation in their skin. Those are the cases where I would say investing in a good retinol that's tailored for sensitive skin can be valuable, but that's the only exception.

Speaker 1:
[22:24] Can I share a Dr. Sam fact that I share with a lot of people, and you can tell me if I'm completely misrepresenting you?

Speaker 2:
[22:28] I'm so curious what you're going to say.

Speaker 1:
[22:30] Okay. So I heard from you that stronger tretinoin does not necessarily get you better results. So if you're doing, I'm so bad at math, I think it's like 0.05, you can drop down to 0.025 and get the same results with less irritation. We have this idea societally that more is better, but the results aren't actually better, the irritation is just more.

Speaker 2:
[22:51] Yes. When you're looking at photo aging, so fine lines, wrinkles, hyperpigmentation, 0.025 tretinoin has been shown to be as effective as 0.1 percent tretinoin. When it comes to acne, the stronger or higher strengths can be better if you can tolerate them, but there's no reason you should be suffering with 0.05 tretinoin when you could be using 0.025.

Speaker 1:
[23:10] When people are trying to work through the tretinoin uglies and they're like two weeks of skin peel, drop it down, drop it down.

Speaker 2:
[23:15] I have so many people who come in, and in their consultation, I can see their skin is visibly peeling off, and I'm like, let me guess, you're using tretinoin, they're like, yes, how can you tell? Then I ask what strength they're using, and they're using 0.1, which is so potent. Unless you have really resilient or sometimes very oily skin, 0.1 percent is just going to be overpowering.

Speaker 1:
[23:35] Then my second acne thing that I wanted to get into before we move on to dryness and barrier stuff is how much of this is about pores? Do we need to be taking our black heads out, unclogging our pores? How much do pores play a role in acne?

Speaker 2:
[23:48] When it comes to acne, it's not about the pore, it's about what's going on inside the pore. For people who are prone to acne, they're getting too much oil production, or the cells that are turning over inside the pore are stickier, and so they're a better environment for bacteria and inflammation to build up. We are thinking about clearing out the pores with either regular use of topicals like tretinoin or oral medications, and that can help regulate that. So you don't have to regularly be clearing out your pores. It's better to just be on a topical that helps regulate the way the skin cells in your pores turn over.

Speaker 1:
[24:18] What do we think about extractions and the masks that you rip off and you see your little black things from your pores?

Speaker 2:
[24:25] So those can be helpful for a very temporary improvement. I find that if you are getting extractions but you're not on a regular skincare regimen to normalize that skin cell turnover, it's a bit of a waste of time. That's a very fleeting improvement. There are cases where extractions are indicated when someone has a very clogged pore or I can see that the skin has closed up over the pore. There's a low chance that that's going to clear on its own and an extraction can be helpful. But I feel like extractions are generally overdone and not always needed. Then the little pore strips and stuff, that's fun. But there's some concern that you're causing physical trauma to the pores which can stretch them out more in the long run. So I'm not the biggest fan. I'm not completely anti but I wouldn't use one.

Speaker 1:
[25:05] You don't need to go to a facialist once a month to get extractions.

Speaker 2:
[25:09] Generally, no. Don't hate me facialist. But I feel like facials to me usually are something that make you feel good, but they're not going to lead to it. It's like a massage. For some people, they can be truly therapeutic and life changing in a really important part of their regimen. And I don't want to say that they're horrible. But I feel like it's more just like a feel good thing and something that keeps you accountable.

Speaker 1:
[25:29] Yeah, I feel like I don't want to pay $150, $200, or something like red products on my face.

Speaker 2:
[25:34] Yes, everyone's different. But I feel like you could take the several hundred dollars that you invest in a facialist and get laser treatment one to two times a year and do so much more for your skin overall. But not everyone will agree with me on that. And I respect that.

Speaker 1:
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Speaker 2:
[33:09] Yes, pores and texture overall, but usually glass skin is just highly reflective of light, so the pores, you don't have these undulations or these microscopic texture in the skin that prevents light from bouncing off of it well. So yes, glass skin is mostly genetic, whether you have big pores or not, but there are certain ingredients that can help tighten up your pores temporarily like niacinamide.

Speaker 1:
[33:28] Do you think I have big pores? I had a 12-year-old tell me once that I had really big pores.

Speaker 2:
[33:33] That's rough.

Speaker 1:
[33:34] That was, I think, 15 years ago, and I thought about it often.

Speaker 2:
[33:39] Well, the kids just are the worst. I would say that you have average-sized pores. There are people who have much bigger pores than you, and there are people who have more refined pores.

Speaker 1:
[33:46] I feel like you have smaller pores than me.

Speaker 2:
[33:48] I have a special camera in my office that looks at your pores and tells you where you rank against the general population, and it does tell me that my pores are on the smaller side.

Speaker 1:
[33:55] So that's important when you're seeing these people on social media, and they're like, look at my poreless skin. A lot of that is genetic.

Speaker 2:
[34:01] Most of that is genetic, and it's really hard when you see someone who's like 15, 18, 20 coming in with this beautiful glass skin. They also have so much collagen, that sort of structural protein in the skin, that's squeezing on their pores and keeping it nice and tight. Everyone's pores get bigger as they get older because their collagen breaks down and everything sort of like widens out. But yes, all of that is genetic, and I definitely have people who come into my office who have the most beautiful glass skin and they're doing nothing for it, they're just blessed.

Speaker 1:
[34:26] But you also said niacinamide. Yeah. If so, if I want to get closer to glass skin, is that the product I should be looking at? You could try. The ingredient I should be looking at?

Speaker 2:
[34:35] I mean, niacinamide is one of them. Now, niacinamide is included in a lot of skin care. So like a lot of sunscreens, a lot of moisturizers, a lot of serums already have niacinamide in them, so you don't necessarily need a separate niacinamide step. But if I have a patient who's really oily, who has very prominent pores, I often will recommend a separate niacinamide step at a higher concentration, like 10 to 15 percent, which is really high. But if they don't get irritated from it, it really can reduce the appearance of their pores when they use it consistently.

Speaker 1:
[35:01] Is it okay to use tretinoin and niacinamide?

Speaker 2:
[35:04] Niacinamide is nice because it basically plays nice with everything. Now, like all ingredients, not everyone's skin is going to get along with that ingredient. But if it does, it can be leveraged well.

Speaker 1:
[35:13] If you're going to look at one ingredient to try to look more poreless, more textureless, that's it?

Speaker 2:
[35:18] I would say my order of that would be like retinol or some type of retinoid for sure. But yes, that can really help. And then also just thinking about skin cell turnover because sometimes the glass skin is also due to the fact that there's not a lot of buildup of dead skin cells on the surface. And so exfoliating acids like glycolic acid, lactic acid, mandelic acid, these are all things that also help with that skin cell turnover and can make things just look smooth and reflective.

Speaker 1:
[35:41] Are there in-office treatments that help with that?

Speaker 2:
[35:43] Oh, yeah.

Speaker 1:
[35:44] What's the best one? If I was just like, I want that like poreless, texture-free look.

Speaker 2:
[35:49] I would say for your age and stage of life, like a fraxel laser, so a non-ablative, but fairly aggressive laser to sort of tighten things up and sort of remove that surface dead skin cell layer would be appropriate.

Speaker 1:
[36:01] Is a fraxel laser the same thing as a CO2 laser? Is that different?

Speaker 2:
[36:04] Fraxel is a brand of laser. And a lot of people, when they're talking about fraxel, including myself, we're talking about the fraxel dual laser, which is a non-ablative laser that is essentially heating columns of skin. And then you extrude those columns of skin and everything tightens and smooths around it. Fraxel does have a CO2 version of their laser, but there are lots of other brands of CO2 laser. And that is an ablative laser, meaning that instead of heating columns of skin, it is truly vaporizing columns of skin.

Speaker 1:
[36:30] Is that right? People look so scary online after they do... I feel like CO2 lasers are having a moment online and everybody's saying, it's the single best treatment you can get for your skin. But then people look so scary after and it's really scary. I'm like, I want to try it and I'm terrified.

Speaker 2:
[36:48] Yes, it's really intense. So always with cosmetics, it's usually like more downtime, more intensity is more impact per treatment. It's also more cost and risk per treatment. But CO2 does have that really intense downtime and you can have bleeding, oozing. You got to be on antiviral medication, sometimes antibiotics. And it's like a true solid week or more of downtime. So it's a very intense treatment. We often refer to it as laser surgery.

Speaker 1:
[37:13] Yeah, I was going to say it feels more like laser surgery.

Speaker 2:
[37:15] In the office, we do a pre-op visit, they get a little bit of sedation. It's a big deal.

Speaker 1:
[37:21] Can they drive home?

Speaker 2:
[37:22] Generally, no, because they've taken a little Xanny or something.

Speaker 1:
[37:25] Do you agree that it's the most effective thing you can do, though, for your skin?

Speaker 2:
[37:30] I do, but I feel like sometimes people assume that because they had a CO2 laser and because they're going through the downtime and they paid these many thousands of dollars, which is usually what a CO2 costs, that they're going to have complete erasing of all of the aging that their skin has done. Even though it's the most powerful, that doesn't mean that it's all treating.

Speaker 1:
[37:46] How long does it last?

Speaker 2:
[37:48] Usually four to six years is like a good CO2 result. It's really intense, but I feel like it's worth it for a lot of people. It really is about expectation management because a lot of people are seeing a lot of CO2s done online on younger patients and so they're expecting their skin to look like a younger patient's skin when they're done, and that doesn't always happen.

Speaker 1:
[38:06] Have you had one?

Speaker 2:
[38:07] No.

Speaker 1:
[38:08] When would you decide to get one and why?

Speaker 2:
[38:10] I would have a CO2 done once the creepiness under my eyes starts to really bug me once I have a full 10 days where I don't have to go to work. But there are real risks that come with a CO2, like infections, like scarring, like prolonged redness, and so someone has to really understand that that is a possibility, although rare, and why you should be treated by an expert.

Speaker 1:
[38:29] Are you in pain the whole 10 days?

Speaker 2:
[38:31] No, it's not actually uncomfortable. You're really well-numbed for the procedure and you feel kind of tight and itchy is the biggest thing that people complain about when they're healing, is like all the little nerves are sort of like coming back to life. You have a lot of dry skin that you're managing. We have you do vinegar soaks every couple of hours for the first few days. You're covered in aquaphor. So by the end, people are just really not happy with the fact that they're so greasy. And then your skin continues to get better for about six months after the procedure. So you'll have some immediate visible results, but then it continues for a while.

Speaker 1:
[39:00] We're gonna get into this more later when we talk about aging, but at a certain point, I'm like, why? Why? Like literally, wouldn't it be easier if we just societally accepted that we will look older as we get older and that's okay?

Speaker 2:
[39:14] It, absolutely. I feel a lot of internal conflict about this because I want people to feel confident in their own skin, but we also live in a society where people are heavily judged by their appearance.

Speaker 1:
[39:25] I know, that's why we all have to like get together.

Speaker 2:
[39:27] I know, it's a collective action problem.

Speaker 1:
[39:29] All of us have to decide together. But like, I'm just like the amount of time, and energy, and money we could get back if we all grouped up and we just said, no, it's cool, like your creepiness is fine, wrinkles are fine, like those are all super cool things.

Speaker 2:
[39:40] I would love that for hair. I would love that for all of us to get together and be like, we don't wear makeup anymore. I mean, there are so many places, we don't do thongs. So many things could be.

Speaker 1:
[39:48] Thongs are crazy to me. Like thongs are like literally like, I'm gonna take something and rub it on my butt hole. Which doesn't feel sanitary, you know?

Speaker 2:
[39:57] My four year old son saw one on the floor of our room recently and he goes, when do I wear that underwear?

Speaker 1:
[40:02] I want to get in to dryness and skin barrier damage. Can you explain in the simplest terms what our skin barrier is and how we can know if it's damaged?

Speaker 2:
[40:12] Your skin barrier is the outer most layer of your skin. It's called the stratum corneum. It's the dead skin cells that are built up on the skin surface. And right below that you have the epidermis, which is sort of the top layer of living skin cells. And when you have a damaged skin barrier, that stratum corneum has cracks in it and environmental allergens or irritants are able to get in and water is able to get out. We call that transepidermal water loss or TUL.

Speaker 1:
[40:37] Like it's evaporating out?

Speaker 2:
[40:38] Yes, it's evaporating out. So we are constantly in this state of trying to get water into our skin and water is constantly trying to get out of our skin. And if you have a damaged skin barrier, that's happening at a more rapid rate and that can lead to inflammation in the skin, which can lead to redness, premature skin aging, et cetera.

Speaker 1:
[40:53] So how do we know if this is happening to us? How do we know if our redness is because our skin barrier is damaged or dryness is because our skin barrier is damaged versus some other factor?

Speaker 2:
[41:01] I think the easiest way to know if your skin barrier is damaged is when you feel any type of stinging, burning, or discomfort when you apply a regular kind of bland moisturizer. If you're using a product that doesn't have actives in it, like vitamin C or acids, and you're still having stinging when you apply it, that is a really good indicator that your barrier is not fully intact.

Speaker 1:
[41:21] Okay, so what do we do if our barrier is not intact?

Speaker 2:
[41:24] The first thing I have people do is look at their skincare regimen and take out anything that isn't an essential, which is essentially you're going to do cleanser, moisturizer, sunscreen, everything else you just put on pause. And you're basically going to use those really consistently until your skin feels better again. And you can do things to support your skin barrier, like using a really occlusive ointment, like Aquaphor or even Vaseline. A lot of people are nervous to use those types of thicker ointments on their skin, but they can be incredibly helpful with repairing your skin barrier. That's why we have people use it after a CO2 laser, for example, because it really prevents that transhepidermal water loss and it kind of is a comfort to your skin.

Speaker 1:
[41:58] But you need to put that over-moisturizer, right? Because it's not going to moisturize unto itself. It actually is. Or it is, okay.

Speaker 2:
[42:04] It's independent. There's a huge misconception that Vaseline and Aquaphor aren't moisturizers. They are. They are not the most optimal moisturizers, so you could use cream-style moisturizer underneath.

Speaker 1:
[42:13] Is it actually moisturizing, though? Or is it just, I mean, maybe this doesn't even matter. But if your skin's always trying to lose water and it's sealing that water in so it can't get out, is it providing more moisturizers or just keeping the moisture from leaving?

Speaker 2:
[42:25] None of the moisturizers really work by providing more moisture. They're really all working by preventing that trans-epidermal water loss. Moisturizers also help draw water to the skin's surface. Those are humectants within a moisturizer.

Speaker 1:
[42:36] Which is like hyaluronic acid.

Speaker 2:
[42:37] Hyaluronic acid, polyglutamic acid, glycerin are all great humectants. And then there's emollients, which is another category of ingredients within moisturizers like ceramides that help smooth the skin. And so a great moisturizer should have humectants to draw water, emollients to smooth, and then occlusives to seal.

Speaker 1:
[42:52] If our skin is super, super dry, should we be looking for a better moisturizer? Should we be looking to repair our skin barrier? Should we be doing something else entirely?

Speaker 2:
[43:01] I would say both. I think looking at your environment. So if you live in a more arid or dry climate, we have lots of people who struggle with dryness here in California. So doing things like adding a humidifier.

Speaker 1:
[43:11] Girl, I'm like California, go to Colorado.

Speaker 2:
[43:14] Yeah, that's true. I did my intern year in Colorado and there's actually something called Colorado Face because it's so dry there and you live at such a high altitude that there's so much sun and wind damage and it's a very premature sort of weathering of the skin that happens when you live in Colorado.

Speaker 1:
[43:28] OK, so sure, the California babies can listen to this. But let's say you're in Colorado or you're in New York in the winter. I'm sorry. I just I've lived in these other places. I'm like California is balmy.

Speaker 2:
[43:38] Yeah, fair enough.

Speaker 1:
[43:39] We live a nice life out here.

Speaker 2:
[43:41] It's pretty good.

Speaker 1:
[43:42] But if you live in one of these other places, what can you do to prevent that?

Speaker 2:
[43:45] One is using a moisturizer really consistently. So I feel like one of the biggest issues I see with people and skincare is they don't use it very consistently or they don't use one product very consistently. You're constantly bombarded with newness and you're constantly kind of trading things out. And so finding a moisturizer that feels good on your skin, that when you sort of think about your skin 15 minutes after you've put it on, you can still sense that the moisturizer is there. I call that having presence. And I like a moisturizer that has presence on the skin and doesn't sort of disappear, which could be good if you're oily, but is generally not good if you have dry skin. And then if you still feel dry after that, I really like a hydrating serum. So something that either has hyaluronic acid, polyglutamic acid that you're layering underneath your moisturizer to help draw more water to the skin surface. And it also gives like an instant plumping effect to the skin. There's not a lot in skincare that gives you that instant gratification.

Speaker 1:
[44:32] Is it drying it from the air?

Speaker 2:
[44:34] It can draw it either from the air or from the deeper layers of the skin. So humectants draw from both directions. Yeah. That's how it gets, you know, you drink the water, it goes through all their organs, it makes its way out.

Speaker 1:
[44:46] Wait, okay. So how much is dehydration showing up in my skin?

Speaker 2:
[44:49] Oh, dehydration can make your skin look horrible. Yes. There's a bit of a myth like, oh, if you drink a ton of water, your skin's gonna look so much better.

Speaker 1:
[44:55] Yeah, that's what every Hollywood actress does, right?

Speaker 2:
[44:58] Just a gallon of water a day.

Speaker 1:
[44:59] They just drink so much water and that's why they look so beautiful.

Speaker 2:
[45:01] Nailed it. But it really is about preventing dehydration because when you're dehydrated, your cells are sort of like shriveled down. I think of it like taking your skin from a grape to a raisin. And we really want our skin cells to be at grape status.

Speaker 1:
[45:12] I'm gonna go through some things rapid fire and you're gonna tell me if they're damaging my skin barrier layer and what I should do instead. Okay. Physical exfoliation.

Speaker 2:
[45:21] Technically is damaging your barrier, but in a controlled way. So it really just depends on how aggressively you're rubbing, how often you're doing something like that. So I love a physical exfoliant maybe once a week to just sort of like buff things out, but don't need to be using that every day.

Speaker 1:
[45:33] And so that to be clear, something with like the little beads or something where you actually feel texture on your skin. And I didn't realize this counted as physical exfoliation, but a washcloth.

Speaker 2:
[45:42] Oh, totally.

Speaker 1:
[45:43] Yeah. Or even like rubbing with a towel. That is physically exfoliating.

Speaker 2:
[45:46] Yeah. When I see some people like drying their face off after doing a skincare routine and they're like scrubbing at their face, that is deep exfoliation and can be very irritating.

Speaker 1:
[45:54] So, limit, yeah, pat it in. Okay. Chemical exfoliation.

Speaker 2:
[45:59] Also intentionally sort of damaging the skin barrier. Now, if you have a excess buildup of dead skin cells, that's what a chemical exfoliant is really meant for. But there are people who will reach sort of the optimal dead skin cell layer on the top of their skin, and then they will continue to exfoliate, and then you start breaking down the deeper layers of the skin, which is not helpful. So if you're using a chemical exfoliant, it really depends on what strength and how frequently you're using it. But yes, you absolutely can wreck your skin barrier if you over exfoliate physically or chemically.

Speaker 1:
[46:26] And does retinol or tretinoin count as a chemical exfoliant because it's doing the cell turnover thing?

Speaker 2:
[46:31] It's not technically put in that category, but it has a similar effect with that skin cell turnover.

Speaker 1:
[46:36] So if we're doing that, would we not want to also do like an acid type thing?

Speaker 2:
[46:39] Often not, although I will say some people like a chemical exfoliant because it just gives an extra boost in that really sort of glass skin we were talking about earlier. So I have a lot of patients who will do a retinoid five to six nights a week and then have one exfoliation night. But I don't usually have people. Yeah, I wouldn't.

Speaker 1:
[46:56] Okay. Layering active ingredients, which ones together would damage our skin barrier layer?

Speaker 2:
[47:01] I think if you're doing tretinoin or a retinoid with acids at the same time, not ideal, that's the biggest one. Everything else, it's really about what your skin can handle. There are lots of people who can do some physical exfoliation in the morning and do a tretinoin at night and be just fine. There are people who, if they put vitamin C on in the morning and they use tretinoin at night, that's too irritating. So it's really about listening to your skin. And if you're having stinging or irritation, the thing I would say is to prioritize the retinoid. It is the most powerful thing in your routine and does the heaviest of lifting. So I wouldn't sacrifice nights of that to use other types of actives in your routine.

Speaker 1:
[47:37] Why do you use physical exfoliators? Like what's better about it versus chemicals?

Speaker 2:
[47:40] They're not better. It's just some sort of, yeah, it could be fun. It can feel good. You get that like sort of immediate satisfaction. So I like it just for the experiential aspect of it, but it's not like-

Speaker 1:
[47:50] I just feel like I've like heard that it rips up your skin more than like chemicals, I don't know, more like gently dissolving stuff in your pores.

Speaker 2:
[47:56] Right, and people talk about physical exfoliation causing micro tears.

Speaker 1:
[47:59] That's never been shown. And I think like the St. Ives thing like ruined it for everybody else.

Speaker 2:
[48:02] Yeah, maybe not with like apricot kernels, yes. But I do think that physical exfoliation can be helpful for some people. And there's lots of people who don't like chemical exfoliation because it can sting or feel irritating on their skin or for people who have rosacea, they might find that chemical exfoliants are just too much and some very gentle physical would be fine for them.

Speaker 1:
[48:19] And then harsh cleansers is my last thing. Is that damaging my skin barrier layer? And how do I know if my cleanser is harsh?

Speaker 2:
[48:25] Any cleanser that you're probably using or like buying at the drugstore or from your dermatologist or esthetician nowadays is probably not going to be too harsh as long as it doesn't have a ton of acids in it. They're called syndets or synthetic detergents. They're different than like old school soaps that were super basic. I mean like acid versus base and those used to really disrupt the lipids in your skin barrier, but now the cleansers that we use generally don't tend to be too harsh.

Speaker 1:
[48:49] Is there anything else that you feel like we get wrong about the skin barrier or that you want people to understand about? I feel like it is just this thing that's like, it's become such a hot topic online that there's so much misinformation about it.

Speaker 2:
[48:59] Absolutely, I think the other thing to understand is that it takes a solid four to six weeks for your skin barrier to repair. So sometimes people will go, okay, I changed my routine, I used moisturizer for a couple of weeks and that didn't do it and sometimes that won't do it. You need more time for your skin to recover and you have to really respect what your barrier is doing. All of these actives and other things you're trying to do for your skin are really not going to serve you well if your skin barrier is in a constant state of being dysregulated or inflamed. You also kind of disrupt the natural microbiome of your skin when your barrier is disrupted. And so there's more data coming out on that, but also really important to think about maintaining.

Speaker 1:
[49:34] That's interesting. Okay, next up is aging. We've already sort of discussed some of my complicated thoughts on aging. We're going to get together our quorum and just decide we're doing it.

Speaker 2:
[49:46] We're aging, baby.

Speaker 1:
[49:46] We're doing it. I mean, I do, especially because of the differences between, I think men are having more pressure now than they've maybe historically had. Men are getting plastic surgery in ways that they haven't historically, stuff like that. But because there still is such a difference there, it does feel like let's distract the women so we can maintain power in a way.

Speaker 2:
[50:06] I mean, I just think of the hour that it takes for us to get ready sometimes to go out. If we had that extra hour every day.

Speaker 1:
[50:11] Or this. I think about constantly, I am performing beauty so that people will listen to my messages more.

Speaker 2:
[50:18] Yes.

Speaker 1:
[50:19] And the men are rolling out of bed, they're putting on their black t-shirt, they're not touching their little buzz cut of hair, and then they just go on camera.

Speaker 2:
[50:27] It's an unfortunate place to be. It's why I think what I do is so valuable to people, but also I feel conflicted about it.

Speaker 1:
[50:33] It's holding both in your mind at the same time, for me at least. It's holding this like, I think we should make changes, I think we should have these conversations, and it's okay for me to acknowledge that I live inside this system. I don't need to self-flagellate about feeling that I need to perform beauty within a system that rewards beauty.

Speaker 2:
[50:50] Absolutely. It's a little bit of like, don't hate the player, hate the game.

Speaker 1:
[50:53] Yeah, that's a much more concise way. I don't need to self-flagellate.

Speaker 2:
[50:58] I like how you were saying it.

Speaker 1:
[51:00] Okay. So when we say I look older, what are we actually perceiving?

Speaker 2:
[51:07] It will depend on each person. A lot of what we're noticing is the shape of our face. So generally noticing that we call it this inverted triangle of youth where we usually have more volume towards the top of our face than the temples and it tapers down. As we age, that triangle inverts where you get more heaviness and sagging in the lower face and around the jawline. So a lot of it is just the shape of the face and where the tissues sit on the face. Next is things like discoloration, whether it's brown spots or redness and unevenness of skin tone automatically makes people clock you as looking older. And then fine lines and wrinkles. But I actually think fine lines and wrinkles contribute less to it than general facial shape and discoloration at least based on what the studies show.

Speaker 1:
[51:46] That's so interesting because I feel like if you ask the average person on the street, they'd be like more wrinkles equals older.

Speaker 2:
[51:52] For sure. But when you look at studies where people are given faces to look at and they have to decide how old that person is, the number one predictors are things like how long someone's upper lip is because that descent of the upper lip or the lengthening between the base of the nose and the upper lip, it's like a dead give away and they care less about like wrinkles on the forehead.

Speaker 1:
[52:09] Wait, so I don't love that because I feel like that means there's not as much skincare wise you can do to reduce the perception of aging.

Speaker 2:
[52:16] This is the toughest thing and I actually think that's why facelifts are on such an uprise right now is because a lot of people are realizing I need to surgically lift or reduce this laxity in the skin and you can't do that with skincare and you can't do that with non-invasive things. There's still a ton you can do to make your skin look more youthful and to feel better but ultimately sometimes people are hoping for changes that are really only achievable through surgical interventions and that's a reality that I have to review with my patients all the time.

Speaker 1:
[52:45] I'm not going to ask you to comment on any individual people but in general, when the internet is speculating about whether or not people have had a facelift, is the answer probably yes?

Speaker 2:
[52:57] Yes, usually it is. I think it's really hard because people hold themselves to the standard of celebrities and they're hoping to have that level of improvement when these celebrities have had multi-hundred thousand dollar facelifts. Sometimes it's not a full facelift but they've had eyelid surgery, they've had a brow lift, they've had a slight reduction in their nasal tip, they've had a little bit of lip filler and all of those things together can read as a facelift. They didn't have a full facelift but most of them have had a facelift.

Speaker 1:
[53:22] Even younger, even in their thirties.

Speaker 2:
[53:25] Yeah, late thirties, early forties, really common. The reason that's becoming more common is because it's less of a shift. It still leaves you in the did she, didn't she kind of thing. Whereas if you have someone like Kris Jenner who's been very forthcoming about her facelift, she obviously had a massive visible improvement. When you do it when you're younger, it's like, oh, is she just wearing a super tight ponytail and got a new makeup artist?

Speaker 1:
[53:45] If somebody gets a facelift in their thirties or forties, are they probably going to need to get, is it like getting breast implants or do you like get them changed out every 10 to 15 years?

Speaker 2:
[53:53] Generally, a good facelift will last you depending on your tissue and what was used like eight to 15 years. It really kind of depends and need is a bit of a generous word. But yes, if you have a facelift when you're in your early forties, there's a good chance that by the time you're in your sixties, you're going to potentially want another one because it doesn't stop you from aging. It just sort of like resets the clock.

Speaker 1:
[54:14] But if it resets the clock, so like if when you're 40, you reset to 30, then when you're 50, you look 40, when you're 60, the clock is reset forever.

Speaker 2:
[54:23] It's not necessarily linear. Your aging really does speed up quite a bit as you get older. But yes, I have patients who got facelifts 30 years ago and they've never done a facelift since, but they still look much more pulled back. Their jawlines are much sharper. Their neck is much more refined than my patients who are the same age that never had that surgery done.

Speaker 1:
[54:40] How scary is that surgery? Is it super painful? I've seen the blood drains that come out of your, that freaks me out a lot.

Speaker 2:
[54:48] It's a big deal. I feel like a facelift is very casually talked about, but it's a really big deal. I mean, you want to put under general anesthesia. So you always have to think about the risks of being under general anesthesia. You're cutting near facial nerves, vasculature. I mean, it's very common to have prolonged numbness on the sides of your face and on your forehead for years after a facelift. So I don't say that to make people scared of them, but just to understand that there's two risks. It's deep surgery. And I would say most surgeons will quote you at about like three weeks of recovery to become restaurant ready. But that doesn't mean you feel fully recovered at that point. You just might be able to go out and hide your scars and feel like you can reenter society successfully.

Speaker 1:
[55:28] So barring facelifts and barring your really bummer news that it's like not our skin making us look older. What are the three biggest needle movers when it comes to reducing visible signs of aging?

Speaker 2:
[55:38] A solid resurfacing procedure to remove discoloration and even out the skin tone. So depending on how much discoloration someone has, that can be something like IPL or intense pulse light, also marketed as BBL or broadband light or a fraxel laser to kind of do that. And how many times you need to do this or with what regularity really depends on how much cumulative damage you have at that point and what your goals are.

Speaker 1:
[56:00] Well, and you told me, so we did an IPL and I was like, is this going to get rid of my brown spots forever? And you were like, no, because they, I don't know, what did you say?

Speaker 2:
[56:09] Well, essentially, your skin essentially has memory. So the damage, the DNA damage that you incurred when you were younger still sits in sort of the basal layer or the deep layers of your skin. That damage can continue to replicate and resurface over time.

Speaker 1:
[56:25] So so annoying.

Speaker 2:
[56:26] It's a somewhat of a temporary thing, but it's not completely temporary. Like if someone does a series of IPL treatments, if you look at them in five years versus you look at their face, if they had never done anything, it's still significantly better. But for a lot of these things, we are doing some degree of maintenance with any laser just to ensure that things stay where someone wants them to be.

Speaker 1:
[56:43] Okay, so that's Needle Mover 1.

Speaker 2:
[56:44] Yes. I will say Botox is really helpful. To me, that is the most easy way to see not improved to improved. Like you smooth out lines, you can do things like lift brows. I do a lot of facial balancing where we do it in the jawline, in the neck, and around the mouth to just sort of reproportion. And some of that's for aging and some of that is for beautification. And beautification, that's a tough word to say because I feel like it's a standard of beauty that we're trying to reach with that, but I can do it to make someone more symmetrical or to just sort of enhance things that sometimes we can't enhance other ways.

Speaker 1:
[57:17] There's been an entire like no Botox movement online. There's been influencers who have been pretty public about having negative reactions to Botox. What do you think about when you hear about those things?

Speaker 2:
[57:27] I think that that's totally valid. They're allowed to say those things. And even though that type of complication from Botox is exceedingly rare, I mean, millions and millions of people get Botox throughout the world and it's one of the most well-studied drugs that exists. And we can use it for things like anti-aging, but they can also be used for bladder spasms and overly sweaty people.

Speaker 1:
[57:47] Or my friend has that vocal thing that RFK has.

Speaker 2:
[57:51] Yes.

Speaker 1:
[57:52] And he gets Botox in his vocal cords.

Speaker 2:
[57:53] Yeah, to relax the vocal cords. It has so many uses and when you're using it, aesthetically, you're using it at such low doses compared to when it's used medically. It is safe, but that doesn't mean that some people can't have an adverse effect. But I've never had a patient have an adverse effect. And I know that's just my experience, but that's thousands and thousands of patients over a decade.

Speaker 1:
[58:12] The best hypothesis I've been able to find online is that essentially, your body is at this tipping place and the botox kind of tips you and then you have a reaction. So maybe you're fighting off a long-term virus or your body is not really in this state of health. And so this thing tips you over. Do you think there's any validity to that?

Speaker 2:
[58:30] I do think there is some to say that you're sort of on the precipice of something going awry. And sometimes it's hard to understand, did the botox tip you over or were you heading in that direction anyway? But it's often, I will say, if I've had a patient come in and say, I don't do botox because I've had a bad reaction, which is rare but happens, they usually do have some type of autoimmune condition or an inflammatory condition. And that often aligns.

Speaker 1:
[58:52] We know that botox wears off after a number of weeks or months or whatever. When it's wearing off, everybody online is like, botox is a toxin. If you put a drop of this in the drinking water, we would all die. Is it wearing off by going through your body, being processed by your liver in some way, and then exiting in a way that you're low-grade poisoning your body with this toxin?

Speaker 2:
[59:14] Your botox does bind at this junction between your muscles and your nerves, and that's where it enacts its force. And then your body, over time, will slowly break down that botox protein into little chunks called amino acids, just fragments that no longer have that activity, and then you naturally clear them through generally your kidneys.

Speaker 1:
[59:32] Wait. So this thing that would have been poison, was technically like it, you could put a drop of it in our water supply and we'd all die.

Speaker 2:
[59:39] Yes.

Speaker 1:
[59:40] Gets broken down into amino acids like what we would get in our protein powder?

Speaker 2:
[59:44] Basically, I mean, different amino acid composition, but yes, it's just a protein. And when you break a protein into tiny chains, it doesn't do what it used to do anymore.

Speaker 1:
[59:52] So is it taxing your liver in any way, shape, or form to process the botox through your body?

Speaker 2:
[59:57] None, because at that point, it's already been sort of broken down at the site, and so it's already pre-processed and then goes through your kidneys.

Speaker 1:
[60:04] Okay, wait, that was number two. What's thing number three?

Speaker 2:
[60:07] I think a little bit of a biostimulatory filler can go a really long way. So that's different than hyaluronic acid-based fillers, which add shape and structure to your skin or to your face, like Voluma or Restylane or Juvederm. These are things people have heard. But something like Sculptra, which uses polylactic acid to stimulate collagen production in the skin, can be a really nice way to, in my opinion, more naturally in some cases, make the face look more youthful without having to do anything that's like a big lift.

Speaker 1:
[60:35] I think I'm just gonna become like an old lady with good skin. I think that's what I'm gonna aim for.

Speaker 2:
[60:40] I actually love that look. And I actually think it looks really good. I always tell my patients, it is better to look old than weird. And there are a lot of people out there who their age is kind of up for interpretation, but you know that they don't look fully human. And that's not a good look.

Speaker 1:
[60:54] Like half of LA.

Speaker 2:
[60:55] Yes, and I think that really comes from picking the wrong intervention. A lot of people get overfilled. So they try to use fillers to lift their face. But it's a gel. It's not very good at holding your features in place. And instead of having surgery, which is really the way you need to reduce lax tissue and put things back where they used to be, if you use fillers or you try to use the wrong interventions, it's just gonna inflate the face without making it look more youthful.

Speaker 1:
[61:19] Or some of the surgeries are making people look kind of weird these days. Oh, absolutely. Especially, I'm thinking about, there's been a few men who've gotten, what's it called? Bleph.

Speaker 2:
[61:27] Oh, upper blephs.

Speaker 1:
[61:28] Upper blephroplasty, which is you take, I believe, a little bit of upper skin.

Speaker 2:
[61:32] Like a crescent of skin.

Speaker 1:
[61:33] I had a person tell me I needed this. It was fun. But you take a little crescent of skin and you get rid of that, but it makes them look kind of weird.

Speaker 2:
[61:40] Oh, it can really change the look of your eye. It can make you look more hollow. It can make the eyes look more severe. So surgery isn't a perfect solution, and you absolutely need to be going to a good surgeon who's going to be conservative, but there's plenty of risk that comes with that as well. And so I always tell people it's better to make the right decision than the easy decision. And a lot of people want to take the easy way out by doing some non-invasive things for their skin. And when it comes to resurfacing and botox and stuff, that can be great, but if they really have a loose skin problem, where they're in my office and they're holding the sides of their face and they're pulling things back up or they're looking at their under eyes and they don't like it, that is almost always a surgical intervention. And it's okay to not have a surgical intervention, but you also then have to be okay with not fixing that aspect of your appearance.

Speaker 1:
[62:21] Don't be spending hundreds and thousands of dollars on products and being like, this is going to fix this thing.

Speaker 2:
[62:26] I think eye cream is like the perfect example of that. A good eye cream can be helpful, but it's not going to change the deep anatomy around your eye. And so many people are disappointed in their eye cream, and that's because that was a surgical job.

Speaker 1:
[62:38] Can it be helpful? I think eye creams are kind of bullshit.

Speaker 2:
[62:40] Yeah, as someone who's consulted for a lot of skincare companies over the years, sometimes eye cream is just repackaged moisturizer, for sure. But there are some eye creams that have like some special ingredients, and usually they have like a better ingredient story, like a couple extra peptides or caffeine or some other things that can help tighten the skin or help with de-puffing to a degree. To me, an eye cream is not an essential, but for some people, I think it's nice because it makes them focus on that area and treating that skin.

Speaker 1:
[63:05] But you can bring most skincare up under your eye, right?

Speaker 2:
[63:07] Yeah, for sure. And I think if you do that, like the role of eye cream then is diminishing returns.

Speaker 1:
[63:12] Can you bring Tret up under your eyes or is that scary, dangerous?

Speaker 2:
[63:16] It can be helpful. Not everyone's going to be able to tolerate it under their eyes because it's just really thin, sensitive skin. The other thing that Tret no one can do is it can cause the oil glands that sit on the eyelid margin to die off permanently and lead to something called mobomian gland dysfunction.

Speaker 1:
[63:30] Okay, so just don't do that.

Speaker 2:
[63:31] I wouldn't. I try to keep it outside my orbital bone. There's some people who have no issue with it, but it's something where I would just prefer to use really good sun protection in that area and understand that that area is going to age faster no matter what, because it's this thinnest skin on your body.

Speaker 1:
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Speaker 2:
[69:44] I think one of the best things you can do is like an in-office resurfacing procedure once a year, like a fraxel, like an IPL, like micro-needling, something that goes deeper than skincare to really...

Speaker 1:
[69:53] But we don't have to do CO2.

Speaker 2:
[69:54] You don't have to do CO2. And if you are someone who's in your 20s or 30s and you're starting regular micro-needling or IPL or fraxel once a year now, the chance that you want a CO2 later in life is really low. You can very much protect against those changes. The people who I do CO2 on now didn't wear sunscreen when they were younger. Sometimes it's their first foray into resurfacing. So there's a lot that can be done to essentially college and bank and help build things up.

Speaker 1:
[70:18] What's one thing that you wish people understood about aging?

Speaker 2:
[70:21] I think having a realistic expectation of what's possible with skincare, with in-office interventions is really important. I think because we see so much on social media and people sort of broadcasting their aging journey, we expect that we are going to age exactly like our peers. And you're different than your friend or even your sister, and you're not going to age the same way, and you have to accept that to some degree.

Speaker 1:
[70:43] I know. It's so annoying because I don't feel that celebrities owe us an explanation of what they're doing in their private time, including things like surgery. And I hate the idea that people are spending so much money, so much time and essentially thinking something's wrong with them, that they're not getting these types of results.

Speaker 2:
[70:59] Yeah. I don't think they owe us anything, but I do think that if you are selling other products and you're sort of suggesting that these are the things that give you the benefit, that's where it becomes sort of tricky.

Speaker 1:
[71:09] Okay. The last thing that I want to get into is hair thinning and hair loss. To start off, I found it fascinating that this is something that you're trained in. I think when a lot of people experience hair thinning and hair loss, they don't know that there's a doctor trained in that. They don't know who to go to. And the fact that that was part of dermatology training was surprising to me.

Speaker 2:
[71:26] Yes. Dermatology is hair, skin and nails. And depending on where you trained, how much hair training you get can differ. But it was a huge part of my training. Every single week we had a hair clinic. The only people in that clinic were people who were suffering from various types of hair loss. And I learned a lot. It's actually a really hard clinic because hair loss is so emotional. And so to have every patient so deeply affected, more so than when I would tell people you have skin cancer or any other thing about their skin, hair loss brings up a lot of emotions in people.

Speaker 1:
[71:54] Are more people losing their hair these days or are we just more aware of it?

Speaker 2:
[71:58] There's probably a little bit of both going on. We certainly see more hair loss now that the GLP-1s are everywhere because they cause hair loss in a lot of people.

Speaker 1:
[72:08] There's a lot of confusion about this online. There's a lot of disagreement. Does rapid weight loss just cause hair loss or is there something specific to the GLP-1s that cause hair loss?

Speaker 2:
[72:16] So we know that rapid weight loss causes hair loss. No matter how you're doing it with a GLP-1, whether you're on diet and exercise, we don't fully understand whether the GLP-1 itself does. A lot of the mechanisms of GLP-1, we would expect it not to because it's anti-inflammatory. So we do think most of this has to do with the weight loss itself.

Speaker 1:
[72:35] Okay, and I feel like men are experiencing hair loss at unprecedented levels. Is that true?

Speaker 2:
[72:41] It's probably a little bit of both, but I think people just have way more awareness around it. Even when I was doing my general dermatology clinic 10 plus years ago, I would see hair loss on a lot of people, but no one would really bring it up. And I think people just really understand and they know to look for it now, which is good because it gives us opportunities to intervene earlier. But I do think there's just so much more chatter about it.

Speaker 1:
[73:01] What's the single most important change that somebody experiencing hair loss could do to their routine?

Speaker 2:
[73:07] Because hair loss is a symptom of something, the single most important thing to do is get a diagnosis of what type of hair loss you have. Do you have female or male pattern hair loss, which is the most common kind, which is sort of progressive and slow over someone's lifetime. But you can have things like alopecia areata, which is immune mediated. You can have scarring types of hair loss. And so until you have a diagnosis of what type of hair loss you have, it's really hard to pick what intervention would be the most helpful.

Speaker 1:
[73:32] So you would treat different types differently?

Speaker 2:
[73:34] Absolutely. Very differently. And also there's a workup that happens with hair loss. So because it's a symptom, we also want to make sure that your thyroid works well, you're not iron deficient, your vitamin D levels are appropriate. So there are other things we will also screen people for. And things like female and male pattern hair loss are a bit of a diagnosis of exclusion. You have to rule out other nutritional deficiencies or medical issues before you can call it that.

Speaker 1:
[73:55] Are there common nutritional deficiencies that you often see in your practice?

Speaker 2:
[73:59] For women, iron deficiency all the time.

Speaker 1:
[74:03] So an iron supplement might be like, if that is, you can get your iron levels tested.

Speaker 2:
[74:07] You can get your iron levels tested and really when you're getting your iron levels tested, you need to get your ferritin tested. So that's the test. I have patients all the time that come in and say, I don't know why I'm losing my hair. I got my labs done. My iron was normal. And I'm like, well, let me just see your lab tests. And they never had a ferritin done, which is really the indication of what are your iron stores. And if those are low, not only are we talking about an iron supplement, but also we need to understand why they're low. Are you not getting enough through your diet? Are you malabsorbing? Are you bleeding somewhere that we don't know about? Or do you just get heavy periods? So it's really important to understand why the iron deficiency happened and not just blanket treat it with a supplement.

Speaker 1:
[74:39] I was also wondering, because I know that there can be, if you have a virus or a viral infection, you can experience some hair loss after that. I was wondering if it's a long COVID situation.

Speaker 2:
[74:48] We do know that COVID causes hair loss. When people have had an acute infection, they can often get hair loss months later. And I think we will need more time to understand if there's a long COVID aspect to this hair loss, because there's been some immune dysregulation that's happened because of it.

Speaker 1:
[75:02] What do you do with somebody who's had a virus or something like that, and that's why they're experiencing hair loss? How do you treat that?

Speaker 2:
[75:07] Typically, it's just supportive. So helping them understand that this is a brief loss in hair due to an intense trauma to the body, the same way women after childbirth will shed a lot of hair.

Speaker 1:
[75:18] Wait, is that why?

Speaker 2:
[75:19] Yeah.

Speaker 1:
[75:19] It's because you've had a trauma to your body?

Speaker 2:
[75:21] A big shock to the body. After people run marathons, if you've had a high fever, if you've had surgery, like even after like I had a patient recently who had her breast implants removed and then is shedding a ton of hair were four months out. So any type of big hit to the body can cause some pretty intense hair loss and it can be shocking for people and it can last many, many months.

Speaker 1:
[75:38] The move isn't to necessarily do anything during that time. It's just to ride it out or can we do stuff to shorten those months?

Speaker 2:
[75:44] You can do things, but I usually say, hey, like you just have to know that this is not a forever thing. Things you can do are like topical minoxidil or Rogaine, which we use long term in people who have female and male pattern hair loss. It can be as short term when people have this stress induced hair loss, which we call telogen effluvium. But I really just try to encourage people that this is a temporary thing. You want to make sure that your nutrition is right, that you're not having ongoing stress in the body. But other than that, I just try to give some emotional support. I think once people understand that this is not going to be a forever thing, they're able to accept it and realize, okay, my body is going to move on from this in a short period of time.

Speaker 1:
[76:18] I always look at women who are postpartum. They're like, oh, here's what I'm doing to get my hair back postpartum. And I'm like, wouldn't it just grow back in a few months anyway?

Speaker 2:
[76:24] Yes, it totally would. The thing that can happen, though, is telogen effluvium or any stress to the body that causes that immediate and semi-prolonged shedding can unmask underlying male or female pattern hair loss. So you might have been prone to this female or male pattern hair loss, but it might not have really shown up in you until five to 10 years from now. And when you have that shed from the telogen effluvium, it sort of reveals that you have female or male pattern hair loss underneath. And for a lot of people, then, that's when we start talking about more long-term solutions for their hair loss or ways to maintain.

Speaker 1:
[76:54] And is that just Rogaine?

Speaker 2:
[76:56] There's lots of things you can do. Rogaine is really helpful. There's a medication called finasteride. There's a medication, spironolactone, that we use for acne, but can also be helpful for female hair loss because of its similar effect on androgens. And then there's like topical hair serums that can be somewhat helpful because they have certain peptides or they change the milieu around the hair follicle.

Speaker 1:
[77:15] OK, I want to play a game called Helpful, Harmful, Doesn't Matter. And these are all hair care things. And I want to know if these things are helpful, harmful, or they don't matter. Rosemary oil.

Speaker 2:
[77:25] Doesn't matter.

Speaker 1:
[77:26] There's one randomized control trial that I found. It was from 2015. And it showed that rosemary oil is comparable to 2% minoxidil for alopecia.

Speaker 2:
[77:34] That's true. If you look at the details of the study, it's a really poorly designed RCT. So that's the issue with a lot of the trials is like, even if it's an RCT, it might not be a well-conducted one. And also that's 2% minoxidil.

Speaker 1:
[77:47] Is that not a normal?

Speaker 2:
[77:48] We're basically never recommending that unless someone can't tolerate 5%. So that wouldn't really even be something we would recommend. Now, anecdotally, whenever I post on like my Instagram, don't bother with rosemary oil, people will tell me like, well, it worked for me. Totally fine. So to me, it's like, doesn't matter. You could try it, but I think temporary are expectations.

Speaker 1:
[78:04] Rice water rinses.

Speaker 2:
[78:06] Doesn't matter.

Speaker 1:
[78:08] What's the purported mechanism?

Speaker 2:
[78:10] The thought is maybe the proteins there help fortify the hair, but in terms of it making your hair grow better, I think you're really just trying to fortify the hair so it doesn't break off in the middle.

Speaker 1:
[78:19] So is it like K18, kind of?

Speaker 2:
[78:23] I would, that's a leap.

Speaker 1:
[78:24] So Olapix and K18 are things you put in your hair.

Speaker 2:
[78:26] They're bond builders.

Speaker 1:
[78:27] Okay, and that's kind of a protein.

Speaker 2:
[78:29] Yeah, that is a protein, but when you're thinking of rice water, those are like little proteins that act almost like glue that fill up the gaps on the cuticle or the outer portion of the hair.

Speaker 1:
[78:39] Do you like a K18 or an Olapix?

Speaker 2:
[78:40] Sure do. Love them.

Speaker 1:
[78:41] I love, I use K18. Do I need to be using both?

Speaker 2:
[78:44] No, I would say one or the other. They work slightly differently. I would say Olapix is probably better for severely damaged hair. It has more comprehensive bond building and it's sort of the OG, but K18 is also very good and just works through its kind of single patented peptide, but I love it.

Speaker 1:
[79:00] I like it because I'm much pickier about products than I know that you are, but I like it because you're not putting on your scalp, so I'll get the K18 cream, I'll rub it in my hands and then I'll put it through the lengths of my hair.

Speaker 2:
[79:09] Yeah, I'm a big fan. Now, if you color your hair, you heat style it regularly, I think having a bond builder in your routine, at least with some degree of regularity can be very helpful.

Speaker 1:
[79:17] Scalp scrubs or scalp exfoliation?

Speaker 2:
[79:19] Helpful if you struggle with a lot of dead skin cell buildup on your scalp. Now, generally when people have a scaly scalp, it's usually due to yeast overgrowth and having a little bit of dandruff. And so really what I would rather someone do is use like an anti-dandruff shampoo. But if you're doing that regularly and you still feel like product is building up or often for people who have really thick hair, they just feel like they can't get a good rinse of their scalp, which is what your shampoo is doing. I do not think of shampoo as a hair wash, it is a scalp wash. You could use something like an exfoliant to sort of like help break that down. And if I have patients who have these like thicker plaques or yellowish gunk, for lack of a better word, stuck on their scalp, we can use exfoliants to help sort of break up that debris.

Speaker 1:
[79:57] Biotin supplements.

Speaker 2:
[79:59] Harmful.

Speaker 1:
[80:00] Harmful.

Speaker 2:
[80:01] For hair loss, harmful. So biotin has never been shown to be helpful for hair loss. If you are not biotin deficient, which is incredibly rare in the Western world. And oral biotin can do a lot of things. It can break you out, so it can cause acne. It can also mess with your lab values. So although it doesn't change the function of your thyroid, it can make your thyroid test read inaccurately. It can make your cardiac markers read inaccurately. So if you think you're having a heart attack and you go to the ER and you're taking biotin, it can mess with your, what we call your troponin levels, and it can make it look like you're not having a heart attack when you are. So it's one of those things where I always have patients who are on biotin maybe as part of their prenatal or they're doing it for nail health, which there is some evidence that can help with nail health, stop their supplemental biotin at least 72 hours before any type of lab test.

Speaker 1:
[80:47] Oh, wow. Are there any supplements that you think are very helpful for hair loss or hair regrowth?

Speaker 2:
[80:52] There are the more studied ones like Vivisgal and Nutrifol, and often they contain some ingredients that are like androgen blockers. So things like sawpalmetto that essentially help DHT not negatively impact your hair follicle. And those are things that are going to work for some people and not work for other people, but can be helpful and I think are worth a trial. You just have to understand that if you have one of these chronic or long-term hair loss conditions, if you do find it helpful, that is going to mean you're going to stay on that medication or on that supplement indefinitely.

Speaker 1:
[81:22] Sleeping on a silk pillowcase.

Speaker 2:
[81:24] Love that one. Helpful. When we're thinking about optimizing hair growth, we're thinking about it in two ways. From the follicle, like what's coming out at the root, but also how are you treating your strands? And using a silk pillowcase really does reduce friction. Some people will do a pillowcase, some people will do like a silk bonnet, but just creating some type of like silkier buffer on the hair can be really helpful.

Speaker 1:
[81:40] Washing your hair less often.

Speaker 2:
[81:42] Depends. Doesn't matter. I think washing your hair as frequently as your hair requires washing. So for a lot of people, what we're trying to do is just keep their scalp clean. And for some people, they only need to wash once a week to keep their scalp clean. And for some people, they need to wash every day to keep their scalp clean. And as long as you are rinsing thoroughly, you're conditioning, you're fine to wash it more frequently. So the like no shampoo thing or decreasing washes really shouldn't have an effect. Unless every time you're washing, you're also heat styling afterward. And in that case, going longer between washes can be helpful. So you're not putting heat as frequently on your hair.

Speaker 1:
[82:15] What about the idea that when your hair is wet, it's most prone to breakage. So you're like putting your hair into this fragile state more frequently.

Speaker 2:
[82:22] That's true. It is more prone to breakage. But just because something is prone to breakage doesn't mean it's going to break. You have to also put it through some discomfort, whether that's you're pulling on it, you're letting it sort of bop around with your blow dryer too much, or it's getting buffeted. But just because it's more fragile, it just means you need to treat it with care. But if you're doing that, then it being wet more frequently isn't really a problem.

Speaker 1:
[82:41] Microneedling the scalp.

Speaker 2:
[82:42] Helpful. There's good studies to show that it can help increase blood flow to the scalp and help with hair growth. More helpful when you combine it with things like minoxidil. But definitely if someone's open to it, microneedling can be helpful and you can do it at home.

Speaker 1:
[82:56] Red light therapy.

Speaker 2:
[82:57] Helpful, for sure. There's lots of good data that shows that red light therapy can be very helpful for multiple types of hair loss. It's anti-inflammatory and it's nice because you can use it whether you're pregnant, all phases of life. I just think red light is very, very good when it comes to hair, even more so for sure than when it comes to skin.

Speaker 1:
[83:13] Is there something that you're looking for in red light, like the irradiance or the types of red light or stuff like that?

Speaker 2:
[83:18] Yes, both of those things. You want to look at sort of the power of the device. You want to make sure you're using the right wavelengths, which are red light, which is like around 630 nanometers and near-infrared light, which is around 830 nanometers, 810 to 850. And you want to make sure you have both of those, that you have enough power. I don't expect the average consumer to be able to look at all those things individually. So I usually look to device companies to talk about whether their product is clinically tested, whether it's shown safety or result.

Speaker 1:
[83:43] I know, but they all want to be like, we're the best, we're so great.

Speaker 2:
[83:45] I know. And this is one of those things where you kind of have to look to the derms and be like, yeah, we've vetted these things. The biggest thing is you're never going to find a cheap red light device for your scalp. It's cheap, that usually is a sign that it doesn't have the right bulbs, the right power, et cetera.

Speaker 1:
[83:57] What's your favorite fur hair?

Speaker 2:
[83:59] Gosh, there's a few. I like Current Body. They make a really good one. Disclosure, I have worked with them in the past. But also, Theradome is very good. Irestore, and then there's one called Capilis that's more of like a baseball cap.

Speaker 1:
[84:09] Can you speak to the person who is dealing with some hair thinning and hair loss, and they're just like, I'm really overwhelmed. I don't have a lot of time and money to treat this, and I'm really depressed about this. Where would you start with them? How would you speak to them about how to find hope in this situation?

Speaker 2:
[84:25] I think understanding that lots of people go through this, so over 50% of the population is going to have hair thinning over the course of their life, and understanding that it's one small step at a time. Minoxidil is something that's very affordable, comes down to $10 a month, so that's a really evidence-backed way that you can start intervening. I also think if it's affecting you emotionally, it's not bad to see a therapist about this. Being hung up on a very prominent physical feature that you feel like is not optimized is a big deal. And I think having those kinds of conversations and being really honest with yourself can be very helpful. Also, lots of people wear hair pieces, wigs, hair transplants. There's so many things you could do if you wanted to feel more confident in your hair.

Speaker 1:
[85:06] This is another thing that I feel like we should talk about more. I have hair extensions in, and I like to talk about them because my hair never looked this thick before I had my hair extensions in. And I feel like, have you seen that woman online and she points out when people are wearing wigs? And she's like, that's a wig, that's a wig, that's a wig. And it's almost every Hollywood celebrity. And why wouldn't you? It's so much easier than damaging and styling your own hair. Absolutely.

Speaker 2:
[85:29] I think it's very freeing. And I think it wasn't something that I even realized. And still I started working with more celebrities and just realizing how many of them have fake hair. And that's not a knock to them. It's just a way that they get a confidence boost. And obviously they're very heavily judged on their appearance. So why wouldn't you want to do something to optimize it? But I try to talk about that with my patients too and say, hey, you can wear a wig if you want to. And initially, I feel like people are a little bit hesitant about it. But once they get into it, if they find a good wig and you get confident, I mean, gosh, it takes you to do your hair. Yeah, it's like five minutes to get ready. Just pop it on. Yeah, absolutely.

Speaker 1:
[85:58] That's why people say that Sabrina Carpenter does it for her tour. And I'm like, why would you not do that for your tour?

Speaker 2:
[86:03] I'm wig curious for sure.

Speaker 1:
[86:05] I wish a hairstylist had told me sooner when I was coming in with my Pinterest pictures of what I wanted my haircut to look like, that it was never going to happen. It wasn't going to happen. The picture I was showing them from Pinterest had extensions in and nobody told me.

Speaker 2:
[86:18] This is many hair follicles to us, exactly.

Speaker 1:
[86:20] Yeah, it really bummed me out. And I will say if you're listening and you liked hearing us go through all the different things you're hearing on social media for hair, we're going to do that in a separate episode. We're going to have you rate all of the skincare advice from social media. So make sure you're following the podcast because we're going to have a whole episode about that. I want to know, though, right now, if somebody is listening and they're just feeling really overwhelmed and they're just like, Dr. Sam, I just want to have good skin. I don't want to think about it that much. I don't want to spend a punch of time or money. Like, what should I be doing?

Speaker 2:
[86:46] Finalizing a morning and night time routine that are locking in on the most effective skin care ingredients can be the first thing. And we're talking a cleanser in the morning, vitamin C, if you can tolerate vitamin C on your skin, and a good antioxidant that's going to help you fight oxidative stress, moisturizer if you feel like you need it, and sunscreen. And then in the evening, cleansing your face using a topical retinoid, whether that's over-the-counter retinol, retinaldehyde, adapalene or prescription tretinoin, and a moisturizer. If you do just that extremely consistently for three months, you will notice a change in your skin.

Speaker 1:
[87:19] What's one thing that we should stop doing right now for good skin?

Speaker 2:
[87:22] I think if you smoke, you absolutely shouldn't be smoking in any capacity, whether it's cigarettes, marijuana, anything that's being sort of inhaled, all of those carcinogens are going into your lungs and then getting distributed throughout your body, including your skin. And it causes a lot of oxidative stress on your skin. And I would put this in a slightly lesser category, but also reducing your alcohol intake. These are also really big things that impact the skin and sorry to take away people's fun, but it makes a huge, huge difference.

Speaker 1:
[87:50] Do you drink?

Speaker 2:
[87:51] I don't.

Speaker 1:
[87:52] At all?

Speaker 2:
[87:53] Maybe like fewer than five drinks a year. Like maybe on a couple of occasions, but I stopped drinking a few years ago and I just, I don't miss it. So I think if it was like a really big part of my life, I would, but there are very few things that we know are so cancer causing and alcohol is one of them. And so because I quit after that JAMA study and I was exactly, that JAMA study is really powerful and very accurate and a very good study. And I found it incredibly compelling. And I do all these other great things for my health, but none would have the same impact as like drastically reducing alcohol.

Speaker 1:
[88:24] It was the number two or number three cause of cancer, preventable cause of cancer, preventable cause of cancer was drinking, which is crazy.

Speaker 2:
[88:30] Yes, exactly. Like if you heard that about basically any other thing in your life, you would say, of course, I'll make that switch. And I get it. Alcohol is like a big social component and all of that. If you're looking to make really impactful changes in your life, you don't have to go cold turkey and you don't have to stop completely. But I think it would be something I would highly recommend for your health in general and certainly for your skin.

Speaker 1:
[88:48] You know what I love and I didn't notice it until somebody pointed out. We, so we're in book club together. We never drink. Like every other book club I've ever been in, it's like wine night. It's wine night. And I don't know if we started drinking or like we, and it went away or what, but like everybody always has like, here's your selection of spin drifts and stuff, but almost nobody drinks and nobody even offers drinks anymore.

Speaker 2:
[89:08] That's true. I feel like drinks are not even like on the table, which I think is nice because I feel like sometimes people feel social pressure to drink and so the fact that that's not there is kind of lovely.

Speaker 1:
[89:16] And it's equally fun. Like I do think that that is like important. People are so, I was so afraid before I stopped drinking as much. I still drink occasionally. I call myself an intentional drinker.

Speaker 2:
[89:25] Yes, I agree with that.

Speaker 1:
[89:26] Before I stopped, I was like, am I ever going to be able to like laugh and be silly and have fun again? And like, we definitely do.

Speaker 2:
[89:30] Give yourself some credit. I know that's the thing. I feel like your alcohol is not your personality. If it is, that's like some deeper work to do. But we have a great time and really good discussions and we remember them.

Speaker 1:
[89:39] Yeah. This can be in the realm of skincare, haircare, or something else entirely. But what's one habit that's changed your life?

Speaker 2:
[89:47] Probably one that I've noticed the biggest change in is just like really optimizing my sleep. Like I wear earplugs, I use a white noise machine. I just really like to be completely in a sort of like sensory deprivation situation. But that one has really helped for me.

Speaker 1:
[90:03] Sleep has an impact on skin too.

Speaker 2:
[90:04] Oh my gosh, huge. When you asked earlier about things that can like impact your skin that aren't skincare, getting enough sleep for sure. There are little studies that show that if you don't get enough sleep, it drastically ages you. You're perceived as older. So whatever you need to do to get more sleep, like I used to wake up early to exercise, and I realized I was sacrificing sleep because of that. And now sleep is like my number one health priority.

Speaker 1:
[90:25] Wait, so you don't work out anymore?

Speaker 2:
[90:26] I work out. I just, I've become more efficient with my workouts. And I feel like I do more strength training now, which I don't feel like I have to sort of like hype myself up or like I used to for cardio. Like cardio, I had to find like the perfect, did I just eat? Did I not eat? That kind of thing. Whereas with strength, I feel like I can even do like a 20 minute lifting video after my son goes to sleep and I can get it done. Sleep though, to me is even more important than exercise for me, but I try to do both.

Speaker 1:
[90:49] Can you leave us with just one thing that we could all do the second that we turn off this podcast to begin to see a noticeable difference in our hair or our skin?

Speaker 2:
[90:56] I would say shave your face. I feel like there's no better way to make your skin look better faster than to do a little, we call it dermaplaning, it sounds fancy, but essentially you're just shaving all the little baby hairs off your face. It makes your skin glow. Like if you want insta-glass skin, do that.

Speaker 1:
[91:12] Wait, what about my barrier layer? Is that OK?

Speaker 2:
[91:14] Totally fine. I mean, you don't want to like rough shave.

Speaker 1:
[91:16] I'm not shaving off my barrier.

Speaker 2:
[91:17] No, I have like a very, I think it's my most popular YouTube video ever is teaching people how to shave their face because people are kind of intimidated by it. But it's so glorious. And a lot of the texture or sort of like irregular light bouncing off our skin is due to the little baby hairs that are on there. And again, it's like not one more thing I want to demonize about the female body. They're like, oh my gosh, now you're telling me to shave my face. But if you want to make your skin look better fast, do that.

Speaker 1:
[91:40] Does it have long-term benefits or is it just like right away you look better?

Speaker 2:
[91:43] More right away. I mean, you were doing some gentle exfoliation when you do that. So I suppose you could call it that, but it's really more for that like immediate effect. And it's so impactful. And it doesn't make your hair grow back like thicker or faster or anything like that.

Speaker 1:
[91:55] OK, Dr. Sam, I know that there's like a million things that you do online. People can find advice from you on YouTube, on Instagram. You have your own skincare line. Like tell us about everything in your world.

Speaker 2:
[92:05] OK, let's see here. OK, so I have my own skincare line. It's called Prequel Skin. You can get it at Target. You can get it on Amazon. You can buy it at prequelskin.com. And the real goal of Prequel is to make accessible products. So everything in the line is generally under $30. Most of it is under $20. And a lot of it is huge, huge, huge, and like lots of value, and also just very supportive of the skin barrier. So a lot of things we talked about today was about optimizing your skin barrier, and prequel products are really meant to like lean into that. We have a lot of support from like the National Eczema Association, the National Psoriasis Foundation, all of that.

Speaker 1:
[92:36] Super cool.

Speaker 2:
[92:37] And then the other things are, you can find me on YouTube at Dr. Sam Ellis, and then on TikTok and Instagram at Dr. Samantha Ellis, where I give lots of advice on how to take care of your skin, but also what is good about certain beauty procedures, cosmetic stuff, all the stuff that I think your dermatology best friend should tell you.

Speaker 1:
[92:53] Amazing. Well, we're going to do a whole other episode where we're going to rank social media skincare advice, which I'm very excited about.

Speaker 2:
[92:59] I have so many thoughts.

Speaker 1:
[93:00] But thank you so much for all this information.

Speaker 2:
[93:02] Thank you for having me.

Speaker 1:
[93:03] That is all for this episode of The Liz Moody Podcast. If you enjoyed this episode, I would so appreciate if you would share it with somebody that you think would love it too. It is my goal to get as much life-changing information out to as many people as possible, and you sharing episodes with people is 100% the thing that makes that happen. I would also love to hear from you in the comments, any thoughts or questions or opinions that you have on this episode. Make sure that you're subscribed to the podcast on Spotify, on Apple Podcasts, on YouTube, wherever you like to listen. You can find every single discount code that you heard in this episode and tons more at lizmoody.com/codes. It is the best way to save money on amazing vetted products. Usually our brand partners make the best products in the world. That is why they're our beloved brand partners and it's the best way to support the show and keep it completely free for you and we so appreciate it. Okay, I love you and I will see you on the next episode of The Liz Moody Podcast. Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes. It is not intended as a substitute for the advice of a physician, a psychotherapist or any other qualified professional. The number one rule of habits is to make the things that you want easier and the things that you don't want harder. Yet so many of us want to eat healthier, but so few of us actually take the steps to make eating healthier easier. That's where Marley Spoon comes in. What I love about this company and what's different than all of the other companies out there that are doing stuff in the same arena, is that you can customize your choices based on the effort that you want to put in. 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